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Home My WebLink About9144-ZTOWN OF SOU'/HOLD BUILDING DEPARTm~IT Town Clerk's (Mice S(,.~i~d, lq. Y. Certificate Of OCCUl:)~ncy Map No .............Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in th~ office dated . .I~.C~ .... ~ ........ , 19.7.7. pursuant to which Bui]d~*~ Permit No .... ~.~..I~Z. 'dated . .N.~.C~...~0 .......... , 19.77., was issued, and con/orms to all of the requir~ ments of the applicable provisions of the law. The occupancy for which t_hts certificate is t~med is ...... ~2I.V~E. 0n. FAFnir. I).~. :~Dlq. ~.H../~.~.0~1 ................. The certificate is issued to ........... l~Y. ~Agby. ................................ (ownor,~ of the aforesaid building. Suffolk County Department of Health Approval .......... N,/R ...................... UNDERWRFrm~ CERTIFICATE No ......... N.}9.a.9.0.7 ............................ HOUSE NUMBEE .... 555 ....... Strut ........ .~..v.~b.'.~. Lane ............................................ .C.u.t.c..h.o~.~., ~.~..r.o.r..k Building lmpector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9144 Z Permission is hereby granted to: at premises located at ...i~.~...~l,~l ................................. ill, i:. .......................................................... pursuant to application dated .................... ~.....~ .................. , 19..~t~/.., and approved by the Building Inspector. Fee $....~.~.q...(~... ....... Building In~ector Ig THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY I~te ,4pplicazion No. on file T~I5~IPIE5 THAT u~as examined on FIXTUR$ OU1tET$ 10 DRYERS [] 2nd FI. Section Block Lot and found to be in compliance with the requirements of this Board. RANOES A~T. A,WPS. TRANS. ~ NO, OF FEET EXHAUST FANS SERVICE DI.~ONNECT NO. OF METER i Garbage Compactor !0 amps H, P. A~T. NO. S E R V I C F,F,McCaffery Brldqe Lane Cutcho~ue, L.I. I I.~35 LlcolI4~E Per I ! ....... This certificate must not be altered in ony monner;~ return to the office of the Board if incorrect. Inspect°rs moy be identified by their credentials. COPY FOR BUILDING DEPARTMEHT. "THIS COPY OF C~I'iF!~T~i Mij~N_Ol'~Kli AI&TI~._?D ~:~ ~..4J~..~MANI~IL ....... TOWN OF SOUTHOLD ~ Building Deportment Town Clerks Office Southold, No Y. 1197! APPLICATION FOR CERTIFICATE OF OCCUPANCY Ins~ruci'ions 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 installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, 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), NIo~-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 B~lilding ................ Addition ~'/ Old or Pre-existing Building Vacant Land Location Of Property ...~...I./Z.6~..~ ...... ..~...~/...~...~...,.....~..~..'~/..~-..~..e.j~.&e~,_,).....~.~..,~; -- Owner Or Owners Of Property ...'~.~.~...../~...~.~l~.,-- Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.~....~..~..~..~...~'. Date Of Permit .~./,~/.~..~..Applicant .~..~...~..e,~../.-~.....~..~....~..~..~.~. .......... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .~..:...~..~...~...~....~...?. ................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate ........... ~ ......................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .....~.~..~..:.....~ ................................................. Sworn to before me this ~/ ~-~ I~-~ t~ ................ day of ............................................ (stamp or seal) ~2//'/r~ ~ Notary Public .................................... County ~_/D~ ~/I I~" TOWN ¢A,~K $ OFFIC~ ~ ~plicoti~ No..~Z..~.~. ............ ~ Examined ...... ~ ............... ~ , 19~.Z. Approved ............................ ~...., 197...2. Permit No ..... ..~....t..~/..(~...~ ~ Disapproved a/c ~.....~ ...... ~ ~ APPLICATION FOR BUILDING PERMIT ~ D te INSTRUCTIONS a. This application must be completely filled in by typewriter ne.in ink and submitted in triplicate to the Building Inspector, with 3 sete of plans, accurate plot plan to s~ale. Fee accord,ng to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n nQ orem ses or nubile streets or areas, and giving a detailed description of layout ofpraperl~/must be drawn on the diagram w~i~h s part of 'this a licotion PP . 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 Cerhficate 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 a terat ons, 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 necessary inspections.~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................... ............................................................................................................................................... Nome of owner of premises ~...~t. ~....~,..~..~.~,~.g~. ~../ /~.~ .... ..... ......................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..,~..;..'.'~..:...~.~.(. ............................. Plumber's License No. ~.....~..~,.,.'t Electrician's License No ................................ ~ ......... Location of land on which proposed work will be done. Map No.: .......................... Lot No. Street and Number ~..~'.~wt~ ,! ~..~ ~ ..-~,~ ,~ ~--~ 7~t~ # ~. ~,P'- ~' MunicipaJ?t~' State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............ ...~. ......................................................................................... b. Intended use and occupancy .............. .~_ ...................................... ..~: ............................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition ....~ ....... Alteration ..,-~... ....... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ~'~/~ ........................................... Fee .~..C ................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... /. ................ Number of dwelling units on each floor ..' .......................... If garage, number of cars ...................................... i ...................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ......~...(~.: ............... Rear ...¢~..Z=...'. ..................... Depth .~...o.. ............. Height ........ ~.~.. ........ Number of Stories ....~m... .................... .~ .................... ; ............................................... ; .............. Dimensions of same structure with alterations or additions: Front ..... .~...~' .......................... Rear .....~...~. ....... : ......... Depth ......~..~. ..................... Height ....... ...~. ............... Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ...............~..~.. ................................... Rear ...... ~.. ................................. Depth ....~...~...( ................... 11. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ...~....d. ............................................. 13. Will lot be regraded .......~...~.. ............... Will excess fill be removed from premises: ( ) Yes (~o 14. ]'tame of Owner of premises ~/r4~.~..,..~..¢.~v'~.~...Z/.'.'.~.~..~. Address ~...~.~.~/s~..¢ ........... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-I;x3ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. STATE OF NEW YO~,K . COUNTY OF ...~..~.~.~-~. ........... .............................. ~'~I~..~.....Wn....~.I~U~ .............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract0 above named. He is the .............................. ~t~'~,~t~' . .. (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 · ........... day of .............. ................. , · Su:~fo ~. ~' / ' Notary Pubhc, . ........ :...../~, ............ ,,~.:~ ......... ..]:]{C~u]ty ..... ~.....: ................ ;:,.: ..-.. ;.'~/~..;~...:,,. ............................. ~L~ZABE'r~ ANN NEVILLI~ NOTARY PUBLIC. State of New York No. 52-8,25850, SuffOlk Te~m Expires March 30. -- i C&, S ,.."r' L