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Home My WebLink About9784-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPAI~TMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z9~65 ..... Date ....... .Augu.st~. 1.1., ........., 19.7.8. THIS CERTIFIES that the building located at .3955..Bayshore. IVl .. 658,644, ap l~os..1.~24 ...... Block No .... XXXX..Lot l~o,s..7,0 ~..7.1,. and.. 72 ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... June. 5., ......... , 19.7B. pursuant to which Building Permit No..978.4Z. dated ..... Juae. 15., ......... , 197a., 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 ........ ADDIT. ION ...................................................... The certificate is issued to .. Russel~ .Spi~a ...................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ... l~./.a ............................. UNDERWRITERS CERTIFICATE No ............. ~. '~ HOUSE NUMBER . .39 Sa ....... Street . Ba~sho~ce. Road ,. C~een~ortv..New. ~rk Building Inspector FORM NO, 2 TOWN OF $OUTHOLD 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? 9784 Z Date ....... ,,Tl,l~e .......... .1~ ......................... 197B... Permission is hereby granted to: ............. Geo~.g~..l~tze~ ...................................... ............. ....................... to ...... ~uicL o~to..,a..l~.rtvat ~ ..0~e.. ~mtly.. ,Dwelling .......................................................... at premises located at .................. ~9,~..~.....]~tlJ~'~.hO~t~..~O.~ ............................................................ ..................................................... Gte enpo~J: ,...Ne~..Y, or~ ............................................................. Pecon./.c .B. ay ..E.s~.a.~.e.s l~Iap ~ 6~8,6/~,'1'12/~ LOt;S--70,7~, 72 pursuont to opp[ication dated ............. ~..IlD,~.....~ ........................... ~9..7..~.., ond opproved by the Building Inspector. Fee $.....1.5.,.1~I0 ........ Building Inspector FOI~M NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Sou~hold, 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, 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, o 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-existit~g dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . .A..~...~..t,.....~/..7..8. ....................... New Building ................ Addition .~.~b~T~... Old or Pre-existing Building ................Vacant Land .............. Location Of Property .3~.,~,~....~,f~.~J~,g~.e..~,~J^ .......... ~.e.~l~.e~'.t,.i..~'.~tr..~r.e~'~, ........................................ ; ..... Owner Or Owners Of Property ....... (~,.~,t~.q~,~..~..~.~.~..,~,..~;J,:l~, .......................................................... Permit No..~2'.,8~, ........... Date Of Permit ...,7.1~,.~..],5...Applicant ...... .g.e.e.t&e..~.,..,~,v.e.~. ............................. Health Dept. Approval ...... ...~../.~..~.. ........................ Labor Dept. Approval ......... ...'~.../..~: ..................... . Underwriters Approval .............................................. Planning Board Approval ....................... Request For Temporary Certificate ........................................ Finczl Certificate .......................................... Fee Submitted $ .~,~ ......... [' .................... Construction on above described building and//~ermit meets all ~pli. c~able codes and regulations. Applicont .............................. Sworn to before me this ................ day of ............................................ Notary Public ................................... County (stamp or seal) l~O'tt~' NO. 1 TOWN OF $OUTHOLD BUILDING I~EPARTMENT TOWN CL£RK'$ OFFICE SOUTHOLD, N. Y. Examined ........ ~Tu,~ e, ....... .'1, .~ .......... , 19..7~. Approved ........ ~..~g....e. ....... .']..~. .......... , 19..~..8.. Permit No ............. ~.?..8.~..Z. ............ Disapproved a/c ............... ~'"'""~"h' .......................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT/~ I/ Date .~J~'x~,~...,Z~.....''-~. .................. INSTRUCTIONS Application No. 978L~ 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, 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 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 0 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 Soutbold, 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 011 applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inS~cctions. .......... ................ (ST~ature of ~pplicant, me, if a corporation) (Address of applicant)~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eiectHcian~ plumber or builder. ..... ................................................................................................................................................. Name of owne~ of premises ............................................................................................................................. If applican~ is a corporate, signature o~ duly authorized officer. (Name and title of corporate officer) Builder's License No .......... .~...~.~ ................................. Plumber's License No ....... -~.'J~ .................................... Electrician's License No...:.~..~· ................................... . . ,~-x~c ~ Other Trade's License No ............................................... ~,~..~. ~c~ ~ Il c~ .7.D~_ _/_ ~ Location of land on which proposed work~ill be done. Map No.: .....~,/..~. ............................. Lot No....~.../.:....Z ...... Street and Number .............................. ~Z~..~/.....~.~.-~..~..~ ........ ~.-J~.-...~ ............................. .~./~(..~.' .~-~?.~..~.A,~'~ t MuniCipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: b intended use and occupancy ........... ~.x..:A..~ ........................................................................................................ 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 curs ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Fror,t ............................ Rear ................................Depth .................... I-[eight ........................ Number of Stories ....... ~. ...................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth Height Nu ~ber of Star es ·. .......................................................... ~;z~ /~i 8. Dimensions of entire new construction: Front .......... ./,..-,.,~., ................ Rear ............................ Depth.~?....,',,...~. .......... Height Number of Star os .................................................................................................. .................... , . , / z 9. Size of lot: Front .......... ,~..~./.. ..................................... Rear ....../..~.,.Z .......................... Depth ................................ 10. Date of Purchase ........................ ~..~.Z.~'. ................... N~,,n~e,o,f_~/O~wne~ ........................................................ 11. Zone or us''e district in which premises are situated ....... ~' ......... ! ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ,~-....~ .......................................... 13. Will lot be regraded . ......... ..~'~T....,-c':f-<tc~.... Will excess fill be removed from premises: ( ) Yes (~x) No of Owner of premises .... Phone No. -- 14. Narne Name of Architect . ............................................................. / Address ................................Phone No ....................... N o,,~. ~...-~ ~.,?- Noma of Contractor ....~X~.~'~.../J~.~,,~.X~....~.;,...~/~.~.-~ddress .,,~.~...~.,:.7.z~,f?¥.~. ..... Phone PLO-[' DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-bock dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicat~ whether interior or ,c. orner Iol. z'~b-~'~ ~_ (~ #) I /". ~,)1~..~ .~/ STATE O- NEW (~~t~J ~. of individ~ol si~ning oontraof) being above named. duly sworn, deposes and soys that he is the applicom Fie 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 e en ~ ed ~n th~s o bcat'on are true to the best of h~s knowledge and behef, and this applicaton; that all st~t m ts conta'n ' ' pp' t,~ ' ' ' that' the work will be perforr~,~ed in the manner set forth in the,,~pplica~on filed therewith. ~ Sw°rni~°re~aeythis ~,r/,~,~.~....~ ........... , 9~.~. ~/ ~ ~ ~ ~ ~ ~ , ~ ~gna~ure or appucont) KO' /000 - '7-- ---- DATE: - ~-,. ! 5-~ _ ~ .... .765-2660 ~AM fo 4PM FOR REQUIR. I. ~6FORE BACKFILLING FOU~DA. T~ON OR S'FA~T 2. FRAMING I~ISPEC'F~ON 3. ~EFORE COVEqING PlP;S OF ANY KIND 4, HN~L WHEN JO~ COMPLETED NOT RESPONsI~- . ,~..c FOR DESIGN OR CONSTRUCTION ERRORs' 5. ALL CONSTRUCT~O~ MUST M~ET REQUIREMENTS OF N.Y. STATE CODE AND TOWN HOUSING CODE & ZONING