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Home My WebLink About12780-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy Z129~5 October 29 .8.4 No .................. Date ................................. 19 . THIS CERTIFIES that the building .. Inground . ~ p.o.i... Location of Property ...R...O..:~:. (pole 818 off road to East End Fi.~.h.er ;-Jouse ;Ye. ' ................... $'treot ............ Hamlet County Tax Map No. ] 000 Section . 0..8 ......... Block .0. 1. ............ Lot ... ~...3. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... 0..c .t.... ! .2 .........19~. }. pursuant to which Building Permit No...1 .2.?.~. 0..Z ............. dated . .D .e.c... 5 .................... 19.63, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... I..n. ~r.o.v.n.d' .D. 9p.l..~ ~.t.a.q~d, .t. 9..tk~. ~>;..hou~.~ .by..de ck,s..wig J% .fen.ce... The certificate is issued to Allerton & Rita Cushman (owner,/~ of the aforesaid building. Suffolk County Department of Health Approval ...... .N./.A. ................................ UNDERWRITERS CERTIFICATE NO .............. .P.e.n.d..i.n~; ........................... Building Inspector Rev. 1/81 FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO 12780 Z Permission is hereby granted to: ................... ~"~ ...... ~:Z;:'~"2'"~';'" ~o ........ ~.~...~.....,~.~. ....... ,:'~.~........~~...~.....~ ~ .......... ...... .............................................................................................. ~ ....... ~.....~..: ............. ~~ .....~ .. ..~~.....~.~..~. ...... ..~ .................................................................................. ~o,,~ ~ ~ ~o. ,o0o ~ec,o. ............. ~ .... ~,~ ............ /. ...... ~,,o ..... .a~...~ ........ pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. Fee $ ........................ Building Inspector Rev. 6130/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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: 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 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 featu res. 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 $5.00 Date. ~. ,~?, ;-?. :~? :'..~. ff ..... ;... New Building ............. Old or Pre-existing Building ............ ~=ccnt-L-a~d ~/.'?C2.c?. ~... Hou~ No. Strut Hamlet County Tax Map No. 1000 Section .., ~ ......... Block ..... / Lot...~ ~.~5. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.t~. ?~J'.Z.). ?--~.. Date of ' ,: ..... :~..Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $ ....... ~-~..T~. ~.~; ................ Construction on above described building and permit, meets all applic,~ble codes and regulations. Applicant . ~.~ :4 '¢. :¢( .~,~ ~-~?/.~7~. -~ ,¢',¢ ................... 0 COSHM~ ~ Vo~ 1~o~e' NO. I BUILDING DEr~RTMENT /, ._ / f// /// TOWN CLE.K S OmCE SOUTHOLD, N.Y. ~ ..... ~ .... INSTRU~IONS a. This a~lication must be .:ompletely filled in by ~ewrit~r or in ink and submitted in triplicate to the Duilding~ nsp~tor, with 3 ~t~ of pl~s, a~ cu~te plot plan to ~ale. Fee according to schedule. b. Plot plan showing I~ation ~f lot and of buildings on premises, relationship to adjoining premises ar public streets ~r~as, and giving a detail~ de, ri ?tion of layout ofprope~ must be drawn on th. diagram which is part c. The work cover~ by this ~pplication may not be commenced before issuance of Building Permit. d. Upon approval of this opp;ication, the Building Inspector will issue a Building Permit to th~ applicant. Such permit ;hall be kept on the premises ave liable for insp~tion throughout the work. e. No building shall be ~cupi~d or u~d in whale or in part for any pu~ose whatever until a Cedificate of ~cupancy hall have ~en gmnt~ by the Building Ink,tar. APPLICATION IS HEREBY ~DE to the Building D,padment for the issuanc, of a Building Perm t pursuant to th~ ~uilding Zone Ordinance of the Town of ~uthold, Suffolk County, New York, and oth,r app cab · Laws, Ordinances or (egulations, for the construction ~f buildings, a~itions or alterations, or for removal or demo ition, as here n described. Fhe applicant agrees to comply Nith all applicable laws, ordinances building c~e, housing c~e, a~ regu at ans. and to ~dm t authorized inspecto~ ~ p~emises and i~ buildings ~r n~essa~ in~ections. ~~~(S'gnatur~f ap~c~nt, or (Address of applicant) ,tote whether applicapt is ~ner, jlessee, agent, a~hitect, engineer, general contractor, electrician, plumber or builder. qome of owner o{ rem se~ , ~ ~ ' " ' f applicant is a co,orate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... i..../..~,..? ........................... Plumber's License No ...... i~..:.Z..../..~...7..~... ................. Electrician's License No..i..~.~.~'.~...T&s~ ................... Other Trode°s License No ............................................... Location of lond'on which I~roposed work will be done Map No.: ................ Lot No Street and Number 4~.r~- 66/ - 6WE- .~...c~r.]' ~ ~ ~,~ .......... .~"'~ .................... ........ ...................................... ............. ............... Municipality State existing use and occqpancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~ t t q 5~;;;r 7 b. Intended use and occupancy ¢~t~' ~('~' ~ '~"'~' ~ ~i ~ ~'~' ,, ,' - X ' ~1 II ~ / ..... ~'6L ................. U"V'~ ........ ~0 A~p ........... ~'" ~1~ pud G~JD~ o~ pud ~JOM pigs eq~ pG~JojJed ~ADH Jo mJo~Jad o~ pGZJJON~nD Xinp SJ puo 'sJeuMo Jo JeuMo p~os ~ ....... ~q~ . ~i 'pe~ou (~ooJ~uo3 6u~u6Js Ionp~pu~ ~o luo2!lddg e~ s~ e~ ~oq$ sXos pud s~sodep 'UJOMS Alnp ~u!eq'"'", ....... ~ ....... ~'""~"~ ....... 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