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Home My WebLink About9635-zFORM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z9026 ..... Date .. Play ..... 22 ............... , 19..7.8 THIS CERTIFIES that the building located at .~/~5. Stgsbe.e .Ro&cl ....... Street Map No.. 80fi ....... Block No ........... Lot No....7.7.. & .7.6 ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. Plal~ch .... 20 ........ , 19.7.8. pursuant to which Building Permit No.. dated ... plarol~. 20 ......... , 19.78., 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 ...... PRI.VATE. ONE. FAMILY. DWELLING. WITH. ADDITION ................. The certificate is issued to ..... L., Hi~gin~ ...................................... (owner,~) of the aforesaid building. Suffolk County Department of Health Approval ........ N/R ........................ UNDERWRITERS CERTIFICATE No ....... N38/4.~..18 .....May..'1 ,..q.97.8 ........... HOUSE NUMBER ...'l~45 ....... Street ...... Sigabee. Road. ...................... ............................................ ~a.~.~:t~ck,. Ne.w. York ............. Building Inspector ffOB~ NO. ~ TOWN OF ~OUTHOL~ 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? 9635 Z Permission is hereby granted to: ..~.~:~..~..,.~ ........ !?06 ~.?/.. .... :Z~. ....... .~ ......... L/../...5.5..:.N.~ .................... at premises located at ................................................................................................. .~. .................. ............................................ : ...... L.&v.~L.~.._...6.~..?..?.?..,.. ....... ~.~..7:....:../..t ................ · i~.zz....t..z...~ ...... ~.~..~',~ ................... ...'...k.,.t. ................. ~,,..., ~ ~,l~=,o. ~ ........................... ~./7.f......A.....,.°., ~,..7.ff.., o,, o,,~ed ~, Building Impector, Fee $ ........................ ,~, /"V, ........... ~.:~ ............... ,; ............................... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD , Building Depa~tment 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: I. 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 disposol--(S-g form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and instal(arians, 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. Far existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex/sting" land uses: 3. 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: J. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy Dote .... ~... ....................................... New Bcdlding ................ Addition ....~,,~.'. ......Old or Pre-existing Building ................ Vacant Land .............. Looa,io, of Property ....... ........ ........... ................................. Owner Or Owners Of Property ......... .~.,.: ....... !.~...t....~,..~,. Sub vson '"' · ' · ................................................ ~ .............. ~. ............... B ix:....o .......... ~.. Hous~ No ............. Permit No. ,.~.~..~.~,...'~. Date Of Permit ,..~,/.,..'~..L?...,~pplicont .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval~. ~'~'~/I ~ Planning Board Approvol Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...... .,~...'...~ ................ Construction on above described building a~d~.mit meets oll~icable codes and regulations. Sworn to before me this Applicont ..... ................ day of ............................................ Notary Public .................................... County THE NEW YORK BOARD, OF FIRE UNDERWRITERS ' BUREAU OF.I~LECTRICIT~ , ~ ; 85 JOHN STREET, NEW ~ORK NE~V ~O!RK t003~ ~ppl~cat~o~t No. on file ~ ~ ~- THIS CERTIFIES THAT ' {+ ~ ~ only the e~ctr~cal equipment ~ described belo~ and introduced by the applJca~t ~a~d on the a~e application number ~n the premises of in the following location; [] Basement -[] 1st Fl. [] 2nd Fl. i Section Block and found to be n compliance w th the r$quirements of th s Board. DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS Lot TIME (~LOCKS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: S E R , ;V I ~ C A. WG OF HI-tEG ~0 OF NEUTRALS AWG OF NEUTRAL This must not be altered in an ~ manner; return to the office identified by~ ~b~:~ d:e~dentials, ANY MANNER. BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. ., 963 Applicmion ~o ................................. Examined .................................... '...., 19..,..~.. u ..................... (Building Inspector) APPLIGATION FOR BUILDING PERMIT i// ; .... %,. ~ ; 19..,:,::..:....~. INSTRUCTIONS ~, a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildin.~~4~ 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 aL areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application.~k 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 o 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 Occupancvr~' 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 Bu~ drag Zone Ordinance of the Town of Southold, Suffolk County New York, and other appl cab e 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. ,:,.,.,,,,,..,,,./ ,...,..:./?,,,..,. ...... , (S g~Zt'~re of apphcant, or namgi~- a corporation) .......... L ............... :,..i ....................... ,...,,.: ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ Name of owner of premises ' / ' "/ q If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............... ..~'...?. ............................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........... ......... ~/.... Lot No ........................ Street and Number ............... ".'' "' ~ ............ ~:.:.:~.':.: ;? '.'~..'..../...'/~ ................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy . .,' . r/, " .' ' . b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition ....... >. ......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cost ............... i ............................... 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, cornmercia[ 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 .s~,~e structure with alte?rati,,gns or additions: Front ...............i; ................... Rear ............................ Depth ................................ Height ....~......: ........... Number of Stories ................................ 8. Dimension.,s of entire new construction: Front · // Rear ............................ Depth / Height,./..:~'. ............. 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. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ...L~ .......................... Phone No ....................... ........................................... Address ................................ Phone No ....................... Name of Architect ................ ...., Nome of Contractor ............... !.~l.~...~b:~.. ...................... Address ................................ Phone N.o~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frore property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STA-FE OF NEW YORK, ~ ¢ c COUNTY, r~F ........................... /.}' "" ....... .¢?..d be ng ..... (Name of individual signing contracf) duly sworn, deposes and says that he is the opplicom above named. ~ He is the .................................. : .............................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oil statements contained in this application ore 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,b~eforemethis ~'~ ~ · '//:~~ ..¢~.L~../~. ...... day of ..~C~ ..................... , 19~. Nota~ Public, . ................................................... Coun~ .... ~.. .~ ...................... ~~ ~,~ ~ (Signat~e of~plicant) Term Expires March 30, 19~ APPLICATION FOR BUILDING PERMIT Dote ............ ......... . INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildin~'~ 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 adjo n ng prem ses 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 opp cant. Such perm 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~C' 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 regulations, and to admit authorized inspectors on premises and in buildings for necessa~nspections. ...... ........ (S gr~ture of apl~licont, O'r namyif a corporation) .......................... ........ ' ..................... State whether opp. licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ ..... .......... :. ................................................................................................... ~ / Name of owner of premises ..................,:~...: ...... :..~..;.x...~.-..:,.(..x../..~: ....................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........... :..~....? ............................... Plumber's License No ................................................. Electr,oans L,cense No ............................................. ~/~ /~ Other Trade's L cense No ~~ ~ ' ' Location of land on which proposed work will be .de~, Map No.: ...................... ./. ........ ~.. Lot No .............. , . Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............. ~...., ............................ : ...... ;...:.. . ... b. Intended use and ~¢u~ncy ............................................................................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .....~ ......... Alteration ................ Repair .................. Re,moral .................. Demolition ....... : ............ Other Work .................................................... (Description) 4. Estimated Cost ................................................. lee ....................................................................................... - (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 ..................................................... Z .................................... ~'"'/ .............. Dimensions af ~,~e structure with alterat.[ens or additions: Front .......... (...~:~ ................... Rear ............................ ..~ · / Depth ................................ Height ...Z ...................... Number of Stones ................................ 8. Dimension,.%of, entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height/.....~...-' ............. 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 ..................................................................................................... i2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Addre ....................... ,;~;....[: Phone No ....................... Name of Architect ...................., .......................................... Address ................................ Phone No ....................... Name of Contractor ...............!.(.../~..~....~29...~ ...................... Address ................................ Phone N .d~?..~..~....~...~...~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oll 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 YORK, COU N TY/,(~F ........................ ............. .~..:...~. ..................... /..~...~......~.: ................................... being duly sworn, deposes and says that he is the applicanf (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 applicction 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-. '"'~'~~i ...... day ..................... Notary Public, . ................................................... County ............ ~.... ...................................................... No. 52-4643721, Suffolk Coulee..,. Term Expires March 30,