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Home My WebLink About6153-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy June 13 No. Z5190. ...... Date ....... I~ ..... , 19.73 THIS CERTIFIES that the building located at ltal,1..She. · L~ne .......... Street Map No... x:x ....... Block No..x~ ....... Lot No.. xxx... }{atl;l~ok...I~ ~... ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~.~p.t... ~ 9.., 19.72. pursuant to which Building Permit No.. 61 dated ........... ~..ep.t....~9..., 197.2. ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for whic~h this certificate is issued is . P~'ivate .garage. · ~.Aeeeesery. bldg) ................................. The certificate is issued to .Louise.. Savicki ..... Ownex' ........................... of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) ..... }I,~ .......................... UNDERWRITERS CERTIFICATE No.. p~ulding ....................................... HOUSE NUMBER..lh,1 ~ ....... Street..~lara, lne. aa ................................... Building Inspector / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6153 Z Permission is hereby granted to: ............ I~..~'~S~.e'~'"l,~, ......................................... to ..... 1~t~..&. ~e~...~z~1~e ..l~t~le .......................................................................................... at premises located at ...... ~1~1~-..~ ............................................................................................. .................................................................. I~.~tm~ ....... ~"~.~ ........................................................ pursuont to application dated ............................ 8~r ...... ~9"'"' 19..~.., ond o~proved by the Building Inspector. Fee $...%C~ ......... TOWN OF SOUTHOLD Building Depes~neM Town Cled~ Off~ Seethald, H. Y. 11~J'1 AFFMCATION FOR CERTIFICATE OF OCC:UFANCY In~mctJon8 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 applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey aT 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 buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other partinent 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 3. Copy of certificate of occupancy $1.00 Location Of Property ................/...y../...~.........~.....~...~...C...~....~.~.~..."~..~....~.....~......../~.....~..`r.~r.~..~..~.~.~J...~:".~... Owner Or Owners Of Property ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~..L~...~.~.~ Dar, Of P,rmit .P~..~.~.Appllcont .~/.~..ii~......~...~....~/....~../...~....~..~2 .................. H~JIth I~pt. Approval .............. ~ ............................. I.~bor C~pt. AppraYal ................................................ Underwriters Approval .............................................. Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate Fee Submi,ed $ ....~.....~ ................ Construction on above described building and per~mijt,j~ a~lioablec_odes and regulations. Applicant ....~......, ./_,/~ .~....~7 7... ;. Swam to before me~is ........ ~..'~.. daye~of ...~..!..~..?....~. .......... (stamp or seal) /nc TERRI LEE ELAK NOTARY PUBLIC, Btate of New ¥or~ Nc. 52-6168295 QuaLified m Suftoik County Commission Expires Uarch 30, 19'7/'/ FOB~[ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ~ ....~... ?. ')~' Approved ~ '~ ?..~. {{ ~ ~' ........................................ , 19 ....... Pemit No ..................................... Disapproved a/c .................................................................................. .... ~ ................... (Buildin~ I n§f:~:{ori ................................. APPLICATION FOR BUILDING PERMIT .,~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witl~ 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, anc~ 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 on the premises available for inspection throughout the work. e. N° building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have be 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, Suffotk 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. State whether.~... ~'~r~pplicant is owner, lessee, agent,' architect,. ...... engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, dgnature of duly authorized officer. 1. Location of land on which proposed work will be done Map No ' ~ ' Lot No . ...~,,,~,.. Street and Number /,~,f~" ~'~l~Z~'~' ~'~"'~ .................. ~ ~i":'"'~i'"'""i ........... Municipality 2. State existing use and occupancy of prej~s and intended use and occupancy of proposed construction: $o b~'~c~ .... a. Existing use and occupancy .......... ~,, ,~, .............................................................................................................. b. Intended use and occupancy ............. t,~ ................ .'.~. ....... .~...~.~...,.,~.~.~ .................................................. 10. 11. 12. 13. 14. 3. Nature of work (check which applicable): New Building ............... J~....... Addition ..................... Alteration;' .............. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) Fee ..../.~'~ ; ............................................................ 4. Estimated Cost ~c..~......,. ...................... (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 .............. ~ .................. ............... Rear .1~...~. ................... Depth 7. Dimensions of existing structures, if any: Front ..~..~.,I I . I I .... ~...~..;.~..../. .............. Height .......... ~/..~. ........................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Hear ......................................... Depth............................................. Height ......................................... Number of Stories ........................................ 8. Dimension, s of entire new construction: Front ........ /..~...s. ......... Rear ........ ~..~.../. ........... Depth ....... ,,,'~...~..f.....; .......... Height ......... ./.,.~,..'. ................................ f Number o Stones ......................................................................................... 9. Size of lot: Front ...... .~..,~...?. ...................... Rear ....... .?...~....~. ........................ Depth ......... ~..~... ................................. Height .................................................... Number of Stories ...................................................................................... Date of Purchase ..../.~../..~...~J/-~... .............. Name Of Former Owner ~.(,...L~....~..M~...~.~..~...~...~..~...,~...J..(,/~.~.~.~'~,,. Zone or use district in which premises are situated ...... .J~(~.~.~',(~)J-wC.Z'./...M....~.. ........................................................... Does proposed construction violate any zoning law, ordinance or regulation: ....~...G). ............................................... Will lot be regraded ~-...~.~. .................... Willexcess_fill be removed from premises: [&l]~es Name of Owner of premises .~.~.~./..~[.~. ...................~..~...LM~... ................................. ~ ........................ (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) · Name of Contractor .................................................................... i~,~J~'~')' .................................................................. (Phone No.) PLOT DIAGRAM ~r!y and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property hneS. Give street and block number or description accordircoKY g ~to deed, and show street names and indicate wheth- er interior or corner lot. ?'ce'r STATE OF NEW YORK, ) ...................................... b~in~ dul~ ~orn, de~o~ ~nd ~a~* that h~ i* th~ a~plicant ~bo~ named. ~ [~ame of individual s~ng con~actJ [Contractor, a~nt, co.orate officer, 6~ said o~ner or own~r~, and i~ dul~ authori~*d to ~rform or ha~ ~rform~d the~id work and to m~k~ and fil~ thi~ statom~nts contained in thi~ application ar~ tru~ to th* ~t of hi~ knowled~ and b~li~f; and that the ~ork ~ill ~ ~orm~d in th~ mnn~r ~et forth in the ap~lie~ion filed therewith. . ~RRI ~ ~ ~By pUBLIC, Stat~,~l i~ew