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Home My WebLink About9796-zTO~q OF $OUTHOLD B[m.nlNG DEPARTmeNT Town Cl~rk's O~ie~ $outhold, N. Y. Certificate Of Occupancy Map No ....~ .... Block No ...........Lot No .....2.~. ........................... conforms substantially to the Application for Building Permit heretofore ~ed in thin office dated ....J.u~..e.....1.5. ........ , 19..7.8. pursuant to which Building Permit No.. ~.~/~.Z. dated ...0'..~..e.....2.2. ......... , 19.7.8.., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which thi~ certificate is ~ssued ~s Private One Family D~elling The cern_ flca~ ~ ~ssued to Dr. James & Brook Dubovlck (owns, ~ of the afores-~d bufld~g. Suffolk County Department o! Health Approval .. ff. al~tex~. ].~..1~.~..-..~C~..69.. t~m)~warrF~s CE~T=ICA~ No ....... .~.~J.?~9.~. ............................. HOUSE NUM]3ER. ~..06.0 ........ Street .......Ca~e.'a .~me .E~t, ................ ............................................ ~utch~gue+ .New..York ............ Building CountT Tax Number FOEM NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) 9796 Z Dote .....,T~a....22 ............................... , 19....~.8 Permission is hereby granted to: .............. ,O~co~/;./labbl ....................................... .............. to ....... huil&..~..;2r:.~.z~.+.,.¢...O~,~..£J~m£~...,~w~Z11~ ................................................................ at premises located at ................... ,l..O...6,.O....~..~.~..e..!..~...~.~...~.~..e.;~.J-...o.~.). .......................................... ....................................................... C~*~cho.~,~.~.. Now..York .............................. ..... · Le~...~...2~r..F~$~,w~y.../Fez, ms,...F.tl, ed..Ma!~..~;..~0~6 ....................................................... pursuont to opplicotlon dated ............ .J..I,Bg.~......~. ........................ , 19...~..8.., and opproved by the Building Inspector. Fee $....1J~7.~.25 ...... 1000-109-5-14.2/* H.S. # 6-S0-7~ Building Inspector 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 wffh accurate location of oll 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 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, ~cupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pe~inent formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existi~ dwelling or land use $5.00 3. Copy of certificate of ~cu~ncy $1.00 / ~*e .......... / ....... / ...................... New BHilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. OCQTJOn rroperw .................................................. ~... __ .x,~ l.........u .............. ~ .......................... ~......~ ................ ~ner Or ~ners Of Prope~y .......... (~..~..~.~......~.L....~.~.~.~.~/.~.~ ............................................... ................ ~. ............................................................... Bilk N ..............Hou~ N .............. o, ........ ......................... Health Dept. Approval ............................................ Kabor ~t. Approval ................................................ Underwriters Approval .............................................. Plannin~ B~rd Approval Request For Tempora~ Ce~ificate ....................................... Fin~ Certificat~ .......................................... Fee ~bmitted $ ~' ~ Construction on above described building and permi~meets all, applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County TEL. TOWN E]F SOUTHOLD OFFI[:E OF BUILDINB INSPECTOR SnUTH{]LD, N. Y. 11cJ71 .... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Examined .....~...¥1~.,..e.......~..~.. ................. , 19..2..,8.. Application No ...........?.~,?.,~. ............. Approved ...:~U,O.~.....~, ................. , 19...~.~. Permit No ........~.~.~).~.:~ ................. (Building¢ Inspector) ^FPUC^TtO. FOR SUILD,.G PERMIT Date .............. ....................... , INSTRUCTIONS o. 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 o7 areas, and giving o 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 hove b~en granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 ~ applicon{')' ~/~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~_/b%~L~' /~-~ ~' ~ ~-~- - . ............................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumbers L,cense No. ~ ........................ '......;].......~..,'~ Electrician's License No, .,~.~,,,..:..,~./*...~,.,:......~..~' Other Trade's License No ............................................... Location of land on which,proposed work will ~be done. Mop No.: ~.....~.......Z~:.%... Lot No...~ ......... Street and Number ....... ~:~ ....... l,~'~... ............................................................. ~~ ....... 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 ...........-- 3. Nature of work (check which applicable): New Building, ~ Addition Alteration Repair .................. Removal .................. Demolitior ..................... Other W~ork ................................................. ... "~ ~...~-' (Description) 4. Estimated Cost ........~C.~./.~ .................................... 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 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 af Stories ................................ 8. Dimensions of entire new construction: Front ....... .~....~., ..................... Rear ....... '.~...~, .............. Depth ..... ,~.~.. ............ ' I-bight ..... /,.~. ......... 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. '~oes proposed construction~ate, any zoning law, ordinance or regulation: ........ ,,,J~..?. ....................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premise_~s: ( ) Yes (/No 14. Name of Owner of premises .?/..~..~~ .............. Address ..~ ........ Phone No. ~.~.'~.~..,.~-. Name o¥ Architect .......... : ................................................... Address ........... ......,.~ ........o e No. Name of Contractor .~.¢C...~..~..~ .................................. Address ...~/~/F~..-.-~.~ Phone No...~...}.~....,.Lf,'..~. PLOT DIAGRAM Locate cleaHy and dJstincHy ail 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 lot, STATE OF NEW YO~.,/,/,, COUNTY OF ..... : .~-~'z~/~ZT....Y.L.. I ......................... ..~..~./~.~. ................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. 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 thor the work will be performed in the manner set forth in the ar~lication filed therewith. Swam to be~k~ff this , , // , Notary Pu-"----. ,. "-unty ...... ...... .... · · ...._ ......... ..... ..................... 5.88 ~8 ..0 I=2. : ItUFF'. ~'1~¢ .FA~"~I D]~I~. A~PROVAL I H. ~. NO. i L J COPIES O~ "~ SURVEY MAP ~0¥ [}EARING EMBOSSED S[~J~SHALL NO~ ]~ CON$1D~R[D ~~.~d.,. i~ The sewage disposal and water-supp~ ~:~.~_~) faollitles fox- this location have been tnspeoted by this departnent ~d ~ound O~e~ of Oeno~l ~gtneertn~ , .~ /I ~ ~ ~ ~ : ~ '