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Home My WebLink About9950-zFORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnle Of Occupnncy No.. Z,9~,98.... Date November 8 lg 78 THIS CERTIFIES that the building located at ...6.Q5.. · .L. qn..gy.i.e.w...L..a~.e. .... Street Map No..290.l ...... Block No ...........Lot No ....... /.~6 ......................... conforms substantially to the Application for Building Permit hereto£ore filed in this office dated ...SM.R~ .e.m.b.e.r....~.8. .... , 19..7..8 pursuant to which Building Permit No.. 995.0Z. dated .. Sap. temb. er .... 20 .... , 19.. 7.8, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ l~r. tvate..One. ~.amiZ¥ .DweliLing ................................ The certificate is issued to .......... .N.i. qg..1.a' .a...C.~.r.o. 1..in..e...D.e..c.e.~.l.l..e .............. (owner, 8 3:Wj of the aforesaid building. Suffolk County Department of Health Approval ............. 8-.S0.-A09 .............. UNDERWRITERS CERTIFICATE No ..... N.4.0. 8. .6 5 .0 ................................ HOUSE NUMBER ....... .6.05... Street ......... .L.o.n. g~r.l.e.w...L..aD .e ................. ~outbpld, N.Y: ............... Building Inspector County Tax Map # 1000-088-5-7 FORM NO. ~ TOWN OF SOUTHO~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N,. Y. . BUILDING PER~.~IT (THIS PERMIT MUST BE KEPT, ON THE Pi~:EMISES UNTIL FULL CQMPLE'FION OF THE WORK. AUTHORIZED) N.° 9950 Z ~' Dote Permission is hereby granted to: at premises located at . ~ursuant to application dated Buld 'g I , ~'~.~ n nspector FOBM NO, 6 TOWN OF SOUTHOLD Building Delm~tmunf~ Town Clerks Office Southold, 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 aT 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 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 3. Copy of certificate of accupancy $1.00 $5.00 Date ....../~.~~ '"u~.. 4.....3..../...~....~. ...... New Building ......~. :~..~, ...... Old or Pre-existing Building ............................ Vacant Land Subdivision ................................................................ Lot No..~ ..... Block No ............. House No ............. Permit No.¢.~.;)...~.;~ Date Of Permit"~,~)...Applicont ;~.,~/~¢~..~(~r~:..~.-,:~ Health Dept. Approvgl ...~..:~..~.....(..~..~. .............. Labor Dept. Approval ................................................ Underwriters Approval .~..g..~..~.~ .................... Planning Board Approval ........... .~ ......................... Request For Zempor~ Ce~ificate ........................................ Final CeHificate .~.~; .................................. Fee Submitted $ ~ Construction on above described building and permit meets a,!l ~applicable codes and regulations. Applicant ............. .~ ....... ,~ ................ Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County TOWN OF SOUTHOLD nFFIOE OF BUILDING INSPECTOR TOWN CLERK'S OFFICE SOUTHC]LD, N. Y. ]1971 TEL. 765-!2660 {t.t ~ 77.77 7~<~ -- 7':~.z : 77 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. .......... _ _ .......... ............ isapproved a~c ........... ~:~ ...............~ ........................................................ APPLICATION FOR BUILDING PERMIT Date .~? / /. ~> , 19.7.~ ...... INSTRUCTIONS o. This application mast be completely filled in by typewriter o~. 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 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 af 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 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. ,..: ..~.~ ...... ~L../.2 .*.~ ..¢.~:-;~L: .... ~/(Signature of applicant, or name, if a corporation) /,. '//' P~,~,,~ ,'z~/, 9~-~,~Address of applicant) IJ'~ G 7 ('/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ame of owner of premises .t..~..L~.?...~.:~.....~....C./3..&..O...~..I...~.~i f~: D...~..¢.. ~%..&..!..~ .................... If applicant is a corp.o~gt~, signature of duly authorized officer. ...... , %:~ ........ ~..~.~.~.:..../..-?.~'.-.~=~- (Name and title of officer) corporate Builder's License No ..................................................... Plumber's License No ................................................. /c'V.::7'l~La~-o~',7- .~= 7 Electrician's License No ............................................. Other Trade's License No ................................................ 'f~/, ~ ~.~'~ V~/~'~ Location of land on which proposed work will be done. Map No.: ....~...~..~.../ ........................ Lot No. Street and Number ..~..~.¢~/V¢~'t~ c~z, ¢/- A r, ~',~ G- ~/! e_ u,,/ /,-if i~, ¢-_ o~c ~ ~, ~, 'r"/y ~ £ ,o L_ , i. ~,v'. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~..~:I~:.~...~.~ . ...................... b. Intended use and occupancy ..... ~ ............. ~. ........................................................................... 3. Nature of work (check which applicable): New Building' ...~ ..... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................. (Description) 4. Estimated Cost '~..~.!..~ .......................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwellipg units ....~ .............. Number of dwelling units on each floor ............................ If garage, number of cars · ~.--~.. .............................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..... '~.~z..: ................ 7. Dimensions of existing structures, if any: Front .........:%z ............... Rear ............ ~ ................... Depth ...-'~.~. ........... Height .............. c ........ Number of Stories ..... .~ ............................................ ~Z ........................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear ......... ~ .................. Depth .................. ::..~ ......... Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Fropt ....~.. .............................. Rear .....~ ...................... Depth .....-~-..~..~ .......... Height ...... /. ............. Number of Stories .... /..~.~..: ....................................................................................................... 9. Size of lot: Front .... Z.P..~...: ......................................... Rear .../.~.c?...~. .......................... Depth /..;Z.~~. ./. .................... 10. Date of Purchase ....... ..~.~.~;....~..,J..~...,~'~..' ............... Name 'if ;~er Owner .~/..~....Z,.'..~..~....!.~...,~.~-.,..~.~..~ ...... 11. Zone or use district in which premises are situated ........ ~.~.~ ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ..~/..0. ............................................ 13. Will lot be regraded ...... ~ ..............Will excess fill be removed from premises: ( ) Yes (~o 14. N a me o f Own e r o f p r e m i ses~, .'F~., ,,¢.~ .~ .~.,, ,,..~J'~¢¢,, Add ross '~ ,,~"e~,, ..~'~· Phone N°'~'''~'''3,'''~'~'''~''~ Name of Architect ....fi,.~..~....~...~ ........... Address .....G~.~z~:~/.~/.~.t"Phone No .................. :...--~' Name o?~ontractor ./~...R..~...3.....?..~...i~../.,~....~z~. ~...~'.z.~/-~....~Address .....'.~_z"~...~...Z ........ ~'//~. Phone No.~..(?.~.~.O....~. (~/P LOT DIAGRAM ~ ~ocate clearly and distinctly all buildings whether existing or proposed, and indicate all set-back dimensions from prop<.rty lines. Give street and block number or description according to deed, and show street names and ind cate whether interior or corner lot. STATE OF NEW~YO~,I~ , I¢ c COUNTY OF~., ,- ~.~r~' ..;..~...~...-h~ ....... ~'~ _ ...~..]..O $ ~..~..,~......~..~.~,,.t.f~.~...LI. ............. be ng duly sworn, deposes and says that he is the applicant (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 tha~ the work will be performed Jn the manner set foffh in the application filed therewith. Sworn to before me this J~ a f ~~ 9~~~ ~ Nota~ Public, . .~~ .......... Coun~ ............... ~..~.~.....~~ ...... ; ........................ CAROLYN MOORS // ~ (Signatu~ 6f applicant) ' Z 0