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Home My WebLink About9909-zTO~N OF SOIYrltOLD B~m.nING DEPARTMENT Tovm Cl~k% O~iee Southold, N. Y. Certificate Of Occupancy No. Z9428 Date ...Febz~ary .9 ............. ,19. '79 THIS CERTIFIES that the bugdl-g located at ~7~. ~,ast. Legion .Ave .... ~ Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ...A.u...g~..t.....1.~. ...... , 19.7.8. pursuant to which Building Permit No. '9~09Z ' dated ...A.u..~..t.....~.~. ....... , 19. ?.8., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which ihi~ cel'tiflcate is issued i= .... .~ddl.~lon..~o. Prlv~f~a .One. Family. Dwelling ..................... The c.~ificate is issued to ....... Norm~. W~a~c .................................... of the aforesaid building. Suffolk County Department of Health Approval ................ N/R ................ UNDERWRITERS CERTIFICATE No ....... N~2.~.la8 ............................. HOUSE NUMBER.. 575 ........ Street ....~as~ Legion .Ave ................... .......................................... lqatt&~uck~..N,Y.. .................... ........ But]ding r-~.oeetor County Tax Number 1000-122-~-51 TOWN OF ~OUTHOLD B,UILDiNG D~pARTM~IT TOWN CL~R.'S OPPICE $OUTHOLD, N. Y. BUILDING pERMIT (THIS PERM!T MUST BE KEPT ON THE PP, EMISE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9909 Z Date .... · -~ ¢'. ........ .~ ....................... , lO.:?j~. Permission is hereby granted L~e~..z,~..ce~,.: .............. : ................. to .......... A~c~ ~n~ .~..~.~a~e ..O~e..; y ....................................................... *::-._ ' at, proem ses Iocat,ed. at ...;.} ........ .~,~.~. ~t~.,,~;.; ............................ :.; ...................... ,and approved by the FOBM NO. 6 TOWN OF SOUTHOLD Building Depat*ment Town Glerks Office Southold, N. Y. 11971 APPLIGATIOH FOP. CF.P, TIFIGATE OF Instructions A. This opptlcation must be filled in typewriter OR ink,, ond submitted in-~ ta the Building inspector with the following; for new bufldlngs or new use: 1. Final survey of property with accurate location of ali 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 installations, 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 uses, or buildings and "pre-existing" land uses: 1. Accurate survey o'f property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or ~and use 3. Copy of certificate of occupancy $1.00 $5.00 New Building .................... Old or Pre-existing Building ...... ~ ..............Vacant Land ............................ Location Of Property ............. ~. ................... ; ...... n. ;r ~ ................ ~.,~ ............................................... Owner Or ~ners Of Properly ....................................................................................................................... Subdivision ......................................... Lot No ............. Block No ............. House No ............. Health Dept. Approwl ............ Z, ............................. ~o Dept. Approval ................................................ zp,,o .t .......................... ............. ................ Request For Tempora~ Ce~ificate ........................................ Final Ce~ificate ~/ Fee Submitted $ ..... ~.~( ...................... Construction on above described building and permit meets a~pplicable c~es~and regulati~s. pp ............. v....~ ......... ~ ............... ff ..... ~ ..................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County THE NEW yORK BOARD OF FIRE UNDERWRITERS ~ ;n BUREAU OF ELECTRICITY I~ 8B JOHN STREET, NEW YORK, NEW YORK 10038 THIS CEEIFIES THAT a~ fou~ to be ~n ~mpllam wi~h the requi~mnts of th~ ~d. A~T, K.W. OIL H,P. GAS H,P, AMT. NO. ~W.G. SERVICE 01S~:~NN~:T I ~.~ I OTHER APPARATUS: ~.lec, Room Heater:l-?.OKW ~,~o~or/s ~ I-I h~ I-G,F,C, I . y-4.SKW M~t Water RANGES E R COOICINGOECKS OVENS IDISHWASHERS V I ¢ E EXHAUST FANS ~T.! ~. ~¢ ~'a I ~er F I n~!er Hattltuck~ Llc. 184~ E II ~#r This certificate must not be altered in' any man~er; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. []J .... _"'_ _--__--. .................................................. ~m~ ~', FOR BUILDING DEPARTJKINY. I ................ TH~ ~C~OPY~ OF. CERTIF~ICA~TI M._ ~U~.~ ~ B_E A~T~IN_~I'~f. _~_~R,~ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. August 22 78 Examined ........................................ , ]9 ........ Approved Augus~ 22 19 78 Permit No. 9909Z . Disapproved a/c ...........~'---~-'"~ ~,-~ ~..........._.._........I .............................. ................................................................ .......... .... (Building Inspector) Application No. 9909Z APPLICATION FOR BUILDING PERMIT Date ........ ............ .... 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 o~ 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 application 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 MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... .................................... Name of owner of premises If oppl~outhorized officer. ........... b-ffi ';'/f ......... Builder's License No ........ ~ ......................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which propf~sed work will be done. Map No.: ~ ................................... Lot No ......................... Street and Number ........ .~....~..~.~..~.~.~..~...~.~.~...~.~..~..~..~..~~(~ ..... -- Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............. .~....~...J...~....~...~.,~........~......~..~.~.... .~.......~..-~.~... ....................................... b, Intended use and occupancy _.~/~/~1, ~ 3. Nature of work (check which applicable): New Building .................. Addition ......... ~Alterotion ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... 4. Estimated Cost ............. .~..I.....~..?...?...:..~ ............. Fee // ~ (Description) (to be paid on filing thi~ application) 5. If dwelling, number of dwelling units ................~ .......... Number of dwelling units on each floor ............. ~ .............. If garage, number of c~rs 6. If business, commercial or mixed occupancy, specify nat~Jre and extent of ea.c~,type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ....~...~..? Height ....... .~...~.. ......... Number of Stories ...................... ~..~...~'.. ................................................................................ Dimensions of same structure with alterations or additions: Front ¢c~'"'~ Rear Depth .......... ~.....~....7... Height ............................ Number of Stories ............. ~. ................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ................... ~..?~.....o_.....,,r~,~.ir. ............. Rear ............... ~.....~.......~...~... Depth ....... .~:...!..,,.~-......J~....T'. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............. .~..~..I.~..~..L~....~ ......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ ,t~..~ ............................. 13. Will lot be regraded . .......... ...~.....~.. ....... Will excess fill be removed from premises: ( ) Yes (~'No 14. Name of Owner of premises ....~....~....t~..~,..~.........i~....~._.l~....~-.. ....... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone, No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exbting or proposed, and indicate all set-back dimensions from property lines. Give street and block number or descriphon according to deed, and show street names and indicate' whether interior or corner lot. STATE OF NEW YORK, t¢c COU NT3~. 0 F¢L.~i...~_r~ ~......~ ..-,,, ,.z~_ ~ ~ ?~¢~_~ ~., , ~,,~' ~'~ (Name of individual signing contracf) above named, He is the ........................ ~.~.~.....~f.....~.....~Z/..~.~.....~ ................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work a.nd to moke and file this application; thor all statements contained in this application ore true to the best of his knowledge and belief; ond thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,~ .... ..... of ............ ...... , Nora,.,, Pub,c,. ........... ....... County ....... .................................. £LIZABETH ~NN NOTARY pUBL C State of 2 8 25850 Suffolk NO, 5.' .- "' ~ 30 APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT AT ~ 9AM to 4PM FOR E[QUIR- ED INSPECTIONS: 1. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. FRAMING INSPECTION 4. FINAL WHEN JO~ COMPLETED NOT RESPONSIBLE FO~ $ T E V E ........ ; I S