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Home My WebLink About5556-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~0.1.6 ..... Date .... I%b 2'~ , 19 THIS CERTIFIES that the building located at .Settth ¥iaw Dr Street Map No. ~r. owlas Hi~ttock No. Lot No.. ~ Orlent; conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... SOpt; t.~ , 19 7.t pursuant to which Building Permit No. dated ...... 0ct; ~ , 19 ~.]., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issuedis p~1~a.te.~Igo..f_amJ.~.y dwo~.iag ......................... The certificate is issued to lial~n. Howarg of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. peBrl.~ng IIOUSI NUMBhR J~O Street 8.o~th Dri~ OloIle~ ......... (owner, lessee or tenant) Btllldmg Inspectol TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRF-J~ISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5556 Z Permission is hereby granted to: ...~e.~t~ ..i~lt...~.~.~...l~.e~.. ~ pursuc~n¢ to application dated ................................. ~t])J~.....~ ...... ~, 19~.~., a~ appmv~ by the ~uilding Inspec~r. ~ ~ X Build~i~tor FO~M NO. 6 TOWN OF SOUTHOLD Building Department 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 triplicate 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 dispcsal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Residences and similar buildings and installations, a cerHfJcate 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 buddings and "pre-existing" 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 an,/ housing code or safety inspechon of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees' 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...v~.7~..~...~. ........................... New Building, ................... ~ Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~'..~?.~..~.,'~. ...... ~../.~..q ...... ~.~.....77~.Z~....-~. ....... ~.~....~.¢~.~.~.~....;. ............. Owner Or Owners Of Property .... .~....;~../.~......~...~ ..... ./~..~..(-~..,~ ........................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ~..~...~?..~.....Z.... Date Of Permit ..~./~../..).?.~'/.....Applicant .~.~..Z~.~...~.~?J...'2~4.-A. ..... ~...~..~.....~.....,.~..~..,~.,,~'/-, Health Dept. Approval ...~..~/.~.....~....~...~...7....'~.. ..... Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....~...~ ................................. Fee Submitted $ ...,.~..'...~.. ........................ Construction on above described building and permit meets all applicable codes and regulations. ....................... Sworn to before me this (stamp or seal) ................ day of ............................................ Notary Public .................................... County S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ ~ - ~ ~ Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. 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 ofproperty 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 ~rernises 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 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 fo cOmply with all applicable laws, ordi nantes, building code, housing code, and regulations. (Signature of applfi:ant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, ageht, architect, engineer, general contractor, electrician, plumber or builder. ..... ...... ................................... :..... ................................................................................... Name of owner of premises ..... ~.(~;,~.,,....~.~4~-.'.~~'~'~' ...... /-:/.~.~.,d~,~2 .......................................................................... If applicant is a corporate, signature of duly authorized officer. ......... . ~(Name and tite o corporate o icer} Location of land on. which proposed work will be done: Map N~.: ....'~....~ ............... :, ......... t.{... L~ N_e.. ;"~'~:,L'; ............. Street and Number .../*/~,'~Z-~,-J...~J.~'....~......~.f~/-,~..~.~/~.~Z.. ,Z~J~'~d..~,~.. ................ /~/~/~ .......... ~ O' ! ~ P'~'~' ~:~ ~/O Municipality State existing use and occupancy of p~'ern!ses .and intended use and occupancy of proposed construction: b'. E~iting use and occupancy ................................................................................................................................. ' ~ b. Intended use and occupancy .......~..~"'~/~.~-~/~--,~ ......................................................................................... 3. Nature of work (check which applicable): New Building ~. ............ Addition .................. Alteration .................. Repair .................. Removal .................. Demolitio~ .................. Other Work (Describe) ........................................ 4. Estimoted Cost .~..~...~...~.,.~ .............................. Fee ...~.~.~..'.....'~.. ...................................................................... (to be paid on filing this opplication) 5. If dwelling, number of dwelling units .............. J. ............ Number of dwelling units on each floor ............................ If goroge, number of c~rs ......~..~../x'.x~..'~.. ....................................................................................................................... 6. If business, commercial or mixed occupancy, speci{y 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 odditions: Front .; ..................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~/..:. ................. Rear ...... ~.~...:. ............. Depth ..;~.; ............. Height ....~.~. .......... Number of Stories ....... ~..~, ...................................................................................................... 9. Size of lot: Front ........ /.-,~/'.'.'.'.'.'.'~ .......... Rear ........ ./.,~...~...~ .................. Depth ../...'~...:....?....~...,~.....-~.... 10. Date of Purchase C~'x~'.~.c~,~.' ............................... Name of Former Owner .~).,.~L~f,a',,L~... ......................... 1 i~ Zone or use district in which premises are situated ..'-~:S/'~:~t-~2~7~lt~. ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~...~ ....................................... 13. Name of Owner of premises ~'~s~,...~.,../'/~A~...~.~.~..Adclress ....~...~.4.-...'~/...~...~a~.Z~... ........... Phone No .... '..... ........... Name of Architect ~'./.~:~.~(. ............. Address ............................................ Phone No ..................... Name of Contractor ~x~2~.,q~j~....X~...r.~., ........... Address ...~<~L,~-,~/~.~-&::~..,/~.~..~_.... Phone No. ?.~..'~..~'.,~..?-.~-~. PLOT DIAGFLAM Locate clearly and distinctly ell buildings, whether existing or proposed, and indicate all set-b~ck 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 NEV~O~,~,~ (S S COUNTY OF~ ............ $ ' , ....... ..'~...~..~..~..~..~..~.4~...../~...i.~2~J. ............................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) , / above no.med. He is the ~~....~x~~' ................................................................................................. (~ntmctor, agar, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this applic~i~ am'tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applicati~ filed ther~ith. Sworn to before ~ t~~ ~~.~.~. 19 ...... ............... .... , · ........ .................. ~. 5~-8125850, Suffolk