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Home My WebLink About9133-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z.!.4.9.75.... Date October 9 .8.6 THIS CERTIFIES that the building....Agl.d.J~t. ~.9.n. ................................... Location of Property 930 .We. st Cove Rdad Cutchogue House 31o. Street Ham/et County Tax Map No. 1000 Section ...1.%1. ...... Block ..... 2. ......... Lot ....12 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... lgo;:.~h. ~5 ........ ,1977. pursuant to which Building Permit No.9.1.3.3.Z. ................ dated . .M.a.r.c..h...2.8. ................ 19.7..7, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for width this certificate is issued is ......... .... Ad~litic)Ja..on..e~i ~;~:,i,rl~J. i:l.w.~ % ~ ~.n. cj: ........................................ The certificate is issued to Martha Paul of the aforesaid building. Suffolk County Department of Health Approval ........ N/A .............................. UNDERWRITERS CERTIFICATE NO ................ N./.A .............................. R~v. 1181 FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9133 Z Date Permission is hereby granted to: ~ Z~il~ an a~i~.~on es ezia~lng dvellin~ pursuant to application dated ~ 28 19...~", and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ to the Building Inspec- tor with the following; for new buildings or new usc: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and scwerage disposal-(S.9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uscs, or buildings and "pre-existing" land uscs: 1. Accurate survey of pm:)perty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date ...... [..0. / .... ?..~.. ...... NewC ons truction.. Old or Pre-existing Building ...... Vacant Land ....... Location of Property ...... O. ....... ' .~... COV ~ .~.~: · . .~.~..-C~.~..~.o¥/~~r~ie; ~--' House No. Street Owner or Owners of Property ..................... ~ ................................. County Tax Map No. 1000 Section ~ ( J Block ...... o~ Lot /~ Subdivision ......... Filed Map No ........... Lot No .............. Permit No. .~ ,~. 3 Oate of Permit 3 J'??...Applicant..~'~....~.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 30 ; Disapproved ~ ..................... ~ APPLICATION FOR BUILDING PEP. MIT D te ............... .......................... INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this applieation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit~/ 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 Occupancy,~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY NLADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southo d, Suffo k County, New York, and other applicable Lows, Ordinances orX, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code, admit authorized inspectors on premises and in buildings for necessary inspections~ (Signature of applicant, or name, if a corporation) TOWN OF SOUTHOLD TOWN CLERK S OFFICE ,~--~-~.~//,~ Applicat,on~ No. Z...(..?....~.. ............ .~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... ..?.:~.~...!...~. ~ ....... ........... ........... .............................................................. Name of owner of premises .~....t~..: .'~.....~...~..~.. ~'*~..~ (~'~..- If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............... !.~.~. ................................ Plumber's License No ........ ...~.....~ Electrician's License No. " '~ Other Trede's License No ............................................... ocation of land on which proposed work w be done. Map No.'...,~. ~ ~ ~ (~'[' /~t kl,~ '~, i~ j L Street and Number ..~....r/~.' ..~...~ ~[ ............................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................... ~"~ b. Intended use and occupancy ......................................................... ~ ......................................... 3. Nature of work (check which applicable): New Building-, ................. Addition ~ Alteration Repair .................. Removal .................. Demolitior ..................... Other Work ..................................................... (Description) 4. Estimated Cost ............ .J...~..~..~..--.~..'. ................... Fee · !...'~.........-. ....................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... ; .................. ~' Rear ..~/...'~*.. 7. Dimensions of existing structures, if any: Front ......~..*~...Z..~....t.,.~'s ....... , ...... .................. Depth Height '9,.~-~ '+_ Number of Stories .................................................................................................................-~ Dimensions of same structure with alterations' or additions: Front ........ ..'~...1 ...................... Rear ....'?t...) ................... Depth ......~..~...~..?.....~..--.. .......... Height ....~..'...~.i...?~.......Number of Stories ........ ~ .................... 8. Dimensions of entire new construction: Front . ...~..'~...'~. ........... Rear ....!..*~...~.~ ............. Depth ...~...~.*....~. .......... Height ....~.....'~...~.... Number of Stories ....................................... ~. ............... .,~ ................................ ;~:~'"'~"'"~ ......... · ~ ~'~ =~ Rear De th ..] 9.S~ze of lot. Front .................................................................... 10. Date of Purchase ........................................................ Named Former Owner 11. Zone or use district in which premises are situated ...............'~rL.~..~.~....: ............................................................ ............. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regroded . ........~..~ .............. Wil~ exce~r~ fill be removed fromm premises: ( ) Yes (*~) No 14. Name of Owner of premises ~ .~...~......~...1~. ................... ~.~. t~r~ ..~.. ...... Address .~..t..~..~.[~ .~..~....~.. Phon* No.'~..~.~..'~ .~...q...~.Y ' ~ Address ................................ Phone No ....................... Nome of Architect ............................... ~,~ ......................... Name of Contractor ....~...!...~..~....~....~...~....~..9...~1...~ .......... Address ...~......~....~.~.~..?.....~..~ Phone No. ~'~'...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOR~. I S S COUNTY OF ..... · .~..9...97.'~.~J. - ......... ..~.I~.~I~'L ..~..~...m~:..?..~.. be ng duly sworn, deposes and says that he is the appliconl (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this app cat on; that a statements contained in this application are true to t~-'~is knowledge and belief; and thor the work will be performed in the manner set forth in the application filed ~herewi~tJ~". Sworn to before me this ......... .~..c3.~.~. ....... day of ......... ...1~..~.rf?...~.. ................... , 19.?..-t.... ....... ~',lo~ary KUDHC, . ................................................ ~vu ~y .............................. ~;,- ................ ;- .......;.' ...... ',' ............................ t~ignature or appucant2 NOTARY PU~LIC~ Stale of New Yo~ %. No. 52-4612739 Qual[lCied in Suffolk Counly Commission Expires March 30, 19'-I'''(