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HomeMy WebLinkAbout9913-z~M NO. & TOWN OF $0UTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificate Of Occupency No. Z9202 Date September 11 19 78 THIS CERTIFIES that the building located at ..... 8200. Skunk. Lane ..... Street Map No ............. Block No ........... Lot No .............. ~.-. ~ ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .A.u.~9.s}... ?.7 ......... , 19..7.8. pursuant to which Building Pemit No .... 9..9.~.~.Z dated . .A.t!.gg..s} .... .2.2 ......... , 19..7.8., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... Acc.e.a~'fy..S.~.r~c.$~..e. ............................................ The certificate is issued to .............. Joaeph. H,. C... l~.enk ...................... (owner,~ of the aforesaid building. Suffolk County Department of Health Approval ............... N./.R/ ................ UNDERWRITERS CERTIFICATE No ........................ N/R/ ................ HOUSE NUMBER ...@200 ...... Street ........ Sku~k. Le~e ...................... Cutcho~.e, New York Building Inspector ~'OE]~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING prERJ~IT (THIS PERMIT MUST BE KEPT ON THE pREMIsES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9913 Z Permission is hereby granted to: at premises located at .............. .~;~ O..O.. t '~1~ ~ i'f~" :"~" :' i k '~/~"~i'' '~ ' .... ~ . .... . ...... ...... ,~.: ..... ?,. ..... ,;......: ~ . ,,; .............................. ................................................ ~.~v..:c.:~ ~.~,~..~:~. ~.~. , ~ .... . ...... pursuant to application dated ........ , ........ :'?,",;~,':-?~',!;:~t;~:~-::-~ ,',': C~:~; ,. pP:. ', Y Building Inspector. Fee $..J...O. ................ FORM NO. S TO~/~I 01: $OUTJ4OLD Building Deportment Town Clerk~ Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in ~-'to the Building Inspector 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 naturoJ or topographic features. 2. Final approval of Health Dept· of water supply and sewerage disposal--(S-9 form or equal). 3. Approva~ 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 aT property showing oil 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 in- formation required to prepare a certificate. 0. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelHng or ~and use $5.00 3. Copy of certificate of occupancy Date .......................... ............... ............................ Location Of Property ,~.~...~.~..~.:....~./J~.:..~ ...................................... '~'..~'.'*",~'"~'~"~" .......... J ................. · Owner Or O~ners Of Property ......~....~. Subdivision ........~./..$...~......~..../..~....~...O.. ........................ Lot No..~.~..,~.. Block No...~..ff ..... House No...~.?...~..- Permit No...~..~/.i~..Z..~... Date Of Permit ..~.;~..~..~.T.?...G/.Applicant ...~....O...~..~.L~....~..../-(. ...... ..~,.;....~/:.......~...~.....~..~/~.... 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/~eets all applicpble codes and regulations. Applicant .......... // "'~ ...~......~.....2.....~..~: Sworn to before me this ~/ da of .P~ .... .~. 2 (stamp or sea ) ................ y r/ff,'; ............... ,.... Notary Public ....... :.L~~ County .. Jo.s!P?~ ~. o~L~ ¥ , / ~'~/ ' ' / ~ I ~- ~aJl~ied in Nassau CounlYnt FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .............................. 19../..~... Permit No ................................. Disapproved o/c ................. ~...'~...~ ................................................. ~ ..... ................................ ................................. APPLICATION FOR BUILDING PERMIT Date ...................... .............. , .... INSTRUCTIONS o. This application must be completely filled in by typewriter om 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 end of buildings on premises, relotior~ship to adjoining premises or public streets or 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 o 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 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 Southold, 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 premises and in buildings on for necessary inspections. ........ i§ ..... ' ..... ........ ....... ................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ....... .~:.ZZ~][~ .............................. Plumber's License No ................................................. Electrician's License No ................................ Z.~. .......... Other Trade's License No ............................................... D~s~'- ~o s~¢-/~¢ ~'~ ~ Location of land on which proposed work will be done. Mop No.: ........................................ Lot No.'.- ....................... do~ Street and Number ~./~...~. ~..~_,/~-, ~/~k/?.) ~'~'~/pJK /~-~ · 0 o'7-&>/c~ ~"~ . Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a.. Exisiting use and occupancy ~..~.~.~(~.Y.~.~..~..~.~.~...~.~..?.~.?..~.~.~.~..~.~.~.~z~.~.~.~.q.~.~..~¢..~.~.~.~ .... b.' Intended use and occupancy ~..~...~.~.~c.~.~../~...E...~...~.~..d.~/..~/.:..K.~.:..~...~Z~'.~...a.~¢:~:.~.~.~).~.~f~]~~ 3. Nature of work (check which applicable): New Building, .....~ ....... Addition .................. Alteration ............ ~', ,, Repair .................. Removal ..................Demolition .................... Other Work .................................................... ~/~...O t~// (Description). 4. Estimated Cost ......... ~...¢.~..~. ..................... Fee .............. ..~...:...~....~. ............................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ~ .............. Number of dwelling units on each floor ...... C~. .................. If garage, number af cars ................... ~). ...................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... .~....~ ........ 7. Dimensions of existing structures, if any: Front .........~.,:...~.. ........... Rear ......... .o... ................... Depth .....T(.......~. ..... Height ....... ,ff..*. ............. Number of Stories ..............~.. ................................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ ~>~ t~ zi /O ~, 0" ' " 8. Dimensions of entire new construction: Front .................................... Rear ....... ~...~.....~.. ......... Depth ........................ Height ..../.~. ........... Number of Stories ............... /.. .................................................................... c,y~.~.~....~..~.¥.;~'~~' 9. Size of lot: Front ........ .~...~..~ ........................................ Rear ......... /~.O..,..(~... .................. Depth .4['~...f/......~-.~.5~'.~' 10. Date of Purchase .............. ~./.~../.?....~... ....................... Name of Farmer Owner ..~...O...~...~....,~...~..~....,.~.:.,~.~,..~...7..,~...~..S.....~..~., 1 ]. Zone or use district in which premises are situated ................../~.~..~..¢..0...~.~'t/...~/...~...~.. .............................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ......... .~...~c......S.. .................................. 13. Will lot be regraded' . ........4~...C~. ......... Will excess fill be removed from premises: ( ) Yes J~) No 14. Nome of Owner of premises .....~..~...~....~...~.....,,'/~',.:.~..:..../~...~'...~.~.. Address .~..~....~'....,~...~...~.. .. Phone No..~.~,~...-...~..~..~.?. Name of Architect .................................................... .......... Address ................................ Phone No ....................... Name of Contractor ............................................................ 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 YQRK, tS S COUNTY OF ...... ~..E..E.~...~...~. ...... ~' ' (Name of indivldual signing controcf) above named. (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 application; that all statements contained in this opplicction are true to the'best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,No, 30-4624788 ,Certificate filed in ,N~ss~ BAY AVENUE o i 4.5 ioo. o~ &.9 0 0 SURVEY' FOR EUGENE 8.,JR. ~ SALLY I~ARTENS AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. scALE: 1"=40' MAY 5 · 1970 SEPT. 30, 1971 JAN. 17, 1972 REFERENCE eUARANTEED TO, INTER.COUNTY TITLE GUARANTY ~, MORTGAGE CO. EUGENE B.,JR?, SALLY MARTENS $OUTHOLD SAVINGS BANK LAND 3URVEYOI! AI.Y.S. LIC. NO.Z~]?25 RIV£HHEADI FLY.