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Home My WebLink About9674-zFOF,,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. ~9.0.~}. .... Date ..... J.u~..e... ~5 .............. , 19.. 7.8 THIS CERTIFIES that the building located at ....8/~.0.. BP.a.Y...Axe. ........... Street Map No .... 8.~.~ ..... Block No ........... Lot No ...... ~..2 .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .Ap~'J-.~....~ .......... , 19.7.8. pursuant to which Building Permit No .... 9.~.7./+.Z dated .Ap~'i.~....~ ........... , 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 issued is .... AC.C..F~..~.0B¥. B.U.I..M).I.N.~. .............................................. The certificate is issued to .... $.'c..an.]...ey..a'. ~. F.~.18~..~.17., ............................ ( owner,~t ) of the aforesaid building. Suffolk County Department of Health Approval ......... I~/R ....................... UNDERWRITERS CERTIFICATE No .................. .N/.I~, ....................... HOUSE NUMBER ....840 ....... Street .......... .B.p .~...Aye. ...................... ................................................ ................. Building Inspector 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? 9674 Z Date -...Apr.t.'l. .......... .'i.~. .......................... 19.78_ Permission is hereby granted to: .... ~lt.a~3.e¥...,,T.....Fi:L~S..,,,T~... ........................... to .***~u&l cl,..e~ .. ac e.**e~ao~.F.. :bu&],~.~n~ ...................................................................................... ~t p,e~ses ~o~ated o~ ................... e~...~.ay..~.v.e. ............. ~.~....U..~.q..~ ...... ...-~./.!.f..o..c........z)t.~.~.. .... ...................................................... N~p..~..86.'l.,.. Z,o.t;..~¢...~ ............................................................ ....................................................... Na~c.~ci't'uck~.. ~l'e~..Yo~ ............................................................ pursuant to application dated ...A.~/L*I]. ........ 'J.]~ .............................. , 19,..~.~[, and approved by the Building Inspector. Fee $.,,.'J.~.,~.0.O. ......... Building Inspector TOWN OF SOUTHOLD , Building Department 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 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 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-ex'sting" land uses: I. 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 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 New Bqilding ...: ............ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .................................................................................................................................. ~.. Health Dept. Approval .............. , ~fi~.....~.. .................. Labor Dc. pt. Approval ...........~.......~.. ............................ nderwr,ters ^ppro o, .......... ....................... P,onn,ng Bo rd Approval ........................ Request For Temparon/Certificate ........................................ Fin~ Certificat~ ...~ ............................. Construction on ~bove describod building ~nd permit m~ets ~11 opplic~blo c~ and Sworn to before me this ~ -~- / NOTARY PUBLIC, State of New Yor~ ~ ~ ~ ~ NO. 52-8~25850, Suffolk Co~ ~/ ~ ~ ~ , Te~m E~[es March 30, l~ f ~ f FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ~ .~.~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property w[th accurate location of ail 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 instal[a- lions, 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 applicaDIe. B. For existing buildings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accu.rate 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 i0forma- tion required to prepare a certificate. Fees: 1 Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy o~ certificate of occupancy $t.00 land use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date .. ,~¢~r~J.1...2-~,..1.985 ........ New Buildin9 ............. Old or Pre-existing Building ...× ........ Vacant Land ............. Location of Property ..... B.4D ........... ~na, y..Ay, argue ............. Nat, t,~,t,u(;k ~ · NY ........... House No. Street Hamlet Owner or Owners of Property ...... .0.a,rtJ..c,e, .al.o.d...~ta.o. Ley..F..].i. ss ............................. County Tax Map No. 1000 Section .... 1.26 ........ Block ...0!, .......... Lot..(~14 ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No 95.7~2~ Date of Permit 1°~7.8 Applicant · Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .1..00 ......................... Construction on above described building and permit meets all applicable codes and regulations. Rev. 10.10-78 Applicant .................................................... GARY FLANNER OLSEN, ESQ, P.O. CUTCHOGUE, L 7 .Y. ]1935 Examined ..~.~. .......... .1.~. ............. 19.?..8.... Approved ..~t~ .......... .1~ ........... , 19.~...8..., Permit No..~..~...~..~.. ......................... Disapproved a/c ..................... : ........ .............................................................. ............................................................................ .......... T)U;"ii .... ..................... /. ....... ................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 9674 Application No .............................. ~-~ a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Buildingog Inspector, with 3 sete 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 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 bujJcling 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 I$ HEREBY MADE to the Building Department for the iss~JancJ of 'J~ Building Permit pursuo'nt to. the~'~ Bu.iiding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Law%'OrdinanceS or Regulations, for the construction of buildings, additions or alterations, or for ~;emovol or demo t on, as h~rein '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 ira. buildings for necessary inspecltions. ........ ..... ....... .............. ...... ........ ' / (~ddres~-of applicant) / State whether applicant is owner, J~ssee, agent, architect, engineer, general contractor,:elect~Jcian, plumber'or builder. ff °pp"c~nt 0 ~orporote, si.nature o~ d.l~ou,horized (Name and title of corporate officer) /~ Builder's License No ..... ;;-J~....~'~....; ............................ Plumber's License No ................................................. ' Electrician's License No ..................: .......................... Other Trade's License No ............................................... ~ ~' Location of ,and on which proposed W~Fk wil' be done. Map No.: ......" i~.-.~..~..~/ ............ :,~.., Lot~.~'~%/ .......... Street and Number ........ ~9(( ~c~?~""(?'"'"~J'd~z:"'~'""~d"f'/, ...................................................... ~'~"~'~'~'"~'~'~"~('x?k'~"Municipality .......... "~ State existing use and occupancy of premi.~es and/intendedT~,/x'~use and occupancy of proposed construction: b. Intended use. and occupancy ,,~.~ .......... A ............ 3. Nature of work (check which applicable): New Eluildin§-...~ ..... Addition .................. Alteration ............... Repair .................. Rernoval .................. Demolihor, .................... Other Work ................................................... /6 ~ ~ -J, Description) ......... D. ..................... ..... 4. Estimated Cost ........ 4. ................................................. - e J ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Namhcr of dwelling units on each floor ..... , ...................... If garage, number of cows .............................................................................................................................. 6. If business, commerciul or mixed occupancy, speciJy nature and extent of each type of use ............................ 7. Dimensions of existing struciures, if any: F~otd ............................ Rear ................................Depth .................... Height ........................ Number of Stories ............................................................................................................ Dimensions of same shuciure with aJie~ations or ~cldilio:~:;: IZlant .................................... Rear ............................ Depth ................................Height ............................hlurnl)or of S~ories ................................ 8. Dimensions of e~tire new construction: Fron~ ......... /~.~ ................ ~ ~ (~' ~ear .......... ~ ............... Depth ....................... 11. Zone or use district ia which premises are situated ..................................................... .~. ........................................... 12, Does proposed construc~n violate any zoning I~w, ordinance or regulation: ....... ~. ...................................... 13, Will lot be regraded ....~_~ ................ Will e~cess fill be removed fro~ premises:,( ) Yes ( ) No ....... ......... Phone No. Name o~' Architect ...................................................... Address ................................ Phone No ....................... Nome of Contractor ................................................. Acldres~ ................................ Phone No ....................... PL()7 DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and indicate all set~bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate h~ ther interior or corner lob }~,x I ¢ 8r y STATE OF NEWYOI(K,~ ~?~ ~SS * - . ica~ (Name of individual ~ni~ontract) ~ above named. He is the ............................................................................................................................................................................ (Contractar, agent, cnrpor¢~te officer, etc.) of said owner or owners, and is duly authorized to perform or baw~ performed the said work and to make and file this application; that all sta~emems con~ined in this application are true to the best of his knowledge and belief; a~d that the work will be performed in the manner set forth in the applicatio~ filed therewith. Sworn to bede me this ~z . ~ ~ ~ ' ~,Jb"r~ ~. T~,,,.. , Oommission Expires ~arch 80~