The URL can be used to link to this page

Home My WebLink About9780-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. 7. 1.1.1.54 ......... Date ........ THIS CERTIFIES that the building ................................................ Location of Property . .7.4.5 .............. ~.Otl l~b.e.v, rl. ~.o.[13,0 .v.a.v.~ ...... ~¢~.~.. ~¢.v.l, qo... House No. Street Hamlet County Tax Map No. ]000 Section . 02.2 ....... Block ... J0,1 .......... Lot ....0.QB .......... Subdivision.. Aq.uavJ, e.~. Pav.k ............. Filed Map No.. 56.2[ 1..Lot No...§ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~l.u.tle. 6 .......... 1970. pursuant to which Building Permit No...9.7.80. ,Z ............ dated ...~k~r~.e..113 ................. 19. ~.8, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...... .a .pri.v. at~e..one~-t.a~llJ, y..d~eJ..l,:~ntg ........................................ The certificate is issued to ..... Doaa. J.d.A.,..&. Pe.ggy. l~.ee. D~.er)l~ol*.8.1~ ~[ ................ (ortner, of the aforesaid building. Suffolk County Department of Health Approval .8.-~.0-. 59.~..8/9Z8~ ~. ~c~bg,../[. ¥;f.,1,~,0 ~..P.,.t~. UNDERWRITERS CERTIFICATE NO ......... $..~.1.2. ~.2.1 ................................ Rev. 1/81 Building Inspector FOP, a~I NO. 2 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) N? 9780 Z Permission is hereby gronted to: ....... ~.~¢...A:...~.2.?.~....%.e.,?...~ ~o .......... ~..t..z. ~ ..~...~.Lv..~..e.....o.~.e....~.t...z.~....~..e..Z..z...t.~ .................................................... at premises located at ..................... 7,.~.,~.....S....Q~...~.~.e.~..~.~..~..'...~..: .......................................................... ................................. East Marion, New York pursuant to application dated Ju_qe 8 19 78, ........................................................ , ........ and approved by the Building Inspector. Fee $.~0 ,..10 ........... 1000-22-1-8 H.S. 8-S0-59 June 8, 1978 Building Inspector FOltM NO. 6 TOWN OF $OUTHOLD , Building Deportment 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 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, an6 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 buiJdings, 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 buiidMgs (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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 ~te .... '../~./..'..~ .................... New B~ilding ...... Addition ................ Old or Pre-existing Building ................ Vacant Land Location Of Property ....~. ............................................................ ~. .................................... Ow.er Or O~.ers Of Prope~y ..~.~.'/..m/..~.~'; ...... '.~.~...~.,....~~..~.,~ .................. Subdivision --~-~-~, ?'/~'~'~ ~ ...¢~.~:.c~./. Lot No *-~' . Block No House No ~..~.~.~.. ~//2 . ....... ........ ....... Health Dept. Approval ..~..r~:..~.:[~..:~:/.L~abor ~p*. Approval ................................................ Underwriters Approval ................... ~.~ ............... Planning B~rd Approval Request For Temporary Certificate ........................................ Fin~! Certificate .......................................... Fee Submitted $ ..~.~ ...................... Construction on above described building a~ permit meets all ~plicable c~es and regulations. ~,,~,, .~~'~ .......~,...~~: ...................................... Sworn to before me this ................ day of ............................................ ~0~ 4~0~ (stamp or seal) TOWN OF SOUTHOLD Office E}F BUILDINB INSPEr~TOR TOWN CLERK'S nFFIOE SOUTHOLD, N. Y. 11971 TOWN OF SOUTHOI.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~Tt~e'""l'~ ............... 19...?~ Application No .........9~'80 .............. Approved ...... J~e......1..~ .............. , 19...*~, Permit No ...........I~.~.~Z .............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, a~ccurate 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 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 whale or in part for any purpose whatever until a Certificate of Occupancy shell 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 SouthoJd, 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 ir~ buildings for necessary inspections. ....... ................... (Signature of applicant, ~Pname, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~'7 ~/~ ~O~er Nome of ow m~ses ....~).~IJS, i.~..,~,~..~.~.e~,..Q'~/~.~...JJ~.~.~!~'iI~.eLD.~I~r~81,£ ................................ , ........ if applicant is a corporate, signature of duly authorized officer. Bu,lder s L,c~se No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... H -S, ~ 6 -~0 -~ 1. Location of land on which proposed work will be done. Map No.: ...... ~ ........................ Lot No...~. ................... Street and Number ....~.~.~~ ..................... ~.~'~.~ .................................................... Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy ~f proposed construction: ..... ................................................................................... b. Intended use and occupancy ....... ~$~..~~ .................................................................................... 3. Nature of work (check which applicable): New Building' .....,~ .......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work '~ ..... ~/- · · · Fee (Description) 4. Estimated Cost ..¢..~,2'...~.,..~)..~..~...: ........................................................................................................................ - (to be paid on filing this application) ? (// be f dwelling on each floor ............................ 5. if dwelling, number of dwelling units ....... ~ .................... Num r o units 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 ..2J~:.~?.'. ......... Height ~.~t Number of Stories ...........~ ........................................................................................................ 9. Size of lot: Front 1;~,.0 . Rear ....1.2~.1.9 ........................ Depth3~6.~.gt6.~.2~.~.Q~,l,0J.. 10. Date of Purchase .~...ay.....~..,,....~.~l.TZ ........................ .~ame~ ~i°~,F~ OvfnerA,l~l~..e,W~a~.i.~..D.z~,~,~l~ri....,' 11. Zone or use district in which premises are situated ..~,¢l~(,YA, f4,~4-~,~.~ ............................................................... 12. Does proposed construction violate any zoning law, or~linanceL' ...or regulation: ....~.~ ................................................ 13. Will lot be regraded ...~.~k~ .................. Will excess fiJJ, be removed, from premises: (~) Yes ( ) 14. Name of Owner of premises .J~.C~I$,1,cl,..&..P..~',le~ .......... AddressB~,~..~...~..~lJ~;JJlili~e N~'~.7~,'I~,0~ ..... 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-back dimensions frora 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 ,~OR,~,£ . ~, I ~ ~ COUNTY OF ,.~-'~..~.'.~ ....... i ~'~ .................... ~".O,l~J~k~J..'~..~.~.l~...~.~..~k ............................. be ng duly sworn, deposes and soys that he is the appticanl (Name of individual signing contrac0 above named· Contractor He is the ................................................................................................................................................................................. (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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this f~ ../ ~ ...... ~ ........ day of .¢...~tf:t~: ..................... , 19~ ..... ( J I1~ ~ , I~ Nota~ Publ~,-~.?e~.~~Z~.... Coun~ ...~ .................... ~¢..... ............................... ~/~' /~'~'~:~ o~ ~ (Signore or appficant) q , I 8TAMP WA~ SUPPLY AND SEWAaE WILL CONFORM TO TH~ O~ gUF~OLK CO. DEPT.