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Home My WebLink About9768-zPOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerli icnte Occupnncy No...Zg.a.~.9 ..... Date ..... .0.ctOb.er.....25 ........ , 19..70 THIS CERTIFIES that the building located at . .9./40..N~r..8. t~.e.e.~ ........ ~ Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . ~.tme .... ~ ........... , 19.7.6 pursuant to which Building Permit No..976E~Z. dated . June .... 8 ............ , 197E~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private One Family Dwelling The certificate is issued to ....... ../L!~t.1}~.r..~.. ~.a~,e.~. ~.~.l.t.h. ......................... (owner, :l~a~c~X'~c~ of the aforesaid building. Suffolk County Department of Health Approval ..... 8.-.$.0.-./L9 ....................... UNDERWRITERS CERTIFICATE No ....... I? ./~). .4.7. 0. ./4 .............................. HOUSE NUMBER .... ?./-~.0. ...... Street ........... .N.~.v~...S~?.e.e.~ .................. ........................ Orie. n.t ~ N.Y. ...... -~'...'i...:.~... :...:...~'~ .......... Building Inspector County Tax Map 1000-25-4-2 FORI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 9768 Z Date ......................................................... ] ~ ........ Permission is hereby granted to: ..... /:..~:!,:.~..(?/:. L×..: ......... (.f.:.L:.f:...: ....................... f~.~.~. /~k'"7'tqL/' '!. t", ,~/ ,if at premises located at ~ b/Q /4 ~ V ~" m T pursuant to application dated ,JU kJ ~ ~ ........................................................ , '19 ., and approved by the Building Inspector. Fee $......LJ...!!.....Z... Building Inspector FOI~i~ NO. 6 TOWN OF SOUTNOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OP, ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--($-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, (3 certificate of Code compliat~ce 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: t. 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 occuppncy $1.00 New Building ......~......... Addition ................ Old or Pre-existing Building ................ Vocont kond .............. Location Of Property ..~"./(~..,....../)(/~...~..~......~../.,. ...... ~,..~..!,.~,_e~..,[.h,,,,,.L~,,:,,Y,,: ............................................... Owner Or Owners Of Property ...~.....~...~.I~.(Z...~.....~.....~:~...~...-~...~,.~,......~....~....~..~.~..~.~...7. .................................... Subdivision ...~,,.?.~,~..~.~..~.~.!}.._..~.. ,.~....~.; ................ Lot No ............. Block No ............. House No ............. Permit No. ?.. 2~ ~...'.~.... Date Of Permit o~-~4/~./,~..~;;~.....Applicant. '.~...~..~..(..v.(?...~.~...~. ,:.. _~.~../~.x.../.~. ~.../..X~.....~. i~ Health Dept. Approval ..-~.~.~.....'~..~...L.~.~.~.o.o..Labor Dept. Approval ................................................ Underwriters Approval ............................ ~..-/..~;~ Planning Board Approval ....................................... Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $ .................................... Construction on above described buildina ancL~oerrm't meets ~Plic~able codes ~at~d regulations. Sworn to before me this ................ day of ............................................ (stamp .or seal) / Notary Public .................................... County TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN OLEEK'S OFFICE SOUTHOLD, N. Y. 11971 TEL. FOBM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Examined ........... ...... Disapproved a/c ......... ~.::.~. .............. ........................ {Buildin~ lnsp~tor) INSTRUCTIONS a. 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 t9 schedule. , b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or 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 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 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) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .../~./~).Z~...~...~......~...~.~..~(~/......~.J../.-~.~. ..................................................................... If,oppli,c~nt is a corporate, si~gnature of duly authorized officer. ....... ......... (Name anc3~title of J(orporate officer) Builder's License No .... ~,~... .............................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ~/..~./~/~.~..~i~/.~.~...~4Y..~.~...~.~.~...~`/:~.~..~.~.~..~/%~./~.¢ ............................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy .~.1~-~....~.--~.~.1~)..I..~..~.[.....~...~..~/-~-I./h~: ............................................................ 3. Nature of work (check which applicable): New Building' ....~........ ...... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ...... ~....~.,/...4.....~....~......~..O,. ...................... 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 ..... J~..~.~: ........................................................................................................................ 6. If business, commercial ar 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 ........................... .~Nu~nber of Stories ................................ 8. Dimensions of entire new construction: Front ....... .Z~.~.......', ................ Rear......~..~....~. ........... Depth ...~....~...~...~.. ........ / · Height ........ ~.. ......... Number~ of Stories ....... ./.. .......................................................................................................... --~.~ ,,~// 9. Size of lot: Front ..... ~...~... ........................................ Rear ...~..~' ........................... Depth ,./...~....z~.....- ............... 10. Date of Purchase ........ ~..~.~,.~.. ................................. Name of Former Owner ...:" ...... : ............................................ . 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ..~..~. .......................................... 13. Will lot be regreded . ......~.~. .............. Will ~xcess fill be removed frompre_mises: ( ) Yes (~No Name of Owner of remises/~/~...//~..~..,~ ~..~'..~'./~./.F~ddress . l~,~b~l~ Phnn~ I~ln~7' /~'~ 14. p ........... ~.,~.. .............. .- ........................................... . Name of Architect .............................................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines, Give street and block number or description according to deed, and show street names and indicate whethe? interior or corner lot. STATE OF NEW YORK, C O U I~C_Y~F ............................... ~'~'~ ~~-~ ~11~ ~ ......... ~~..~...x....~..: ......... being duly sworn, deposes and soys that he is the applicon, (Name of indivic~ual signir~ contract) ' above named. He is the .............................................. ~-.~..z,~-.'~../~.~..~...~....~... .......................................................................................... (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 ........ Notary Public,. A tE~ 7'T."zT//JS~: ILl(. AA/ZV/-Tlz~,Z ~7, Z_ /'-7:'~z-'' ! ,.D /W / AT" OWNER: ~[ WA~R SUPPLY AND sEWAGE DATE: ~ ~ DIS~L ~YSTEM8 FOR THIS RBI- H, S. RgF: NO.: _ ~AN~ OF SUFFOLK CO. DE~, RODIn:RICK ~A,N TUYL, P. SEA~.J ATEMENT SUI~F' ~0. ~ ,~.OF HEAL? ~RV ~T Or INTENT FOR APPROVAL OF CON~'t~U~ON~ ,,~ ONCY.,,, TH~ WATER SUPPLY AND SEWAGE DATE: : DIS~9AL ~Y~TEMS FOR THIS RESI- DENCE WILL CONFORM TO THE ~TANDARDS OF SUFFOLK CO, DEPT OF HEALTH, ~ERVICES. APPROVED: APPLICANT