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Home My WebLink About9773-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .q. 6. 7. ~s.l..a~..d...V.i?.w..L..ap..e.... Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .J.~.e .... .~ ........... , 19.7.8. pursuant to which Building Permit No. 9.7..7.~.Z... dated . .~!v~.e.... ~12. .......... , 19.7.8.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... A~.~ition. (I).e.c.k)..~.o...a..I~..iy.a.~..e..0~e., .F..a~.i..ly...P~. ,e.l.l.i.W~ ........... The certificate is issued to ......... .R.q.b.e?.~..K.e.~.e.~..h.o?. ............................ (own~ of the aforesaid building. Suffolk County Department of Health Approval ........ lxl/.13 ........................ UNDERWRITERS CERTIFICATlg No .................. N../.B.. ....................... HOUSE NUMBER ..... '1.6,? ...... Street ........ %.s..l.~..d...V.i.e?...L..a~.e. ............... ............................................. ~r..e~.p.o..~.~.,. ?..e.~..yo..r.~. ........... .... ....... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq,. Y. BUILDllqG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9773 Z Date ~..LI~I~ ....... .1.2 ...................... , 19..7...8... Permission is hereby granted to: to .acTcl (ct~.~t¢). ~.¢.o..~ .~.e..F.~..Zy......D~..e...Z..Z..~.n.g ....................................................... at premises located at ............ .16'~...T.B.~.81~l....V.~.eI~...I~r~$ ................................................................ · .C~.~.~P.p.r..~.,. N,Y~ ................................... pursuant to application dated ..~Tl~le- ......... ~ ................................ , ]9...'~8, and approved by the Building Inspector, Fee $....4,.~.r0~ ........ 1000-57-2-~/~ Building Inspector TOWN OF SOUTHOLD , Building Department Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPblCATE 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 app cab e. 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: 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 v/ Date ................................................ New Building ................ Addition ................ Old or Pre-exJstlng Building ................ Vacant Land .............. Location Of Property ......................................................................................... ~. .... Owner Or Owners Of Property ......... t-~..;~:.~.; r.t · . Subdivision ............................................................... Lot No. ~....~.. ..... Block No. ~/' House No Permit No ¢[ J3 ~'%. . ..... .......... Date Of Permit .~b ~ Lq..~........Applioant. . ...~'. !~ .~.~.~ ~......~..~,/£:~..~.!~.~ ,:~. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate Fee Submitted $ ....~..M~....~... .................. Construction on above described building and perq~t meets all appliq~a~e codes and regulations. Applicant ............... ~.., .~..~~ ................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) TOWN OF $OUTHOLD IUILDING DIPARTMINT TOWN CLEI~K'S OFFICE SOUTHOLD, N. Y. Approved ........ ,~.g~e..,.,.'l~....:~ :... ..., ., 19..."/~. Permit No ..... ~.~ ................... Oisapproved ~/c ............................ .~... .............. · ......................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTP, UCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicat~ to th~ Build[hD Inspector, with 3 sate 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 o~ areas, and giving a detailed description of layout ofpraperty 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 permi't shall be kept on the premises available for inspection throughout the work. e. No building shah be occupied or used in whole or in part for any purpose whatever until a Certificate of ~cupancy 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 constru~ion of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building c~e, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for n~essa~ in~ections. 4 ........ ...................... (Signature of applicant, or name, if ~ corporation) ....... ...... t~4~' '~ (Address of applicant) ~ State whether applicon owner, lessee, agent, architect, engineer, general contractor, electrician, p~umber or buildan Name of owner of premises ............. .~.~.~..~. .......... ~/~.~..I~L~.~ ................................................................. if applicant isa corporate, signature of duly authorized officer. ~.~X (Nome and title of corporate officer) J'~N ~'~J~ ' Builder's Lic~se No. ~ ~ ~ ~ ~ '~ Electrician's License No ............................................. j~ Other Trade's License No ............................................... l O ~ 0 ~ D q ~ '~ '~ ~ % ~. ~o~t~o. of ~a.d o. ~hi~h p~opo~ed work w~, b. do... M~p No.: ~..~.~.:.~ZZ.;.~. ........ ~ot No ......................... Street and Number ~.~...~.~..~.~..,.~e.~.~.....l~b~.~.~.'.F~.~.~.~ .............................................. Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Exisiting use and occupancy ......... ~,,~,,t~,,~,~,..,,,~,~i~,.~,,~,.~ ................................................................ ~ b Intended use and occupancy ............ M,..,,.~,~ ............................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .~.~..Y..'7...'f~v..,.. Alteration ................ Repair v/ Removal Demolihar ..................... Other Work (Description) 4. Estimated Cost ................................................. ........... Fee .......................................................................................... (to be paid on filing this application) I 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial ar mixed accupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, il' 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 ........................ I-leight .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ..../Y3,,.~,q.. ........ t..q..J..J ..................... Name of Former Owner ...~'.~.?....P~..~-,,.....,/k..~..ff;...1. k,.~.?...'C...?. .... 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 regroded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .~..b....A~....TT.....(~..~.../-'..b...IM~..~-. ....... Address [.~,.I'...~/.?,,.~..).~.0.~:.~... Phone No. Name of Architect ............................................................. Address ................................ Phone No Nome of Contractor ........................................................... Address ................................ Phone No ....................... PLO]'' DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frore property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW(~glg, . ...... ~...(~::~:~ ................. ,z..~...:.z.~':.~(Z../..:~c..=x ........... being duly sworn, deposes and says that he is the apphcam (Name of indivi~ua~signing contract) above n~med. He is the ................ ~.,..&..~:.,~.,.4x':~ ................................... (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 the manner set forth in the a~lication filed therewith. Sworn to bef°r~ me this ...... ~>..4~;.(& dov( o~ ..~..~ Notary Public, ...~.~M{~ ~ ............. County ......... , ..................................................... g ................................ ,*~t* ~. scu~ttf,~ ~~ (Signature of applicant)