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Home My WebLink About4227-zNO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....~...3...~.~.~. .......... Date ...................... ...1~..~. ......... .~.~. ............ , 19.1~.~... THIS CERTIFIES that the building located at ~.~...J~.Q~I. II~tI..A~t~I. le ........................ Street Map No ....................... Block No ....................... Lot No ..... l~.Ol3.~,h~.],~,...~l...~Q~ ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................. .~...~..~...~..~. ................. .~...0.~ ............ , 19..~...~... pursuant to which Building Permit No. dated ....... &P.~..$.~,. ................... .~., ........... , 19...~.~., was issued, and conforms to all of the requirements of the appficable provisions of the law. The occupancy for which this certificate is issued is ........ ..... p.~.e....~.~.e....~.~,~...,~ellJ,~. ......................................................................................... The certificate is issued to .....%,f~.,....~..J~l.,...~.,...~.~le%'. ........................................................ (owner, lessee or tenant) of the aforesaid building. Building In~'6ctor aouee, FOl~'~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 4227 Z Permission is hereby granted to: ...... C}nld.sm.it;h. ...................... ~o.u.~hold ...................................... Bui d ~d ~ddition on ~ existing d~ellin~ .... :...~.~.~ ......... E/~.....~i~u.~e .............. ~.ou~l ................................................... at premises located at ............................................................................................................................ pursucn,t to application dated ........................... ~ .......... 20 ......, 19...~, and approv~ by the Building Inspector. Fee $....5.0~ .......... Building inspector I FORM NO, 6 ToWN OF SOUTHOLD I~ilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERlrlFICATE OF OCCUPANCY Instructiom A. This application must be fliiad in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final .,.trey of property with accurate lo.sion of all buildings, property lines, streets, and unu~,al natural or topographic feamre~. . 2, Final approval of Health Oept. or water supply and sewerage disposel-(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 instella* tions, a certificate of Code compliance from the Architect or Engineer m~ponsible 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 peoperty showing all property lines, streets, buildings and unusual natural or toppgraphic features. 2.Sworn statanlant of owner or previous owner as to use. occupancv and condition of building~ 3. Date of anv 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. Certific_a_te ... .n on re-existin~ / land use --F~,e-Existing C.O. $15.00 VacanC 19nd/C.O. $ 5.00 Date ... ~./.~ .?.~ .......... New Building ...---~ ....... Old or Pr~xisting Building ............ V~ant Land ............. .... ...................... Ham/er , ............... C~nW T~ Map NO. 1~ Section ..... ~... Block ....... .~. ....'. Lot ............. ~ivision ....................... Filed Map No .......... Lot No .............. .......... .............. Heal~ D~t. ~pr~al ........................ Labor Dept. A~roval ........................ U~e~rim~ Appr~al ........................ Planning Board ~proval ...................... R~ue~ for T~m~ ~nificam ,' .................... Final ~nif~m. ~ .................. · · ~{ ........... Con~ction on a~e de~ri~ ~ilding and ~it~eets all agplicabl9 c~e%a~ re~lation~ ~ ~ ~, 1/~ J.~~ ~ ...... ~ ~q ~ Applgant. / ~ .~ .~.: .... ~ ~" ~' ~ ;'~ '7 .......... ~g ~ / ~ ~ / Re. 10-l~78 TOWI~ OF $OUTHOLD BUILDING DEFARTMENT TOWN C~ERK'$ OFFICE SOUT~-IOLD. N. Y. Examined Appr,ovecl .............. ~ '~ ...... 19 .... Permit No...Z./.-.2...~..'Y....Z::~..... Disapproved a/e ....... ............... (Bull,ding Inspe~ctcyr) Application No...~...~. ~..~ ...... APPLICAT!O;~q FOR BUILDING Date INSTRUCTION.S 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 l!~t and o,f buildings o n premises, relati, o.n.ship to ~dj~oining p~emises .or public streets ~C~T areas, .and giving a detaile~d description of Iayout 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 issu.ance of Building Permit. .d. Upon approval of this applicati,~n, the Building In spec~or svill issue a Building Permit to the applicant. Such permit shall be kept ~o,n the premises available for inspectio~n througho,ut the progress ,of the work. e. No building shall be occupied or used in whole e~ in part f~o~ any purpose w.hatever until a Certificate Occupancy shall have been granted by the Building InspectOr. APPLICATION IS I4_~E~3Y MAI)E to the Building Department for the issuance of a Bull, ding Permit pursuant t~o the Building Zone O~dinance of the ~own of S.$,athold., Suffolk C~o~nty, New Y,~rk, and other applicable Laws, O~dinances ,or Regulations, for the construction ~f build ings, additions or alterations, ,ch' for removal or demo-. litton, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building co,de, h,~using code, an, d regulations. (Signatu.re ,of applicant, o~ name if a c,orp,o=ation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .... .~..0. ?.) '.V..~.~.~.C.'.Y..O..~. ........................................................................... Name .of ,owner of premises ...... .~..?.~..~....Y~..~.~ .... .-~..,....L~..V.~.~..~.~..~. ~ ................................ If applicant is a carp,orate, signature of ~ duly auth,orize d <ffficer. ....... ........ (Name and title of corporate officer) 1. Location ~of lan,d o,n ~vhich preypo.sed ~vork will be done. Map No ................. Lot No .............. Street and Number ................................................ ~:n'i~i~'~{~; .................... 2. .State existing use and .occupancy ~o~ premises and intended use and .occupancy of proposed construction. a. E'xisting use and occupancy .................................................................... b. Intended u.se .an,d ,o.ccupancy ................................................................... 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Othe~ Work (Describe) ...................... 4. i~.stimated Co.st ................................. Fee ...~.. ...................................... (to be paid ~n filing this application) 5. If ,dwelling, number ,of dwelling units . ..~.... Number of dwelling units .on each floor .............. If garage, number .of ears .......................................................................... 6. If business, eo,mmereial .~r mixed occupancy, specify nature and extent of each type of use .... · ' , 7. Dimensions of existing structures, if any: Front . . ~ff~ ....... Rear . ~1~. ....... Depth Height .. ~-,~.~ ......... Number of Stories . ~ ................................................... Dimensions .of same structure with alterations .or additions: Front . ..~,~..~.~. ..... Rear ...~..a~. ....... Depth ..... ~/.../~T.... Height .... .~../~. .... Number of St~aries .... ~ ............ 8. Dimensions ,of entire new construction: Front ................. Rear .............. Depth ............ Height ............ Number ,~f S~aries ............................................................. 9. Size of l, ot: Front .... L.2~....qW.... Rear . .. 1.~. ~.nt? .... Depth . .~.e2.0...~. .... 10. Date of Purch.ase ............................... Name (~f Former Owner ............................. 11. Zone ,ar use district in which premises are situated .................................................... 12. iDoes proposed construction vi.elate any z~vning law, .ordinance or regulatkm? ...... /k(.c}.: ................ 13. Name of Owner.of premises ~.,41~ ,~. ll)~{~l~F--A, ddress ~C)k)l~[.~O~ .,.~J.C/. .... Phone No ............ iName of Architect ............................. A'ddress ...................... Phone No ............ Name .of Contractor ~:} .~ ,~t~,1~14... ~ .... Address ~1).~ ~.. ~.,..~.~.11.~. Ph.ane No. ~...~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ,or 'proposed, and indicate 'all set-back dimensi,ons from p~o,perty lines. Give street and block number ,~r description according to deed, and sh~)w street names and indicate whether interior ,or corner 1.et. STA~[~ OF NEW YORtf, )S.S'. COUNTY OF .............. ) .../?~t~.,¢.~.D ..... ~.~.4~/&z~.t.4~.~:/. ................... being duly sworn, ,deposes and says that he is the appli- (Name ,of in.dividual signing application) . ~ cant above named. He is the ....(?~,*r?~2.: .... O.'././tC&/~ ................................................ (Oontractor, agent, oarp.arate officer, etc.) of said owner ~ar ~owners, and is duly auth,arized ~o perform or have performed the said w~k and ~o make and file this application; that all statements contained in this applieati~on are true to the best of his k~owledge and belief; .and that the m~rk will be performed in the mann er set forth~ in the applicatio~ filed therewith. Sworn to before mo this N,r~tary Public .... ~/~ ...... County '" (Signture of applicant) LIZAB£TH ANN NEVILL~ NOTARY PUBLIC, State of New York No. 52-8125850, S~flolk Coumtv J~rm Expires Merch 30, 19