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Home My WebLink About6099-z~VOBM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMI~.NT Town Clerk'8 Office $outhold, BT. Y. Certificate Of Occupancy No. ~c).8.? ...... Date ..............~T.',ll~' ..... 3-.., 19. '~.LI'. THIS CERTIFIES that the building located at . Marl:ln~ .Lan~ ............Street Map No..XZ ......... Block No..x~.. ....... Lot No....~....~..t.t..~..t~..k...N.,..Y? ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..............~ep.t;...~, 19..?~ pursuant to which Building'Permit No. 6099Z. · dated ..........3apt...7. .... , 19.?~., was issued, and conforms to all of the require- manta of the applicable provisions of the law. The occupancy for which this certificate is issued is .P.r~.v.a.t..e...o~.q..f..a~..i.ly. dwelling with an addition The certificate is i.~sued to ...A~.....S~tW...o. ..... .0~...e.~. ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N:.R., ............................... UNDERWRITERS CERTIFICATE No ..... .by. ..W~...~.e..~..r.~. ......................... HOUSE mnVmER ...~..~.. ...... Street .....~..~! .m.e...~...~. ........................ ........... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6099 Z Permission is hereby granted to: ,. ...... ~.~ ..~a~.. ~ ..~m · al~ ........... to filled., al~..a~d&t .~ en..~l~ ..e~et ~aZ.. ~lw®~..l~n~ ................................................................ ............................................... t~.~"~t .............. l~t~tl~: ............................................... at premises located at ............................................................................................................................ pursuant to application dated ............................. 81~ ....... ~ ........ , 19~,~..., and approved by the Building Inspector. Fee $.1.5.e0 ............ LX ~ Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT · ow. CLERK'S OFF CE ~UTHOLD, N. Y. ~ 19...: ............ 19...~{.. Pemit No. &..9...~..~.~. Disapproved o/c ............................................................................................ APPLICATION FOR BUILDING PERMIT _~ 0fe .............. ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an giving a detailed description of layout of property must be drawn on 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 o~,' the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupencv shall have beefi 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. 5-o- ' J aaX- ................................................. ~/,/~-,~ /~/~,~,. --~.,,~//. (Sig corporation) ........... ...................... / Addre. o, pp,c l State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, 'plumber or builder. Name of owner of premises ........ .,~-~.~.~V~ .................................................... ' ..................................................... If applicant is a corporate, signature of duly authorized officer. 1. k Ilbedone Ma No / ~// J~..~.. ~ /~4otNo Location of land on which proposed wor wi . · P .: ................................. ~ ................ / nnunicip~lity 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: ·a. existing use aha occupancy ................... ~, /22~ .......................................................................... 3. Nature of work (check which applicable): New Building ....................... Addition ............. Alteration ............... Repair ............. · ............ Removal ......................... Demolition ../..~--~ ....... Other Work .................................... 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 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 ~ 5 / "~ 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 ...... ~L~..~.~- ......... 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 ...... ~'~.../.C~.~.~.'f./..~.~,. .................................................................. 12. Does proposed construction violate any zoning law, ordinanCe or regulation: ...... ~/.¥.~ ......... ; ..................................... 13. Will lot be regraded ........ .................. y... Will excess fill be removed from prgmjs~s: [ ] Yes [~/j ~o Name -- //(Address) / ~(Phone No.) Name of Architect ...................................................................................................... (Address) /- (Ph ~.~o.. ~ (Address) 7 / (Phone · 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 according to deed, and show street names and indicate wheth- er interior o~corner 10*t. STATEOFNEWY~)~IC~,,~ /~I~. ~ } ~ ' COUNT~ .......... ) ~ · " ............ ~...~ ...................... ~ ........................... ~ing duly s~rn, de~s and ~YS that he is the appli~nt above named. // ~df i~v~.si~ing con~act) ' .......... : .......... ....................................................................................................................................... // I { Con~cto,, ag~t, commie o/fi~, etc.} of ~d owner or owners, and i~y authorized to ~rform or have ~rfor~d the said work and to make and file this applimtion; that all state~nts contained in this applimIion are true to ~ ~st of his knowled~ and ~lief; and that the work will ~ ~dormed in the ~no~r ~t fo~h in the application filed therewith. ~ ~1 LI~ ~ .......... ........... ........ - ~o. 52-8730350 ................................................. I~ORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR C:ERTIFICATE 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, 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 buildipg. 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. ~ccurate 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 Bud ng Addition ~' O d or Pre ex st n Bu dj .... 'ocat on Of Pro e Owner Or Owners Of proner~ ..... /~..~ ..... -- ' .......................................................................................... X. ................... ............................................ o ~o ............. ptock.~lo. ....... r.~louse r~o ............. Permit No .....~ ........... ..Z'Date Of Permit .......~......7./..?..~pplicant ..... ~ ....................................... , ',/ N Health Dept. Approval ..... : ...................................... Labor Dept. Approval ...... : .......... I'"'"'r'f')'~'; ........... Underwriters Approval ../..~.. ..................................... Planning Board Approval ...... -. ................................. Request For Temporary Cert~ate ........................................ Final Certificate ...~T... .................................... Fee Submitted ~ Construction on obove described building and codes and regulations. Sworn to before me ~h~'~ ., . II ............. /day of ....~ ....... ./...?....~.~...// (stamp or seal) ~/~ Commission Expires March 30, ]~