The URL can be used to link to this page

Home My WebLink About9750-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No... ~.91.67 .... Date . .August .... ~ .............. ,19...78 Rd. THIS CERTIFIES that the building located at . .Pvt....Rd,.1.-.Stephensons. Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... April...~.8 ....... , 19...7.Spursuant to which Building Permit No...9750Z dated .... May. .... 25. ........ , 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 .... Prl.v. ate. One. Family. Dwelling .wi.th .addition .of. Bedroom .&. Sun Room The certificate is issued to ....... l~s....&. M~... J. ohn. Lonms ....................... (owner, ~b~t~ of the aforesaid building. Suffolk County Department of Health Approval ........... .N/R ..................... UNDERWRITERS CERTIFICATE No ....... .N395.82'1 ............................. HOUSE NUMBER .............. Street ... Rvto..~.. ~ .-S.tephensona ... Rd~ ....... ......................................... .0rSe~.'c, .York ................... 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) Ne 9750 Z Date May 25 1978 Permission is hereby granted to: John Bertani Builder Inc, a/c Mr. & Mrs. John Lomas at premises located at t~Vt, Road #l---St~lqhenson's Road .................................................... O~.~,.en.C.,...N~.. York ...................................................................... pursuant to application dated .A.~I~i~ 'J8 19~8 , and approved by the Building Inspector. 15.00 ,Fees ........................ 1000-017-1-6 Building Inspector FOF~I N~Oo 6 TOWN OF $OUTHOLD , 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 dispasal--(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 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 $5.00 3. Copy of certificate of occupancy $1.00 New BHilding ................ Addition ...... ~. ..... Old or Pre-existing Building ................ Vacant Land .............. ~..d. · ocotion Of Property ..... .................... ~;....~ ............... :: ....... ,Cq~,.~.....~.~ ............. Ow.er Or ~..~s O~ Pro~.~ ..-:~.~..~.~...~.~.~.....~..~ ................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. ............................... ~.t...~.~. Approvn .................. .................... ................ , ........................... ~ ~ ......................... ,~.~m~ ~ ~o~ ........... ~../..~ ................ ~flueft For Tem~or~ Fee ~bmitted Sworn to before me this /.~..~, day of ~..~ ~.~.. (stamp or seal) EUi'ABErH ANN NfZ~/JL~ ~) ~_~ ~1'/~ NOTARY PUBLIC, State 0f New ~ N~. 5~-8125850, SuffOlk FOILM NO, ! TOWN OF SOUTHOLD BUILDING Ds:PARTMI:NT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Examined ...~,~&~; ........ ~. .................. 19...,.~. 19...,.~, Permit No ......~:~.~C~ ................... h~oproved ... ~,'~,y ....... ~,..~i .................. Disapproved a/c ..................................... ,) ~.~.... .................................. ...,"G~ ~. , '::; 7~'' . '~/~ / (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............................................. , INSTRUCTIONS o. This application must 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 according to schedule. b. Pict pl?n showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed descr pt on of layout ofproperty must be drawn on the d agram 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 o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the walk. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall hove 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 necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) ,'/_:,)~7 / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...................~'..~rr......~'~...~.~.-. ........... .~:.~......~"g~ ...................................... applicant is a corporate, signature of duly authorized officer. (Name and title of corporate affiX'er) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... JDc00 - O / ~7 -/~' ~ Locotion of land on which..E,roposed work will be done. Map No.: ........................................ Lot No ................ Street and Number .... ..~4~..~...~..'...~:..,~...~.. .............. ..~?..~..( ....... ~.....e~....~... ....... ...~..~.. ........... 4~.4/~,~...~.....~....~. ......... 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 ........... .~'J~.~..~......~..~."~"..~....~'.. ......................................................... 3. Nature of work (check which applicable): New Building~· ................. Addition ..,~.......~-.. ..... Alteration ................. Repair .................. Removal .................. Demolitior ..................... Other Wor, r,r~ ................................................ (Description) 4. Estimated Cost ................ ~....~.t./,l~ ....................... 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 nacre and extent of each t~,e 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 ....~...~... ............... ............. ~.....~. ...................... .~...~...../.....Number of Stories ............ ~ .............. Depth Height 8. Dimensions of entire new construction: Front .............. ~.~....~.. ......... Rear ....... .~.~...f.. ........ Depth ......~'...~....." ..... Height ....... --~'.~..~....~... Number of Stories ~ ............ 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 construction violate any zoning law, ordinance or regulation: ...... ,~..~ ....................................... 13. Will lot be regraded . ........... ~.~g:l ...... Will ex.~ce~s fill. be removed from premises:() Yes ( 14. Name of Owner of prernise,~..J~.~.~..~....~J~..~,.~l~ddressl~' ..... l~)~/.~'/l~..I.~ ....... Phone No. Name or'- Architect .......~..~).iU.~I~. ......... ~.~-,*~.l~ ........ Address.~.,~ll~.,~i(~..~/~... Phone No. ..~....~...~..~.~.~. Name of Contractor .p.0'~-~.~....,~.ll~,k~/~..I ................. Address ...~.~.~..~.~. Phone PLOT DIAGRAM Locate clearly and distinctly ell 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 NEW YORK, lc c COU N-FY~,,~_ ,~..~OF "'/ "7'/ '/ f '""" .~1~,~.. ............... ~m.,~.~-...~.~-~-r.~.I, ............... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ............ .~...~...~..~..~:~.~ .......... (~...l~..~.l~ ............. : .......................................................................... (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 all statements contained in this application are true to 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 ', .............. ~. day of ............... :.,..,~.,...../.". ............ , 19....~.},:' ' '~("~1'I' ~' /"~ ~,~i~~ ' ~ 1'' /' "' Notary Pubhc .,.,.......,~,....~,~/....,~....,,2~/.~l~..~:z~Cou ty ................ 1 ....,~ ...... ~ ~, _~ r~i,v /-/~ ~ * "' 'j~/~ t~gnoture of applicant) ~ , JUDITH T. TERRY ~"/ Notary Public, State of New York ['~g: 52 0344953 Suffolk Cou. n~/. ~BP~lfl[§~i-3n Expires March 30, ,~=~/