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Home My WebLink About9614-z11~0~31 NO. 4 TOWN OF SOUTHOLD BUn.nlNC. DEPARTMENT Town Clerk% Ot~iee Southold, N. Y. Certificate Of Occupancy THIS CERT~ES that the building located at .195. ~reton .Couzt ........ ~x Map No.. -6447 ......Block No... x.~x .... Lot No .....3 ............................ conforms substantially to the Application for Bui/ding Permit heretofore ~ed in thi.~ office dated ...January./J., ...... , 19. ~.a pursuant to which Building Permit No.. 9614~. · dated ...Jan~atry. E2, ....... , 19.7~1., was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occupancy/or which this certificate is iaStled iS ..... P~IVATE .ONE. F. AMILZ .DWELLZNG.~ ................................. The certificate is issued to ..... DENNIS. ~..SUSAN .ttUBt/kRD ......................... (owner, 12_: .... of the aforesaid buildin/. Suffolk County Department of Health Approval .8/.8/. 7..8 ..... .8 :-.5.0. r .0.3 ................ UNDERWRITERS CERTIFICATE No... iN .3929.0.8 ................................ HOUSE NUMBER .195 .......... Street . .Greton .Co,irt ,. Matti~uck,./~ew. ~ork. ..... ........ · With second floor non-habitable, Building Inspector will require a building permit to use, ; , · 'iTOWN OF $OUTHOLD BUILDING DEPARTMENT Town CLERK's OFFICE SOUTHOLD, N.. Y. BUILDING P£RFAIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9614 Z Permission is hereby granted to: ...~?;.-~ ...... ./**~:..).'. ......... ~.~Z.~.Z..~:.~ ...... ~" ~ .... ~/,c-...,.,~.~..!~.~/. ~. ...... /.<..~..~..~..~.~. .... at premises Iocatea at ~ B ~ R' ~ T o r~~OU (~...~ pursuant to application doted ............................... ~.~.-~. ....... ,(.t.., 19..~.~, and approved by the Building Inspector. Fee THE NEW YORK BOARD OF FIRE UNDERWRITERS 1! S BUREAU OF ELECTRICITY ~ July 5, 1978 85 JOHN STREET, NEWYORK, NEW YORK tOO38970,~2.q Date ,,,,,,,,c.,,,o. N392908 THIS CERTIFIES THAT was e~amined on JUnE Z",J, ~ I':/ I U and found to ~e in complionce with the requirement$ of thls ~rd. FIXTURE [ECEPTA I WIT HES I FIXTUI~ES I OUTLETS ~RCLESISc ~'* I :~ F I 2 12 I I~0 CB x ~otors= I-I hp Smoke detectors TIME CLOCKS BEU* UNIT HEATEIS OF CC, COND. !/o MULTI-OUTI/~T SYSTIMS HO. OF FlIT EXHAUST FANS ~RS I/0 R. Eugene Huller ~ ~ E Elsc. Box 206 East Isllp~ Lol. 11710 Per. This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. FORM NO. $ TOWN OF SOUTHOLD Building DelMr~ment Town Clerks Office Southold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 disposol--(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 oT 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 3. Copy of certificate of occupancy $1.00 $5.00 New Building ...... ~... Old or Pre-existing Building ............................ Vacant Lan. d ............................ Location Of Property .../...~..x.~ ....... :.~'.~.~....~..t~......CO..~.?./~.~ .......... ................. Owner Or Ow,ers Of rZ:/.. ...... ............................ Su~ivision .~.~.~ ...... ~.~ ......... Lot No. ~ ...... Block No ............. House Permit No. ,~..~.. Dote Of Permit/~/.~.Applican, Health Dept, Approval ............................................ Labor ~pt, Approval ................................................ Underwriters Approval ...~8...~,~.~.~ ........... Planning B~rd Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Ce~ificate Fee Submitted $ ...~..~...~..~ ................. Construction on above described building and permit me, ets _~11 applicable codes and regulations. Notary Public ............... ~~ County JUNEWILSON NOTARY PUBLIC, State of Nae/Y~'k No. 52-4615212 Suffolk Ceui'l~! Cemmission Expires Mai'ch 30, 197 BOX .,.,q5 N'I~TT[TU,_ '-~"~'~' I ~/'~l~&' 'J Thl ~i~aKJ disposal and water ~ppl~ ~ ' Se~lce~ hl'AP OF LOT ' SUF:FOL~X :-':0. MAC,.:' AT HAl' T ' t .... , _~ WN UF SOUThOLD N,Y. C,~IITI F. ~ 'f'HE WATL~ 8UF,PLy AND lEV/AGE DIIPO~AL SYSTI211 FOR THII III!.1. DE:NCE WILL. CO~NFQI~M TO TH[ ~J'ANDA~D~ OF' BUFIfOL.K CO. DEPT. OF' H~LTH. ~RVIC:~..~. (S) . · APPL.I~-.,ANT I~,R APF'ROVAL OF CONIT~UCTIOH ONLY DATE: H I REF NO.; APPROVE:D: :UFFOLK O.D. T&X ~~, I~-'¢, IUPP. CO. DE:PT OF Hf.A~.TH ~,~Vl~..l~ BUIU)ING DKPARTMKNT TOWN CI.KI~C'S OFFICK~/~_/_/-~/-'~ ~ /'/~ /~ ~D, N.Y. //~///~ ~ ~ ' ~ ............... ~ ................. , I~ ........ Applicmi~ N~....:&..~.~.~ ............ ~r~ ............. ~.....~, 1,~ ~it ~o ..... ~.~.~..~ ~~~~ ~ .......................................................................... ....................................................... ............. ............. .............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ntr p icate to the Building~gx' 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 prem ses or pub ic streets of~l areas, and giving a detailed description of layout ofprpperty 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 app cant. 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 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 regu ations, and to~I admit authorized inspectors on premises and in buildings for necessary inspections. .......... .. ...... ........ ............. (Signature of applicant, or name, if a corporation) NJ;) (Address of applicant) //~' 6'~ State whether applicant is owner, lessee, agent~ architect, engineer, general contractor, electrician, plumber or builder. ................................................... ........................ . Name of owner of premises ..... Z.~...~.~....'~../.~.. ........... ..~..~.~..~,~.. officer. If app~ ~:_ ~,~ate, signature of d~ly authgrized ...... ...... (Name and title~'tt'corporote officer) Builder's License No ..................................................... Plumber's License No ................................................. /0~0~ I0 7-- ..g. -- '.~, // Electrician's License No ............................................. /~/'_~c'. ~ -~t ~- ~ O - O~ ~her Trade's License No ............... ; ............................... ]. L~ation of land ~w~ich p~osed work will be done. ~a~~ N~.: ..~..~ ............. ~ ........ Lot No...~. ................. Street and Num~....~~ .......... ~..~ ... . Munici~li~ 2. State existing use and ~cu~ncy of premises a~ intended use and ~cu~ncy of pr~ed construction: a. Exisiting use a~ ~cupancy ........ ~..(~ ...... ~/.9. z~ ...................................................................... b. Intended use and ~cu~ncy ......... ~.~...~./~(~ Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration Repair .................. Removal .................. Demolition..: ................. Other Work ..................................................... (Description) 4. Estimated Cost ...~....~.-.~..?.?....~..:..~..~ ............................ Fee .~....~. (to be paid on filing this application) 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 ..L ........' ................ 7~ Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........ L...~-...~ ....... Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear %:....~...~.....~.. ........ Depth ....... : ........................ Height ............... ~. ............ N~mber of Stories .......~..~........-~.~.'i[.~ ...... 8. Dimensions of entire new construction: Front ..... ~...~.. ....................... Rear .....~'....'~... ............... Depth ..... .~.~....~. ....... Height ~...~...'. ......... Number of Stories ....~?~ ............ ~ ........ ..~,~.: ........ ~'..~'..--'~....~..~-. ............................. 10. Dote of Purchase ..~.~.~.....~...~. ................................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .../..z~..d~..z~....~..~ ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~..~. ............................................. 13. Will lot be regraded ...~'..~.~-~. ................ Will excess fill be removed from pre.~ses:J,J~es (~.No - PLOT DIAGRAM Locate clearly and distinctly all 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 YJ~)RIC. - -/ ~ ¢ c . CO~U NTY OF...... ~J~'~l I ' I I ~mj ..~./~..y~.~.,~. ............ ~......~./~..../~..~ .........0~...:,.l.~. ............ being duly sworn, deposes and soys that he is the applicanl (Name~ ~f~i/~vi,~ signing conl~octY above named._/,~. ~r ../.~..../~.. He is the .../...~/'~. ....... ....... ~..'....'~... ....... /.)..~.~.... ........ '~ '7'Z'?~-- ~'T~Z..~?.L.~..~. ........ ./...~...~...: ................................................. (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 ~,a~ the work will be performed in the manner set forth in the application filed therewith. Swqrr~tq I~efore me this ; Notary Public .... -,~ .......... ~.r~......~--* ............ ~..~. County ............... i~ .............. ~¢ ....... .~ ............................................ ~~ (Signq~'ure o, applicant) ELIZABETH ANN NL~VILLD NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk County.. Term Expires Ma~ch , DATE~ NOTE~;Y BUILDING DEPARTMENT, AT" ~0-~; ' ~ ~ to 4PM ~OR REQUIR- ~ ~ ~s~cnc~s~ ' ' : , ' 4, FINAL ~?f~;N J~ CCMPLEFED ,' ,f~-~ ' ,, ,' ~" ~,C l:Loo~ ,/ L~o or./D /-