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Home My WebLink About9361-zFOn.M 1~0. 4 TOWN OF SOUTHOLD BUILIHNG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No...Z.9.23.~ ..... THIS CERTIFIES that the building located at ..... 8.8.0 .L.e.e~9.n' ..DF., ...... Map No ............. Block No .......... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. · July 12 ..... , 19..77 pursuant to which Building Permit No ..... 9.~61Z dated . .Ju~y .....~2 ......., 19..77, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ........... .Pr.~.v.a..~.e..0.n..e..F..a~n. 2.~.¥...D~.e.l.~.~.n.g...w~.~.h.. A.d.d.i..t.i.o.n. ......... The certificate is issued to ..... 0'..ar~.~..~.....Hg.r.t.s..ch ............................... (owner, of the aforesaid building. 'N/R Suffolk County Department of Health Approval ......... , .................... UNDERWRITERS CERTIFICATE No ........................ .N/.~. ................. HOUSE NUMBER ....... .8.8Q... Street .......... .L.e..e~.o.n..D.?.. .................... ................................................ qz: .......... Buildin~ Inspector TOV,'N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL CGMPL~ION OF THE WORK AUTHORIZED) ]~Io. 9361 Z Permission is hereby granted to: at premises located at pursuant to application dated Building Inspector. Fee $.../.~i ........... .... ~.~i .......... , approved by the l~O~ NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerh Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFICATE OF OCCUPANGY Instructions A. This application must be filled in typewriter OR ink, and submitted in, triplicate to the Building Inspector with the following; for new buildings or new use: ]. Final survey of property with accurate location of all buildings, p.'roperty lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept of water supply and sewerage disposhl--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences a~nd similar buildings and installations, a certificate of Code compliance from the Architect lot Engineer responsible for the building, 5. Submit Planning Board approval of completed s~te plan requiremer~ts where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buQdings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy a'nd condition of buildings. 3. Date of any housing code or safety inspection of buildings or prer?lses, or other pertinent in- formation required to prepare a certificate. C. Fees. 1. Certificate of occupancy $5.00 2. Cert~hcate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 New Building .................... Old or Pre-existing Building ...~.~ .................. V~cant Land ............................ Location Of Property 880 ~¢~ton Drive $outhold~ Suff~.lk Count~.~ N.Y. Owner Or Owners Of Property James W. Hertsch Subdivision ................................................................ Lot No ............. Block N~o ............. House No ............. Permit No..?..~,~.!....~ ..... Date Of Permit .7. r..1..2..r.7..~...Applicant .......... .J..~.~,.~.~...~......~.~.~..'l;,,fi.q~i. ................. Health Dept. Approval ....~..9.~.~...~'.e. gD.~;~.~.~ .......... Labor Dept. Approval ..L.~Q~e...~e~,9.1~.el:] ............. Underwriters Approval ..~.o..q.e.....~..e..cj..q~.~.e..c]. ............. Planning Board Approg?l ...~..9.~.~..~fi.~$.E~.~t. ..... Request For Temporary Certificate ........................................ Final Certff~cat, e ....................................... Fee Submitted $~..~..'....~..~.. ......... Construction on above described building and~~--~s oil applicable ~codes and regulations. Annlica,,,/... ~- C~-~ Z~.~ ~-~ , ,C.~-'-'-~- , ....... ' ................ ................................ ..... Sworn to before ................ day of ............................................ (star ~p or seal) Notary Public .................................... County This was £or a 2 car Car-Port, attached to existin~ building. N~ P~umbing, No Electric - Constructed of wood and Fiberglass fIut~d panels. FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~amined 19....,(,. ....... .~/,...~.. ............ ..... ....... . ............ ~i~ppra~d ~rc ............. 2.~...'2 ..... 2~ ...... ~ ...................................................... ............... {Buildino Ink.tot) APPLICATION FOR BUILDING PERMIT /~/. INSTRUCTIONS a. This application must be completely filled in by typewriter or, in ink and submitted in triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premsses or public streets, areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio, c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector w~ll ~ssue a Building, Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, andother applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describer The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and ir~ buildings for nece~j;z~.~ections. ~ · State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ Name of owner of premises ............... ....~: ......................................................................................... If applicant is a corporate, signature~f duly authorized officer. (Name and title of corporate officer) Builder's License No ......... ~Z~........ .................. Plumber's License No ................... ~' '7 ........................ / 6 Dr) - ,_~.~_ / _ _~ Electrician's License No ........... .7/.-. ........................ Other Trade's License No ............// ................................. 1. Location of land on which proposed worj~ will [?e_ done. ~? No ............. ---'E.....t ................... /~.ot No ....... ~..:~'-'-'~'. .... Street and Number ......... ~..c~.~..~.~ ...................................... ~.~ ................ -- _ Municip~lityi 2. State existing use and occupancy of premises and intended use an~d occupan( / of propased construction: , .... ................................. b. Intended useandoccupancy.~ ..... ~ ~ ~..~.~r~.. .................... 3. Nature of work (check which opphcable) New Budding'. .............. Addffion T. .............. ..-*Alteration ............ Repair ............ Removal .............. D. em,o!ft~or ........ t.-;; .'... Other Work ........................................... 2~ ;, ~ ~ ~ ~. (Description) /~ ~Fee ~ 4 Estimated Cost ................... ~..~.~.~ ...... .......................................................................... (to be pa~d on filing thts apphcation) 5 If dwelhng, number of dwelhng un,ts ...................... Number of dwelling umts on each floor ..................... If garage, number of cars .............................................................................................................. 6 If business, commercial or m~xed occupancy,~f~sP~'nature and extent~c~e~ ~[ of use ......./~f t~ ..... ? ...... 7 D,mens,ons~f~,stmg structures, if any Front ....~kZ~ear ,..~..Z.~.. ....... Depth ~..~...~.~.~ Height ...~ .......... Number of Stor,es ...... ~ ..... ~...~ ................................................. , .... or ..... ..... ......... ....... / Depth .... ~ .... ~ ...... Height .~.~Z. Number of Stones ...~. ~ ........... 8 D~mens~ons of enttre new construction Front ........... ~ ................. Rear ..~...~ .......... Depth .~ .......... ~.. He,ght ...~-.~ .... Number of Stones ....... ~ .............................................................. l l. Zone or us~ d,str,ct ,n wh,ch prom,ses ore s,tuoted .... ~. ..... ~..: ...................................................... ]2 Does proposed construction wol~te onv zomn~ I~w, ordm*nce or re~ulot~on ...... ~...~ .................................. 13 Wdl tot be regraded ...~.O ' . ..... Wdl excess fill be removed from premises: ( ) Yes (~No 14 Name of Owner of premises ............................................. Address ................................ Phone No. ..................... Name of Architect ................................ Address ............... r ................ Phone No ...................... Nome of Contractor .......................... Address ............... '. ................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~shng or proposed, and red,cate all set-~ck dimensions fra~ names and ind~cat property lines Gwe street and b?~.k number or descnpt,on ac.~cord~ng to deed, and show. s~reet whether interior or corner lot'/ /~ ~ ~"O~__~ ,~,~_..~..~_ . ~ .~...~ ...',~..~.~.~. ........................................ g uly sworn, deposes and says that he ~s the apphcan ~. ~jnd~wdual s~gning contract) 61~ve name~/ ~ (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to oerform or have performed thb.said work and' to make and fd this apphcat~on; that all statecnents contained m thts apphcat~on are true to the bbst of his knowledge and belief; an. tha~ the work wdl be performed m the manner set forth in the appl~"'F-d' ed therewith/~ ' ' Sworn to before me this ~ , ( ~ I / FIOTARY ~J.,BLIC. State el New York Ne 52-v~43721, Suffolk Cou.qty, Term £xp~re$ March 30,