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Home My WebLink About6238-zFOlt~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located atbl~J.l~ i~o. ad .................. Street XX conforms substantially to the Application for Building Permit heretofore filed in this office dated Nov 1 ~ 19 72 pursuant to which Building Permit Nc dated ~ov ~ 19 72, ....................... , .... was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate The certificate is issued to M~s t~l. 8~eln (owner, lessee or tenant) o~ the aforesaid building. Suffolk County Department of Health Approval ~ ~]]~ ~ ................................ HOUSE NUMBER ...1.~ ..... Street ~ain Road Building Inspe{~or · 0~ NO. 2 TOWN OF SOUTHOLD BUILDIH~ DEPART~EIqT 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? 6238 Z Date ........................... ]J.J~ ........ t3 ........ , 19.~1~.. Permission is hereby granted to: at premises located at ........ ..~/.~I..JI~I~JL.]~IIIL.(...W/...D&~..[~D~tI~). ................................................ ......................................... ...~....,..t,...~..r~..o.~ ....... ~.,'/., ............................................................................ pursuant to application dated ....................... ~. .......~J..~ ............. , 19..~,., and approved by the Building Inspector. Building Inspecto~ TOWN OF SOUTHOLD Building Depaltment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF 'OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subm tted 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 sewed'age dispcsal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Rdsidences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. S. 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 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, ~cupancy 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 dwelHng or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ...~.?. ?...~. ~... ?.. ,~. ,~.....X.?...7. ~ ............. New Building .................... Old or Pre-existing Building X . Vacant Land ............................ N/$ ~Sn ~ld..(W/..~..~ Po~) E~ Nl~r~e,, N.Y. Location Of Property ................................................................................................................................... Owner Or Owners Of Property ..~,~..,~,.t...~.(?.....S...t;,?,~.~. ....................... .............................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. 623g Date Of Permit ~../.~.,~../.J.2. Applicont Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all?k°plicoble codes and/regulations. App,,can, ............................... ....................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County FO~M NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 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 u~e: 1. Final survey of property with accurate location of oil 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 Ur~derwriters. 4. Commercial buildings, industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance fram thd Architect ar 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 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, ~ccupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildiqgs 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 $I.00 Date .~.~ ~.¥.o....~ ?). ,....}.~ i~..~: ............. New Building .................... Old or Pre-existing Building ..........~ ................ Vacant Land ............................ Location Of Property ~.?~/.f~..~`~9.~.~?%~:~``..~.(.~`~/.D~.R~.L..~.?.~.)...~.L~.~x.~.~.~.~.~ ............................ Owner Or Owners Of Property ~,,z', ~, .,.~. ,,~..e:lq ....................................................... Subdivision ................................................................ Lot No .......... ~.. Black No ............. House No ............. Permit No..(~.~.~ .......... Date Of Permit .],.].Z'..~.~/..'/.~.Applicant ',.~¢.-~.~.e...~.~.e.;c.$...~.,~,ff.¢..~:.,....~..~..e,.~ ......... Health Dept. Approval ............ .................... Lobar Dept. Approval ................ ~..,:....~, ................... Underwriters Approval ....... l~,.~.~,:t .................. Planning Boa~'d Approval ......... ,,~,.:.L,~/,,~ .................. Request For Temporary Certificate ........................................ Final~ Certificate .......... ~(. .............................. Fee Submitted $ .,..;-~.., ............................ Sworn to before me this (stamp or seal)~-~''~ ~-' ~( ~> ~ ....... o, ..... ............. ..Y.. Notary Public ............... : ~,~.CCounty FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE~ UTHOLD, Y. Examined ~ / % ~-- ............................ , 19/~ .. . ....... .. 'L . , Di~pproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT ,' ~1~ ................. ..... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Bud ng nspector, wit~ 3 sets of plans, accurate plot plan to ecale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises relat onsh p to adjoining prem scs or public streets or areas, ar~ 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. No 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. ~-'"-'A'PP[.I~ ElY MADE to the Building Department for the issuance of a Building Permit pursuant to the BsJilding Zone Ordinance of the Town of ,c ~uthold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alten :ions, or for remov, al or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, hc lg code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signatul¥of applicant, or name, if a corporation) 1,~,. J, 1-~ ~ . ~/~1-~' (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; Name of owner of premises .......... .~',~/~....~.~..~ ................................................................................... If applicant is a corpo~te~ s~gnature of duly authorized officer. ~r~ame and title of corporate officer) 1. Location of land on which propo,?d work will be done. Map No.:.................... Lot No ............................. .... .... o :. ...... Street and Number ....~..~. ........ ~....~~ ............................................................. /~ ,.~ ~),.5'"'" Municipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~~ ....................................................... b. Intended use and occupancy ............................................................................................. ~ 3. -Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ............. ~ .~Jri~. ................. 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, speci~ nature and extent of'each,~3/pe of use ..................................... · ~'/ _~ 7. Dimensions of existing structures, if any: Front ...... ,~....~.~. ........ Rear ....... Z ................ Depth ....... ~ ..................... Height ..... ~ ............... Number of Stories' ............................................................................. ~ Dimensions of seme structure with alterations or additions: Front .......................... Roar ......................................... Depth ............................................. Height .............. .....~,< ................... Num~l,bfir of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height .................................... Number of Stories ............................................................... 9. Size of lot: Front ..i~JlJJJJJJlJJ. .............Rear .......................................... Depth .................................................. Height .................. .~...~.~......~..~..... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. 12. 13. 14. Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: .................. ~ .................................. Will lot be regraded ~.xCd~. .................... Will excess fill be removed from premises: [ ] Yes ,~ No Name of Owner of premises .;~.~....~. ~'~ (Addre~'s) ~ x'~'~y· (Phone No.) Na~me of Architect ........................................ (Address} (Phone No.) Name of Contractor{~...~.¢~1~....~..J~J~'d~lC..,4Jl~...~~~ .......... ~.-... ......... (Address! ~,ZJ~I~¢~¢,~- (Phone nlo.t 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. ~. - , J _ _,-~-- STATE OF NEW Y~,,~.,,~_ ~... ........................ ~~:......:: .............................................. bein§ duly sworn, depo.~s and says that he is the a~licant abo~ named. (Name of ~l~lj~idual si~ning contract} (Contractor, 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 ~ F.L~K /~ ~. ~-- J~JTARY PUBLIC. State of ~'~ew York ............................. Z. .day of ........ ........................ Notary Public, ..~....R::~-,,,~,~.~ ....... County ................... ..'~...~.....'~.....~_.........~ ........................................... ~ ~Signature of applicant}