The URL can be used to link to this page

Home My WebLink About2038-zFOR~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .SO~[.~h..l',~O ............................................ Street Map No ..... ~ .......... Block No ......~ ......... Lot No..~X,~ ...........[~l.~t,...~.~.~ ..................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................................... Ap~:[.].....2~....., t9-63, pursuant to which Building Permit No..~.....~...0..~.~. dated ........................... ~.:[.~,.....2~. ....... , 19...63, was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ............. ~-~iv~te...o~e...t:az~ilT....~w~llin~ .................................................................................... The certificate is issued to(~.eo.o...&..Ru.Ck.Zwe~J, gez ................. .~.~.e.~.e. ................................... (owner, lessee or tenant) of the aforesaid building. H.D.A~p~oval Sept 17, 1963 by R. Villa ................ : ": .......... ~".,ctor ~ ...................... 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.o 2038 Z Dote ................. ~]JF.~I,~ ....... ~,~, ................ 19..6,~. Permission is hereby granted to: Q-n~,kex~...R.tdg.e.. ]~cLld.er ~, ....... AZ.C..... lttto;r.g.e......~waJultgez' to .~!;I...id...new..~r~..£,ult~...dwe-l'l lt~g .................................................................................... at premises located at ..... .~el,t..~.]rl...~l~]...(G,~,[,,.) ...................................................................... ........................................................... ~,a at .. 14a/,.t~,...ll...~T, ............................................................. pursuant to application dated ................................ .~,jl~[~....~. .......... 19.6,~.., and approved by the Building Inspector Fee $. ?10~,.0~ ......... Building Inspector ( TOWN OF $OUTHOLD , Building Department Town Clerks Office 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 Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, end 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), Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey.of property showing a{I property lines, streets, buildings end 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 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 D~te ...~{~... ~,....]~ ~.~.~ ................ New Building ..~...~..~..Z.. Addition ................ Old or Pre-existing Building ..~.. ..... Vacant Land .............. Location Of Property ..... ..~..e...~.....a..~..~...e3..~.~,~.,~,,,,,~,,~1~. ................................................................................. Owner Or ~ners Of Property .~.~.~...~.~...~.~..~.~..~Wg.~.~g~ ................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant ~.~..~..q~P.]~..~.~..~:.~.~,~ ............................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate .............. ~ ......................... Fee Submitted $ ....... P.t~,L¥.....,C.....,..=-~ ..... Construction on above described building and permit meets all applicable codes end regulations. Applicant ......................................................................................................... Rudolph Sworn to before me this ..... ...3~..~. day of ..,~.a.~.,,....~..g..7.~. ................... Notary Public o~;~Q~ .................. County (stamp or seal) C · 0 TOWN OF $OUTHOLD BUILDING DEPARTMENT Tow. ¢,.ER.'S O,,,CE $OUTHOLD, N. '. Examined ............ ....~.....~...~...~.~.., , ~.~...~.... Approved .......... ~...%~....~....., 19~....~.~..Permit No.....~.~..~....-~......~...... Disapproved a/c ............. u_._,..,~;; .................................................................. Application No ............................. (Building inspector) APPLICATION FOR BUILDING PERMIT Date ......... ?;......~:.. ............ , 19..~....3.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate 1'o the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adioining 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 applica- tion. 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 th& work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MA~DE 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordinances and regulations. ....... (Signature of applicant, or name, if a corporation) ....... ..................... (Addfc~ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, p~umber or builder. ............... ........ .C... ............................................................................................. Nome of owner of premises ...~....~. ~ .~...,~...e=.....~...Z~...~'../..-.J.....,Z.....~...~...,'~...Z..L.'.~...~......~... ............................................. 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.: y~ (/x~, Lot No.: .....~./. ............ Street and Number ....S..m.....~...~....A:./......~....~.../?...e~... ............. '.~..'~.../.~...~...T...,,.,~, .'~....~...~.!...°..'.,~/. ..................................... Municipality 2. State existing use and occupancy of premfses and intended use and occupancy of proposed construction. a. Existing use and occupancy ................................................................................................................................ b. Intended use and occupancy . .~..,~..~...~. .....I~-zz.C~.A.~.z..~I ............................................................ 3~, Nature of work (check which applicable): New Building ...... , .............. Addition .................. Alteration .................. Repair .................. P-~rngv~ .................. Demolition .................. Other Work (Describe) .................. 4. ~.Estimated Cost .............................................................. Fee ...... ~...u. .............................................................................. (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 ................................ Height /~F Number of Stories ............. 9. Size of lot: Front ....v~.~. ................ Rear ........ Z.~.....~ ............ Depth .:~.~..~...~ ...... 10. Dote of Purchase ...................................................... Nam~ at rorme uwner ..................... : ..................... Zo.e o, dist,ict which it..t d ......... .5 ........... ................................................................. 12. Does proposed construction viol.ate any zoning law, ordinance or regulation? ............... v~,~.~..~,.~ .................... ]3. ~m~ o~ ~w~r or pF~ml~S .../~,....~,.~ .................. ~.,., ~oor~s5 Nome o~ Architect ........ ~.(../.~..~: ......................... ~ddress .......................... .~. ................... Phone No ........~Z ........ Name o. -- ac .................................................. Address ........... '~'77~';~'~'~"w~ .......... ~ ~ c~ Phone PLOT DIAGRAM Loc~¢e clearly and distinctly aH buildings, whether existing or proposed, and indicate all set-back dimensions from property li~es. Give street and block numbers or description .according to deed, and show street names and indicate whether interior or corner lot. ~tzTM ~ 73 (Name or indigidual signing app ication) duly sworn, deposes and says that he is the applicant above named. He is the .......... .~.z..~..~;?7~.~.>.?.c..,~.~.vc ..................................................................................................... (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 al/ statements contained in this application are true to the best of his knowledge an~ belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... ~..:..~. ~.~ o~da of ................... ~' ~j T ~ ' "~ ....... ~ . ' .................................... Notary Public;~,:~,~..$