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Home My WebLink About9934-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..7.,.3.1..2.f, 9 .......... Date ..... Q~t;o.b. qt'. 2.1 ................. 1982. THIS CERTIFIES that the bn'ikl'hvg ...p.o. 9J. ......................................... Location of Property .1..09.0 ................... I.n..d:t.a.q .~.eg.k' . le.a.n.o' ........ .P. ~.q 9 .n.J..c.... House No. Street Hem/et County Tax Map No. i000 Section . .0.~ ....... Block . .q~ ........... Lot .2... ! . .&..2. :.2 ...... Subdivision...7: ........................... Filed Map No..X. ...... Lot No.. ~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. ?.u.n.?..ltl .......... , 19 .7.8. pursuant to which Building Permit No..9. 9~J)..Z. ............. dated .... ~.e.p..t ??.b.c.v...1.2. .........19.7.~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... an in,round swimmin~ pool. The certificate is issued to ...... .H.~.]: ]...i.c.e..n..t. JO.,.. 9 9.~.s.n. 9.v ............................. (owner, I~.~t,.~ete~t¢ of the aforesaid building. Suffolk County Department of Health Approval ..... r)./?; ................................. UNDERWRITERS CERTIFICATE NO ............. (4...3.9.3..8.37 ............................ Building Inspector Rev. 1/81 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? 9934 Z Permission is hereby granted to: R · Zo 6-0 .zz-~,br,~...~... ~v~-~/ /,_/~/~E atpremises locatedat ................................................ ~ ................................... ~1.1... ......................... - ...~ ................................ ~ ........................... Z~..E...c...~.~:..~ ....................................................... Building Inspector. · pu~rs~nt to application dated . ..?...~. ~:- C .~ 19 d approved b :the~ Building Ihspectbr ' FORM NO. 6 TOWN OF $OUTHOLD Building Delm~tment Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 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 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 Date ..................................... New Building .................... OTd or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .....~,~-..../b~..L../~.f..~'......,/.~,.¢K4..% ....... ..,.~..~.,.<.= ............. ~.,¢;,.,~.(~.tkZ.~..? .................... Owner Or Owners Of Property ...~.f...'.~.~.'...~.~..~.~ ................... ~.~..~.: ..................................................... Subdivision ............... ~....'~.~ ........................... Lot No.....~7..~:;... Block No.....~..... House ~1o~ Permit No. Date Of Perm t Applicant .~..~ ~.~..~....~...~ Health ~ept. Approval ............................................ Labor ~ept. Approwal ................... ~ ............................ Underwriters Approval ...............-- -- ~.....~,~/~'~..?.o. Planning: ;.,~,ann,~Boar~ ............ Request For Temp~ Certificate ...................... ' ~ ................................ FeeSubmitted*.--...... ............. /// .. Construction on above described building and/perm~l~./?Wcod~ and regulations. Applicant Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) "~* TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ SOUTHOLD, N. ,Y./ Examined ~,.: ............. .~-~..:: ........... , 19 ........ Approved ............ ~ ......... ; ...... ........ .............................. Disapproved a/c ............... ~.}..., ............................................... Applicotion No.' .~....~-.,~..X APPLICATION FOR BUILDING PERMIT ' 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on diagram which is par~ 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,shaH 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 ap, l>~ant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors/1 -°~re~nises_and in buildings for necessary inspections. .... .- ........... (Siggature of applicant, or name if a corporation) (Address of applicant) State whether applica/(t is/(~.~r,~'essee, agent, archite((t, engineer, g~~act~/elec:trician, plumber or builder. .................................... ......... i .................. .................... :..., ................. , ......................... P -.--.<~,.?~. ........................................ ;: ......................................................................... If applicant is a corporate, signature of duly authorized officer. Builder's License No .......................................................... Plumber's License No. E ectncmn s bcense No .................................................... 1. Location of land on which proposed work will be done. Map NO, ................ ...... ........................ Lot No ......................... Street and Number ........ ....~.....~....~.i...~.....~.. ...... J~/.....~......~...~... 'J~. ............... -- ..~.[..~...~...C.'?...}~...?Z.~f:~.~...~Z~.. .................. Municipality 2. State existing use and occupancy of pr/~ises and intended use and occuPancy of PrOPosed construction: a. Existing use and occupancy ........ [~..~...~..--k.:b.:b.:b.:b.:~..:.........................-- -- ~. ............................................................................. b. Intended use and occupancy ...~. ........................ ~ .......................................................................... Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Renair Remov I Demoli-ion ....... ~7)~j ~" ~ .................. r.l.., a ......................... no~$ ........................ umer WOrK .~....~,,'~/......¢..q,~..~,~.: ......... ~ ~ ~ (Description) 4. Est. mated Cost .~.I.2~.~..~......:........~-. ..... Fee ........ ~ .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .......'~... ....... Number of dwelling units on each floor .., ............... T. .................... If garage, number of cars ....:.; ..................................................................................................................................... If business commercial or mixed occuoancv, specifwj,,~natu? and extent/o°f eac? type of use ...~ 6. Dimensions of existing structures, if any: Front '"~'7' ......... Rear ....~ .............. Depth ...... .~....~.. ..................... 7. Height ........................................................... Number of Stories ...../'z ~ ............................................................. Dimensions of same structure with alterations or additions: Front ........... 2 ....... '~ ..... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front .......4 ........ .t ................. Rear ......................................... Deoth ............................................... 10. Dateof Purchase ..... ~.I..i.Z~Ii~... ....... Name of For. mcr Owner ~..fl~. ........... ~' ..~...~...~.....~...~'/~.l~.~..~.~...~.. 11. Zone or use district in which premises are situated ................................................................................................... 12. Does proposed construction vio!ate any zoning law, ordinance or regulation: ........ .~....U. ............. , ...................... 13. Will lot be regraded ...... ,~..:.l~l.., ......... ~.....J~/ill excess fill be~z~mov~d from, premises: [ ] Yes ~[1~ No 14. Name of Owner of premises ~'~]~'~'~'~.1~`$~'~..~';~'`.~'~'~'''~.(~'~..'~''~'~.'~.:~'..~.'.' ........ .~...~.~.....~....~....'~..~. .... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... c~ t/ ~'~ ~'~ / (Ad._dr~ss)~-~ (Ph?e No.) Name of Contractor ...~...~....~..~l~Z.,d,~..~..;,....S .........4'.~.~.¢..~rm.;.;. ................................ ..................... ~-- r (Address) (Phone No,) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW ) ~ COUNTY OF __ ) (Name o£,indiHdual signing contract) , ' (Contractor, agent. of said owner or owners, and is duly authorized to perform or have p~rform statements contained in this are true to the best of his knowled set forth in the application filed ith. ......... {~ ......................... day ~ Notary Public, ............. o~J[~,o~.co~*,,.~,.~.., ...... being duly sworn, deposes and says that he is the applicant above named. etc.) work and to and that the and file this application; that all the manner (Signature of applicant) ~0~ 0 0 0 NOTE: ~i~ALE: I''= 40' MAY 22, 1969 SURVEY FOR HELGA E. GARBADE -- /~I,'[/¢F,'~'~ PECONIC TOWN OF SOUTHOLD SUFF. CO., N.Y. GUARANTEED TO= HOME TITLE DIVISION ' PROFES$t4~[~z' FrNI~I~R AND LAND SURVEYOR,~ N.Y.$.~.I C. NO. 12845 RIVERNEAD t N.Y,