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Home My WebLink About2923-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTJv[ENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY - . .... Beach Place THfS CERTIFIES that the building located at ..~.~.F~ L'2~e.~ ~rtf~ ~.. ~.~.$~.e....~ ....... Street Map No ........XY~[. ....... Block No ......... Y~. ......Lot No ........G:P.~e~t~D.~..t,.~..,,~.~ .......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................................ NO.V.,,,,,,8. ......... , 19.6~... pursuant to which Building Permit No....'~'~".~.~.....~ dated ................................ ~.~.I/'.,.~..~. ......... , 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 ........ ...... ........................................................................................... The certificate is issued to ..~t~.~f~....C.[~.~¢.~. ...................... ~.e.~.. ................................................. (owner, lessee or tenant) of the aforesaid building. FOP~M 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? 2923 z Date .............................. llo~.embe~.....~..., 196.~... Permission is hereby granted to: .1'o se. ~.~..,~ Sa. ~...... Ag..~.....,[~e~.t,e~....qlezke ............. ............. flreenp~.t, ............................................ to ....B...u..l...1.d....1;.e,.l~.....one..~amLl.~'...d~lZ~.z~ ................................................................................. at premises located at ..I~/~.....]~I~..RO41~ ....................................................................................... ................................................. ~.e..e..~..o.~.~ ........................................................................................... pursuant to application dated ...................... ~.O.?.........~. ...................... 19.6~..., and approved by the Building Inspector Fee $..~..0..:....0~.. ........... TOWN OP SOUTHOLD Town Clerks Office Southeld, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Inst~uctlons 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), Non-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 formation required to prepare o certificate. C. Fees: 1. Certificate of occupancy $5.00 ~te of occupanCy~ dwelling or land use $5.00 ~ Copy of certificate of occupancy $1.~ Property---- .................................... Location Of Owner Or Owners Of Property ............,~/~?'~Z.......-c'.'~.~.f ...................... ~/..~...~..~.(q.~../.- .~..~. ....... ~ .......................................................... / . Health Dept. Approval ..... : ...................................... Labor DeJ~t, Approval .............. ~ .................... Underwriters Approval ...;z .......~ .............................. Planning Board Approval ~ Request For Temporary Certificate ........................................ Final Certificate .....~ ..................... / Fee Submitted $ ..~. ................................ Construction on above described building and permit meets all applicable codes and regulations. Applicant ................ . .~... ~/~ ~../...,~...~---- .................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County FOI~M NO. I TGWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OI:FIGE Examined 19...!.. Approved 19 ........ Permit No. ~..;.~' .~.~.'.~...~. Disapproved a/c ................................. :.~. .............. -:;./.'(,~ ......... ,:~:::..~r. ...... Application No. ¢z~' (; '~ ~ APPLICATION FOR BUILDING PERMIT Date ................................. N~ emT~.e.~....8 ....19...6~' ..... 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 ad olning premises or public streets or areas, and giving a detai ed description of ayout of property must be drawn on the diagram which is part of thi~ application. 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 Lows, Ordin.ances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant egrees to comply with all applicable laws, ordinances, building code .and regulations. (Signature of applicant, or name, if a corporation) .................... G~'..o. e,~ ~ .-i;, ....................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. C ~n.tr. a~.. ~;~ .......................................................................................................................................... Name of owner of premises ....Tc¢.,.,.t..~.z:...d;Le~zke ....................................................... 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 ~./.P ~.~c;h..Pla.c.e.~....(.s.a.~dy..]~.e.s.c]cl.) ~r~z~T).o.~..~ .............. Municipality 2. State existing use and occupancy of premises and intended use end occupancy of proposed construction: a. Existing use end occupancy ....... .~.fC.g.~]g...~. ~d .......................................................................... b. Intended use and occupancy ........ .o..~..~....~..~..~...~..~!_,~.....~..~..~?~.~.~...~ ........................................................................... 3. NatL~re of work (check which applicable): New Building ...... )'~:X~ Addition .................. Alteration .............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... (to be paid on filing this application) 5. Jf dwelling, number of dwelling units ........ ~1~.~. ..........Number of dwelling units on each floor ........................ If g~rage, number of cars ........... ~ .................................................................................................................... 6. If I~usiness, 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 a.lterations or additions: Front .................................... Rear ........................ Depth ................................Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~'f ..................... Rear ...~,~1, ..................Depth ..... ,~ ......... Height .................... Number of Stories ......... ~.. ............................................................................................... 10. Dat~ of Purchase ........................................................Name of Former Owner .................................................... I 1. Zone or use district in which premises are situated .......... /~.....1~.~.~ .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............... ~ ................................. 13. Name of Owner of premises ...~-A~.~.~'.~.~J.~...~..~J~....Address ............................................ Phone No ................. NerVe of Architect ......................................................Address ............................................ Phone No ................. Nar~e of Contractor ....~t....,J)$~JJjD., ........................... Address ..... C-z'.,2. e~pg~.~ ..................Phone No ................. PLOT DIAGRAM L.ocet~ clearly and distinctly all buildir~s, wh~er existing or proposed, and indicate all set-back dimensions fn property lines. Give street and block num~ter or/~d~scription according to deed, and show street names and indic( whether interior or corner lot. \ .~x \ STATE OF, NEW YORK, } c c ................. ~. .............. ~c)8.o~..]~:J:.~ ...................................... being duly sworn, deposes and says that he is the applic. l(Name of individual signing application) abow~ nar~ed. He is the ................. .C~o~;~'.~,e.¢o~ ........................................................................................................... (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 this oppliaation; that all statements contained in this application are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. Sworn to ~efore me this Notary ~' (Signature of appli ,)'emi Exp,res Marc.., ~-~