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Home My WebLink About5495-zTOWN OF ~ 80UTIIOLD BUILDING DEPARTM~qT Town Glezk's Oliee SouthoM, N. Y. Certificate Of Occupancy THIS CERTIFIES t~,t the building located at. B./$. ~.cp.o.t..%~.e. ......... Street Map No. x~ .........Block No..xx ....... Lot No. ~x.. 0~.%¢h~ue.. H,Y, .......... conforms substantially to the Application for B~ Permit heretofore ~ed in this office ments of the applicable provia~ns of the law. The oceu~ancy for which th~s cert~eate ~- ~sued ~ . Private..one. £amilM. dwelling..~ltk.an, a~dltion, &/~lY~e.' g~age The certificate is ~mue4 to .~.1.~.:1:.~..mi ~a..o.o~s. ..... . .Oj:~. ~ ............................ (owne~, levee or tenant) of the aforesaid butldin~. Suffolk County Deparlment of Health Approval .~ :.Pi.: .............................. UNDERWRITERS CERTIFICATE No..p.e.~...i-v-.g, ...................... : ........... HOUSE NUMBER ... %%~1 ....... Street. ilepo~. ~ane ............................. 1~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5495 Z Permission is hereby gronted to: ................ :~,,~:U~..~r~ ~.~. ............................. ....................... O~®~..~ ..................................... to ..~;L~ ..~..e,0,~ll~;~,e~...eG..e=[~,st~,=~,. ~hmll~...~~..~) ................. at premises located at ............... .~/.~..~e~.~,..~;~.~-~- .......................................................................... ......................................................... Cate~ ...... ~1~o ................................................................. pursuan¢ to application dated ............................ ~e~p~ ......... ~ .......... , 19...~$., and approved by the Building Inspector. Fee $ ................. ~ ,~uilding ~nspector ~ TOWN OF SOUTHOLD 74~,-~ ~'* ~ BUILDING DEPARTMENT~'Y~.~/~. /~,~ TOWN CLERK'S OFFICE ~ ~ . ~ . SOUTHOLD, N.Y. ~'~ ~ ~ ~<'~<"" ........................................ , 19 ........ Pemit No .................................. ........................................................................................................................- INSTRU~IO. ~ ~ ~ - o. Thi~ ~ppdcation must bo completely filled in b~ ~pewriter or in ink ond ~ubmitted in duplicat~ Inspector. ' b. Plot p~on showing location of lot and of buildings on premises, relationship to adjoining premises or public areas, and giving o detoil~ description of layout ofpr~e~ mu~ be drown on t~e diagram which is po~ of this a~[icat~. c. The work covered by this opplicoti~ may not be commenc~ before issuance of Building Permit. d. Upon approval of this application, the Buildin~ Inspector will issue o ~uilding Permit to t~ ~licant. shall be kept ~ the premises available for inspection throughout the progress of the work. e. No building shah be ~cupied or used in whole or in pa~ for any pu~ose whatever until o Certificate of shall hove been granted by the Buildipg Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to Budding Zone Ordmance of the Town of Southold, Suffolk County, New York, end other opplic-able LaWs', Ordinanc~ ~, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein clescrlbe& The applicant agrees to comply with' all applicable laws, ordinances, building code, housing code, and regulation& /~./~ -- ( 'g of app i{Lg~lt, dr.flame, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem sas ..... ~(~..i~..~.i../~ ...... .dr. J ~.~.....~.. ~.. ............................ If applicant is a corporate, signature of duly authorized officer. .................. iKi;;;;;;' ......... " ! L~at on of and on wh ch proposed work w be done Map No' ~'" Lot N Street and Number ...['~i.e..X......(..?..~..~....~..(..~...C-..-~....~.Z......~.'...~/Zd~....~..,.. C.~..~...C.~..~/~': ~(../ ......... -~..Q~}~/.~.., , ..~-~0/'-~ Muntcipality .... 2. State existing use 'and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy oJ 4~ . . ........................................................... b. Intended use and occupancy / 3. Nature of work (check which applicable): New Building .................. Addition .......... Alteration Repair ................... Removal .................. Demolition ............. ;.... Other Work (Describe) ........................................ 4. Estimated Cost .../...~...~ .................................... ~..".Fee .......................................................................................... (to be paid on filing this applicatiOn) 5. If dwelling, number of dWelling units ............................ Number of dwelling units an each floor ............................ if garage, number of cars ....... ~....(:.'.../~....../~....: ............................................................................................. ~ ................. 6. If business, commercial or mixed occupancy, speci~Ey_nature and extent of each type of use ..... ..'~.... .................. 7. Dimensions of existing structures, if any: Front ...... ..J~...~, ............. _Rear ......~.....~..-. ............... Depth ~..~.. Height ...c~..~...~ ........... Number of Stories ....,~:.....~.....~...~.~.../~.......~...~....~...~.....~.. ............................................................... Dimensions of same structure w th a terat ons or addit ons: Front~., ~ .O.. .................... Rear .../....~. .................... Depth ....~...~'....~ ................. ;. Height .,....~....~...~ .......... Number of Stories ...~........~..../-~.?...'~.~...~. ..... 8. D~mens OhS of ent re new construction' Front ..... L5- ............... Rear /.~- D~nth ~ Height ..../~... ......... Number of Stories ........... ~.....~..~......~;e,e,e,e,e,e,e,f~......,~'.. ........ : ............................................. ~)' C/C2 ' u '~ /LZ ' 9. Size of lot: Front ....... TZZ.. .............. Rear ....... /.../ ...................... Depth .....~::.......-L.......~ ......... ~ , 10. Date of Purchase .,..X~..~,...~....~.. ...................................... Na~,~of Former Owner .......~.../~.,:...(.~.~...~..~(:.~....T~... ............. 1 i. Zone or use district in which premises are situated ......... ~.C~...~.~.....~Z~....,~...~,.-~....~. ......................................................... 12. Does proposed cOnStrUction viola,te/~ny zoning Ipw, ordinance or regulation? ...... ~.....: ...................................... 13. Name of Owner of premises .~..~/.~'.:~......~.;...~/./~...~...~ddress .~....../...4g...,~...~...-. ne No. 7..~..~..'...~....~../...~-- Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... 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 ir~ether interior or comer lot. ~/f~ ,~' ~. //~'C. ~,- ~- N vir")rOll ,, A COUNTY OF ~ ........... ~'~'~ ......... ~...-~,~.,....,~--.~/~.. .......................... being duly sworn, d~o~s and says t~t he is the applicant (Name of ind~ual ~ning application) above named. He is the ;..~ ................. : ...................... ~ ............................. : ............................................................. (~ontroctor, ag~t, co~orate officer, etc.) of said owner or ~ners, and is duly authorized to per~orm or have performed the said work and to ~ke and file this application; that all statements contained Jn 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 therewi~. Swom~tore~,, me this,~ ~ ~.~ ~ ~, ~ ~_ ~ ~ ~ ........ : ....... ......... NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk~o aunty Term Expires March 30, ] TOWN OF ~UTH~D , Building ~m~t Town ~le~ ~ce ~u~ald, H. Y. II~i APPLIGATION FOR C:ERTIFIC, ATE OF OC:C:UPANCY 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 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 Cede compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of Lompleted 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. Swam 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 pregare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certifioate of occupancy $1.00 ~../..~. ~ Date ..... New Building ................ Addition ................ Old'or Pre-existing Building ................ Vacant Land .............. tocation Of Prope,y .................................. ............................................... ........................................ Owner Or Owners Of Property .~.~...'~../~...~.....~..*;/.//.~/........~..:.....d...~,r~./'~..~. .................................... Subdivision ................................................................ Lot No...~... Block No. 5.... House No.~ Permit No. ~ .~..~.. ~ ..~..... Date Of Permi ..~'....~..5 ! ..~r.~/ppl icant ...,.....~.ff.~. Health Dept. Approval ................... ~...,.J~ .............. Labor Dept. Approval ................................................ Underwriters Approval ............... .'..~........~...{ ............... Planning Board Approval ....... ..../~....~.../....C7...: .............. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ............~.....~... ................ Construction on above described building and ~Lr~jt meets all applicable codes and regulations. Swam ,o before me this ................ day ........................ (stamp /.~-~..~* Notary Public -.7/< ...........::~7 ..... County