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Home My WebLink About9667-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of ~the Building Inspector- Town Hall Southold, N.Y. Certificate Of Occupancy No. Z11566 Date FIa~ch 55 .... ...... , ........ . ...... .......................,19... THIS CERTIFIES that the building Addition L~.~^j ~ ~ ..... ,~, &30 Washington Ave. Gree~ort County Tax Map No. ]000 Section ~ .Block fl .... Lot .. 38 Subdivision ~?~ .~ ......... ~iled Map No..~ .... Lot No ..... ?~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ~..~Q .......... 19~. pm'suant to w~ch Building Pe~it No ..... ~7~ ........... dated ...... 4~.~. ~ Q ............. 19 .~, was issued, and conforms to an of the requirements of the applicable provisions of the law. The occupancy for w~ch t~s ce~ificate is issued is ......... ...... ~3~?~. (~.%. ~.q~)..~. ~5. gv~.;~ ....................... Thc certificate is issued to ... V~.~9~ .~. ~.~P~..~.~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~[~ ................................... 595098 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOP,~ NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9667 Z Date Permission is hereby granted to: at premises lecated at ............................................................................................................................ pursuant to application dated .............................. ~.i~.~.~. ...... {.9, 19~,........ and approved by the Building Inspector. Fee $......./...~...~. ..... Building Inspector 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 subr~itted in duplicate to the Building inspec- tor wi~h 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 topograohic features. 2. Final approval of Heaith Dept. of water supply and sewerage dispose --(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and instaHa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Beard approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings af~d "pre.existlng" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topograph ic 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. / .' 1. Cerzif[cate 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 New Building . .~~[DId .... ~ '~ Owner or Owners of Property/~ZA~ ... ..' ......... · .... ...... :..' ....... ...~h o.p~. ~pp,o..~'~/~ .................... L,~o, g.p[. ~pp,o..~ ~/~ ................. ,.. Unde~riters Approval ........................ Planning Board Approval Request for Temporary Certificate ..................... Final Fee ~ubmitted S~A ~ · .................... ........................ ...,. .. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR CITY ~-~ 8~ JOHN STREET, NEW YORK, NEW YORK 10038 Date /lppllcation No. or, file N THIS CERTIFIES THAT in the following location; ~ Basemet~t ~ 1st Fl. ~ 2nd FI. Section Block Lot was examined on J~J~Z'U~i:'y~,.~')" ~ ~.~,~.~ and found to be in cornpliance with the requirements of thls Board. DRYERS OTHER APPARATUS: s E e .v ~ c, 'O OF-E-~G~COND;~'~ ~ A W. ~. "O. OF HI-LEO A W. ~ NO. OF NEUTRALS ~ TM O. OF CC. COND OF HI-LEG OF NEUTRAL 1 , Per %. This certificate must not be altered in any manner, return to the office of the Board if incoyrect. Inspecto~, may be identified%~ 'e~re~ls. COPY FOR BUILDING DEPARTMENT TH $ COPY OF CERT F CATE MUST, NI~T.~BE ALTERED N ANY MANNER. TOWN OF' SOUTHOLD OFFIOm OF' BUILOIN~ INmP~OTOI~ TOWN ~.L£;~K'S OFFIOI~' SOUTHOLD, N. Y. 11971 TEL. '765-~660 TOWN OF $OUTHOLD BUILDING DEPARTMEHT TOWN CL£RK'$ OFFICE SOUTHOLD, N. Y. Examned' ~)/'~'~. ~.~., 19...7. ~ ......................,/~Oz~'"': ...........~/~/2/ ~.~7 .__Applicati°nN°' ..~....~..5z / .............................. Approved ................. v.~,j~._.. ......... , 19 ........ Permit No....~.... ..................... : ..... ...: ...................... , (Bui ding Inspector) APPLICATION FOR BUILDING PERMIT oo, : ........ INSTRUCTIONS a. This application mpst 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 accord ng to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is port 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 Deportment for the issuance of o 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 constru~ztion of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bud ng code, housing code, and regulations, and to admit authorized inspectors on premisesr and ir~ buildings for necessary inspections. ~ , ......... State whether opphcant' '~s owner, lessee, agent, architect, engineer, gene~ntra~ctrician,,~ ~--~'-__~~..__ plumber or builder. Name of owner of premises ....... .x..'..N~......~ ...... ..~..~L.~.. ...... L..~..~....~.k~ ........................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporat~e officer) Builder's License No ..................... '.e..~.....~...~.[J1 .................. Plumber's License No. \'~'~-- OherTrodesLlcenseNo ............................................... ~~ ~. ~ .~ Locatio~ of Jo,d o, which propose~ work wJJJ be do~e, Mop No.: ....... ~.~.~,~k ............ Lot No......~,~'. ........... State ex~stmg use and occupancy of premises and ~in,~nded use and occupancy of p'roposed construction o Ex st ng use andoccupancy . ~ ~ ~'''' ~'~%`~ '~ r .....................,....~ x_....,...~_...........,.,,.~............,_ ~ ...........,...,,......,. b. Intended use and 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... '~?'?i ,~,) ~'') I ~/ (Description) 4. Estimated Cost ............................................................ Fee ...................................................................................... '~/ t ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwellin9 units on each floor ......... i .................. If garage, number of cars ............................................................................................................................................. 6. if business, commercial or mixed occupancy, speci~¥~noture and extent of each type of use ............................ 7. Dimensions of exigt'ing structures, if any: Front ...C.,.f.~.2: ................ Rear ................................Depth ...... :'-~f( ....... Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear ,~' ' '~ , Depth ................................Height ............................Number of Stories ................................ , / 8. Dimensiori~ ~f e,~t re new construction: Front ................... , ................ Rear ..!:.M....' ........,.:,..... Depth ........ .U ........... Height .................... N,6~ber of Stories ......................... t ............... ;'""i ..................................................................... 9. Size of lot: Front ........ ~.%..)..~) ..................................... Rear .............. : ........................... Depth ........ ~.:)~;~,~. ................. 10. Date of Purchase ........................................................Name of Former Owner .............. : ............ , ......... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed constructi~,~ v'olate any zoning law, ordinance or regulation: ............... 13. Will lot be regraded . ....... ~;,~'~'~;v'":t'"': ~i!,l.,excess fill be removed from premises: ( ) Yes ( 14. Name of Owner of premises Address.. ..... .,.. ~. ~ ...., Phone No. Name of Architect . x..\.~.:.,~:X.....~..,i:.i...:.~....(,.,.;] .................. Ad~l. res,s ...................... · ', ~' .........., Phone No Nome of Contractor ............................................................ Address ,.~..,.,? ........ .....,, ....... 1 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 STATE OF NEXA(~O~r'~,~ [ S S co j -F¥ ' ~.~ .... ~.~..~ ........... be ng duly sworn, 8eposes nnd says that he is the applicom (~ome of individusl signing contrscf) ebove nemed. He ~s the ............................~ ............................................................................................................................................. ~ (~ontrsctor, sgent, corporate officer, etc.) of s~id owner or owners, ~d is duly ~uthorized to perform or hove performed the s~k~ work ~nd to mske snd fits this epplication; thst oll statements conteined in this ~pp~icetion ore true to the best of his knowledge ~nd belie~; and ths'r the work will be performed in the m~nner set fogh in the ~pplicstion~filed therewith. Sworn to~ore me this ~ '~ ~ ~ ~ ~ ~ ..... ..... .......... , ....... ::.....:: .............................. JUDI~4 T, TERR