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Home My WebLink About1324-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLDl, Iq. Y. CERTIFICATE OF OCCUPANCY No ........~..~.~J.~ ...... Date ..................... ~&~'.y..26. .......... , 19..62_ THIS CERTIFIES that the building located at ..I~./.~.,~,~..~,~i~=...~,~I,~uC~, ........ Street Map No.*~.~ ................ Block No....~. ............ Lot No ................... ~ ...................... , .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~.¢~J~...-~. ................................. 19...~.~. pursuant to which Building Permit No. ~...~,11.~.4.. dated ..~t/~l,~'~,t'L.],5 .............................. , 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 .......... z ............. .... This certificate is issued to . ~..~.~.~..~.....~...~.~..h~.L..~..~..~.~..~... (owner, lessee or tenant) of the aforesaid building. ..... "~'B'uilding Inspector J 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? 1324' Z ,~, ~E /5'~ ~ Date ............. ~ .~;.~....;.:.:...~. ........ 19.~...~... Permission is hereby granted to: .... ............ ............ ~..~.:~.~:,../.~ ......... .0... ............ pursuant to application dated ..................... ~/:t.~...q:.~. ,...(.~. ......... 19.~....t'.., and approved by the Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Southoid, N.Y. 11971 APPLiCATiON FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of properW 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion 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 /~ Date .. ,4~.~.~ .~.~I, .~.~8.~ ......... New Building .~ ........... ~)1~ or Pre-existina Buildina · .~9~'9 ..... Vacant Land ............. Location of Property .~?(}(} .~,~Jq .]~9a,8, ................. Z~, .u-To.],, .~ ....................... House No, Street Hamlet Owner or Owners of Property County Tax Map No. 1000 Section . .~.-.?:.6:2,: ..... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.3-0..~].. '~~, ..... Date of Permit .b,%..~.8, .0 .... Applicant ... ,~TS~.c.J,.s. ..~, .~.~.2h.~r ............... 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,~pj~rrfiT~-~ets ~ odes and regulations. FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ........ ~.~ .../..~...~...~.../.. Approved ............. ~...../.,'-~...~ 19...~.../.. Per m it .. No .... .... Disapproved a/c ......... ~,,-.... ~-~..... ....... .......................................................... (Building Inspector) Application No ..... ./.~...~..., ,~. ....... APPLICATION FOR BUILDING PERMIT Date ............... ~, ~.....~....,.,f.,, .~...."..,. 19.(~l ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted Jn 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 Department for the issuanoe 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, os herein described. The applicant agrees to comply with oil applicable laws, ordinances and regulations. ...... ...................................... (Signature of applicant, or na~e, if a corporation) ........ ................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .~...~......~.. ........................... Lot No'~N~.. ............... Street and Number ...~../...;~..;...,~'-~.~....../...~.....~'.....~.......-....~.~., ....................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.....~.· .~. .w. .................................................................... b. Intended use and occupancy ..........................................................'*' '1 ...~../......~.....~..~' ................................ 3. Nature of work (check which applicable): New Building .................... Addition . .......... ,~.........AIteration .................... Repair ............ ~......Removat .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost..~J...0...0.....~... ........................................ Fee ......_.~.....i ............................................................................... (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 ..~...i~ ................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front.~...~./......./...O. ....... Rear ...~,,~../.......~...(,) ..... Depth/...~./.......~....~.. Height ............................ Number of Stories ..~ ..... 9. Size of lot: Front ../. ......................... Rear ............................ Depth ............................ lO. Date of Purchose ...... Nome of..~:ormer Owner ............................................ ] 1. Zone or use district 'n wh'ch premises ore situated .... ~ .................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ....~...~'....~. ........................................ 13. Name of Owner of premises..~....~c....~.Address ............................................ Phone NO ..................... Name of Architect ............................. fL ........................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~/~Y(JI~IK, oJp ) S S COUNTY OF .~~..) ' (Name of individual signing application) obove named. He is the ............ ~..~......~~.: ............................................................................ (Contractor, agent, corl~orate 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 ~.,st of his know~edge an~l~;belief; and that the work will be performed in the manner set forth in theapplication~Nl~d)herew~j~. Sworn to before me this JUDITH T.B3KEN---- --0 f/ tar Public, State o[ New York .......................... y~¥ ..... ~..~...-/~... Cb'~'rh*~ Ix,ires March 3Or~"[ff(e~'''~ Notary Public, ..~ZZ~...~'...:...~.~nty ~o~ oo0 %4.. M~TTI T,..15K