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Home My WebLink About6186-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ;~1/~ ...... Date .......... ~ ..... ~t~ ....... , 19.73. THIS CERTIFIES that the building located at F~I;. ~o&d~..~,~nox~ .IH;. l~$treet Map No. ~x ......... Block No.. X~ ...... Lot No. XX ...... ]law./~l~ft'olk...1~ ,]~... .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 0~t...1.9..., 19.7.~ pursuant to which Building Permit No. 6186Z.. dated ......... 0~;.. l~. ..... , 19.72., was issued, and con/orms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P..x..i.v.a.~.e...o.n.e...f.a~..~..ly..d..w~.l~L.~.g ....................................... The certificate is issued to . ]/~o~,~nox*. Et. Cox*p,...(1~0.9)..t/ai;so~ ..... (~. .... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approval . I/,H~ .............................. UNDERWRITERS CERTIFICATE No..]/,I~.,. ........................................... HOUSE NUMBER.. 10~.5 ...... Street.. ~:ogenor. Et. B~.~.. ~E~) .................. FO~M 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? 6186 Z Permission is hereby granted to: at premises I~ated at ....... ~.~g.~.~.l:..~...~.~.....~],~.~...~ .......................................... pumu*nt to ~pplic~tlon d~ted ...................... ~ ............ ~ ............ , 19.~..., ond opprov~d by the Buildin~ In~ctor. · OID~ NO~ I TOWN OF SOUTHOLD Building Delmrl'ment Tow~ Cle~ Office So,held, iq. Y. 11~71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Ind'motiom 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 otc property showing oll property lines, streets, buildings and unusual netural 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 D~te .................... New Building....................X Old or Pre-existing Building ..... ]~.a:~.a3r.~;,,.... Vacant Land ........... ~, .............. Location Of Property ......... ..~..~:...~..~.j~.e...~..~.~.~.~.~.~..~.~.~.e...w.~.S~.~.~.~..~...~s.~.~.~:; ............................................... J oK.Watson Jr. Owner Or Owners Of proPerty ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~..1...8.~...~ ..... Date Of Permit ..l...0./..1..~.../.~..~Appli~:ant A, Reill~ and I,lc. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ 5 · 0O Construction on above described building and Permit meets all applicable codes and regulations. Applicant ....~..~,.~...~;)' ...... ~ ......./~'~:......~..~.~ Sworn to before me this Notary Public .................................... County (stamp or seal) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No...~.,/,,~,..,~,, ................ Disapproved o/c ............................................................................................ APPLICATION FOR BUILDING PERMIT ~ Date ..................... INSTRUCTIONS it~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, w 3 sets of plans, aeeurate plot plan to scale. Fee aeeording to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to ad oining 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 Occupancy shall have bec~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zor~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable law~-4 ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspection~ (Signature of applicant, or name, if a corporation) h ! Ma ' ',~ ~ .t.t.~.~.UCk ~ ,.~ ~ .......................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; Contractor Name of owner of premises .~i~a~or...~.~i~t..~.or~ ....... 9...J......~.4.~n...~.r3 ..................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) k t C 1. Location of land on which proposed work will be done. Map No.:..~,~,,.'.....~,....'. I-b~:t~ .............. ~_~__x_~ ..................... Street and Number ......~,~,,Y,~;.~.C.,.~,Q{~,..D.~..,~,~..~.Qi~.~,~.~...~,~.W..~13.~ .................................................. Municipality 2,State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,,~,w~,l'[~.~ .............................................................................................................. b. Intended use and occupancy ........ ~,~, ................ .~,~,~,.,~T~,.,~.~,~,~,~J,D~, ................................................................. ~ I 3. Nature of work (check which applicable): New Building ....................... Addition ,.~ThTh~ ........... Alteration ............... Repair ......................... Removal,,.,.,.,.,........,,.,,,, Demolition ........................ Other Work ......... {Description) 4. Estimated Cost ................. .1...~. ~ .0...0..0... + .......... Fee ......... .1,.~ o0~ ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...o...~..e. ........ 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 ...~..~=..~....+.. ........ Re~._L~, ................... Depth 11+_1 1 + Height ................................................. Number of Stories ..... ..~. ................................................................................. 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated "'" ' ............................. ~....~zs.t ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regu)ation: ..... ~ .................................................. 13. Will lot be regraded ...... ~Q ........................ Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises .... ~±mo~..e.~_or ~.t ~,s sn (Address) (Phone No.) qe Name of Architect .............................................................................................................................. (Address) (Phone No.) nf nntr t-tnr A, Rezlly ons [, attztuok (Address) (Phone No.) 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 or corner lot. STATE OF NEWYORK, ) COUNTY OF ........ ~Z]~.O~k .......................... ) filed plan ............................ ~C~3~L~[~.:D...~.~'i ~.~. .......................................... being duly sworn, deposes and says that he is the applicant above named· {Name of individual stgning contract) He is the ................................................. ~. Ol~.-f~EtO~..0 ..................................................................................................................................... ~ntractor, 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. TERRI LEE EL~K ....................... ......... ................... ..... ~ ~ua 'in Su % .......... .............................. OF ,3URV£Y F'OR f:)O INT ,.~ U F'F'O L. K O~ ~'OU~O~D COI~tPA IV Y I1