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Home My WebLink About5967-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .I~T-.Rg-tlt~.3. l~e.term, lleek. Street Map No .... X~ ...... Block No.. ~ ...... Lot No..arr.. Ol'l®nt~-N.o.~, ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~e.. a~., 19..~ pursuant to which Building Permit No.. ~96~ ' dated ........... a ...... ,~ ..., 19.~,~., 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 . .l~l.~.~ate. oil®. f~ily, dv®l.]~ ...................................... The certificate is issued to . ~,L,8.t~aei~n ....... O~ne~, ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~,ll, ............................. UNDERWRITERS CERTIFICATE No..]~,l~, ............................................ ~OR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5967 Z Date ....................................................... , ........ Permission is hereby granted to: ...~.~.....~....s..t..~.......~.... ................................... ........... O~,~.en~ ...................................................... to .I~LI~ ..~..&~X~on .. a~..m~L~ tang ..~.e:~3.1z~g ............................................................... at premises located at ..... ~J~l~..,l:~..Rl~....lJ~J,,~....~4.0ellle.~O..~.~.~el'l..lltl~l~. ....................... .............................................. 4~z,~tr ...... .]t~.¥v .................................................................................. pursuant to application dated ............................... ~l':tZl~.....~'~......, 19..~.., and approved by the Building Inspector. Fee $..:1.~0(~ ......... ....... ...... .................... ' ~ Building Inspector t~ I~ORM NO. 6 TOWN OF $OUTNOLD Building Depa~tmenf Town CEerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instrucfione A. This application must be filled in typewriter OR ink, and submitted in tripHcate to the Building Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of aZl 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), Naa-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusuaJ 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 3, Copy of certificate of occupancy $1.00 $5.00 Date .......... /..........,Z.Z....~..~, ........... New Building .................... QId or ,Pre-existing Building ............................ Vacant Land ........................... Location Of Property ..~..~....~.~'.~,~.- ~.~.,., ~ ~. ~ /~.~.~.1~..:*..r~.~ '/~"~'~..,~..~./.~..(:-~.~.t...~..,~.//-~V ~'- Owner Or Owners Of ;~';ert;' ii. i...i~..~.~ii;iiiiiiiii~.~i~.~...~..~.~,./.~. .......................................... Subdivision ............... ~ ...................... ~ ................ Lot No ............ : Block No ............. H~use No ............. Perm,t No.~..:~.~..~....~... Date Of Permit ...~.'./.=..~ ./2~..Applican, ...~..~.Z~..,4Z..*~;..../.~ ...... .J..; .~.,~..~...~...~..~/P' Health Dept. Approval ......... .-.~.~.~..i .......................... Labor Dept. Approval ................................................ Underwriters Approval .~... ........................................ Planning Board Approval - Request For Temporary Certificate ........................................ Final Certificate v_ .... Fee Submitted $ ..,.~...'~.,.......~. ................... Construction on above described building and permit meets all ,epplicgJ~le codes~end regulations. App,ican, .......... ............................... Sworn ~before me ' S Notary~Publi ...County ~ f~.Jbll¢, ~ta o~ New ¥or~ ~. I~o. 52.7438195 \ IDuatlfled In Suffolk Count~ ~n Expires March 30, ~974 FORM NO. ~ TOWN OF ~OUTHOLD 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 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. 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 $1.00 Date ................................................ New Building Old or Pr~e-existing Buildin '/"~- Vacant Land o,,on o, Owner Or Owners Of Property .............. ..~..~........~....~.......~.J./..~...~...~..'.--~.x'~./.~. ............................... ' ........... Subdivision .......... .~.~ ................................................... Lot No ............. Block No ............. House No ............. Permit No.~...~.~...~.'~. Date Of Permit ....~.~.>....~..~..Applicant ...l~..~.f~..,~...~-.~.....?.'..~/.-~..~..~. 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 Be.~rnit meets all/~applicgl~e codes t×end regulations. Apphcant ......... ~.~. .... Sworn to before me ...... ~ :+day of ~~'~..L.Z~ Nota~ Public ~,~~~. Coun~ Term Expires Examined ..~..~..~. .......... Approved ...(.,~... ................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ ' '~ TOWN CLERK'S OFFICE , .-~ ,/ 0 /~' ~'~ SOUTHOLD, N.Y. ~?/~h~ ~t ~ A ~ ................. Disapproved a/c~......~ =~ APPLICATION FOR BUILDING PERMIT , ~ Date ............~i.~..~..~.. ................... , ] 9..~......~::~...~ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit.~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or crees, 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 o 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 Occupanc~ shall have beel~ granted by the Building Inspector. ~' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zond~, Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction o~" 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.~ .... ~i'~r name, if a corporation)" . ....... State whether_ applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................... ................................................................................................................................................... Name of owner of premises ....... J~..,..L..~....;.~..~.~..~.~.~..~I--~. ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Street and Number ...... .~.'.....~....!.~.. ........ ~[~....~..~'~......~....ii. ii[~;[~.~[i~[iiii, ii'~...~ ............ Municipal 2. State existing use and occupancy o'. t~)e,m,i,?~)?2ntended use and occupancy of proposed construction= a. Existing use and occupancy ...~Z..~...~ ......... ~..~, ........ ,. .............................................................................. b. Intended use ano occupancy .................................. ~,. ............................................................................. 3~. ~lature of work (check which applicable): New Building ....................... Addition ........ ~.... Alteration....~.....:..:.. Repair ............. · ............ Removal ......................... Demolition ........................ Other Work .................................... 4. Estimated Cost ........~...;.~..~..~. .................... i=,~ ~ ~ ~ IDescription) j (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 type of use ..................................... 7. Dimensions of existing structures, if any: Front ...... .~...~.. ....... Rear ........ .~.,~. ............ Depth ........ ~...~ .................. Height .............. ~... ........................................ Number of Stories ............. ~..~.~. .................................................. Dimensions of same structure with alterations or additions: Front ........ ~-~...~-~ ....... Rear ....... ~.....~,, ...................... Depth ............... L~...~.. ..................... Height .............. ~ ..................... Number of Stories ........ ~..~./~. ................. 8. Dimensions of entire new construction: Front ...... Jl~t~J~.[. ..... Rear ......... .-~!~..!~.... Depth .......... .~..~ .............. Height ........... . .~... ................................ Number of Stories ...........~..~-,~ ............................................................... 9. Size of lot: Front ...... ~[..d~C~ ................... Rear ....... /....~...~'. ....................... Depth ........ ..~..~....~. .............................. 10. Date of Purchase ....... L..~....--~...~... ............. Name of Former Owner ........ ~...---~.6P,',~./~....~..~:~-.,~..~-,~ ............... 11. Zone or use district in which premises are situated .......... :~.~ ................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ J~.~ ........................................... 13. Will lot be regraded .......... W~ ............... Will excess fill be removed from,premises: [ ] Yes [)~, No ..... ..... ...... ........................... ," I ( ~ ~ · Name of Contractor ../~..~/~.~Z..~,-~....~..~,',~..¢.~..~x~. ........ ~..~.-~..~.~..~...~..~),&'.~-..~..'.,..~..,~.~..-.~.~.~-.~.~'~wV (Address) (Phone No.) PLOT DIAG RAM /O, '~_~ _ ,,~__~_/,/, I.ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbe~0o~~ng to deed, and show street names and indicate whet~h- er interior or corner lot. STATE OF NEW YOR K, ) ~ COUNTY OF ...................................................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name o£ 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. Notary Public ...................................................................... County ........ ~~;....~..~ .................. ' /I (Signature of applicant)