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Home My WebLink About10354-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Cedificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property 1980 North Road to Bayx..iew Southold /~s~ ~id ...................... '~i ....................... h~niei County Tax Map No. 1000 Section ....o79. ..... Block ..... .~ .2. ....... Lot..0.5.9.: .5 .......... Subdivision ....-.~ .... Filed Map No .... 2~C..Lot No... ~ · · conforms substantially to the Application for Building Permit heretofore filed in this office dated · .. ~..~lr~c. ~. .......... ,19.7.9 pursuant to which Building Permit No .... ~J0'~/~Z ........... dated ... ~Llg~$~..'1.3 .............. 19..7.~ 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 ......... ... ~.~..~ ?~ .~. e?~..~..~.~.Le.~..o.~..e.o., 9.n~..~.~..X.Z.~r. r.e.~.~..~?.n.c.e. ........................ The certificate is issued to ......... ~. ~'~.e~..~Ogo. v..~O ................................... of the aforesaid building. Suffolk County Department of Health Approval ....................... I~[]~ ................ N/R UNDERWRITERS CERTIFICATE NO .................................................. / Building Inspector Re~ 4/7~ FOE~I NO. 2 TOWN OF 5OU?HOLD BUILDING DEPARTA4ENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) Ne 10354 Z Permission is hereby granted to: /~.~ ~., .... ~ ....... ~'..~..~......(. ..... at premises ,~ed at ..... ~:~...~...~~~ pursuant to application dated ...... .~.....~ .................... , 19.~,~ and approved by the Building Inspector. ~ Building Inspector 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 "pm-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. 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 t/// Date .~. ~ I?..? ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of P roperty.~.~.~.~ .~%~,~..~/.~... ................... ;.-~. .... :. .L.., House NO, ~ ~. ~)_~ (~ Street--,, Ham/et uwnerortJw asa r' p y ..... ......... .-..,,.-.,~._.O~ ............................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Fired Map No. ~ ......... Lot No .............. Permit No./.~.?.~.--~..~. Date of Permit~../(~/~.~..Applicant~.~''/~, ~.::., .~.'/~i:::::: Health Dept. Approval ........................ Labor Dept. Approval Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~:~ ................. Fee Submitted $. --~--' ~ Construction on above described building~ermit meets~,l applicable code~m,d regulations. Applicant ,~, .~.~.,. ,~,~.~. ~, .,'~ ................... - -,,NOTE .~: MONUMENT NEAR[ST WATER MAIN- [ MILE WATER SUPPLY' PRIVATE WELL now or formerly George H SCALE 1% 40' SOUTHOLD SOU THOL D FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 /~,) ..~5""~7Z/ TEL.: 765-1803 ...... ............ ....... (Budding Inspector) APPLICATION FOR BUILDING PER~IT INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Bmlding Permit. d. Upon approval of this application, the Building Inspector will issue a Building Pemait 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 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 buildings for necessary inspections. admit authorized inspectors on premises and in ..~.~ ~~ .............. ;ia'till (Signature of applicant, fir n , ' p ' ) .... ....... .,3 ............ .......... 0~lailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ~v'~ ~,~ .................................... Name of owner of premises . ./.'~._F: ~..~.:~.. ~. ~.+.o..t/../.~.'7. .............................................. (as on the tax roll or latest deed) If applicant is a corporation, 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 ................................................ House Number Street Hamlet County Tax Map No. 1000 Section ...~...7.1~. .......... Block ... ~..~.~. .......... Lot...(~...~.. ~.~..~.-~. · ..... Subdivision .................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~.LA.).~ .................................................... b. Intended use and occupancy . ? ~ .~.L.~:( {~. ~.. ?./...~..~.~ ./C....A)..C>..~. (.-~. ~..o. ~.~. 3. Nature of work (check which a~plicable): New Building .......... Addition ..~.. ~..~.Cr/.QAlteration , ......... Repair .............. Rempval .............. Demolition .............. Other Work ................ ..... 7~ (Description) 4. Estimated Cost O00'q~ I (to be paid on filing this application) 5( If dwelling, number of dwellingiunits Number of dwelling units on each floor If garage number of cars 6. If business, commercial or mixeld occupancy, specify nature and extent of each type of use ........... ' .......... 7. Dimensions of existing strnctur~s, if any: Front ............... Rear .............. Depth ....... · Height ............. ;. Number of Stories ................. . ....................................... Dimensions of same structure With alterations or additions: Front .................. Rear .................. Depth ' Height Number of Stories ..... ' .... 8. Dimensions of entire new construction:, Front ............... P~ar ............... Depth ............... Height ............... Number of'Stories ...... : ................................................. '/9 Size of lot Front ' R D pth · : ...................... ear ............. ......... e ...................... ¢10. Date of Purchase .......... i. · .. .............. ,q. Name of Former Owner ............................. 11. Zone or use district in which premises are situated 12. Does proposed constru~iog violate any zoning law, ordinance or regulation: ../X).~). ......................... 13. Will l~°t be regraded . .(~..c,..r~ [ ........ a ........... Will excess fill be removed from premises: Yes, No 14. Nameiof Owner of premises .[.~A~-~...~.o~o.~. ~G. Address ................... Phone No, .~.[a~5~.: [ .~l~.. .... Name of Architect ....... ~ .............. Address ................... Phone No ................ Name 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 bloc} number or description according to deed, and show street names and indicate whether interior or corner lot. , · ' STATE OF NEW ~ORll~f COUNTY .~...~ (N~vidtba'I signing contract) being duly sworn, deposes and says that he is the applicant above named. H~ is~he,. !. ~ ........... : ~ (Contractor, agent, corporate officer, etc.) of said owner or Owners, and is drily authorized to perform or have performed the said work and to make and file this applicatipn; that all statements contained in this application are true to the best of his knowledge and belief; and.that the work will be performed in the mann'er set forth in the application filed therewith· Sworn to hefore me this ............... ~, ........ day ~f ............ 19 , Notary Public, .. ~'. ..... County . .~ ~ .... , .................. , .......,:;.. ~. ~,~ , ~,,:~.~S ~0. - ' ' ' ~/(Signature of appfic wELL LOT PBOPOSED F/ELL ~ wATER I 'D I00~ now ) or FOrmerly George H )"-- 40' NOTE Il= MONUMENT NEAREST WATER MAIN - I WATER SUPPLY'PRIVATE ~LL , ~UFi~bLK COUNT+ 'FOR APPROVAL OF RE~ \ S,79.o$5'~0"&,, LOT I0 sjooo o"w. tie line ~O,qD tPO,4D l YOUNG & YOUNG 400 OSTRANDER AVENUE, RiV[RHEAD, NEW YORK ALDEN ~' YOUN~ ;SURVEY FOR HOWARD W YOUNG PETER BOGAVIC