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Home My WebLink About10210-z TOWN OF SOUTHOLD BUILDING DEPARTMEN Town Clerk's Office Southold, N.Y.: Certificate Of Occupancy The certificate is issued to I~tll~..SJJ: 001tlti .................... of the aforesaid building. No ............ Dale . . THIS CERTIFIES that the building HoOse No. 'Strdet Hamlet County Tax Map No. 1000 Section ..... ~.'1 ..... Block .. ! ~ ......... '.Lot ...... ~. .......... Subdivision ' ...Filed Map~ N~ ........~ .Lot No. conforms substantially io the Application for Budding Pefini~ heretofor~ filed 'in this office dated · ..Ap~t,3,. 2.8. ........ , 19 79. pursuant to which Bmldi/ag ~ermit No.' ~ .. . .................. 10210Z dated Iqltty..1'~. 19. ..................... ~ a~d conforms to al/' of the requirements of the applicable provisions of the law. The occupancy for wt~cl/this cert~figate m issued is ......... Suffolk County Department Of Health Approval .... UNDERWRITERS CERTIFICATE NO ................. Rev 4/'/9 Buildin~ Inspector FOI~M NO. ~ TOWN oF $0UTHOLD ~ BUiLDiNG DEPART/~ENT TOWN GLERK'$ oFFICE ~ SOUTH'OLD, N. Y. BUILDING PERMIT / '**"~/~ (THIS PERMIT MUST BE KEPT ON THE PRE~IS~ UNT~ COMPLETION OF THE WORK AUTHORIZED) N? 10310 Z Permission is hereby granted to: "~ ~ ,o ....... .~,,,~.~,.c...~ ............. ~.~..~..~...~:~y ......... .~.~:.~.~..:~.~ ............ ....................................... ot pre~,ses locate~ ot .................... .,...~,. ...... ........... .,..,,.....,.~.,.~ ........ ,.~..,..: ..................... ~ ................. .............................................................................................. ~ .......... ~.~,:.~i ...................... ............................................................................................. C~.~ ~:'"'f:;~'~ ......... : ...................................... pursuant to application dated ................................. .. I 19...'. and approved by the Building Inspector. Fee $ ....... I.~. ............. Building I~nSpector Ac FORM NO! 6 TOWN ON SOUTHO~D Building Ddpar tlfient TownHall Southold, N.Y. 1197~1 APPLICATION FOR CE RTl FICATE OFiO Instructions : ~CUPANCY B. For existing buildings ~.(prior to April 1957),:N0n-conferF~ir~g :uses, or )3uildings and "pre-existing" land uses: 1, Accurate survey of ~eoperty showing all prop6rt¥ linesi ~eets, buildings and unusual natural or topographic features. { 2.Sworn statement of owner or previous owner as to u~,.~c~u~ahCy and c~ndition of buildings. 3.Date of any hous ng ~ode or safety inspection bf buiidin'gs ~r;premi~s~ or other pertinent informa- tion required to prepare a certificate, C. Fees: 1. Ce~ificate of occupaOcy $5.00 , 2. Certificate of occupancy on pre-existing dwelhng or' land ~ ', $5.00 3. Copy of certificate o¢occupancy $1.00 New Building ........... ~.. Old or Pre-existing Building .... ,.~... V¢cant Land~¢?~.~ O~n,r o~ O~.... o~,ro,.r~ . ~.', .... ~.~ ...... ...................... ~,~,~,~,~ ............. ........... ...... ~ .~,~ ~,. . ~. . ~ ........ ~ . ~,, ~, ............... Health D6pt. Approval ...................... La r . royal . ~ .................... Unde~riters Approval .............. ; ;Planning'BOar~ ~pproval .................... Requem for Temporary Certificate ..................... F~n~l ~ert~flcate, ............. Fee Submitted . . .~ ~ r.~ ' . Con~"~io. o. ~bo~ de,o, ~b~d ~u,~d,ng ~nd perm,~ m~,, ~p~,~,~e oo~e~ r~gu~,o.s. .... .... ...... natural or topographi 2; Final approval of Hea 3. Approval of electrical 4. Commercial building tions, a certificate of 5. Submit Planning Boal : featu res. ~. Ith Dept. of water supp!y a~d sewerage installation from Board of~Fi~e ~d~ ;, Industrial bu dings, MaJt pie R6~Jd~ Code comp lance from th~ Archit~t; approval of completed site plan ~e~lui li'sposal~-(~9 form or equal). ~es and ~lmilar bu?dings and installa- . r ~Engine~r~ responsible for the building. !ements w~ere applicable. This application must ~e f ed in ty.p, ewriter OR ink, and subm!tted in du~'l cate to the Building Inspec- tor with the following; for new buildings or new use: i ~ 1. Final survey of property with accurate Iocatibn of all bu~ild ngs, prope~:ty lin6s, streets, and unusual . Examined. ~ .. (%, 19. ¢ Approved .......... .f. ,( Disapproved a/e ...... ~L~'' ' TOWN oF sOUTHOI~D ~ SOUTHOLD/N;Y. 11971 ~ TEL: 765-1803 ~ ~ ...... N (Buil~ding Inspector) APPI. ICAIION FOR BUILDING : INSTi UCr ONS; ERMIT a. This applicaff~,n must be c~mpletely filled in by typewriter o~: i~ ink and sObmitted in triplicate to the Building,~ Inspector, Wi~h 3 se{s'qf plans, accCrate plot plan to sclc. he6 acco~i~g t dchedule. b. Plot ~lfin show~g location ~f lot and of buildings 6n prdmi~{s ~re] fionship t~ adjoining premises or public streets~ or are~, and ~ving a detailed description of layout of pr0pe~y musfibe lrhwn on t~e dia~m which is part of this appl~ cation. " , ) ~ ~ , ~X ~ : c..~e~rk cov2erea by this application may not be oommenbe~ ~of~ i~suance p~f BuilOing Pe~it. ~' ~m~f ~ppli~ation me Bmld~g ~~em!t to the apphcant. Such pe~t ~ ~' ~g sha~ be o~upied or used in whole ~~~~~~ sh~l have been granted by the Bufl~ing Inspector. ~ ~f ~ ~ ~PLICATION IS HEREBY MADE to the Buildi~~i~rs~o ~e ~ilding Zone Ordinance of the Town of Southold, Suffolk County, Ne~ York, and 'other applicable Laws, Ordinances or ~e~lations, for the construction 0f buildings, additions or flterations, o? for removal or demolition, as herein described. Fhe applicant agrees to comply wi~ all applicable laws, ordnances, building code, hous~g code, and regulations, ~d to admit authored inspectors on premises and in buildings for necessaw inspections. (M~ling address of applicant) 11106 S State whether applicant is owner, lessee, agent, architect, en~neer, genOral contractor, electrician, plumber or builde · ??~I~ I~ O~ .................. ......... ................ Nme of owner of premises .~..~9~g~. ~. 0~ ............................................... (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 ......... i · ~ - House Number : Street : } Hamlet / ¢/. 7<7../ County Tax Map No. 1000 Section . ...... ~ Block ! . .... '. Lot ........... Subdivision ..................................... Filed ~Ma~p ~NO ...... ......... Lot ............... 2. State existing use and occup~Oy of premises and intended;use and bccgg~cy of proposed construction: BACK Y~D i ti nd a. Exs ng~ usea occupancy .' .... . ................. :;.......~ ?.: ....... ~ ............................. Intended use and occup~cy i: .... 8gORl¢~ · · J... · :..~. · ~ ........,~ ............................. b. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ... Repair .............. Removal .............. Demolition .............. Other (Description) 4. Estimated Cost . ~SO0...O0...i ......................... Fee . .'810,0.0 ............................ '\ : (to be paid on filing this application) 5. If dw~elling, number of dwelling Units ............... Number of dwelling units on each floor ................ If garage, number of cars ......................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure: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..10.' .......... Rear . .10~ .......... Depth .. '9 ' .......... Freight' .. 1t ! .......... Number of Stories .IiASE .I,ESEI'~ ........................................... 9. Size o£ lot: Front ..... '~[~[' 'i '9'00.' ...... Rear..18.7.,.~ ~.' ............ Depth ~OR~ti · ~'1'~; ~§'~ ....... 10. Date of Purchase MAY. gT-. :1,970 .............. Name of Former Owner ....... ~.anmw ~.2~8~' ....... · ~ PERSA AT~NS 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................... 13. Will lot be regraded ... ~tj.. I~.OI~0P~E. ~J~OOR.. Will excess fill be removed from premises: Yes 14. Name~of Owner of premises . W~ .GON.~ZE$ ....... Addres.. 55t~49'..~tl. S~ .... Phone No212-,726--661.7. · Name'bf Architect .......... ................. Address .. AI$~ORIA ..ltl .lll~ne No ................ Name of Contractor ......... I ................. Address ............. .,, ..... Phone No ................ PLOT DIAGRAM Locate clearly :md distinctly all! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blocla~m~d~&o.cd~cri~tion accord!~ to deed, and show street names I/ : ':';.-' $,$J'i7'40"tt¢. - He is the .............................................. ............................ ~(Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Public,..~.~ .~. ~ .... County \[ MA~V~NOZUR~ , II4OTAJ~Y pLJBLJC, S a e of New Yom ,, · .l./.'~.:,~.;C , No, 4633833 ............ ' ....... ~ualifi~d n W,ustchester Cou~ty.. (Signatureof applicant) Term ~xp~res w,orch 30, 19~) ~