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Home My WebLink About4753-zFOR~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCC[JPANCY THIS CERTIFIES that the building located at ........... {~e,.p~..[~.[~([...])2~ .............................. Street Mop No.C.~.~..t..,...~;[~BIock No ....................... Lot No.!4~.1..~ ......... ~.~,~;:[,t~,~.....~l'.p.,~.~ ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. ,~ ....... .'j.~ ............. , 19..~O. pursuant to which Building Permit No. ~..~.~; ..... dated ..................... J49,~ ....... '1~ ............... , 19...r/~), was issued, end conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ............ P. ~.i.va~e.. m'~e...i'a~ ~1¥....d~ 3L.1 ~[~ ........................ ............................................................ The certificate is issued to ..... ~[~h~].l~..}f.,...]~.~l~.t~lll$ .................... (~dl~el~. .................................... (owndr, lessee or tenant) of the aforesaid building. House ~1800 Building In~'~e~tor FOF~[ NO. 2 TOWN OF $OUTHOLD BUILDING DEFARTMENT' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER/VtlT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4753 Z Date ............ ........... ~ ............ ~ ........ , ~9...?,9. Permission is hereby gronted to: to at premises located at lot 133 ............................................ ~/~ ....... ap~;...~td fL ~.rl~ ......... ! ......................................................... ...................................................... ~att!t~e~ ........ ~..,~.~ ................................................................. pursuan¢ to application doted .................. ~,~* ............ ~.~[ ........... i..o.., 19.,.~.0., and approved by the Building Inspector. Fee $.~.~..*.~.. .............. .. ~,. :~-.~.xc.....-~. .................. 6 ....................+-'~ ................. -- Building Inspector / / FORM NO. 6 TOWN OF SOUTHOLD Buiiding Department Town Hall SouthoJd, N.Y. 1 i~71 APPLICATION FOR CERTIFICA?E OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and'submitted in duplicate to the Building lnspec- tor with the following; for new buildings or new use: , 1. Final survey of property with accurate location of ali"buildings, property lines, streets, and unusual natural or topographic features. 2. Fina~ approval of Heaith Dept. of water supply and sewerage dispdsal--(S.9 form or equal). 3. Approval of electrical installation from Board of Fire U'nderwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buflding~ and installa- tions, 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 appl cable. 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 lin'es, 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. Data of any housing code or safety inspection of buildings or premises, or other pertinent informa- lion required to prepare a certificate. / 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 New Building ............. Old or Pre-existing Su, ilding(:~,_. /~ ,- , , ' .... :~ ................ =..k.. , LOt / ~ / Perm t NO ~ .... ~ o= -+ Hea th Dept Approva ~ ' ' ......................... Labor Uept. Approval ........... ~ ........ Unde~riters Approval ............. . .......... Planning ~oard Approval .................. ..................... ....... - ...... Construct on ~n above described build ng and r~it me ts a a ' - ~.~(~, ~ . ~(~{() '~ e~ Pp~cabl~oCes and regulations. ~-- TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Date ......................... ~...~C~. 15-- INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und 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 an 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 sh~ll 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/V~DE to the Building Department for the issuance of a Building Permit pursuant to thew Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~. Regulat OhS, for the construction of buildings, additions or a terations or,for remova or demolition as herein described ~'~ The apphcant agrees to comply with all applicable laws, ordinan~:~eS~-'b,~ding code, housing code, ~nd regulatlo"ns. ' /; \/'~ IJ~ /"~' ~' (Signature cf a~)plicant, or name, if a corporation) V ' ..................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ............................................................................................................................................................... Name of owner of premises ~../.~.t~.. ~..~....././......J~...~...../~...~......~'.~....~.....~.. .................................................................... If applicant is a co~orate, signature of duly authorized officer. ~ (Name and title'of co~orate officer) land o Which rosed work will be done Ma No ~ /~ ~ ' 1~' ~ 1. L~ation of >~ P qP . P ,: ..m~z ............. ....... ~.: Lot No.: .~.~ ............ ~ / ' - Munici~ll~ ' ~ 2. State existing use and ~cu~ncy of premises and intended use and occupancy of prap~ construction: a. ~isti~ u~ and ~cupancy ~ ~ ~ ~ ~/~ a,a ....... ................................... 3. Nature of work (check which applicable): New Building ~ ................. Addition ..~. ...........Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...'-~.....~..~..~..~..o....-~.. ............................ Fee ~' ~ (to be paid on fi!lng this application) 5. If dwelllng, 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 ,~....~'......7-.. ....... Number of Stories ..... ./. .......................... / Dimensions of same structure with alterations or additions: Front .... . .~..~.. ....................... Rear ....~..~.. ................. ! Depth .....,~....O.. .................... Height ............................ Number of Stories ..... ./.. ....................... /' 8. Dimensions of entire new construction: Front ..... ~.. .......................... Rear .....?/.../...~ ............. Depth ........................ ,~, O ! Height ,Z'..~..../~....~.... Number of Stories ..... ./.. ......... 9. Size of lot: Front ..../...~....~..../. .......... Rear ./.43 O ' Depth ~.. 10. Date of Purchase ~..~...~4 ...... ./~...~./. ................ Name of Former Owne~.~?4~...~....~...,~..../~...~'...~, ................. ! 1. Zone or use district Jn which premises are situated ..................................................................................... 12. Does proposed construction violate any zoning aw, ordnance or regulation? .~...~....~ .... · , ~./ .., ........ 'J~/~'~' ~-~-// ~S~. .s'~. ........... ;y'j~j,;~ ................. i3. r~ame of Owner at premises/~K.:./..*/..,~....~:~..4~7..~....~.:_e~...Address,E'~,ZvJ.,~../,~E,~'~..~..~hon~o.~.~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of C~ntract~/.~..d.K/;...~...k~.....`~/~./d~..A..../-....~.[../.~....Address~i..~-../-~..x~....~./.~.....~?..~...//...c....~.~...././/.~!~Phone No.?.~...~...T..~../.~..7 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 N~O~,~i J~ ~ COUN~ OF ~~ ............ ~ ~ ~mame of individual signing a~plication) . a~ve named. He is the ......................... ~ ...................................... j~ ....................................................... (Contractor, agent, co~orate officer, ~c.) of said owner or owners, and is duly authorized to pe~orm or have performed the said work and to ~ke ~d 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 fo~h in the application filed therewith. Swam to ~fore me this ..... ...... .......... .................. . No. 52-8t25850. Suff0fk C0~ Term ~pires March 30, tg~