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Home My WebLink About5964-zFO~M NO. · TOWN OF $OUTHOLD BUILDING DEPARTM~,NT Town Clerk's Office Southold, N. Y. Certificate Of Occupency No. Z.fi96] ...... Date .............. A10rl~,..5 .... , 19. ?.~. THIS CERTIFIES that the building located at . P-~.ne~ood · Road ........... Street Map No.F.~Lee.t .l~k... Block No ..... :ct ...Lot No. x,x..C~,~hogue .. ~...Y, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............Jmue..7. ·., 19.7.2. pursuant to which Building Permit No..596b~. dated ............J..un..e...2.2.., 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 .P.r..~y.a.~..e..a.e.q .~.~.s. qr.y..b.u..~.l.d~n, g ................................... The certificate is issued to gdwar~.. Morea,. .... fi~ner ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N.P~, ............................. UNDERWRITERS CERTIFICATE No..1~ oR, ....................................... HOUSE NUMBER .... 670 .......Street ....P.:Ll~e~e~od. PA ........................ .... ....... ~0~ NO. ~ TOWN OF $OUTHOLD 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? 596~ Z Permission is hereby granted to: ...~..I~,.,~ ..................................... ............. ~.~t~.eJ~jl~ ............................................. ~o .~..~.?..~.s..~.~.e....~.?~.?...~....~.~ .................................................................... at premises located at .......... .6..~..0.......~...~...eL~'..~.~........[~....~. ...................................................................... .......................................................... .g.g~t~.l~ ...... 1~. ................................................................ pursuant to application dated ................................ ..~.~?......?.. ...... , 19..~......, and approved by the Building Inspector. Fee $....?..~..~ ...(~.. ........ .......... ........... FORM 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 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: 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 o certificate. C. Fees: ]. 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 ..... .............. New Building ~' Addition Old or Pre-existing Building ................ Vacant Land Location Of Property ........... 6.~..O........?..i.~...~l~.;.....C~U~~.~- .................................... Owner Or Owners Of Property ........ ~l~C~..~...~liCl~. ............................................................ Subdivision ..:" ........................................................... Lot No.....;;::.... Block No ..... i ....... House O. Health Dept. Approval ........... ..H.......~.:,. ...................... Labor Dept. Approval ........... N;I~.. ........................... Underwriters Approval .....~......O..~..~....~.. .............. Planning Board Approval ....-~..':.-.~.' .......................... Request For Temporary Certificate ........................................ Fined Certificate Fee Submitted $ Construction on above described building and permit~,,._._.~ ~blemeets ' codes and regulations. Applicant ........... ~.~ ....... Sworn to before me this ................ day of ..... "~"7; ............................ Notary Public ................... ;:.~ ............. County (stamp or seal) Examined Approved BUILDING DEPARTMENT ,~.~.,~, --~ 7. ~/~ ~ TOWN CLERK'S OFFICE ~-/~ ~ ~ / ~ ~ S~THOLD, N.Y. ~'~' ~ ~pplication No ..... ~.....~ ............... Disapproved a/c ............................................................................................ ~',~ '~ '~ ~'t'~ ' ~. ................................................................ ........................ ~' ~ ~ APPLICATION FOR BUILDING PERMIT ~'/ ~ ~ ~' ~~ ~ ~' // Date ~ aJl~ 10~ ? ..... _ ~ INSTRU~IONS a. This applicati~ must be completely fillS.in by ~ewriter or ip in~ and submitted in d~licate to the Building Ins~ctor. ~ ~' ~a~ ~ ~ ~ ~ ~ b. Plot plan showing I~ation of lot and of buildings on premises, relationship to adjoining premises or public streets or~ areas, and giving a detoil~ description of layo~ ofprope~ must be drawn on the diagram which is ~ of this applicati~. c. ~e work c~ered by this a~lication may not be comme~ before issuance of Building Permit. d. Upon approval of this application, ~e Buildi~ Insp~r will issue a Building Permit to the ~plicant. S~h permit shall be kept ~ the premises available for insp~tion throughout the pr~ress of the work. e. No building ~all be ~cupied or used in whole or in part for any purpose whatever until a Ce~ificate of ~cupancy~ shall have been gmnt~ by the Building Insp~tor. 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, (Signature of applicon~ or name, if a corporation) (Address aT appl,cant) ~J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer· .~ 1. Location of land on which~roposed~rk will be done.. ~J: JJ~J Ill l~lJ J.,....................... Lot "O...~ ................. Street and Number ....... ~..~.......~.J~,l~.4..~..,...~l.'~'~.~. .......... ;..: · Ipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed conetruction: Exisiting use and occupancy ................................................................................................................................ Intended use and occupancy ....... ~~ ~ .................................... TOWH OF SOUTHOLD [UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application ~o~ Approved ]9 ........Pem~ No .............................. D~sapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT : ....... a ~h~s app ca~ on mus~ ba completely filled in by ~y~wr ~er o: n n~ and subm~t~ad in duplicate Inspector. b. Plot plan shaw~ng IocaHan of bt and af buildings on pr~m[ses, reb~ansh~p ~o a~ain~ng araas, and giving a d~taHed description of layau~ ofpraper~y mus~ be d~awn on ~he d~agram which is part of ~his application. c. ~he work coverad by ~h[s application may not b~ cammenc~d b~fore ~ssuance af DuHding P~rmit. d. Upon approvat of ~h~s appHcafion, ~h~ DuHd~ng lnspec~ar will ~ssu~ a DuHding Permff ~a th~ applicant. Such p~rm~ shah be k~p~ on th~ pr~mises available fa~ inspection throughou~ the p~ogress of the wark. No building shah b~ occupiad ar used in whale or in pa:~ ~o: any purpasa whatever until a C~rtifica~e shah haw b~en granted by ~he Duild~ng APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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. ordinances, buildin housing code, and regulations. The applicant agrees_ _~.:t° comply with all.~ applicable laws, (S'g a o pp ' a t, or name, if a corporation) .. .......... ..... : (Address o7 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 corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whichoroposed ',y~rk will be done. Ma~:~p.: ............... ~. ........................ Lot No..~.~D Street and Number ....... t~.~.~.~.......~J, Jt~.[~ ....... Z~:~.~.J~t~,~ ........... : ~ Jvf~icipality 2. State existing use and occupancy of premises and in~:ended use and occupancy of proposed construction: Exisiting use and occupancy ................................................................................................................................ Nature of work (check which applicable): New Building ......~... ......... Addition .................. Alteration ' ' ~ Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ~,~;1~{~ ...................................... 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 ~e,,~ use ..~...~.._..~ ....... 7. Dimensions of e~xisting structures, if any: Front ....~.. ................. Rear ~l~l~....~..~/.~D~n~lL...m.....~.. Height ...... .~.~ ............. Number of Stories ...... ..~... ................................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories Rea'~~'* ~ 8. Dimensions of ,entire new construction: Front ...~1~...;~, ................. ~i Height .....8 .......... Number of Stories ............~.. .... ~- · ............... ~iiiii 9. Size of lot: Front .......[~1 ............. Rear ........... ~..~...~. .................. Depth ....J..4.~. ................... ....... J~..~.. ...................................... Name of Former Owner ....~..~....~---- ~ ................... 10. Date of Purchase 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulati.on? ..... ][1111~. ............................................... 13. Name of Owner of premises .~l~l~.~41~Jl~ddress .~.~.~...~..I.'~ Phone No. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM ~cate 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 whether interior or comer lot. STATE OF N E-W,.~ORI~,~ ~. ! ¢ ¢ COUNTY OF ..,~"~..:....,f';'.'~. .......................... ~-~ ...... ~ ....... being duly sworn, deposes and soys that he is the applicant (Name of'individual signing application) above named. 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 end file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor .the work. will be performed in the manner set forth in the application filed ther~e~. Swam to before me this ~ Notary Public~..~..../..~.... Count~ .................. ~~"a~ ............................ . ~" JUDITH T. BOKEN - ~ .... ,"r' ........ Notary Public, State of New York No. 52-0344963 Suffolk Comrni#ion Explre~ March 30, 0