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Home My WebLink About5937-zFORM NO. 4 ~ 'H~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~. ...... Date .............. J~me. · .29 .... , 19. ~'~. THIS CERTIFIES that the building located at . ~. l~Nk. RS. &. l~k-wa~eJtrivet Map No.. 3:r~X ....... Block No .... ~ .... Lot No... ~ ..... Ml~ti~llllk.. ]1,][, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J'~e.. '9"', 19..F2 pursuant to which Building Permit No.. dated ............ June..9..., 19. ~2., 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 ... 8~e~ .dwe.~t~ug. ~lnit. .......................................... The certificate is issued to ... p.,..Cerr.i.~.e.A./~I .Ve.rsal ./'tol~g. Co~ ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval SI,R, ............................... UNDERWRITERS CERTIFICATE No... ]~.,~R, .......................................... HOUSE NUMBER.. 2-.50 ·. ~,.l'~.el' .Rd- .......................................... Building Inspector FORM NO, 2 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? 5937 Z Permission is hereby granted to: .............. ~. ........ ~.~..~.~.~...T...~. ................... at pr,emises located at ................. ~..~.~. ............. .~..~..~:...~..../~'...[t/..~..'~..~...;~. ......... ~.~"~.,~ ............. .................................................................................. .~..A .::..~../...E~&..~ .~ ............................................. pursuant to application dated ........... : .................... ~.....~,~/Z:~.~/~'~...,' 19'~..~-and approved by the Building Inspector. ~:ee $...J~.i~... Building Inspector FOUM NO. 6 TOWN OF SOUTHOLD Building Deportmeat Town Clerks Office Southold, iq. 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 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 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. 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 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 3. Copy of certificate of occupancy $1.00 $5.00 New Building .~..P.~. .............. Old or Pre-existing auiming "~;j:F/"Y'YP~ ...... Vacant Land ............................ Location Of Property ..... .~...6...~.....~....L.~.~../,.('.....~.....~....~'....~'.....~....~.-..~I...~ ~/'Y'.A.....-~..~.~......~.~.~ ........................... Owner Or Owners Of Property ~' ~--/~-)~'/~' I '7-O Subdivision ........................ .~..-.ii ................................ Lot No ....... ~lock No......--~ ...... House No...~-..~'...O... Permit Date Of Pe, it .................... ^pp,icont .................................................................. Health Dept. Approval ............................................ L~bor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........... 7 .............. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..... .~....~ .............. Construction on above described buildin~~plicable codes and regulations. Applicant ~...~....~..~ ............................................................. Sworn to before me this %/ ........... f. doy of ............................................ No. 52-0344963 Suffolk Count~ Commission Expires M~rch 30, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved Disopproved o/c ............ ~ ..... \..... ............................................................ (Building Inspector) Application No....~'...Z..?..~'.... ........... APPLICATION FOR BUILDING PERMIT Dote .............. ..~....~ .......... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and 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 been 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, Suffolk 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. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................ ............................................................................................................................ Name of owner of premises ...................... .,/~,'. ...... ..(7.:...L.-..,,/~'..../~..../....../.,....~.. ............................................................................ If applicant isa corporate, signature of duly authorized officer. ~,' ~/' ---~/~ ' (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ..................................................... Lot No ............. Street and Number ............................................................. ~ .................. ~ ........................................ .~......;..:....;: ............. ',~ -" Ivlunlclpallty 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 ................. ~.. ~ ...../~'.../.., .T~.... ........ ..,~..,~.%~.../...-~.../.~..,~. ........................................ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ......,.u .............. Other Work .................................... '~ ~-: [~ / C- ~ (Description) 4. Est'mated Cost .................... .~. ....................... J 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 usa ..................................... 7. Dimensions of existing structures, if any: Front ...... ~..~,; ..... Rear ........................... Depth ....... ; ........................... Height ...................... ~ ...... .; ........................ Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front ............. .~;)..~: ..... Rear ............. .:~....r. .................... Depth ............................. .(. ............. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ............ ; ............ Rear .................. ~; ........ Depth ................................. , (./~ Height ..................... ./....~.'. ..................... Number of Stories ......................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. Date of Purchasa ..................................... Name of Former Owner ............................................................................ 11. Zone or usa district in which premisas are situated 12. Does proposad construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be re~'aded ............................... Will axoess fill be removad from premisas: [ ] Yes [ 14. Name of Owner of premisas ...................... : ........ ~..~4~.~-.~.;.-..~...O ........................................................................... (Addressl (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 proposad, and indicate all sat-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er inteFior or corner lot. /.\ 4 dSTATE OF NEW YORK, 5 / ~:5 ;~-t~.~ COUNTY OF ................................................ ..~) .......................................................................................................... ~ing duly sworn, de~s and says that he is the appli~nt abo~ named. (Na~ oI indiv~ si~ing con~acO Ha is tbe ........................................ ~..~..~.../.~.~..~.....~.~. ............................................................................................................................................. ( Con~ctor, a~nt, coyote o~c~, etc.} of said ownar or ownars, and is duly author~~ or ha~ ~dor~d t~ ~id ~ork and ~o make and fils tMs a~li~fion: that all statsman~ ~ntai~sd in this a~li~fio~t~sg~ ~owls~ a~ ~lisf: and that tbs ~ork will ~ Commissio~pl,~ ~arch 30, ...................................... day of .......................... ~ ....................... 19 ................. ~ ...... No.fy Public, .,.: ..................................... ~; ................... ~,. ~unW ....................................... ~ ............ :~ ..................................................... (S~m~ of ~pll~t)