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Home My WebLink About5566-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. ~16~ ..... Date ............. ~ay .... Dc) ......, 19.73. THIS CERTIFIES that the building located at .. 0ale .Drive ............... Street Map No.~Y~ .~. Block No.. ~. ....... Lot No. ! ~. ~ .!~ .... ~q~a...~ ~.' ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 0~.t.. 1 ~ .... , 19 7.~. · pursuant to which Building Permit No.. dated ........... ~...~.~..., 19.71., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .~$~a~e. one. ~y. ~g. (Iuc~.~. or~.g~ .d~.~ns. The certificate is issued to gharle.~ .&. E~. Bachtold ....... ~mer. s .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Pr.e,. Sx~ztl~g .................... UNDERWRITERS CERTIFICATE No..~e~..o~z.t~ng ................................. HOUSE NUMBER.~ ]~ ....... Street...Q~. ~.t~V~ .................................... Building Inspector FOIIM NO. ~, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5566 Z ~e ............................. e.t..t.~ ............. ~9...~1 Permission is hereby granted to: ...a,~..~.tt.....~c..c~.~,~,~t,,.ut... ................... ................. ................. to ,.:.~t,1~ .. a~...~.~t,.$.~,~.. ~...~'~t ~.t,~t~..(~.~g ......................................................... ............................................... 9ak...l~;t,l~ ........... .Se~i.t~-~.....~.,,l~, .............................................. pursuan¢ to application dated ........................ ~¢~ .............. ~l.~ .......... ,~ 19..~.t., and approved by the Building Inspector. Building nspector ~f ~OltM NO. $ 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 duplicate to the Building Inspector with the following; for new buildings ar new use: 1. Final survey of property with accurate location af all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept of water supply and sewerage d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buildings, Industrial buildings, Mulhple Residences and s~milar buildings and installations, 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 applicable B. For existing buildings (prior to April ]957), Non-conforming uses, or buddings and "pre-exishng" 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 any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a cerhflcate. C. Fees: 1. Certffmate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ................................................ New Building ................. Old or Pre-ex,sting Budding ........ .Z ............... Vacant Land ............................ Location Of Property .............................................................................. ~, ..................................................... Owner Or Owners Of Property /~/-I/~J,E-~ /~. ~ ~DN'A A4 ~O~-/TOL~ Subdivision .~...E...y.~..o,.~,.,..~..~...~..&'...E..~ ......... ~.~.C....?_.. ...... Lot No./.~..~./..?. Block No ............. House No./.'.(.~...~..,. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........... Fee Submitted $ .....~.:.~.o. ........................ Construction on above described building and permit meets all applicable codes and regulations. Applicant .....~.. ...................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) FOEH NO. ~ TOWN OF $OUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 AFPLIGATION FOR CERTIFICATE OF OCCUPANCY 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, aha 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 F~re Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Arcbtect 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 buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property hnes, 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 any housing code or safety inspection 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-exist~ng dwelling or land use $5.00 3, Copy of certificate of occupancy $1.00 Date ................................................ New Building .................... Old or Pre-existing Building ~ Vacant Land Location Of Property ~//~~/~E~7~/~Z~/~(~ ............................................. Owner Or Owners Of Property ....................................................................................................................... Subdivision .,.~.~. ,~,..~..~.,~. ........................ .,~.....,~,. ...... Lot No/ ~/¢ Block No. House No ......................................//x Permit No ........... ; ......... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described budding and permit meets all applicable codes and regulations. Sworn to before me this /]/L~.~ -7 (stamp or seal) ................ day of ............................................ Notary Public .................................... County TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ........... Approved ................ ........... ....... , ,9. L Pem t Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT 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 premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port 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 to comply with all applicable laws, ordinances, building code, housing cede, and regulations. (Signature of applican_tt o~r name,~ a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If opplicgqt is a corporate,.~igna~e of ~1~ authorized off' · ...... . - (Name and title of co./~orate officer) ~ Location of land on which pr ~osed work wil~ be ~[one /V'~:~ No.: ~?~ Lot No ~'c~/~ -i~ I~'/~ ' ~// Municipality 2. State existing use ahd o~'upancy of premises and intended-use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .....~ ..... A n .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ............ .L .......................... 4. Estimated Cost ............................................................ 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 c~rs ...................................................................................... LL ..................................................... 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 .................................... Pear ............................ 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 ........................................................ Name of Former Owner ...... ? ....................................... ~ ......... 11. Zone or use district in which premises are situated .................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or re~Ulation? ............................................................ 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... 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 aocordJng to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~)P.~I/'1~1 ~ ¢ c .................. · ~.C.,~...~......'~.;....~~i ...................being d~ly swam, deposes and soys ,hot he is the applicant (Nome of individual sig,~ng~il~,a.' tion ~)..3_ 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. Swam to before me this ~ ~ ....... Notary Public~~~l~'~ount3,~"""i~i~l'~'~l~'l~ ~"~/l~i~'~t~i ............................ No. 52-8]25850, Suffolk Te[rn Expires March 30,