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Home My WebLink About10172-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Locatior~ of Property/~. ~9o?. ,],.O~/~VIE b~/ .I-,.~. ~..~. '~OU'C~'Ol'. · · .................. ~ .................. County Tax ~ No. ]000 Section ...... ~g..Block ........ .~. ....Lot...~..~/ ........... Subdivision.."T~.~... 0/g1.'7'£ l~.~ ......... Filed Map No.~.9..0./....Lot No.../~. ~. ........ conforms subStamttsny to the Application for Building Permit heretofore f'led in this office dated ............. ~L~r~... , 19 .'~.~ursuant to which Buildi~ Permit No..../..~.( .7..~.. ~ ..... dated ~?.~t~, ! ,~ 19~..~. wasissu~d and conforms to all of the r~quir~ments of the applicable provisions of the law, The occupancy for which this certificate b J~ued is ......... t) .~.~ v. nT£ o~.~.. F..~. t?.~ .~.r. ~.t/.~..~ ..... The certificate is issued to . ~/~/TO../~/ ~ O ~ A 0 ~//~* ~ (ow, w, '; ....... -,~l of t~ aforeMid building. ~.~. ~"Z> ............................ Building Inspector FOl~I NO, ~ TOWN OF SOUTHOLD BUILDi~G DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TIlE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 1017~ Z Permission is hereby granted to: ..... CB..~.~..~L~.(:.-. ......... .~..w..~.z~.u.(,.~/..~...~. t'~ ~' ......... ~/c. ....... .A~L~.o..~ ......... .~.A.Z>.O..~.Z o v' ~ c t~ at premises located at .......................... Z~..~ ...... ~..~..~.~..~.[~..1~ ........ ~.~. ............................. .................................................................................... ~.~.~.Z~.o..b.~ ........................................... ...... ~.~ ....... A ~ ........... ~X ........... 7 ............................. 7 ........... ~"~'~ ........ ~/)"~ ...... pursu.nt to epplicotion d~ted ................................... ~ .......... , ]9.~ end epproved by the / Building Inspector. Pee ...... Building Inspector TOWN OF SOUTHOLD BulJding Department Town C~¢rks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ~n typewriter OR ~nk, and submitted in DUPLICATE to the Building Inspector w~th the following, for new buddings or new use. l. Fmc~l survey of property with accurate [ocahon of al~ buildings, property lines, streets, on6 unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage d,sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buddings, Industrial buildings, Mult~pie Residences and s~milar buildings and installahons, a cerhficate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planmng Board approval of completed site plan requirements where applicable. B For existing buildings (prior to Aprd 1957), Non-conforming uses, or buddings and "pre-ex~sting" land uses' 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buddings or premises, or other pertinent in- formation required to prepare o certificate C. Fees' Certificate of occupancy $5.00 2 Certificate of occupancy on pre-existing dwelhng or land use $5.00 3 Copy of certificate of occupancy $1.00 Date ............................................ New Budding ................ Addition ................ Old or Pre-existing Building ............... Vacant Land .............. Location Of Property ...... Z..~...~..~..~..,J.,~'.~.......Jm....~.J~.,,~ ............... .,~,,.~.,..//.j"~...~...~.~. ......................................... Owner Or Owners Of Property ...A..:..../.f.t~ .~./~..~.~...O..~/~..C'.~.. ...................................................................... .... : ........... ................. Lot B,ock No ....Y. ,ouse No Subd vision Perm t No.~...~.../.~7...~.~.. Date Of Perm t ./~..-./..(.'.?.~..App cant .....~..:'.....~..'...~;..~.~.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 and perrnit meets all_applicable, codes and regulations. Sworn to before me this App cant~/ /,V .. ~'.///////'J~..... ................ dc~y of ............................................ Notary Public .................................... County (stamp or seal) Memorandum from .... ~q BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD Town HALL, SOUTnOLO, N. Y. 11971 /~/~ ,6~.1~o~ ~ Memorandum from... · BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD Tow~ H^LL, $OUT~OLO, N. Y. 11971 765-1802 '~OL1 G M ~ T~L u iv/~ I i'../ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 Cornell Construction Crop. Southold, New York Dear Sir: This is to notify you that Building Permit No. 10172Z issued _4/16/79 to Anton Radoslovich- will ex, ire on 10/16/80 .... If more time is required to complete the Job and obtain a Certificate of 0ccupanoy, you may apply, ~y letter, for a six (6) month extension. ' If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, GEORGE H. FISHER Sr. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined ....... Disapproved a/c ................ .~.~. ..................-~. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No../.~.7..'~.. ...... Date .................. , 19... 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 Building Permit. d. Upon approval of this application, the Building 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, bqild!ng code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signatu~eof?p~ic,,an~orname, ifac p ' ) (Mailing address ~/applicant) State whether applicant is ow~rchitect, en~neer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No ..................... /) .... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .................... ................................................. House Number ~ ¢ Hamlet4t~ ..~.. County Tax Map No. 1000 Section .................. Block ............... Lot.. ,~,-. ...... Subdivision..fi. ~.~..~.~./....~.~./.~.~..~i ............. Filed Map No. ~ 2.O./. ...... Lot...~.~ ...... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~/~ .d:.,~..~..~. .................................................... b. Intended use and occupancy .... ~.~ ~.....~r.A.~././r.x//f../?~.~j~. }..~..~. ................................. ' 3. Nature of work (check which aPplicable): New Building ....... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... : (Description) 4. Estimated Cost ..... ~..O~...~.. ....................... Fee ...................................... i (to be paid on filing this application) 5. If dwelling, number of dwellinglunits ... ~]~ ~ ...... Number of dwelling units on each floor ................ If garage number of cars ' ~./~.~ 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structuros, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ......... . ........ Rear .................. Depth ................... i.. · Height ........ ~ a ............ Number of Stories ...'0~.. . 8. Dimensions of entire new construction Front .... ~,.,,ll. .......Rear...~.~ ......... Depth .. i~i .~. i i ..... Height ............... Number of Stories ........................................................ 9. Size of lot: Front .... /.0.0. ! Rear /. 0 .0 Depth /.,5~. ·O. 10. Date of Purchase .......... , ................... Name of Former Owner ............................. 11. Zone or use district in which piemises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ .~. ~..-~.. ~. ..... . .....,.. Will excess fill be remo.ved from l~'0n)~s~s,;/Z>,. ~Yes No Name'of Architect .~A¢c,t~..~ ,~J~/.Lfi.~T?. ...... Address .,.J~/~./2~/.~.~.../,f? ...... Phone No ............ ~ Address Phone No Name of Contractor .............................................................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocl: number or description according to deed, and show street names and indicate whether interior or corner lot. OF.. · ~...~.'...~ ....... · .... being duly sworn, deposes and says that he is the applicant ~/ // (Name of individual sighing contract) above named~ He is the...~ ................................................................. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dgly authorized to perfom or have peffo~ed the said work and to m~e and file ~is appficafion; that all statements coat,ned work will be perfo~ed in the m~ner set forth in the application filed therewith. Sworn to before m ..., 19~ co~,,,~o~ c~,~.~,~, ~0, (Signature of applicant) OWNER: RODe'RICK VAN 'ruYI. p. C. ' ~' ' ' LIC. LAND SURVI[y(~IR~ GRI[ENimO~T N Y ..T, ZeZ.U.~ I.-- su~, co. or~r ~ ,~^L'r,~ ~ ---------- ':. 1° · ~ FOR APPROVAL OF CONST'I~UCTION ONLY DATE:: APPROVED: Z At,/_/_ C073L~ ~7'-0' B~O ~oo~ ~a x~ED ~00~ # 2 2O; Z/V//VG 1~oo~ ~'COi~, lC/A/I- FiLL JOZTD I-' i_ .J 7t7" ¸Il ~q 112- FLA ~'~y ,C U~CAL~-: '/'~' = I'- o" ~t~Co; t3 APPROVED AS NOTED NO~~¥~ 765-2660 9AM to 4PM FOR REQUIR. "Alteration of this Document by an Architect or Ucensed Profes- sional Engineer, is illegal'. Section 7209, Subdivision 2, N. Y, State Education Law, ~ ami Engineer's Seal and Sillnature only good for initial use of draw{q, Changes, alteratioaq er ¢~- visiofl~ to or re.use of drewl~g~ wi~ out ~chiteet er b~in~r's ~vll voids ~al and Signature on Same, ALBERT A. SACCO ^.D GORDON K. AHLERS ARCHITECTS & EN~iINEER$ 54655 MAIN ROAD, SQUTHOLD, N.Y. 11971. l FL / Lou NO ~¢'A L E , O v~NA NG /CAL~. /.~ '/- 0 ALBERT A. SACCO ^"'~ GORDON K. AHi, ERS ARCHITECTS. & ENGINEERS 54655 'MAIN ROAD, SOUTHOLD, N. Y'. 11971 57~0Z Tt O/V£ ~