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Home My WebLink About9726-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk'8 Office Southold, N. Y. Certificate Of Occupancy No. Z9293 Date November 6 19 78 Corey Creek Road THIS CERTIFIES that the building located at . 290 .PrLv. a~ce. Road...~. Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated May 8 19 78 pursuant to which Building Permit No. 9726Z dated May 16 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 ............. ?.r.~.y.a.t.e...O.n.e..F..a.m.i.~y...~..e.~.~.i.n..g ........................... The certificate is issued to ....... .W.i.n.d.s...W.a.y...B.u.i.1..d.i.n.g..C.o.r..p., ..................... ( owner, :h~,f-~m~z~t ) of the aforesaid building. Suffolk County Department of Health Approval 8-S0-27 November 2, 1978 UNDERWRITERS CERTIFICATE No .... Pending .... Pi-~_'~' 1~6~1' '# '~2 ................. HOUSE NUMBER 290 Street Corey Creek Road Sou~chold~ New York Building Inspector County Tax Map # 1000-78-6-16 1L~OB,M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9726 Z Permission is hereby granted to: ..U..!.~.o....s.. ....... ~..'./....:./ff~..:~...q ~ ~.~.....~.o.~. ~ .J~......~.:.L~..,.Z~...Yff ........ .~L!~.~;.,.: ...... C~~~'~ ~o ..... ~.u..!..c...~ ......... .R ....... ..~:.'..?..~.~ ........ ~.~.~ ....... b...~.~:?.~.~.'~: ....... .~.~.~.z..~.f.~.. .................... at premises located at ...I.7....0.. ........ .~..LV..~2.~. ...... ~.~ .~..~ ...... /.~.. ...... ?~......~..~.~.'.~. ...... ~l~J~b~.....~.(~.~-~ ..................................................................... : ........... .~.o..t~..'T...~..~..~.~...~ ................................................. pursuant to application dated ............................. ..~.?...'~....~. ........ ~..., 197...~'....., and approved by the Building Inspector. Fee $ ...... ..~....~..'./..~... Building Inspector TO~VN 0/: $OUTHOLD Building Depaftment Town Cler~ Office Southold, H. Y. 11971 APPLIC~TIOH ~R CERTIFICATE OF ~CUPAHCY 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 o~c 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 in- 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 occupancy $1,00 $5.00 Dote . Z ~' ~ ~ ..... ......................... New Building ....'.~...~... ...... Old or Pre-ex.shng Building ............................ Vacant Land ............................ Location Of Property ...[.[~..~.,r~.~........~.~.c. ....... ~.~.:z.:..~ ................................. ~ ................. t ................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. ' Permit No.. ~ ~ CZDate Of Permit .................... Applicant ..~..~.~......~ ...... ~ ................ Health Dept. Approval .................................... / ....... aDOr ~pt, ApprovQl ................................................ Undorwriters Approvol .................... ~lonnin~ Board ~provol ........................................ Request For Tempor*~ Ce~ificoto ........................................ Final C~ific~t~ .......................................... Fee $ubmittod $ .................................... Construction on above doscribod buildin~ ond per~_~l)~p~bl~ c~ond re~uloti~s. ............... ............ Sworn to before me this "~~ ~ ................ day of ............................................ (stamp or seal) TOWN OF ~OUTHOLD OFFICE OF I=IUILDING ~NSPEOTOR TOWN I't'LERK'S FIFFIOE SI:]UTHnLD, N. Y. 11971 TEL. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined . ...~...."¢.f, Z~/ 19'~'...~ ' ~,.:.- .¥ ....... Application No ~'~ 7~. . Annroved ~/ [& ,O'7~"e,~,"~ ~7~ 7 ~ , ,~ ................................ Disapproved a/c ............. ~ ............................................................. r ................................................................... ............. ~~ .................. ..... .................... ........ (Building Inspector) ......................... .......... .... INSTRUCTIONS a. This application must be completely filled in b~' typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t,o s. chedule; b. Plot plan showing location of lot and of buildings on premises, reJa~i~ns~ip to a~joining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application.maY not be comg~e~ced be, fore issuan, ce of Bui!ding 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 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 necessar}, inspections. , ...................... (Signature of al~plicant, or nan~e, if 9/corporation) s State whether applicant is owner,~es~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................... / ...................................................... :...j ............................. Name of owner of prem ,es ..~..~- · T4c~. ~.~.~....~....~..'.~...~...z:2 (...~..~~ ~.~-.'.'~; ~*- .' .~.' ................... ............. ......... Builder's License No .................................................... Plumber's License No ..... Other Trade's License No ............................................... ]. Location of land on whichproposed.~/_ ~ O/ ,,, cw°rk will be done. Map No.: ........................................ Lot No. 5 ...................... Street end Number ~/~(~1~Z~:~/~~?~~/~f~//;~/~/~/~:~`~ f '7 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: occupancy a. Exisiting use and ¥.,~ .................. b. Intended use and occupancy~ .....................,, ....... ... ................................................................................................ 3. Nature of work (check which applicable): New Building....' .~...... ...... Addition .................. Alteration ................. Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... (Description) 4. Estimated Cost ...... ~.~.~...~../..~..~ ......................... 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. Dimensions of entire new construction: Front ....... .&~...~..~ .................. Rear ..... ..~.....~. ............... Depth .~.~.(.~..~ ....... Height .....~,~.~ ...... Number of Stories ~ ~ '. ................ 9. Size of lot: ~ont .......... ~.~.~..~.'~ ...................... Rear .......................................... Depth ................................ ~* Date of ~c~ ........................................................ N~me of F~mer Own'e~ ..~.~.~.v..~.m~ ....... ~ Zone or ;; di:trict 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 fro~premises: ( ) Yes ( ~o 14. Name of Owner of premises ~'Z ~Z~ ~' .... Addr~Z~.~.~ ..... ~ ~ ~ n o Name of Architect ..... ~...~ .................................................... Address .......... ~ ..............Pho e N ....................... Contractor ~ ~g~ Address jO~ ~ .. Phone No . ............................., ............................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or praposed, and indicate all set-~ck dimensions from prape~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. co JN ¥ oF ..... .............................~e ~ n~v~ ~~ ............................. ~c~' ................... ~. above named. 7~ ~ He is the ................. ~.....................~ .... ~ .......................................................................................................................... (~ontractor, age~,~cor~ate ~r, etc.) of ~id ow~ o~ own.r~ ~d ~ d~ a~r~Dto p~o~b~h.w p~ed ~he ~,d wo~ ..d to ~k~ a~d f,~ this application; that all statements]contained in this application are true ~the best of his knowledge and belief; and that' the work will be performed in the manner set fo~h in theppptication filed~her~w~h. Sworn to b~f~ me this /'~ Mot~r~~~~.-.Pub' . ............... ~ ~ .................................................................... ..... ~ .......($i~noture o{ ~pplic*nt) Cemml,slen EX. es Ma ch 30 ~ i OCT. RE A,R · E L LVATIO q ~' APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT ~ CAM to 4pM FOR REC.~:~- TION OR START FRAMING 2. F~AMING iNSPECTION 4. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOE DESIGN OR CONSTRUCTION ERRORS A~ CONSTRUCTION MUST REQUIREMENTS OF N.Y. STATE CODE, 0 C..L, ,"t 1