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Home My WebLink About6083-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Occupnncy No.~-...~..~-.O. Date .......... ~).~.C,. .... ~ ..... , 19.~Z- THIS CERTIFIES that the building located at .-~.~S..D.~. ~.~O o.O ./~... D./~. (~"~Jtreet Map No ...... '/,, .....Block No .... Y~ .....Lot No..~, .... ,.~o~. T.t~.o t,l,~ ....~; ~.... conforms substafitially to the Application for Building Permit heretofore filed in this office dated ......... .A.u fa .. ~t.~.., 19 .-)~_ pursuant to which Building Permit No. 60. ~. t ~ dated ....... ~t..~..~....~.~-..., 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 issued is ... ~.~,~! .~ A .~. I-~'.. 0 bJ .~.. ~. ~. ~,~ ~. t.. ~.... L~ ~.~ .~ ~. ,. ~.~. ~ ................ The certificate is issued to ...[.~.~.TT.~./.. ~.~.cJ.~ .~... ~c~J.A/C .f.~ ................ '- (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... Z~/.: ~,_ ......................... UNDERWRITERS CERTIFICATE No.. / .. ]~. ....................................... house nUMaEr.../.q.q'5.. .... Street .... 0.4 .fO .t.,.a O.cx 0... ,/.).,/e:.f ~f'7 .................. FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6083 Z Permission is hereby granted to: at premises located at ........~...O~'IE4I~..D~It .................................................................................. pursuant to application dated ..................... .,~.lJl~..~[~... , 19..~.., and approved by the Building Inspector. Fee $~.~,OJ). ............ Building Inspector FOltM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved Ii ' ~ '-~ ).~ ~- ........................................ , 19 ........ Pemit No ..................................... Application No..~.....O...~....~ ........... :~ Disapproved a/c .... ~".'.' 'ZZL ................................. (Buildi~tor) 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 orR 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances 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. (Sign~ure of applicant, or 'name, if a corporation) (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~~ .C~ .~..~.~.t.u~ .~.~.~1..~..~ .~ t..h..~ii .i id officer. If, lame and title of corporate officer) ~.~ 1. Locat on of and on wh ch pro~)osed work w be done Map No~ .... Lot No Street and Number ........ ?.~..~. ................... 4~'~...'~,~.~.x~.~ ......... ~ ................................ Municipality 2. State existing use and occupancy of premises and in?ended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ b. Intended use and occupancy ....... -2~1~':~'~/ $. 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) §. 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, specif~ nature and extent of each type of use ............................ 7. Dimensions of ex~sting structures, if any: Front ............. ~;~.~. .......Rear ....... ~2.~,. ................. Depth ...~;;~,.~... .... Height ...... /.'..~.. .......... Number of Stories ....... ~ ................................................................................ same structure with alterations or additions: Front ............. 6.~.. .............. Rear ..~?.~.. ................ Dimensions of Depth ............ .~.~C .......... Height ........... /..~..'/. ........ Number of Stories .......... i/.. ................... 8. Dimensions of entire new construction: Front .................................... Rear .......~ .............. Depth ....L.O. .............. Height ...... ~.'~;...f' ...... Number of Stories ....... ~.,. .......................................................................................................... ]0. Date of Purchase ........................................................Name of Former Owner ........................................................ ] ], Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation.;) ...~]..~. .................................................. Name of Architect ...................................................... Address ............................................ Phone No ..................... PLOT DIAG~ ~ate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~ lines. Give street and bilk number or description according to deed, and sh~ street names and indicate whether interior or conner I~. /- STATE OF NEW v/kiRK/// .~ _~ ~. S S above na med. He is the .... ~" ~:'l] 'o¥: "j 'j 'J 'r~;:"j '(; ;'1~ '; ;'J [';' ';'#i 'c~ 'e';; ";;'JJi ............... 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 ........ ...... Notary Public, ~~.~~/~. ~unun~ ...................... "~'"~'r~(~/~:jl~;;':~';;l~licon~'i ............................. FORM NO. S TOWN OF SOUTHOLD Building Delmr~ment Town Clerks Office Southold, N. T. 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, Multiple Residences and similar 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 opplioable. 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. 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-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ............. /. ...... ~. ........................ New Building .................... Old or Pre-existing Building ..... . ..~........i .......... Vacant Land ............................ location Of Property ...,.~..~..~..~7/~. ...........~.....~...~.~.!.~..~.....~.~.~..~.'. ............... ~~' .~. ........... Owner Or Owners Of Property . .~./~,..¢..~.~..~....~..~. ........ ~[~.J~.. ............................................ Subdivision ...~ ................................................ Lot No ............. Block No. ............ House No ............. Permit No...~...~....~...-~...... Date Of Permit .~./.~..¢~...~..~pplicant ..~-c~.~..~..,~,¢~,/~.~...~..,4~ Health Dept. Approval ............. ,~/',~......../. ............ Labor Dept. Approv~al .............. .~..~... ....................... Underwriters Approval ...~.//~....~.~..//~.) ................ Planning Board Approval ........ ~./~ ..................... Request For Temporary Certificate ........................................ Final Certificate ......... ;~ ..................... Fee Submitted $ .................................... Construction on above described building and permit meets all app~cgble codes and regulations. App,cant ................ .......... ................................................ Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) t t