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Home My WebLink About3881-zFORM NO. 4 TOWN OF SOUTHOLD BUII.IHNG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~.~).6. ...... Date ............. .~.~ ....3 ...... , 19..?~ THIS CERTIFIES that the building located at ~O~ll~..I~O~ ............... Street Map No .... ~ ...... Block No..~1:~ ....... Lot No~...~esap. q~l;...~.,~.o .......... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............. lialr...t~., 19.6]~. pursuant to which Building Permit NO. dated ....... .N~.~....1.~. ....... , 19..~.~., was issued, and conforms to all of the require- ments of the applicable provisions of the ]aw. The occupancy for which this certificate is issued is . P~'J,v. a~;.e..Q.~..f.a~-.]3.'. ~.~ ~. g..~.i.~h..~dqll.t.~,ola ...................... The certificate is issued to .J..o.hlq .&.. ~.cl~ .2ACI'.~.a$9 ..... ~.~.a .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N. :.E.,. ............................... UNDERWRITERS CERTIFICATE No..p~nd, l~g ................................... HOUSE NUMBER .... 2B. ....... Street .... //Om~Cl .RO~A .......................... Building Inspector / 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) 3881 Z Permission is hereby granted to: ............. .~..&. F,d,,d.na.. ~h:eeae~ ............... at premises located at ...~.QI~I~..~I~X~d. ................................................................................................ .............................................. .e.l~.ea~.o;t~..... ~..~:, .............................................................................. pursuon~t to application dated ........................... ..~.~. ......... .~..~' ........... , 19..~,~.., and approved by the Building Inspector. Fee $..~.,..(X). ............ FO~M NO. 6 TOWN OF SOUTHOLD 0 Building Dopo,tmont 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, and unusual natural or topogrophJc features. 2. Final approval of Health Dept. of water supply and sewerage dlsposol--(S-9 form or equol). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installatlons, 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-existiog" 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 o certificate. C.' Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existiog dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ~......~...~ ...~....~....~-~ New Building ................ Addition ................ Old or Pre-existing Building ................ Ya¢ont Land .............. Location Of Property ....................... ~....~...~...o. ..~...~. ............. C7" i~/ × ................................. ~ ./.....~....~. ...... ..~/.~...~....~. .................. 7~ Owner Or Owners Of Property ....... x~. ...... ~. .................... : ..~.....~. ......... .~...~......~......~ ..... Subdivision ................................................................ Lot No ............. Block No ............. House No...,,~,,.,...~. Permit No. ~,~.~..~.../....~... Date Of Permit~.~/..~...?..Applicont ..... "..~..~......?..~/..'~.... ............. Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......../~.. ..................... '.. Fee Submitted $ ..... ..~..%...O....0.. ............... Construction above on described building and perrr~' meets all oppLical~e codes and regulations. Sworn to before me this of ........... Notary Public ..... ~.....~..~....~.. ..... County APPLICATION FOR BUILDING PERMIT Date ................................ . INSTRUCTIONS 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 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 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 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations. (S'gnature~of applicant, or n~me, if a corporation) ............ (Address of applicant) // u 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. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number ....~.Z .......... ~.~..U.()...~. ......... .~2 ............................. ~...I?...~;....~...~l~?.9...IZ.7,.......~..T. ......................... MunidJpality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .J. ....... ./..~4t'J. ,: ./. y ................ ~.k~..~,. ~J.lJ 4~.. ~. .......................................................... b. Intended use and occupancy ..... s~..,J).~.~. ......... '.~..~.,].~..T.I~.~ ...... ,~.Z~....l ........ ~../...J~...~...~t~..'~... .............................. 3. Nature of work (check which applicable): New Building .................. Addition ~ Alteration Repair ............... .~ Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ......~..Z~...d. ....................................... Fee .......................................................................................... (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 construction: Front .......... ..~....~. .................. Rear ............................ Depth ...~,...c~.. ............ Height .................... Number of Stories ...........~.~..C...~..~...~.....~'. ................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ N~me of Former Owner ........................................................ 11. Zone or use district in which premises are situated ....... .~/~.'.'......D..r...~..~.. ..................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... .../~'...O. ............................................. J c~ ~: ~'~'~Z~6 A"r ......~....~.?...~...~.~..?.~..~. .............. Phone No ..................... 13. Name of Owner of premises ........................................ aa ess Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................... ..~...~...~...~... ........... Address ............................................ Phone No ..................... PlOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF Nb-Wc-Y~R[~,~, Dx 1S S ............................... .~/.Z..~~.....°~...~4'~,,-z'being duly sworn, deposes and says that he is the applicant (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 statements contained in this app!ication 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 ~'~,,~ x~ -- ,. ...... ....... ................... .............................. Notary Publ ic~ .~...r../.~.....~...-... / ..~..~ ..........County No. 52-3233120 Suffolk Cau,, Term ~pires March 30, 1~