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Home My WebLink About9803-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .2.07~..1~..~.r~?.s...Rd.; ......... Map No ....~.~. .... Block No ...........Lot No, '.Z.. 7.~79.,.8.0.. & .8.~. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......,Iv. ne.. 2 ....... , 19..~.8 pursuant to which Building Permit No .... 9.80~Z dated ......~.une...26 ....... , 19..7.8, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ............ .P?.$¥.a.~.e...Ope. .F..~. ~ly...1~..e~!~.n.g' ........................... The certificate is issued to ..... .F~..e.d..&....P_~T..g.~..e.~..S~.o.c.c.o. ......................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ...8.-.$.0.-.~.~...D.e.c..~..b.e.r...6.,.. ?.9.7.8.... UNDERWRITERS CERTIFICATE No ........ ............................ HOUSE NUMBER ...... 20.7~.... Street .......... .M..s~r.. '..s..R.o..~.d. .................. ................................................ F~.~cl~,. ~. y.o.r.l~ ......... Building Inspector County Tax Map # '~ 000- ~ 07-9-~'1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9803 Z Permission is hereby granted to: .............. .~.e. ~ ..~ ,e.,n..d..o. ~..z. ~. .................................... .............. ~/.~ ....... F~. ~.d.. ~..~'.e..¢....S..C.~..C.C.O at premises located at 207~ F. at"y' S ~oad ......................................................... ~f~l; .'t;,$..'.'.~c .k.,... ~.e~. X.O.~..k. ......................................................... ........ I,o¢s...78 ,.."/.9 ,...O0...&..&l.,./~ne~ded.. ~s~p...o:f... pursuant to application dated ............... ~_.t~...e.. ....... .2.. ...................... 19...~..8., and approved by the Building Inspector. Fee $ ........ 1000-107-9-;Sl H.S. 80S0-5h Building Inspector TOWN OF SOUTHOLD , Building Deportment 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 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 dispasal--(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, 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 pete . ,..~- ........... ~ew Buildin ~.......... Addition ................ Old or Pre-existin Buildin ............ ac n L ............ '".' ....... r::"'T': ....... ..................... Subdivision ..:......~..,~ ...... :~ .............. Lo~No.....?......i~ N~ ....... .~.... House No ............. Permit ~.~.....~....~....~... Date/~///~/~'Of Permi.~/...~..:..... ~Appllcant ............... i'"': ........................................ Health Dept. Approval ../,.~.~x,/~..~....:-..~..' .......... --'~'~/kab°r Dept. Approval ............................................. Underwriters Approval ~..,~..~.~.~.r~...~..L .................. Planning BOard Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate .... ~,~..~-..--~.. ........................ Fee Submitted $ ..~...,.~ ..~/.~... ...................... Construction on above described building af~/permit me~ts all applicable codes and regulations, Sworn to before me this Applicant ..~~..~ ................ day of ............................................ (stam~ o, seal)/~/~/~ ~-~ Notary Public .................................... County FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall 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 Inspec- tor with the following; for new buildings or new use: I. Fina~ survey of property with accurate location of al~ buildings, property lines, streets, and unusual natural or topographic featu res. 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 ~... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .../~...~...~. Owner or Owners of Property .... .~..~:-...-~...--....~. ........................... ·.//. ........... Lot ................ County Ta~:~M/ap No. 1000 Section . ./. ?..? ........ Block ~:~ ~-~/ Subdivision .',///~.~../~. .......................... Map No ............... Lot No,7~¢ ~,~ ~.~ P~.. No.C/~.45.~..~... Date of Permit t~///~..Applicant .................................. Permit Health Dept. Approval/.~.~./.~...~.....~..-~.~..~.-~,. Labor Dept. Approval ........................ Underwriters Approval ~.¢~ ~'.7..~./ .......... Planning Board Approval. ..................... Request for Temporary Certificate ..................... Final Certificate ~ ............. Fee Submitted $..~f..~.. ..................... $5.00 Date .... ,Z', ,~, .~../. ~, ,'.. ~,~, ....... Construction on above described building and p~,meets all ap~codes and regulations. Applicant,. ,~'~-~.~ .~[~...~%~..,%~ ...... F~iLM NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. (Building Inspector) Application No ........... ~,0.~, ............ APPLICATION FOR BUILDING PERMIT Dote J~L~ 2, 19 78 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,: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 par~ of this application. c. The work covered by thins 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 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 a app icab e laws, ordinances, bu Iding code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections, F~ANOES ROSE HO~ES, INC. ..... .~.~.'.~..-:},,.:~,~.~:.....'...<..::'~:;.~:~'7¢..,,,7.;: ........................................... /~/~(SJg,natuj'e of appljgant,/~,-~r~e, if a carpal, arian) ...................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises ...... .~...~..~..~...~....~..~.~.?..~..'J]...~.g.~.l~.9.~. ........................................................................................ If applicant is a corporate, signature of duly authorized officer. (N.cime and title g,f corporate officer) Ben .iendozza, Builder's License No ..................................................... Plumber's License No, 263 P Electrician's License No. 307 E Other Trade's License No ............................................... 1. Location of land on which proposed work will be dbne. ~Map No.: ............................... , ........ Lot No ......................... Street and Number Municipality 2. 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 ............ .Q~..~...~,.~10~],~r...fJ~.e~,],;],~.~ ...................................................................... 3. Nature of work (check which applicable): New Building~ ......X. .......... Addition .................. Alteration ................. Repair .................. Remova[ .................. Demolitior. .................... Other Werk ................................................. 4. Estimated Cost ...... .~...]:.~.!..0..0...0.~.0..0. ....................... i ...... Fee ~' ~'~O.~ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ..o..~..?. .............. 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 of Stories ................................ ' ' 28' B. Dimensions of entire new construction: Front ......... ~..~.. ...................... Rear .......... ~.~. .............. Depth ........................ Height 18 Number of Stories i ........................... 9. Size of lot: Front .................$..0..0, ................................. Rear ........ ~.QQ ........................... Depth ..1[,~,,,,~.9 ............... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance ar regulation: ......... ~O .......................................... 13. Will lot be regraded ......~.e.~ ............... Will excess fill be removed,fr_o.rn~pr.e, mi.s~s: ( )~Y. es (~) No /.~,~/~4 , · Fred & ar aret So .~ .~. ~ ..~ p 2.0.~. 861- 14. 14ame of Owner of prem,ses ....................~...,.~ ................ .(7.g.g(Addres~,~,~..6J~..l~ ~.,.. ~. hone No ..................... Name of Architect .............................................................. Address ~5~)'"~'~:'"~1'~ ........ Phone No ....................... Nome of Contractor ..?...~..~.~.g..e.~....R.g..s..e..,.~.o..,m..e...s..t....:.D...o..: Address Q.~.~.Q~g~I~.~..~'. Phone No. ~.l~..-.~.{~.l~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior ar corner lot STATE OF NEW YOt~I<, [ c c COUNTY OF ....~..g.~f.o. lk ........... ~'~ Inc. ~.e.~):....~..e..~..~.~...~.~.t..`?..~...e.~.t.a..~...~.~..~.g..e.~.....~.~.~.~...~'~.~.~..be~ng duly sworn, deposes and says that he is the applicam ~ (Name of individual signing cbntr(~cf) . ~ above named. He is the .............. ..~.~..~.?...~..-..O...O.~.~.-°...~-.%..~..e.....0.~.~.:lr.9..e.~ ..................................................................................................... (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 ore tru~ tha~ the work will be performed in the manner set forth in the application Sworn to~b~ore me this ,-~ -- FRANC JUDITH T, TERRY ~O~aW public, State of NeW Yor~ Camm'°' [s;Ion~ Expires' March 30, 19~. / to the best of his knowledge and belief; and i~s~l:therewith. ' ROSE HO~ES, INC. ........................ nctozza, ~r es lc~e~ ~c~/e 40 '= t" 63 ~' /A,~ I1 .F-;~' ~::...~z:~ /c /<,~^,~ ,MA~A?~£"?'~' ~d..occ' o ~. AT AZ,4 '~ ,~') 7-we ~, IV. ~ //?e lo4.