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Home My WebLink About5285-zTOWN OF SOUTHOLD BUILI'HNG DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Ot Occupancy No. Z~291+ Date July 2~ 19 73 THIS CERTIFIES that the building located at....~.6.0.~..~..C.C.?..t~...I~o. ?d. .... Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. F~i~Y. ~l,Q ............ , 197.~.. pursuant to which Building Permit No..~.2.8.~.Z... dated .. ~. ~,Q ............. , 19 ?.l.., was issued, and co~orms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... ~0~.~$~O~J~. ~],~L~.~ ............................................. The certificate is issued to ....... A~. ~¥~i~....~... $~..~.o...l~....~...~.......0~...~. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... .~:.R.? ......................... UNDERWRITERS CERTIFICATE No ............... .P.~ ..................... HOUSE NUMBER .. ~.~ ...... Street . .CO~;~.l~o~5. ~....C.~.~..~...~..e. 1..N.:~. :... Building ~ ~OEM 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? 5285 Z Permission is hereby granted to: .............. A,~oJLtu~ ............................................. to ~laL.m~.~l~t ~ee~.&..amlm..~l,t e~at~oee., el~.®~ettme.-~ll~l~l .............. pursuance to application dated ............................................................ , 19 ........ , and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hell Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in dup cate to the Building Inspec- tor 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 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 requ!rements where applicable. For existing buildings (prior to April 1957), Non-conformir~g uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. C, Fees: 1. Certificate of occupancy $5.00 prtificate of occupancy on pre-existing dwelling or land use $5.00 y of certificate of occupancy $1.00 ate B/. ..... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ....~.~. .... .-~-~1. ,~., .~.~..: ................ House No, Street / ¢ Ham/et Owner or Owners of Property ............... ~. ....... ; ................................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No~ ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .. ~ ............................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Tempora~y.~C~ ................... Final Certificate; ....................... Fee Submitted $ ./~ ............. .....1 , i Construction on above deseribed buildingt~/~[r~ timeetsall appl~cable codes and regulations. AppJ,cant .'.~/t.~t ~..~".~.; .............................. TOWN OF SOUTHOLD ~//~,~ ~-~// .~"'~'~/'" ~' ~ BUILDING DEPARTMENT~j ~/~,~,~, ~ ' ' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. £×amined ....... ~ ........ ,~..f...... ] Approved 'l ~ ~q- ~' .~ 7---. ........................................ , 19 ........ Pemit No ..................................... Disapproved a/c ............................................................... ~ .................. Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT ~'~ Date ........................... ...J~..~. ....... ~.~., 19.....~..!... ~ 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 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 8~uildjng Zone. Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordnances or Kegu~ations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, orl~nances, building code, housing code, and regulations. ~/~e~ ~ ~ ~'~ ~ Cutchegue (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~ Cemtrac~or Name of owner of premises ....A~..~ ................................................................................................... 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 be done Map No ....... ~ .... Lot No ~ "- ' n .... N/~ Nerth Rea4 Green~ert I~.Y. ' ........................ ~rreer a a iNumoer ............. .C .................................... /~ / -- .~ ~.~z-_~' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy 6wJ~].:Lu~. ' b. Intended use and occupancy se. me with accessery bldj: add~ 3. Nature of work (check which applicable): New Building .................. Addition ..~ ......... Alteration ~ Repair ......... ~ ........ Removal .................. Demolitic~ .................. Other Work (Describe) ........................................ 4. Estimated Cost 1 ~0.0. -I- ~ . ~.~..0.0 (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 ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ::.....~...+...--. ............... Rear -6 .. Depth .....1.~...~ ......... Height .................... Number of Stories ................................................................................................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ "A" dist 11. Zone or use district in which premises are situated .......................................................... 12. Does proposed construction violate any zoning /aw, ordinance or regu at on?. TL~. .............................................. 13. Name of Owner of premises ,iL. A..~...q~.. Addr~e ...................................................................................... Phone No ..................... Name of Architect ...................... -,a /1~"~ .............. i ............. Address ........................................... ,~ '~'---;9-'-"-'"'"" Phone No ..................... Name of Contractor .~...;.~.~~..: ....... A6dress .....~ .......... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ind cate 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 Comer lot. STATE OF NEW,YORK COUNTY OF .....~.'..1~....?.~.~, ......... ................................................................................................. being duly swam, deposes and soys t~ he is the opplicont (Nome of individual signing o~lication) above n~med. He is the ............ .~.~.~ ........................................................ ~ ........................................................... (~ntm~or, agar, co~orote officer, etc.) of said owner or ~ners, and is duly authorized to pedorm or h~e pe~o~ed the sold work end to ~ke end file this opplicotion; that ~11 statements contained in this opplic~iOn ~m t~ to ~e ~ of his ~owledge end belief; end thor the work will be perfo~ in the monner set fo~h in the ~pllc~i~ fil~ ~er~i~. Swam to ~fore me this 1 ....................... ....... m_., _ .... .oro of oppUcon ) NOTARY pUBLiC, ~t~ No 52-81258~, ~floik '~m Expi,.