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Home My WebLink About9919-z1~0~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMF_aNT Town Clerk'~ Office $outhold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the building located at .69.0...Ng..~..~..i.e.l..d...L~...e ..... Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in thl.q office dated ...A..u~t...s? .... .18. ...... , 19.7..8. pursuant to which Building Permit No.. dated ...A.u..~..s?;.....2.9 ........ , 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 ~ued is .......... ~r..~y.a~e.. ~e...~..e~..~.~r..~..e~Z..m. ~ ............................. The certificate is issued to ............... .P.i.n.a...Rg.c..t~. 9r..cl' ......................... (owner,:~ of the aforesaid building. Suffolk County Department of Health Approval . .J..~..u..a~... ~.. ?.9.7.9.....8.: .~.0.-.9.? .... N41~25~ UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER .... ~9.0 ....... Street ...............,~,., .z~, .f.i,e. ,1,(:t,, ,L~A...e ......... ..................................................... .s.o.u.~.o~, :. ~:¥: .......... Building Inspector County Tax Number 1000-079-3-4.2 FOI~i~ NO~ ~ TOWN CLERK'S O~FI~ SOUTHOLD, N~ Y. ~ BUILDING ~ERMIT:," (THIS PE~IT M~ST ~E KEPT 6N THE PRE~ISES UNTIE FULL COMPLETION OF THE WoRK ~,UTHQRIZED) ' ' ~ermlssion,.is h~reSy g Date Building Depmtment Town Clerkc Office 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 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 natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal--(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. Far existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .... .......................... New Bqilding ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... ~........~.~.~../~..~/.~...~.4/~'.......~..~..O-..~..~.~.C....°'.~.-~.~./~-.~.. ......................... Owner Or Owners Of Property ...... _,1~./.~,.~.....~,~.~...~.~.~'.~... ........................................................................... Subdivision ~i~r~r ........" .......................... :' ............... Lot No...~'/~....~... Block No ............. House No ............ Permit No. ~?..."'uate Of Permit .~..~..~..T..~.~..,Applican,, .._?.......~:...~:...~....~.._e~.... ............... i .... Health Dept. Approval ...~....~...O...-..?./. ........................ Labor Dept. Approval ................................................ Underwriters Approval ...~.....~.~.~....~.~. ...................... Planning Board Approval .... .-..]? ........................... Request For Temporary Certificate ........................................ Find Certificate ...... .v. ................................. Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and reg~tj~:~ ....... Sworn to before me this ~_ ~j' ~ Nota~ Public .................................... Cm,~ i~ ~/'? ~ CAROLE GAMBh'LLA / / '/ ~ ' No. 52 - 4624933, Nassau ~unty ~m~i~sion Expires Mar~ 30. 19~D ~ ~~,~ :: Lt ~ : 8$ JOHN- $TREET; NEW YORK NEW YORK:IOO3B~: .:':~:J:~!-'~' _ _ _ TOWN OF SOUTHOLD Building Inspector's Office Southo~d, N.Y. 765-2669' " ..,, ~ ~ ~-~4.t~'~ ~( x.~:~ ~ .~, ~,..., , t, ~.~ .~ ~ T~L. FOI~M NO. 1 TOWN OF $OGTHOL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ../.......,~..1... .......... ~prov~ .~.......~.~ ........... , 19.~ ~ormit ~o. _.~.~ ......... {Buildin~ In~p~tor) INSTRUCTIONS Dote '.....~g~a.t...i~ .................... , 19~£ ....... a. This application must be completely filled in by typewriter off 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, 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 al~proval of this app'lication, the Buildin~j 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 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 on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) 1427 Wm. Floyd Pkwy., nlrley, N.Y, 11967 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ........................................................................................................................................................................... ?. · zna Rochford Name of owner of prem,ses .................................................................................................................................................... If aop/iccmt is a g~rpg~gte, ,si,$~atur, e~of d~ly authorized officer. (Name and tit e of corporate oTficer) · Builder's License No ..................................................... Plumber's License No ................................................. ~.~. //~/C~ Electrician's License No ............................................. Other Trode's License No ............................................... B ' Location of land on whmh' proposed work wdl' be done. Map No.: ............ a~.l. ew 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 .............. .V...R..O..~..~....~..8....~.~ ........................................................................................ b. Intended use and occupancy ....... g.D.e....~.~.~.3.~...r.e~&de~c~e ......................................................................... 3. Nature of work (check which applicable): New Building' .....~ .......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . $28,500.00 ~ ,,~,.~/ ~ (Description) 4. Estimated Cost ............................................................ ~ee ...,~.~ ................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .1 ................ Number of dwelling units on each floor ............................ If garage, number of cars .................. .t ................................................. y,.i ................... ~ ............... . ............................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ , 47.' 24' 8. Dimensions of entire new construction: Front ..... ~.~. .......................... Rear ........................... Depth ........................ Height.......13 ........... ' ,. Number of Stories i ...................................... 9, Size of lot: Front ........ 5,!,. :1'~/~ ........................ Rear ................ .1.'~.0.! ................. Depth .:L/~6...8,...Z:L.~...;I~ 10. , Date of Purchase ........................................................ Name of Former Owner ....~...$...~...~.~..~.?...d...,~,~..~...~.,~.~..~..e.. ........... 11. Zone or use district in which premises are situated .................................................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ........ ~.O. ........................................... 13. Will lot be regraded ....~..e..~ .................. Will excess fill be removed frfjrjCje~r~i~-~: ( ) Yes (x) No 14, Name of Owner of premises ..... ?..~.~.~....R..O..O..~o.]¢.~. ............... Address .~j~7~j~.~.~.CJ~Lt..~L~o~ne No. ? Name of Architect ...P.O.~l,d...~.....~8,~l.c~ ......................... Address .Pa~ho~e ......... Phone No. Nome of Contractor ..~g,~,..]~9,rho~..D.uild~.rs.,...,T,~CAddress .L~2.?...Wm,..~..~,o~'~hi~. 399-2222 PLOT DIAGRAM Shirley Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions frorn 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 YORK, [ c c COLINTY OF ................ ~ ........... f~'~ .......... ~/.'~)¢~..x¢~.~.. ...... ~.Z~,~.~.. ........................... being duly sworn, deposes and says that he is the applJcam (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 application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner ~et forth in the application filed therewith. .......... ~.~ ......... day o~.~~ .............. , 19.~. ................... co.., ..... ................ EILEEN RICHARDS HOTARY pUbLIC, STATE OF NE~ BUILDER'S JOB NO. TITLE NO. IHE EXISTENCE OF RIGHT OF WAY~ AND OR/EASEMENTS OF RECORD, IF ANY, NOT ,SHOWN ARE NOT GUAP, ANTEED~ THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE EXISTING CODE DE PRACTICE FOR LAND SURVEYS ADOPTED RY THE NEW YORK STATE ASSO- CrATION DP PROFESSIONAL LAND SURVEYORS. UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION Of ~EOTIO~ 72~ SU~DIVISION 20~ THE NEW YORK STAT~ EDUCATION LAW. COPIES OF T~lS SURVEY MAP NOT 8EARIN~ THE LAND SURVEYOR'S INKED SEAL O~ EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAL D TRUE COPY. CErTIFiCATIONS iNDICAT~D HEREON SHALL ~UN ONLY TO THE PERSON FOR'~HoM THE SURVEY m PREPARED, AND ON H~S BEHALF TO THE TITLE COMPANY GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON AND' TO THE ASSGNEES' OF THE LENDING NSTTUT~ON. CERTI~CATIONS ARE NOT TRANSFERABL~ TO ADDITIONAL iNSTITUTiONS OR SUB6EgUENT OWNER~ SUFFOLK COUNTY TAX MAP DlSt,--/~SECT.--~ BLK.--~ LOT--~/O~ MAP NO. DATE: LOTS BLOCK BURTON & HAND EFT SIDE. 'EL EVAT ON 'E £'EVATION ;RIGHT'..SIDE E APPROVED AS ~OTED BEFORE BACKFiLLInG FOUNDA- F~ING INSPECTION 3.' ~O~ COVERING PIPES O~ ANY 4. FINAL WHeN JO~ C~MPLETED OR 'CONST~UCTIGN E~RO~S -5. ALL CONSTRUCTION M~ST MEET REqUIREMeNTS OE N.Y. STATE COD~ .-:RE AR:EL E VA'FI 0 N L.EV. ATICN -t EFT SIDE. 'EL EVAT ON 'E £'EVATION ;RIGHT'..SIDE E APPROVED AS ~OTED BEFORE BACKFiLLInG FOUNDA- F~ING INSPECTION 3.' ~O~ COVERING PIPES O~ ANY 4. FINAL WHeN JO~ C~MPLETED OR 'CONST~UCTIGN E~RO~S -5. ALL CONSTRUCTION M~ST MEET REqUIREMeNTS OE N.Y. STATE COD~ .-:RE AR:EL E VA'FI 0 N L.EV. ATICN -t