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Home My WebLink About9990-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No.. Z98.~ ? .......... Date ... THIS CERTIFIES that the building ................................................ Location of Property .... .8R'7...~9~.~-..B.rt..yTV..1 ~.w..R. 9t~.d' ..............$.o.~.~].~O?..d,~ .~1,~,. House No. Street Hamlet County Tax Map No. 1000 Section ...~.~ ....... Block ..... .8 ......... Lot ..... .~ ~ .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. 0¢.~.o.l~¢7~..'1.6 ....... , 19 i?.b~, pursuant to which Building Permit No ..... 99.0.0.Z ........... dated .. 0Og.o.~9X'. 2.0 .............. 19 7B., 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 ......... ................... P~i.v.a%o..On~. F~mily. ~elling ............................. The certificate is issued to ..... %Tindmeag..Build, lng .CorP~al:ima ................... of the aforesaid building. Suffolk County Department of Health Approval . .8~I~.Q.-.1J.7. .... 1.2../.19f.7..~.' .R.,...A,..V.g.l.l.a... UNDERWRITERS CERTIFICATE NO .... N../4. 6.'1.'7.8.91~~~1 ~~t~ ............. Rev 4/79 ~OP~ NO. ~ TOWN OF SOUTHoI:D~. ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. Permis~i~i~i~ h~r. eby granted to: .,, BUILDING pERMIT (THIS PER/~IT MUST BE KEPT ON THE PREMiSES,UNT!L'F01~L COMPLETION OF ,"~tE/WORK AUTHORIZED) Dote . at )remises located ;., ,pursuant tO application dated · Building Inspector. Fee $...~.....:;~;;!:JJ.J..~..... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in dupiicate to the Building inspec- tor 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 installa- tions, 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 "pm-existing" land uses: 1, Accurate survey of peoperty 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 informa- tion 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 occupancy $1.00 $5.00 Date ... .8.0 ..... New Building .... .~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....~27. ~T.o..~r.-c..J,~/, ~O~d ............ ~q.Q~t~C~O.],(~,. ~¥ ............. House No. Street Hamlet Owner or Owners of Property ...... W£~c~8~/,~.. ]~t~,~,c~,Tzg .C~0~.., .......................... County Tax Map No. 1000 Section .... .7.8 ........ Block ..... 8 ......... Lot ..... :1.3 ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..999.0.2~... Date of Permit .'J. 0,/~.O./7. ~pplicant . . .W~-~..:~:]-~o.. (~;~.~ ~ ....... Health Dept. Approval . B~-?_S0~-.'I.'I,7. .... '[2/.'lg./TCJLabor Dept, Approval ........................ Underwriters Approval . ~ ./+(~.'1.7.8c~ ............. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .~,00 ........................ Rev. 10-10-78 Construction on above described building and perQ~t meets all a, pplicablP'~'odes and regulations. Applicant ~ '; ................................................ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2N'D [ ] INSULATION FRAMING /[~] FINAL~?~//~. DATE TOWN OF' SOUTHOLD OFFICE DF BUILDING INgPEOTOR TOWN I~-LERK'S ['~FFICE ~RUTHI~LD, N. Y. 119'71 TEL. 765-266D Disapproved a/c FO~M ~0. 1 TOWN OF $OUTHOLD BUILDING DEI~ARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y? (Buildi~ APPLICATION FOR BUILDING FERMIT Date .......... ~...'...../¢ ./...~... ............. , INSTRUCTIONS a. This application must 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 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 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 necessar~ i~ectioDs./ ,,~ /.2 (Signature oJ-,applicant, or narr~, if a corporation) (Address of applicant) !1 ~ )j State whether applicant is owner, lesse~.~ ag,ent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................. .. o, ow,, o, ....... ....................................................................... If applic~orp~o~te/sigpel}ure~6~f A/aBthorizec~ficer' (Name and title of corporate officer) /~ Builder's License No ..................................................... Plumber's ,License No .... ~..,~...-Z.~...~....~-..~..~~-t/?~ ~ ~'~ Other Trade'sLicense No ............................................... ~Z2.~v~ ..~....~....~ 1. Location of land on which proposed work will be done. Map No.: ...... No ......................... Street and Number .................................................................................................................................................... Municipality 2, State existing use and occupancy of premises and intended use and OcCupancy; of proposed construction: a. Exisiting use and occupancy ....................................................... ; ........................................................................ b. Intended use and occupancy .......... *~ ........ ~ '5 Nature oJ work (check which applicable): New Building ...... L .... Addition .................. Alteration .............. I~epair .................. Removal .................. Demolitior .................... Other Work .................................................. (Description) ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................... garage, number of cars ............... ~....~ ....................................................................................................... If 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 ................................ 8. Dimensions o~tire new construction: Front ......... ¢.¢..,..~ ............. Rear .......... ~....~ ........ Depth .~ ................... 9. Size of lot: Front .......... ].~.~ .................................... Rear ..... ~.~.~. ......................... Depth ...~ ................. 10. Date of Purcha~,,..t'.,.~,Z~///~.~ .......................... Name of Former Owner ...~Z~..~ ............................. 11. Zone or use district ~'n which premises are situated ..................................................................................................... 12 Does pror~osed construction violate any zoning law, ordinance or regulation: ......... ..~ ................................. 13. Will lot be regraded ................. .r,....*.. Will exces~fill be removed from premises: ( ~ Yes (I) No Name o{ Controctor ....... ~.~.L..~ ...................... Address ................................ Phono ~o ....................... PLOT DIAGRAM Locate c~early 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. STATF OF NEWc~,ORI~ ,L. / S S ..................... being duly sworn, deposes and seys that he is the oppliconl (lx~ame of inoividual signing contracf) above named. (Contractor, agent, corporat~ officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work ~nd to make and file this application; that all statements contained in this applicction are true to the best of his knowledge and belieF; that the work will be performed in the manner set fodh in the 'application filed therewith. Sworn to before me this ~ /'~ ~ ~ ~ / ~ ~ ~ (Signature of applicant) ~Prm F~l)~re~ March 3~. ~ ~7%° OC th" ~- ,, I ZOO .00'