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Home My WebLink About9651-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z910.~ ..... Date ' ...Jul.y.... 12 ............ , 19.78 THIS CERTIFIES that the building located at .. 255. Wo. ddcl£ff. Dr., ..... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. Ap~'il .~ 5 .......... , 1978.. pursuant to which Building Permit No ..... .~6..S1Z dated ...Apl~±l.. 5 ........... , 19..'~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 .......... AC.C. ES$0RY. STR. U .CT.I~/ ........................................ The c:ertificate is issued to ...... J.o. hn..W....I~...qW.s.kx. ............................. (owner;z]~) of the aforesaid building. Suffolk County Department of Health Approval ...... N/.R .......................... UNDERWRITERS CERTIFICATE No ............... .N./..R .......................... HOUSE NUMBER . .. 255 ....... Street .......... .W.o.q .d.o.l.i.f..ff..Dr.: ................ ................................................ .k,. .............. Building Inspector lvOl~M NO. g TOWN OF ~OUTHOLD BUILDIN~ DEPA~TMEN? TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING I:ERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLEXION OF THE WORK AUTHORIZED) Permission is hereby granted to: ..... ~i.~ ,~-~-~_.d~u_ .,~. I · ......... ~~"~:/,~.""'": ,, ....~....~.... ~a4x~%...~..,,~ .... ,x~.../.~...~..~....//~;...~£~/~c ' ~ ~i~ ~t~ ~t ...... ~.~.. ........ ~.tT..~..~....~..._~.~ .................... ~ ..................................................... ~~ .......... ~...~....j....,..: .................................. ................. * .................................................. , ........ '..? ................................... t" ........................................ Building Inspector. TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Soutbold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application ~nust 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 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 ~7//// Oote ..... ./........,c. ............................ New Btdlding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .................. ..~... ..................... .,~'.. ................. /. ....... i~.. ............... /. ................................... Owner Or Owners Of Property .................................................................... '.~... Subdivision ................................................................ Lot No ............. Block No ............. House No. ............ No ?. ~. f; L: .~ Date of Perm t .¥/..~./2 ~ App ,ea,t . .- ~.. :~.?..b...W..O...t~ S.G . Permit .... ~ ............................ ~ .... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .....~ .......................... Fee Submitted $ ~..:.o..~-. ....................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) 7~c ~ / V~-/ FOBM NO, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned .... '....5 , .................. ............. ~proved ........... , Permit No. Disapproved a/c ~' ' .................................................................... .............................. ......................... ?"u---"'-in~{Build Inspector, ..... Application No. /o ~' APPLICATION FOR BUILDING PERMIT Date ............... INSTRUCTIONS v ' 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 Cra schedule: b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises 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 o Building Permit to the applicant. Such permit shal[ 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 regulations, and to admit authorized inspectors on premises and in buildings for necessary i .r~oections. (Signature of applicant, or name, if a corporation) ~l '/ "- ) -- '':' ' ...................... "(A~Tdress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises 0 If applicant is a corporate, signature of duly authorized officer. (Name and tide of corporate officer) Builder's License No ........ :~.'.~..~..'~.'..'. ............................ Plumber's License No ...................................... ........... Electrician's License No ............................................. Other Trade's License No ............................................... , ...... , Location of land on which proposed work will be done. Map No.: ~[~ '-~'~"~ Lot No. Street and Number ....J~...p..q.~..c..~../..~...~......~.~.: ......... ..T....T..4..u..~. ../. ..... :. :. ................................................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exisiting and occupancy ,,?,~.!/,~:,~,,' .-~dV.:[,~,~.' ,~...;.,~./,~.¢;.~-..( ...~.:.~M~".~.~/.,<'.~¢.~".'', ..................... b. Intended useand occupancy S~D/t'/z}(~- S~/~/ /..O~./..~ ~OJ- / 3. Nature of work (check which applicable): New Building' Alteration Repair .................. Removal ..................Demolition .................... Other Work .................................................... ~ o ~/0 ~ (Description) 4. Estimated Cost ...........o,..~....!..] .................................... 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, s~ec'~fy nature and extent of each type'of use '. ........................... 7. Dimensions of existing structures, if any: Fror, t ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ......................... '...Number of Slories ,. ............................... 8. Dimensions of entire new construction: Front .......... ./. ........................ Rear ....... /..~..: ............. Depth..~....~....". ............ Height .................... Number of Stories ..... /. ............................................................................................ ~; ................ 9. Size of lot: Front .............. ../...0...0..~ .............................. Refer ...... ./...0. ............................... Depth ................................ 10. Dote of Purchase ....O..,c.~..~'..T..~..?...~....~. ........................ Name of Former Owner ..~..~./:'.~.~.......,.~....~..~.C..~...~., ................ 1 ]. Zane or use district in which premises ore situated ................................................. ;..~ .......................................... 12. Does proposed construction violate any zoning low, ordinance or regulation: ....... J.~.:.~.?.....~ .................................. 13. Will lot be regraded '6z° Will excess fill be removed from pram ses,; (_) Yes ('~ No ............. ,'""i ......... ,~ . v~ootJ~l,~£~- · I,~,L) tl/q~ I,u~f ~.~..~I'~T~,~ h n ................... 14. h~ame of Owner of prem,ses ..~..P../Z.~. ........... g. ............... .,~...,. Address ........................... P o ~ No'~.?.~' Name of Architect ............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone 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 ~vhether interior 6r corner Io~. C~TATE OF NEW YORI(, COUNTY OF ............................... f "'-' , ..... J~:..~....~.......q~.....~.~....~'~..~'.~,~ ........ ............................. being duly sworn, deposes and says that he is the applicam ~' (Name of individual ~ni~g contracf) above named. He is the .....~ ........ : .......................................................................................................................................... ' (Contractor, agent, corporate officer, etc,) of said owner or o~ers, and is duly autho{ized 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 tha¥ the work will be performed in the manner set fo~h in tho application filed therewith. Sworn to ~efore ~e this ..... ..... ............. ....... ........ ......... Nota~ wblic, · .......... ~ ..................................... ~X_'.:.~.' ;~.:...... 7 ':'"~ ~o. 52-4843~21, Suflo~kCOUl9~)~p