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Home My WebLink About9676-zFOB~ NO. & TOWN OF sOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Date .. D. eve~ahe~.. 2.1 ........... ,19...7.8 THIS CERTIFIES that the building located at .. 2~7.95. S. ou~;k .Haz'b.ar. Rg,. ~ Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .A..~.r.k~... i~. ......... , 19.~/.8.. pursuant to which Building Permit No.....q.5.?.6.Z dated . .A.p~.f..:L.....q.~. ......... , 19.7.8.., was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... .~:qc.' .e~.o.~ .y. ~.L.' .z~. 9.~u.~? ............................................ The certificate is issued to ....... ?(.qb. 9.r~ ..g:..K.q .19~i. ............................. (owner, te~~t ) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No ..... HOUSE NUMBER ..... ~7.'?~ .....Street ........ /?.,'8°u'~h .................. Harho~ ~oad'/ ............ _ ......................................... · ........... ;,..:? .............. Building- Inspector County Tax Nu~be~' ?OW~ OP $OU?~OLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9676 Z Date ........................................................ , ly ........ Permission is hereby granted to: at premises located at ................................................ ;; .................................................................. m-. .... · pursuant to application dated z4'/~'J't~ ~/' 19.:..~., and approved by the Building Inspector. Fee $,,Z,~.,.~:. ....... Building Inspector TOWN OF SOUTHOLD , Building Department Town Clerks Office $o.~hold, 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 oil 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 formation required to prepare a certificate. C. Fees: ]. 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 .............. Locotm Of Property-22~..Z..~C.~..~//£~...../~.~,..~<?.C~.--Z/..~..4~,...~</...' .~/... .................... O ner O, ........ ................................... Subdivision ................................................................ Lot No ............. Bilk No ............. House No ............. ~m, m..,.~.,..~....., m,~ of ~em~ .*~p,oa-~ ~--~.~...~.-.,..~..~m.' ' ~ ............ Health Dept. Approval ............................................ ~bor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate ...... ~ ............................ Fee Submitted $ ...,~......'.T. ...................... Construction on above described building and permit, me,~ts all 9pp~icab~e codes and regulations. App cant ..~....~..., ...~ .... ~. ......................................... ......... Sworn to before me this .... ~...~.&. day of .._,~.~.~..~.~.~.~.~ ............ (,tm~ or ~eo~) Notary Public ............. ×~-~.,.~.~. Cou~ NOrARy PUBLIC, State of New Yot~ No 52.8z25850, ~u[fo~k Co~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOt. D, N. Y. Approved ...................... ;,;,.',~. ,'.,../... ~, Permit ..................................... Disapproved a/c ............................... ./). .......................................................... ................................................................................. -., ............................... ~;'"' ,/, .. .: / / . . ...................... ....... :: .......... ..................... (Building Inspector) Application No ....... ; ........................ APPLICATION FOR BUILDING PERMIT Dote ..................... , INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the BuiJding(~g 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 adioining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diogrorn 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 an the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port 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 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 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. .... ' (Signature~Sf~pl~licant~,~r nome, if a corporation) .... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ............. 2' ............. ; ...................................................................... Name of owner of premises /.A.~.~..'P4'..Z ~...x.t..~.'.. ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which propo~sed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ~..~...~.~...~..'.~...~./?.~.../.f~.~..~z~...~.~.~.'~...~.~Z~.~;~..~ ........................................ Municipality 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 ..2'~...~..~......~..~Z~.~......%...~..~......~.2~....~../..~..~.'.~..~..~...~2~)..~.~Z~ 3. Nature of work (check which applicable): New Building.. ................. Addition ...... :4~..~.,,~.~f~,~t~ ................ Repair .................. Removal .................. Demolition .................... Other Work ..~.~C.:..~.~/.¢..~..~.m=:...~..CG.(J..'F~ (Description) ZOo o .......................................................................................... 4. Estimated Cast ....... ~. ............................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling 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 ............................ 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. D.mens,ons of enhre new construction: Front ....... ~.~. ........................ Rear ......~ ................... Depth ..Z~..~ .............. / Height ...... ~ ............ Number of Stories ..................................... ~ ............................................................................. 9. Size of lot: Front ...... ~..~.~2; .................................. Rear .Z~ ...................................Depth ............. ~.~ .......... 10. Date of Purchase ....~g..~(..~,*.~.~ .............. Name of Former Owner ..~.~....~.~ ......... 11. Zone or use district in which premises are situated ..................................................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from Rremises:.(~ J ~es~,, ( ) No 14. Name of Owner of prem ses ~~.~..[~6 ......... ~t.. Address ..~.:WP..~.P ........ ~hone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from proparty lines. Give street and block number % description accordipg to deed, and show street names and indicate whether nterior or corner lot. Q .~//Lr2~'z P~o~/~f~,. STATE OF NEW YORK, t c c COUNTY OF ....... S~. f f~lk. ........ .................................. Ro~e~..~..g;........K6~.o.§i....., .................. being duly sworn, deposes and says that he is the appJicanl (Name of individual signing contract) above named. He is the ......................................................... Q.-kv~D.~ ............................................................................................................ (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 oil statements contained in this application are true fo the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............. .~.~,h.... day of ...... .Ap.~ i.~. ......................... , 19...78. No_taW. Public,. ........ ..~ ......... .~. ........ ¢.q~.:~Q.:k~... County .... dd/j-'~/~ ......... ~ ................................. ~r ELIZABETII ANN NCVfLLI:. / NOTARY FUBLIC, State of New ~or~ No. 52-8125850, Sulf01k Co t~ ~'~rm Expires [~arch 30, 19~