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Home My WebLink About786-zF(~E~VI BIO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. g 647 Date lc) THIS CERTIFIES that the. building located at Map No. *~ Block No. *w* - - ........................ LOT No. conforms substantially ¢o the AgpJicofion for Building Permit heretofore filed in this office doted ~u~y ~9 59 ~ 786 19 ........ , pursuant to which Building Permit No. dated ................. ~..~. ................. 19..~.~.,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 ................ T~s ce~Hfic~fe ~s ~ssue~ $o ................... ~..~...0~ .................................................... (owner, lessee or tenant) of the aforesaid, building. Building Inspector /' 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) Z Date ........................ .(·)~.:V.....',....~..... ........... 19...~...f.. Permission is Jlereby granted to: · .A~.ti~.~. ~ ,~a~ ........................................................ ..... l{i{~.d d le.. L~,.m'~.~,.. ~,d., ...................................... to ..B=ild.. ~.. o~e. £~i1~. ~.ell J~g ............................................................................................... at premises located at]~ts ,~o~d 1~/.~ (~a.~,~4s ~/..~ .~.~,v.F.:~.e..~...~..o.~..~. ................................................... Southold~ pursuant to application doted ............................. J~1¥......2~ ................. 1c~.9....., and approved by the Building Inspector Building Inspe(~tor FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tar with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, p~operty 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 ~he Architect or Engineer responsible for the building. §. -~ubmit Planning Board approval of completed site p an requirement~ where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "preexisting" land uses: 1. Accurate suwey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn s~atement 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 / land use -- t~re-Exis ~,inS C. 0. $1 § · 00 3. Cop¥ of certificate of occupancy $1.00 Vace. nt~, ].and C.O. $ ~5.00 New Building ...~. · .~/~. · · .... OId~ or P re-,existing Building .... ~ ....... ~can,,t Land ........... Local,on 0, Property · .~.(~.-.~...~. ?~ .. ~ .......... ~' L"~' .i ..... '~" '~'~/' '~' ........... Owner or Owners of Property ..... ~.; .e< .~:~: :~.' .~.~? .... v;%'>:...¥~.. ............................ Caunty Tax Map No. 1000 Section ........... Block ...... ¥~.? ......'. -o~ ................ Subdivision ................. Filed IVlap No ....... Lot No ............. Permit No ........... Date of Permit .......... Applicant ............... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval Planning Board Approval/' · · Request for Temporary Certificate ..................... Final Certificate . y~ .................. Fee S. bmitt. .................... Construction an above described building and.peTmit meets all apptjcab~codes end,regulations. R~. 1a.~0-78 FORiV~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTFIOLD, FI. Y. Approved ........................................ "Y ~ 19 ........ Permit No....~...~..'.7...~..~. ......... D sa roved a/c '~..~.c. ~ . PP ......................... ~ ....... .'0..(} .................................................... ......... ........ .......... .......... ........ ............... ~W~-~.;~. 2: ....... ¢!ff..b:.~.1 ...................... (Building Inspector) ~ Application No. ~ °~ ~' APPLICATION FOR BUILDING PEP, MIT Date z..: · 19 .................................... / ...................... ~.../. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 location. 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 progress of 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 Deportment for the issuonc.e of o 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 and regulations. .... ~...o..~./~..p.//. ...... .~.I.¢.¢A ~z~..~....~.¢.<c.,~.~ .~¢ .~.~.~, (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... .¢.. ,r,:'~./.~>~..~..:.....~. ¢~E~a. c .2:..¢..~, .......................................................................................... Name of owner of premises ........ ~./.~.,,¢~.¢¢,,~. ....... .~....~.!.~.X~.* ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ...~.~ .~....~...~......~...(~...~...~.....~..~.....~....'~.~......~..~..~. ....... .~./0..~.:...~-~../.~....~.~.~..' .~..~.~..~i....~....~..: · nic'pality 2. 5tote existing use and occupancy of pnerdises and intended u~e and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. intended use and occupancy ........... -~..~...~../..~.'~..-~.'..~.' ........ 4~...(?.~.¢.¢~ .................................................................. property lines. Give street and block numbers or description according to deed, whether interior or corner lot. 3. Nature of work (check which applicable): New Building ....... ../.........Addition .................... Alteration .'~.: ...... i ......... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ............... ~. .... 4. Estimated Cost.....~...~-~'i~,.~..~..t..~ ............................ Fee ........ '..4~...~..r...~ ............................................................... (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 ........................... : ................................................................................................................ 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 ............................ 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 construct,on: Front.......~...~ ............ Rear ...... ,,~-~..~...~ ......... Depth ...~:..~...~ .............. Height ....../.~....~. ............ Number of Stories ......... ..~.. ............... 9. Size of lot: Front ..../..~...~'...~ ......... Rear ..... ,~..~..../. ....... Depth ......~....~..I~....~ .......... 10. Date of Purchase .....~..~/'~.*...,~/.../..~..~..~'. ........... Name of Former Owner ..... .~...,..../~....~:...~,.'./~...~...,~...~. .................. 11. Zone or use district in which premises are situated ....... ~/..,....j~.~..,,~.]..~,,~.,6d.~',~.~.s.....~T...,,~r.l~.[~.~'./, .~.~../~-~/-, 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~.....~.. ................................... 13. Name of Owner of premises...~./"~J~.~J.~....~.,~.~9..~J}Address ...F~.~:~/c./~4L,,.~....'.~......Phone NO....~..~..~14/~ ' '~- s ............................................ Phone NO ............. Name of Archaect ........................................................ Addre s Name of Confractor .................................................... ~,aoress .O/.~l~l~..../'..~/~/~lO.v.~,.4.4~,~qone NO. PLOT DIAGRAM Locate cleorly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from and show street names and indicate STATE OF NE~7/Y(~J,JRJ~ ) S S COUNTY OE/~.4.~:'.~tf;:JYtC.'t .......... ) ' / ., I~.,-'~ ' . . .... .'...-~..~.,J~.~.,q....../...~.,t..~...~.~.;J. ,~...J).,./. ....................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ~/~/' ~' ~/'Y~"~'~/~ ~ ~/~ ' (Contractor, agent, corlSorate 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 ali statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed Jn the manner set forth in the apglicatlon filed therewith. Sworn to before me this /n, .~.~..~ /~.,,z~.~._ ,~,~//_ __ ____//~"~ ....... ~,. day ~f,~ ........... 19.....__. '~/ ~J~Fgnature~'o!'"apphcant} Notary Pub ~'~'~~...~....' ............ County ~'/ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No. ~ ~:~ (~ Disapproved a/c ..~.?.c.....%~. .......?..~.~.~ ~.~.......?.~:~.~..~ ................. ..... ......... ................. .......... ............... ......... i'~uilding i ' ;Zfor> .............................. Application ............ APPLICATION FOR BUILDING PEEMIT Date ....... .~........~.....~. ..................... 19...'~.(. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 location. 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 progress of the work. e. No building shall be occupied or used in whole or in port 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ............. ure of applicant, or name, if a corporaHon) ................ (Address of applicant) State wheth.er a~plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..................................................................................................................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number .~..~.......~.......~.....~....~.~.....?...~..F.~..~..~..~...~....~..~.~.......~..~.~....~.....x:~........./~...x:4 ......... ~...~. D / /v~nicipality 2. State existing use and occupancy of pr. emises 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 .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Fstimoted Cost ..... ~ .................................... Fee ......... ; ............................................................................... (to be paid an filing this application) 5. If dwelling~ number of dwelling units .............................. [ ..Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................ 6. If business, commercial or mixed occuponcy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures~ if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front.. ~ 2~ Rear ~/'/' . Depth ~ o ~ Height / (~' Number of Stories / 9. Size of /of: Front ..../...~....?....~ .......... Rear .....~.~....o.....~..; .......... Depth ...,/,.,,~,,,~,,.,~, ........... 10. Date of Purchase .....~...~..~...,~.. ........ ..~'...~.. ...................... Name of Former Owner .....~..'....?~ ............................... 11. Zone or use district in which premises are situated ...... '~.~....~....~.....~..~':~.....'....: ................................................. 12. Does proposed construction violate,~ -, ,any zoning law, ordinance or regulation?'~__ z'¢,,~,~(~,"/~'""O' .................................... N 0.~..~.~.T. ~'~, z. ~.,.. Neme of Architect ........................................................ Address ............................................ Phone NO ..................... Name of ..................... PLOT DIAGRAM Locate cleorly ond distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block numbers or description occording to deed, ond show street names ond indicote whether interior or corner lot. STATE OF NEW~-YO~ ) S S COUNTY OF .,~~.,..,) ' ~ ~ ~'c~ ~ ben du sworn de oses and says that ~e s the app cant .......................................... (.~ ...................... ;..; ....................... g Y P (Name of individual signing application) above named. 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 statemente contained in this application ore 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 ~ ~ ................... Z.. dw of ......... -- ................ 9..ZZ .... (Signature of applicant) Notaw Public, . ........................................................... County