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Home My WebLink About5684-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at Mm.'~: .St, t*oo~ .............. Street Map No..l~ ......... Block No.. ~ ...... Lot No..ll:l~ ... 01~t,®la~; .................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... DOg"-2~ ...... , 19..~ pursuant to which Building Permit No. dated .......... l~e.. l>.3 ...., 19.O., 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 . .101,4.Vat®. ola®. £~t.tl.~' .tl¥O'l. Ti~ ...................................... The certificate is issued to ...Ztli~;h .&btlI:&(le .......... .~®l'. ...................... (owner, lessee or tenant) of thb aforesaid building. Suffolk County Department of Health Approval · II,R, .............................. UN DERWRITF. RS CERTIFICATE No .... l~l[l~:]Jl~ ..................................... ltOUSI.~ NUMBER. "~ 0~ ...... Street .... ~a~ -8'~ ..... O~'i[~l~.'~ ......................... / Building Inspeclor FOEM NO, ~ TOWN OF $OUTHOLD BUILDING DI:PART~ENT' 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? 568 Z Permission is hereby granted to: ~ at premises located at ...... J!j~..J~ ...........................................~. ......................... .~ .............................. ................... Or~n~ ~.~ L pursuan~r to application dated ................................. ~.tJ.....~....;,...,., 19...~.., and approved by the Building Inspector. Fee $"'t '~i00 ......... [-,:;:,i',,';l'J' INCLUDES APPBOVAL t TO RE~.,OVE EXCES~ FILL~ ~ FP~.OM ABOVE pRkMISESI~'~Y~,,~! ",,,V?,TAY cON~TRUCI'ION -/ -- _z~.i ,~ - ~ cONS] RUCTION ~ (E.L.~,R CONSTRUCTION ~- ~ TOWN OF SOUTHOLD Building Dq~K'meM Tm Clel~l O~k4 Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OC:¢UFANCY Imtmctiom ,~. 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: I. 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 Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Beard 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 lines, streets, buildings and unusual natural or topographic features. 2. Swam statement of owner or previous owner as to use, occupancy and condition of building~ 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. Date' / '~ "~" ............ New Building .................... Old or Pre-existing Building .,.~ ................. Vacant Land ............................ Location Of Property ..~.....,~.,.,,~.. ................ ..,.Z~.~ ......................................................... (/ Owner Or Owners Of Property ....... ~.....~ ............................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~.-~...~'....~..?'...?T.... 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 ~uilding and permit meets all applicable codes and regulations. ' Sworn to before me this ..... day of ...... ............................... Notary Public .................... ~ ....... County (stamp or seal) FLOYD F. KING, JR, Nc~my Public State of New Yak No. 52-7267800 Suffolk County. Term Expires f.~arch 30, 197~ FOKM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...................... ......... , 19 ........ Applicotion No. ~..~....~.., ........... Approved " 19...~... Pemit No..~'...~. ~....~...~. Disapproved o/c ..................................................................................... i~iiiiiiiiill 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 o 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 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 o 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 code, and regulations. (Address of applicant) State whether appJicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~......~ ............................................................................... 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 b.e d~ne. Map No.:. ......... ::..~~t No.......~... .............. Street and Number ........ ...~..~......~....~...' ................................................................................ ~//~ '~',._~- Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed const~.ction: o. Exisiting use and occupancy ...,~.l. ...................................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition / Alteration Repair .............. .~?/ Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..~.../...~., Q..~...~.. :~...6? .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 ............................................................................................................................................. 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 ....'?..~..~.4...:.~ ............ Depth ..~.?..:..z~...:[.. Height ....Z'..~..; ........... Number of Stories ...... /.. . ......... Dimensions of same structure with alterations or additions: Front .......... ..2T.~'/..~..~...;.'. ........ Rear 2 x~',/~ ,, Depth ......~.~..~:..~..~. ............. Height ........ ./..~...r. ............. Number of Stories ....... ./. ...................... 8. Dimensions of entire new construction: Front ....... ./. ~.. .... Rear ...../...~.....~ Depth ...../...~...~ ............ Height ...../...~.~..'. ....... Number of Stories ........... ./. ...................................................... ~ ............................................... 9. Size of lot: Front ........ ...~...~..../. ......... Rear ....... ..~....7...~ .................. Depth '~' ~' ~- 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~ .. ~,~,5 13. Name of Owner of premises .~-..:..~ ........... Address .....~...~X<~..~....~... .......... Phone ...................... NameName of°f ContractorArChitect .................................. '"'-~' '~'""~"~~'~'-~ .......... ...... AddressAddress ]]i~~]]]]]]] PhonePh°ne No? .;'.~....'Z...~...~...~./N° ..................... PLOT DIAGRAM Locate clearly and distinctly all 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. ,4/,4 v y 57, ~lq ,~. ,, STATE OF NE~, YORK. ~ .... COUNTY OF .5..~..?...,~.~.Z...~H'. ............. ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ~/Z~[/~ (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 N ................................... Joi'~]~ry Public, ..d~.Y.~'-,'- L 'Noto~r~ .Z~'zt~...~tN ~.,. · -~"' :~Publlc S,c~,~ oF New'J R::°' :Yorkt'ntY7[ ..... ........... ' '~'""~ No. 52-7267800 Suffolk County Tcrm ~ .p .... A,. rc~ .~, 1972