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Home My WebLink About6297-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sonthold, N. Y. Certificate Of Occupancy No..Z~2.].~ ..... Date ............. .~.lll~...~0 ..... , 19. THIS CERTIFIES that the building located at . 1~/I~. 14~d~lle..R~a~..(gP~) Street Map No... ~ ....... Block No..I~ ....... Lot No.. ~ .... Y~t;t;:l.~ok..II,Y., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... D(I~;...lO.., 19.~. pursuant to which Building Permit No. dated ........ D~O. · .S8 ...... , 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 is issued is . P'l'$~at, o. ~ .fa~.l.~,. ~ll~'l].~,ll~ ....................................... The certificate is issued to .. JOOl~. · 80]al~llol~ ...... ~l' .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .lt o1~o .............................. UNDERWRITERS CERTIFICATE No.. ttOUSE NUMBER...~g)~ ..... Street ....... l{'llt~l, le. l:kO~.. (l~llt~} .................... Building Inspector FO~ NO. 2 TOWN OF SOUTHOLD BUILDIN~ DEF~RTMENT 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) 6297 Z Date .......................... ~;)e e,e~e a~ ....... .1~ 19,~.... Permission is hereby granted to: ....... ~ ~m..~eh.~.~er~z ............................... .......... ~t%~.~ek ................................................ ~o ~u~..~..a~&~&~..~ .. ~x.~.~.~.fig...~-~-~t~ ................................................................ .............. .(ap~.r~mge~..h~r..Ld...;q~pe,.~l.s~ ........................................................................................ ~t premises located ot ....~/,~..14.~s4~e..~a~...~Gl~..~.~.) ................................................................... ........................................... ~.ti.tuck .... i~ ~.Y~ ................................................................................. pursuant to application dated ........................... 0e%..-%0 .............. , 19~?..., and approved by the Building Inspector. Fee $.'1.~..00. ........... FORM NO, 6 TOWN OF SOtJTHOLD Building Depo:~men~ Town Clerks Office Southold, N. Y. 11971 APPBGATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink,, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, in duplicate to the Building 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. 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, 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. 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 $5.00 Date ....~...~....~....C......../....~...j..../....~....~..~..... New Buildin .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property~--~3'0. ...~'.../~., ~ ..o.~' ,~..~;/',).¢.,~. ~ . .~..~.,~....~..~...~'...~.~ ~.~..- ..~. ,~7/'//7z~'~ Owner Or Owners Of Property ..... .~..o....../~....~....~.. ......... ...~...~..~.../.~.~....~....~...~...!..."~, ........................................ Subdivision ................................................................ Lot No ............. Block No ............. House No~C~, ,~,. Permit No. ...... Date Of Permit ........ Health Dept. Approval ....... .~'....:..[.~..:. ...................... Labor Dept. Approval .............. .~...:....~... ..................... Underwnters Approval .............................................. Planning Board Approval.~... .......................... Request For Temporary Certificate ........................................ Final Certificate ....v, ................................... Fee Submitted $ .....~....~ .............. Construction on above described building anti, permit meets al! ~/~ plicable code~ and regulations. Sworn to before me this ......... ~ day of ...~...~/...C(..~.,~. ........ (stamp or seal) Notar~ Public .................................... County FOB~i NO. 1 TOWN OF SOUTHOLD BUILDING DEPAItTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,' ................................. ._7 INSTRUGIONS This ~ppli~8tion musl ~ ~mpletely filled in by ty~writer or in ink ~nd submitted in triplie*le ~o the Buildin~ Inspector, with s~t~ o~ plans, ~ur~le plo~ plan ~o sa~le. Fee 8~ording to ~a~edule. Plot plan ~howin] Io~lion of Io~ ~nd of buildings on premises, rel*tionship ~o 8d]oining premiss or public streets or ~iving * d~t~iled d~*~ription of I~youl of pro~rty must ~ dr~wn on disgr*m which is p~rl of this ~pplio*lion. Th~ work ~ver~d ~y this ~pplie~tion m~y nol be aommen~d ~for* issu~nee of Building Permil. Upon ~ppro~l of this *ppli~fion, the Building Inspe~lor will issue ~ Building Permit to lhe ~pplio~nt. Such ~rmit sh~ll be kepi on pr*mi~ ~wil*ble for in~tion lhroughout the work. No buildin~ sh~ll ~ o~upi~d or used in whole or in p~rt for ~ny purpose whslever until ~ gertifie~te of O~aup~ngy sh~ll h~w '~, ~r~ by lhe Building In~tor. APPLIgATION IS HEBEBY ~ADE to lh~ Building Dep~rtment for lhe issuance of ~ Building Permit pu~u~nl ~o the Buildin~ Zon~ Ordin~n~ of the Town of ~uthold, Suffot~ gounly, New York, ~nd other ~ppli~ble L~ws, Ordin*n~s or ~egul~tions, for building, ~ddilions or *Iterations, or for r~mo~l or demolition, ~s herein described. The ~ppliosnl ~grees ~o ~omply wilh ~11 ~pplia~ble I~w*, ordinance, ~uildin~ oo~, housin~ ~ode, ~nd regul~lions, ~nd to ~dmit *uthorized ins~etors on premises 8nd in buildin~s for n*~s~ry {Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, arch'tect, eng'neer, general contractor, electrician, plumber or builder~ .... ..O...~.~.~..e. ........................................................................................................................................................................ ame of ner f ' ~o~ Ut~ Ck i ~'kol N ow o premises ...................................~. ......... L...~. ........... ~ .......................................................................... If applicant is a corporate, signature of duly authorized officer. ~ ..................... {ii'i~ii'i;~'a"iiiiii'ii~' ili~-}i;~'~i¥~';~¥~igl;:i ........ ............. ~ 1. Location of land on which proposed work will be done. Map No.: .................... Lot No .............................................. vg.,2. Street end Number ......................... [ ............................................................. ~../~. '. ....... .~ ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... 1 ....... ~.~..~....~..~...(.~. ....... ~......~.. ~. ~ ~ .~..(.~.{~ .............................................................. b. Intended use and occupancy ............. ..~.,..~..~..~....~... .............................................................................................. Repair ...................... .. . Removal .... ............... .. .... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ..~...]...~...O....~.....~.~ ..................... Fee ................................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... If ra , 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~..Z~ ......... Rear ..... ~..~....:. ........... Depth ....... ..~.....~...~ ................ Height ....,.[! ................................................... Number of Stories ...........~/. ............................................................... /, Dimensions of same structure with alterations or additions: Front ...... .~...~...i .......... Rear ........... .~. .......................... I ~ ~(' ! H~ nht l 43 ................ Number of Stories ./. ......... Depth ................................................ = ........................................................ 8. Dimensions of entire new construction: Front ..... /..,~.../. ............ Rear ........ /...~...~ ............ Depth .......... ..~.....~....~ ........... 0 Height .......... ~. ..................................... Number of Stories ...... i ......... I. ....................................................................... 9. Size of lot: Front ...... LO....°..'. ..................... Rear ......... -/...°....O....~ .................... Depth ........... .~...~...: ............................ Height ............................................ Number of Stories ............................ Former Owner ..L~:~ .~. ............................. ~ .................. 10. Date of Purchase ...~...u..~...[.......~...~.....,~.~..1..IName of /~ J°~'~/- '~ ~.~'[~.~ .~.~ Z~. ~ ~.~' v s...~.... 1 1. Zone or use district in which premises are situated ...,CZ ........ x~. ................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... .~. ............................................... 13. Will lot be regraded --~.~...~ ....................... Will excess fill be removed from premises: [ ] Yes [,~J~o 14. Name of Owner of oremises ..................... .,~'.~..../.l.g'.. ................................................................................................. (Address) (Phone No.) Name of Architect .................................................................................................................................... ~ ................ (Address) (Phone No.) Name of Contractor ............................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate a)l 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 NEW YORK, .~//,/~ ) ,~, ~.~ ~ COUNTY OF .............................. ~ .~..!....~....) ............. ...~...~..~...../~..~.. ....... ..~'_...~..!~..L...!..~.....~......~....o...L......-~.. ............... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................ (~.....~...~..,.~-..,~ (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. TERBI LEE ,~J~TARY PUBLIC, State 0t New Yo~k ........................ ~ ....... aay o ................................. I)ua~i~..i6 .{~ul ~ IL ~J~ .. _