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Home My WebLink About3713-zF~t~M NO. 4 TOWhi OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, hi. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..$.~..~....g~.~..~...~..~...~..~..~.....~...~.?....[.~..~..~..~.. ............... Street Map No.....~ ........... Block No. ~ ............... Lot N~ .............. ..~..~...~..t..}.J..O...~..~.......~..:..~..:. ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................................. NQ~'......~..., I0..~8. pursuant to which Building Permit No. 3.~..1.3~ .... dated ..................... .~O.V. .......... 20. ........... , 19.,.~8, was issued, and conforms to all of the requirements of the app][icable provisions of the law. The occupancy for which this certificate is issued is ........ ......... Pr.i.~.Ca..~e... f~.t~m~l;;...d.~.e]].iz~ ...................................................................................... The certificate is issued to ....~*.~g.~...~.~.~.f~ .................... (,.{~t,~),~. .................................................. (owner, lessee or tenant) of the aforesaid building. Health gept approval 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? 3713 Z Perm ssion is hereby grouted to: to .~.~..~e~..or, e...~a~,.l~...~'1~ ................................................................... ~ ............... at premises located at ..~...~.~....,l~;~.~..~....... .......... i .......................... ........................... .......................... ~t~e~e~..&ve ......... ~t~.~*.*~.~-~ ........................................................... pursuon¢ to oppl!¢~ation doted .......................... ~0~ ......... ~ ............ , 19...~', and approved by the Building inspector. Fee $..,;J,O*O0. ........ e FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor with the following; for new buildings or new use: 1. Final ;urvev of property with accurate location of all buildings, property lines, streets, and unusual naturel 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, Industr al bu Idings, Multiple Residences and similar buildings and In?,talla- tions, a certificate of Code compliance from the Architect or Engineer responsib e for the bu lding. 5. Submit Planning Board approval of completed site plan requirement; where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "preexisting" land uses: 1. Accurate survey of peoperty showing all property lines, street;, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Data of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Cert f cate of occupancy $5.00 / 2. Certificate of. ..occupancy on pre-existing dwelling / land use -- ?re-gx ia t, ing C. 0. $1 §. 00 3. Copy of cert.flcate of occupancy $1.00 Vac=nt,/a~and C.O. $ 5.00_ N~t Building .../..'~. · '... Old or pre-existing Buildin§ ............ Yamnt [.and ........ 1DOOS cfi '.~.0 ~.. ' ~ Ceu ty T Map ............. n ax No. e on .......... Block ............ Lot... Subdivision ................................ Filed Map No ........... Lot No .............. Permit No .......... Date of Permit .......... Applicant ./..c~-~/7. · ?. ·. ·: ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval......... · ...-. · ........Planning Board Approval ...................... Request for T~mpore~ Certificate ..................... Final Certificate '~ .................... Fee Submitted $ ~' ~ ....... Construction on above described building anc~pgrmit meets all applic~l~ codes and regulations. Rev. 10-10~78 S-9 SUFFOLK COUNTY DEPARTMENT OF HE~LTN JUL - 2 1968 Date Bldg. Peri. it No. ~,/ ~ ~',,' , TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. JUL" 2 1968 Distiller Engineer District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exom ned .......... / Approved .................. ~..~ ................. , 19..!./.... Permit No. ~/ ~ Disapproved a/c .]~.~~...~.......~( / ~-~- ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~'~/ ~ ................... ./. .................................... , ,d..?. ..... 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 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 pram ses 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 issuance of a Building Permit pureuant 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 laws, ordinances,/~uilding code, ho~using~ode, and regulations. .......... : / ................................. ~gnat~ of ~pplicant, or ~ ~f a corpora.on) .... .:. . . . . . . . :. .:. .c. .: .{. . ,. ?. : ?. :(. . . : ................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,£ .................. .......................................................................................................................................................... Name of owner of premises .... ~ ..... .d...?. ........................................................................................ 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.: ...~C .............. Street and Number ...... ~.~.~L.~f.6~(:~..~.~.~/. ...... ~f.,~ ............................................................................ Munici~lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... .~.~..~ ............................................................................................................ b. Intended use and occupancy ~ ~....¢ ................................................................................................. 3. Nature of work (check which applicable): New Building .~( .............. Addition .................. Altera¢ion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... g/,..y .............................................. 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 . ~. A/~' ~ 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 ~? .............................................................. Depth ........................ Height ..,~..~'.. .......... Number of Stories ................ ~ ................................................................................................... 9. Size of lot: Front ...Z./..o; ................. Rear ...... /......~..d...~ ............... Depth ..... ~...°...O..:..~i~. ......... ~ 7 10. Date of Purchase ........ .¥.~...../~...~'.. ....................... Name of Former Owner .................................... 1 1. Zone or use district in which premises are situated 12. Does proposed construction violate any Zoning law, ordinance or regulation? ..... .../~..o..~.~: ........................................... 13. Name of Owner of premises,.~.~.~.~...~,,^.<~...~,, Phone No ..................... .o..¢.c:.....Add ress ...~.~...~ ~..~.cr.~..../.~'. .............. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~.~.~..~.Z~.~..~/~.,..~)/..$..~cz, ............ Address ...¢./.5(..~?.~.'.~...~..~.....~.g."..... Phone N~/Z. 2.T../...~..~...~.~.... 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ ................................................................................................. 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 application 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 ..... .~...¢0 ............ day__ ,~°f .~..~J3T~.~...'~..~ ............ , 19.(o.'..~.. ....... .~.;'R.~,~I....~..:.,¢~¢~...~...~ ................................ Notary Public, ..~~...~.%..~~County , (Signature of applicant) ~OTARY pLIBHC, State ~o. 52-3233120 Suffolk ]e~m Expires ~arcl~ 30,