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Home My WebLink About6257-zFOEM NO. ~ TOWN OF $OUTHOLD BUH.]~ING DEPARTMRNT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~,~l ...... Date ............I~0~. · · ;..7. ...... , 19. THIS CERTIFIES that the building located at . [~,~ .ge~p .Hol~ ~D~ .... Street Map No. ~ ......... Blo& No.. ~ ...... Lot No... ~... ~tt~t~ · .N .~.~ ..... confo~ subst~ti~y to the Application for B~d~g Permit heretofore ffl~ ~ t~ office dated ..........~t.. ~0 ..., 19~2. p~su~t to which B~l~g Permit No.. 62~7~ dated ........~...~ ....... , 19.72., was ~su~, ~d co,ores to all of the req~ ments of ~e applicable pro~sions of ~e law. The oecup~cy for whi~ t~ certffica~ is ~su~ is . 'Pr~' ~e- f~- d~' w~.~. ~ .~d'~t~on A. P~$va~ ~e ce~ificate ~ issued to . ~,. j~. Font. & .~fe .... ~1 ................... (owner, lessee or ten~t) of ~e Mores&d b~g. S~olk Co~ty Dep~ment of He~ Approv& N.,~, ............................... UNDER~ITERS CERTIFICATE No. N .09~8 .... : ............................. HOUSE ~ER . ~ ........ Street .. Deep. H~e. · ~ ........................ , ............ ............ FOEM NO. i~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6257 Z Date .................. liO~i~e ~....~. ......... 19....~.~ Permission is hereby granted to: · 'l)m~'w't~e~bw'~'"ao~z'""A/~'".~'~P ~ ~ozdll& li~£e ........... ~tc~g. ue ............................................... to ..~A.~..~n...a~i.~..r~..~,ak~..~.Zte_-a~ivz~..o~..~.~,t~r:g..d~T~i~g ................ at premises located at ........ ~/~..~ee~..i~o.].~..~r~ve ...................................................................... ...................................................... ~$t ~.t~e~.... ~..~.. ...................................................................... pursuant to application doted .......................... 00~......15 ............. , 19...~., and approved by the Building Inspector. Fee $"'~'~',0~ ......... IPO]LM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c .~-----~..~....~......~ ~ ~ ............................. ....... ~-~ ~ ~,~ INSTRUCTIONS a. This appli~tion mus~ ~ ~mpletely filled in by ty~writer or in ink and submitted in tripli~te to the Building Inspector, wi~h~ 3 se~s of plans, a~urate plo~ plan to scale. Fee accordin~ to schedule. b. Pict plan showing location of Io~ and of buildings on premises, relationship to adjoining premims or public streets or areas, an~ giving a detailed description of layout of pro~rW mus~ be drawn on diagram which is part of ~his application. c. The work ~vered by this application may no~ ~ commenced before issuance of Building Permit. d. Upon approval of ~his application, the Building Inspector will issue a Building Permi~ ~o the applieant. Such ~rmit shall be kep~ on~ the premims available for ins~ction throughout the work. e. No building shall ~ occupied or u~d in whole or in part for any purpo~ whatever until a Ce~ifica~e of Occupan~ shall have been gra~ by the Building Ins~mor. V APPLICATION IS HEREBY MADE m the Building Department for the issuance of a Building Permit pursuant to ~he Building Zon~ Ordinan~ of the Town of ~uthold, 8uffoJ~ County, New York, and other appli~ble Laws, Ordinance or Regulations, for the constru~ion building, additions or alterations, or for removal or demolition, as herein described. The applican~ agrees to comply with all applicable laws, ordinance, building code, housing code, and regulations, and to admi~ authorized ins~ctors on premises and in buildings for ne~ssa~ ins~ions. ~licant, or name, if a corporation) State wh~an~ is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; .............. .............................................................................................................. __ _A,.. ,_ .................................. , Name of owner of premises~"~.,~., .~,.....~...~..~..7'.~.~...~'~,~..'.....~../.~'t..~......~..L~...., ......... 1. Location of land on which prooosed work will be done. IVJao No.: .................... Lot No .............................................. Street and Number ....................................... ....: ..... / MUmClpm i'D/ 2. State existing use and occupancy~;[[ premises an~ intended us~and occupancy of-proposed construction: a Existin sea n · gu nd occupa cy ~..~. ........ .~/.~. ...................... ' .~..........~ ............................................. Intended use and occupancy ...................................... .......... b. 3. Nature of work (check which apl~ I: New Building ..~Z~ ....... ~lteration....;:~ ...... Repair ......................... RemoYel ......................... Demolition ........................ Other Work ~r {De~eriptionl 4. Estimated Cost .....~.~,3-~7~.... ........................... 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 ...... .~.....~.. ..... Rear ..... ~ ............. Depth .......~... ......................... Height ...... ./..~ ................................. Number of Stories ...... /. ....... ~ .............................. ~;;~.y ..................... Dimensions of same structure with alterations or additions: Front ......~..ff.. ..............Rear ....... ~..?. ........................... Depth ......~.....~. ................................. Height ........ ~.. ............ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ! ~ ................ Number of Stor es /. ....................... i ........................ i .............................. ...................... : ...... T, 9. S~ze of lot Front ..... ./....~...~. ........................ Rear ........ ~..~..i~.. ........... Depth ....................................... Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ...... ~ .................. Will ~/[~ r~ .~'~"~- / l~/~texcess !i~ll be remo_~.from~_~ ~./~ ~[_~.premi~es: [ ] YesNo 14. Name of Owner of premi ~.,....~...,~......,..~..~...._~,,.. ...... ~......,...,..~..~....,,.,.......~.~F.~.....; ............... (Address) // / (Phone No4 Name of Architect ...................................................................................................................................................... .~ ~ , ~ (Addcessb (Phone No.) Name of Contractor~ ....... i~ ........ ~ .;.~.~.~...' ....... .~. (~1.~ h~ ~'~..) · -~' ·/' ........ 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 descriptio,n L3~cording to deed, and show street names and indicate wheth- er interior or corner lot. ~,~, ~/. /2' ,. STATE OF NEW YORK. ) COUNTY OF .....'~..~-)..'~..~..~.~..~- .........................) SS .............. ~;~..~w3~.~,~........~)~.... .......................................... being duly sworn, depots and says that he is the appli~nt above (~me of individ~l si~ing con~act) He is the ............................ .~ .................................................................................................................................................................. (Contractor, a~nt, co~o~te of~cer, etc.) of said owner or owners, and is duly authorized to ~rform or have ~rformed tbe said work and to maka and file this apPli~fion; that statements containad in this application are true to t~ ~st of his knowlsd~ and ~lief: and that the work will ~ FORM NO. 6 TOWN OF $0UTHOLD Building Depmtment 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 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 building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings and "pre-existing" land uses: ]. 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 $].00 .~.... Date / ../.../...~.../.Z '~' New Building .. . Addition ....~.. Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~..~...~....~.....~....~.~...~.~.. ~-~ st~/~ ' ~.~../.'~./.~/.~.~..~.,./~.~-~ ~L~ Owner Or Owners Of Property .....~..~..~{..~.......~......~....,~...?....~,.....'~.../. Subdivision ............ ~ ............................................. Lot No ..... ...--~.... Block/"/No......--~. ...... House No.............~"~"cDC) - Permit No ~..~ ..~..?. ~. Date Of Permit/.~././~../7....2~/Applicant ! 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 p~it meets all _~j?lic~ cod.~.~.d regulations. Sworn to~ ~,~ore me t~,/~, ~..~day of ...~~~ .. (stamp or seal) No 52-743250B ' ~UH~: ~" ~1~7/./