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Home My WebLink About10080-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Off, ce Southold, N.Y. Certificate Of Occupancy No....Z.9.~..~. ......... Date ..... .ff..~..e .... q. .................. 19..7.9 THIS CERTIFIES that the building ................................................ Location of Property .... 3.2.0.0.....Q .~.p..M.~r~9~o.:l..a...RO.a.d. .............. ~I.R/;~:.li..~k,. l~.T.~w ¥o1~k House No. Street Ham/et County Tax Map No. 1000 Section .... 123 ..... Block ...... 5 ........ Lot ..... ~6.2. ....... Subdivision ...... ~ ................ Filed Map No..K:~...c~....]Lot No...~. conforms substantially to the Application for Building Permit heretofore fried in this office dated .D.e.c..e.m.b.o.r. .... ~0. ..... , 19.7.Spursuant to which Building Permit No....'I.QO~{3Z~ ........... dated .. ~.~¢¢In.heC .... 21 .......... 19..7~3was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ................... ~.~.iv~te · On~ .F~m~ly. D~elli~g ............................ The certificate is issued to ......... .R.~.~.a...Y.o..m'l. g ...................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval 7-$0-'1/~-1 5/09/79 ........ RbB'~z~c' A',' 'Vi[3.'~i ................ UNDERWRITERS CERTIFICATE NO. N/~29627 ~''~/ / / /~(* L ...... Building Inspector Rev 4/79 l~O~I NO. ~ TOWN OF $OUTSOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT 1OO8O (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: at premises located at~:~.....~..:~;.~ ....... . ....... ~ ......................................................................................................... ~.~~.~/../ ~ ~ * pursuant to application dated ~~..~ ........ , ,9..Z~and approved by the Building Inspector. Fee $..~.J...f,J......ii....~ TIME CLOCKS UNIT HI~TB~ $1MMeI~ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink., and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 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 sewerage 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 P~anning Board approva~ of completed site p~an requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 or land use 3. Copy of certificate of occupancy $1.00 New Building ....~.. ....... Old or Pre-existing Building ..... $5.00 Date-~.~. ~..~..-..~..~ .............. ....... Vacant Land ............. House No. Street Hamlet Owner or Owners of Property..~.'~.'.~..0'., · .~O00~. ~~ ........ ~:.~ .......................... County Tax Map No. 1000 Section .~..~.,~.: ........ Block .0. ............. Lot .~.~..0. .......... Subdivision ................................. Map No ............... Lot No ............... Permit No. ~. ~)O~.O. · · Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .~.,.0,~) ....................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ........ Rev. 10-I0-78 INSTRUCTIONS ' ' ' a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building 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, relotionsh, lp t.o. adjoining p, re. mises or_ p.u.bli¢ st?ets amos, and g ving o detailed desariptie.n of layout afproperty must be drawn on the diagram which ~s pa~ of this application. c. The Work covered by this apphcation may not be commenced before issuance of Building Permit. j _ : '. d. Upon approval of this apl~llcation, 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 port' for any purpose whatever until o Certificate of Occupancy shall hove been gr~nted by the Building Irmpector. APPL CAT ON IS HEREBY MADE to the Building Depar1'.ment for the issuance of a Building Permit pursu.?nt to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Oral,nonces or Reaulotions, for the construction of bu Idinge, additions or alterations, or for removal or demolition, as herein described. Th~ o llcont a roes to comply with oil oppllcable laws, ordinances, building code, housing code, and regulations, and to PP g admit authorized inspectors on premises and in buildings for necessary inspecticns. (Signature o~ ~ppllcant, or r~me, if a corporation] , .......... ~ ............... ~..~ ....... '. ........ ~ ....... 'h....', ...... ~.~ ........... ~...~.....~ (Address of applicant) State whether c:pp]icont is owner, lessee, agent, orchltect, engineer, general contractor, electrician, plumber or build~. ~f :ppKca~t ~ m ca~am:te~ signo~re of du~y authorized af~icer. ........ (Name and t~ of co~pa~e aMicer) Jo Buitder's--~ ....... P,u ,ber's L,c,ns, .o ..... .......................... E, ectr ,io 's Lic,.se No ...... ..................... Other Tr,de's License Na ............................................... '~ ~/O~ ~ -- /C ~-- ~ -- ~. ~ Location of land an whlc~ p~pased work will be dog~. MonNa.: ..................................... l" Lo~,No ....... X'7' ........... ~' =" ~"~ "' ........ ~ ~ Municipal 5ta~e existing use and occupancy of premises and intended use and occupcr~ oF proposed const~ction: a. ~isiHng use amd ~cupancy ..... ..~.~J .......... ~.~ .............................................................................. 3. Nature of work (check which applicable): New Building Addition Alteratlo~', .............. R.epair Removal Demolition .................... Other ~/ork .................. ' ................. (Description) 4. Estirnoted Cost .... ; ............. Fee .............................................................................. ........................ (to be paid on filing this application) §. If: dwelling, number of dwelling units ........ ! ................... Nurnber of dwelling units on each floor If garage, number of c~rs ........ .~. ....... -~....'-.' ........ ',"": ....' .......................................................................... 6. If business, commercial or mixed occupancy, specif'/ nzture and extent of each type of use 7. Dimensions oF existing structures, if any: Front ............................Rear ................................ Depth Height ........................ Number of Stories ....................................... Dimens[cns of same structure with ~lterations or add,dana. Front .................................... Rear ......................... tleight Nu,~ b~-r of $~on~s ................................ ~.'e~th ................................ I ........................ ~or ...... .g'.k~,! ............. ~epth AE.r;~..'A.' .... [Dimen3i~ns ~ entire new construction: Front ....~..'.~- 8. }Height ~'~o .... Number aflStories .... .~ .................................... f, ............................................. ( s,2 eor ........................ .................. 9. af[ 10. Date oF Purchase ........................................................ Name of Former Owner 11. 2'one or use district in which premises are situated ............................................................................. 12.. [Dams proposed construction violate any zoning law, ordinance or regulation: ...................... ~. 13.Will lot be regrc~ded .............. , .......... Will excess fill be rernoved from premises: ( ) Yes ' ( ) ammof ............. ,ddre,$ ........ ........ No...! ............... · Nome of Contractor .~.~.'~...~2~..,.~o~: .............................. Address .~.~,S.,..I~:.~.,....~'J.,'~' Phon~ 1'4o. PLOT DIAG,qAM Locate clearly and diet nelly all buildings whether ex~ting ?,.r proposed, and indicate eli set-b~ck dimensions ~ro~:erty lines. Give street and bi?ak number or descrip,ian ~c,.ording to deed, and show street names and indk whether interior or corner lot. ........... ~ ...... :'"Y"". ................................... being duly sworn, deposes and says that he is the appli~ ~'/"~me of indi.~dual signing contract) ' ~ovm s~id owner or owners, and is duly ~uthorized to ~erform or hovo per¢ormed the said work and t'o ~ke and this ~pplicaden; th.2t elf statements contained in this ~ppl[czd~n ore true fo the b~st o~ his knowledge and thor the work will be perfumed in ~he manner se~ forth in the application filed therewith. ....... , .~ ........................................... tar Public .~~O~c,,~tt~ ...................... . f liccnt HOp/ or formerly ~Ober/ leyden ' ALL£N '~.. D~IV~' I OCT. NOTES · MONUMENT [3 STAKe' THERE ARE NO OTHER DWELLIH6$ WI~'HItV /00 'OF THIS PROi~RTY OTHER TH.~N THOSE SHO~ HEREON. SURVEY FOR GUARANTEf~. ~ MA TTI TUCK .... SOUTHOLD ,JFFOLK COUNTY. N Y YOUNG & f:~uNG, LAND SURVEFORS 400 ~STRANDER AVENUE ~ cERHEAD, NEW YORK ' APR.30, t~TG I = 40 78 -285 :4' '~ now or formerly FPOber! L~Yd~n ~ 7-17'Z£ AIO, (2 "6" I /J NOTES' · ~MONUMENT E~ ;~TAK~' THERE 4,?~ ~0 OTHER DWELUNGS WITHIN I00 'OF THIS PROPERT~ O~HER THAN THOSE SHOWN HEREON. .CUR VE Y, FOR n/T4 ~. YOUIVG ~' MA ~TITUCK .~ . SO~ITHOLD ~ GUARANTE.~ , SURVE '~0i~''''~'' YOUNG & ¢O'UNG LA-D 400 OSTRANDER AVENUE ; R:vERHEAD, NEW YORk, Oy formerly l~obert l ey:d~n: TEST HOLE WATE~ 0.0 ~ 4569 NOTES i M<ONuMENT ~3 STAKE THERE ARE iNO ~ THER DWELLINGS WITHIN IQ0 'OF THIS PROPERTY OTHER THAN TH, O~E SHOWN HEREON. T~R SU~P~- PR/VATE ~W~LL S ' '" SURVEY FOR' GUARAN~'EE~ TO ~o3~'7.. ~/, VO , '~ , :.~', ~ ' ~.~ ~" FOR DATE. "S "~'. NO ~ ~' YOUN~o~ OST~NDERYOLJNG' L'ANDAvENuESURVEYORS RIVERHEAD, NEW YORK Q ^PP.OVED/^S ,~OZ~D NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM fo 4PM FOR REQUIR. ED INSPECTIONS: 1: BEFORE BACKFILLING FOUNDA- 0