The URL can be used to link to this page

Home My WebLink About10159-zTOWN OF SOUTHOLD BI.m'.r~NG DEP~ Town Clerk'~ ~ Southold, N. Y. Certificate Of Occupancy No...z. ?~ I.~. .... Date ... ~.Y...~. ................. ,19.79. THIS CERTIYTES that the buildin~ located at .. ~05. B~t~. A.v.~ ........... Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore ~ed in thi, office dated . .Apt.t1.9 ............ , 19..79 pursuant to which BuiMing Permit No.. dated . .A.p.r.i.l.....1.0. ......... , 19..7..9, was ~sue~ and conforms to ~11 o! the require- memts of the applicable prov~ions of the law. The occupancy for which th~ certificate is ~sued is ...... ~rl,v.mtm. 0n~. Fmm21y. ~well~ng .wi.th .Ad~tlozm ................ ~VOseph & .V. ivian CO.~..a.c.c.h~. a The eertlfieate is issued to ........................................ of the aforesaid building. Suffolk County Department o! Health Approval ....... N/R ......................... U-NDERWRITERS CERTIFICATE No ................. N/P~ ........................ HOUSE NUMBER ..... 9305 .....Street .... Bay. .Ava ............................. Cutchogue New York Buildin~ Inspector County Tax Map Number 1000-10/4-03-19 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, lq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10159 Z Date .......... ..~......~.....~...~.. ........................ , 19.Z~... Permission is hereby granted to' /'~~ .~,,~.z~..~. ~. ~...~~ ,o ...~::.~....~...... _.:...~....~ .~......,.~_ .~... .......... · '~~'"::'~: ......... ....................................................... (. .......... ..~., ...?.:..o..~Z ................................. ~ ....... / pursuant to application dated .............. ...~....'?.....~.. ......................... , 19~...~..., and approved by the Building Inspector. ~ee Y..~:~ ........ /~')~ildin~ Inspector FORM IVO. 6 TOWN OF $OUTHOLD , Building Deportment 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: 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 installat,on from Board of Fire Underwriters. 4. Commercial buildings, Industrial build,ngs, 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 in- 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 pete ....... New Bud ng ................Addition ................ _Old, or Ple_exist{ng,~Building ................ Voca' .v nt Land ...~. ...... L at,on of Property ......... .... Owners Of Property .~/~_~......~..~......~~ ................. Owner Or Subdivision ............................................... --'~ ,..... ............ Lot No.../...~..~,.. Block No.....~....~... House No...~..~.~....~.~5~-~ Permit No./~...~..~..Z Date Of Permit ..~.~'.~-~.Z~.....Applicant .~.~J..~...~........~.7~..~.;~..~...7.~.......~z~_. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate .......................................... Fee Submitted $ ........... ~ ................ ................ day of ............................................ Notary Public .................................... County Construction on above described building and p~r.~it ~eets/all opp~c~es ~d regula~ons. Applicant ............ /.~..~..~.. ........ .~-... {~,...,~,,~..... .......... ...~..... Sworn to before me this )~l~i~j~c.~ ~ (stamp or seal ABSTRACTERS' INFORMATION SERVICE, INC. N.Y.C. 125-10 Queens Blvd. · Suite 322 Office Kew Gardens, N.Y. 11415 (718) 268-8355 Long Island 100 E. Old Country Rd · Suite 26 Office MIneola, N.Y. 11501 (516) 742-2290 COMPANY DATE TITLE NO. Ir'7 PLEASE PROVIDE COPIES OF ALL CERTIFICATES OF OCCUPANCY AND CERTIFICATES DF COMPLETION ON THE FOLLOUING PARCEL: DISTRICT: BLOCK: LOT: ~EscRIPTION: LOT SIZE: IF THERE IS NO INFORMATION PERTAINING TO IHIS PARCEL CONTAINED IN RECORDS PLEASE PROVIDE LETTER ADVISING, SO. PLEASE INCLUDE TITLE NUMBER ON ALL DOCUMENTS AND CORRESPONDENCE. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18013 Examined .... </;:. ..... ,19.M ^pproved... ~ .//. 0. ...... '~..7. Permit No../.~./3~ ~-- (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No./(.0/.~. · .~. ...... 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 buddings 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 Building Permit. d. Upon approval of this applicahon, the Buildmg Inspector will issue a 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 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 necessarX inspections. ,,/~ ~ . .. ........ (Signature of applicant, or name, if a corporation) ........ :~.~.~.~..~W,~':"~.,-..>/.x... t.. ,. ........ r~.. x (Maitin~ddress of'applica~., -:~!1: State whether applicant is owner, lessee, agent, m'chitect, engineer, general contractor, electrician, plumber or builder.:.' ........................ .LT.~..-~.. .................................................... .~ Name of owner of premises . ,. · ~ .................. .~ (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 ...... L ..~. ............... Plumber's License No ........ :.--::. '.":~r ......... Electrician's License No.. :~.~ ......... Other Trade's License No. ~ 1. Location of land on which proposed work will b__e done ...................... .~ ........................ ..... ............ ................ House Number Street County Tax Map No. 1000 Section .... /.~...~.. ...... 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 .... .~. '~.. ~.~,,~,~.:.. .......................... b. Intended use and occupancy .... ~.~.. ~~~' / 3. Nature of work (check which applicable): New Building .......... Addition ........ teration Repair .. .~,_... RemCval .............. Demolition ... ;, .......... Other Work ............... 4. Estimated ............ : ......................... vee ...................................... / (to be paid on filing this app~cation) 5. If dwelling, number of dwelling ?nits ~ ........... ! Number of dwelling units on each floor ................ If garage, number of cars .... ~ ................................................... ~ ........ 6. If business, commercml or m~xed occupancy, specif~ll~rg and extent of eac~,~ge of use ....... ~ ~ ........ 7. I)imensions/o~cxisting structures, if any: Front ....'?~,.~,,;~ ...... Rear ..'~.: .......... Depth .... .q ......... Dimensiql~ ¢~ ~ame structure with alterations or,~ttlYtions: Front . ............. Rear,,~..-'. 7~. ............ Depth .. ~. ~ ............. !.. Height .... f 2',~ :o '~ ........... Number of Stories .... ~.,~r,, ......... 8. Dimensions.of e, ntire new construction: Front ...~..'~. ~, ........ Rear ............... Depth . :.~. ........... 9. Size of lot. Front .... /. .... ~ ........... Rear ...................... Dept .............. .,~.;:~: ..... 10. Date of Purchase .......... ~ .................. Name of Former Owner ..................... /2, }'. .... 11. Zone or use district in which premises are situated .......................... .A~r.t,> ............. ', .' ...... 12. Does proposed construction vjo)gle any zoning law, ordinance or regulation: ..... r. y...~ ............. } ....~,,~..~, 13. Will lot be regraded ...... (.r~,. .................. Will excess fill be removed from premises: 14. Name of O~vffer of premises .. i ................. Address ................... Phone No ................ mam~ Contractor .t.~..°~.. :. ,~.~. ...... Address ...t~..(.~2 .... Phone No ................ [ PLOT DIAGRAM Locate clearly and distinctly alI 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. ' S S ¥O ~ ................ being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) abow~, named. He is the . . ~ ((Contractor} agent, corporate officer, etc.) of said owner or owners, and is d~ly author'lzed application; that ail statements contaned ~ this application are true to the best of his knowledge and belief; and that the work will be perio~ed in the m~'er set forth in the application filed ~erewith. Sworn to before me this ............ J. ay .. ~;~,,~o~ t~,,o, ~.-,~ ~0~ /7~ ~ ~ (Signature of applic~t) APPRLOVED AS NOTED ~EE? IV - BY. ~ k'.OTJFY BUtL,g;NG DEPARTMENT AT ~5-2660 9.~,M to 4PM FOP. REQUIR- t. ~EFOaa BACkFiLLiNG FOUNDA- TiON OP. ST/~T 4. Fi~'IAL W~ JO~ CO/APLET~D NOT ~SPON~3L~ FOR DESIGN CR CONSTrUCTiON 5. ALL CON~'[~UCTiON MU$T MEET REQUI~MEN~ 2.~ N Y. STATE CODE AND TOWb! HO~Si:IG CODE & ZONING Il r~