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Home My WebLink About5836-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTME~NT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at/f..~.0...~.~.~.~?..~ ~... ?..~.~ .... Street Map No ....... '-:. ..... Block No ..... ~U. ..... Lot No.~'~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............~'/./?/.7..~., 19 .... pursuant to which Building Permit No. dated ................~.~. ~ 19'7'~L., 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 . .. ! ~..t~.iC0O~4D · · · .~.e ~ L. .... l~v r Z/:.~... f .~?..c..~.--. ...................... The certificate is issued to .... (owner, of the aforesaid building. Suffolk County Department of Health Approval ........ ~f../.~..., .................... UNDERWRITERS CERTIFICATE No ...... A/. HOUSE NUMBER ... Jg ~Z~... Street .... ./~..~..~...~.47~ ..... L..?.~./..l'.~ ............ ~p U T ~ I4 o 6 U L:' Building Inspector I~OB,M NO. ~1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISE~UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 5836'z/_ Date ........................ ?.,..,.~:;.~:..:~.;'.:;...' ............ , 19 ........ Permission is~ereby granted to: ...... ........... F,.t...2,~..A.. ~a3.1aclc ..Ia&. ~& ............ RockT' ~oi~t ~uild new ~rivate swim. Lng po~rl (accessory) at p~mises located at ....W~.8.....t~T~rl~9~...I,~;~ ................................................................................. ................................................. .~t,~,c~ ......... ~.,.~ ...................................................................... pursuant to application dated .......................~t.~.,1....J.~ .......... , 19...~.~., and approved by the Building Inspector. ALl Imel. ~ levee ~e~ee ~a ae~erate l~Zlit Budding Inspector FORM NO. $ TOWN OF $OUTHOLD , Building Department Town Clerks Office Soutkold, 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 dispasal--(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-existiog dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 w ~ a:ng ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property / ~ ~ 0 ~.) /q T~..'~.. O..~... I_ ..~., CO Owner Or Owners Of PropedT ........... ...~....[,~..~..4...~..~....I~ ........ ..~,...!..N........~........~....,,L...~J~..~..~.. ........................ Subdivision ............................ ~ ............................. Lot No.....'~. ...... Block No." House No.[...~....~...~. Permit No...~...~.~....~.....~-Date Of Permit ..?../.~...~../..?.~pplicant .... ~.?.~..~........?.o..?.!.....~c'~..~ ......................... Health Dept. Approval ....................... ~ .................... Labor Dept. Approval Underwriters Approval ............................................. Panning Board Approval ........................................ Request For Temporary Certificate ........................................ Finctl Certificate _, ~,,~0 Fee Submitted $ ......... .~ ................ Construction on above described building arC'mi J; meets all applical3~'c~es and regulations. ........................ Sworn to before me this// (stamp or seal) ~c '~ Notary Pu~...~County TOWN OF SOUTHOLD BUILDING DEPARTMENT ~/~ C, 0, TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~:....~.. ~/ '~ Approved ~' ~ 19.....~... Pemit No. ~"~::~ Disapproved a/c ............................................................... (Building Inspeclor) APPLICATION FOR BUILDING PERMIT D INSTRUCTIONS ~ ~..~.w~m_..-. ~"?..,~,~Z ~"~ff ,.~j~_I,,M,~, a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Jnsl)ector, with~ 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 areas, a~d~ 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 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 Oceupency shall have been granted by the Building Inspector. APPLICATION iS HEREBY MADE to the Building Department for the issuance of a Building Perm!t pursuant to the Building Zone ,~ Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, OrdinanCes dr Regulations, for tlte~Onlt, ruction of buildings, additions or alterations, or for removal or demolition as herein described. The applicant agrees to comp~wi~ all epPlJcable laws, ordnances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildingS for neeessary inspections. ....... (Address of applicant) State whether appli_ca[tt.~owner, lessee, agent, amhitect, engineer, general contractor, electricran, plumber or builder. Name of owner of premises ~t~.~,.~("~....RV~.....~.)~L~,~.[~b. ............................................................................. applicant isl~corporate, signatt~e of du~y authorized officer. (Narne"alad title of corporate officer) 0 1. Location of land on ~(hich propgsed work will be done. Map No.: .................... Lot No .............................................. Street and Number· .,.[~...~.~.......C~...~-- ........ ~ ~., .............. ~ ................................ ~ ~0 Municipali~ b. Inten~u~and°~u~J ~ ~/~'~ ..................... 7 ................................. 3..o ~lature of work (check which applicable): New Building ....................... Addition ..................... A.~era,tio~n.....:..,~... · Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ....~ .%...0...~....~,,. ....................... Fee ...... !..~..~.. ~.,......~....O.. ~.!. ~...~,.~. .................................................... (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 ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... 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 .................................................. Height ........ ; ............................. ; ............. Number of Stories ...................................................................................... 10. Date of Purchase [.~.~...~\.....~..~..~.~...'~... ..... Name of Former Owner ............................................................................ 1 1. Zone or use district in which premises are situated .................................................................................................... k| 12. Does proposed construction violate any zoning law, ordinance or regulation: ..[..~. ~..t~...~......~ .................................... / 13. Will lot be regraded __..~Q ....................... Will excess fill be removed from premises: [~J Yes [ ] No 14. Name of Owner of premises ~.4~.~[~L..[~Af,~I:~J~%~.....~..J.N~.~.~.~. ................ ~..?..~.?...~..~.~..-....~..~...~.~.1..~..? ...... ~ _ ~, ,. · ,/ ----~J~ ~t~,~:~ I,, I~M~ (Address) C U~'c~ O~Oe. (Phone No.) · ....... ....... ................................................................ ^ (Address) (Phone No.) Name of C~tra~t~r~D~j~~~~-/~ .......... .~..~.~...~..~jT..O..O.. ................ (Address~ (Phone No.) 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 description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, . ) oo COUNTY OF ...............,J.....°.. F~ .~... ,L. L% ....... ) OO ............ : .................... being duly sworn, deposes and says that he is the appliCant above named. <~ (Name df~dg~al signing contract] He is the ......~4aC~ ........ ~_~...ex~ZS~ ............................................................................................................................................. ~ ~ [Contractor, agent, corporate officer, etc. J of said owner or owners, and is duly authorized to o~rform or have performed the said work and to make and file this a~plieafion; that all statements contained in this a~lication are true t~ ~[of his knowl*d~* and belief; and that th~ work will bo ~fform*d in th~ mnn*r ............... .......... ............... Notary Pubhc, ...~......;.;;: ........ ; ................................. Cou~ ~ ................................. ~?~~ .............................. ' ~ (SJ~mr~applicant} J 0 'T i ,/ MAP 01;' LAND Su~v'E¥~O FO~ ~T TOVqN OF;SOLrrHoLD~. ~.IY ~C,A, LE; .?,0'= 1" -¸% 0 MAP OF' LAND, su~?w~ rc~ I CI.4,~r4' D *$ALL'Y' Li TOWN OF~HOLD, ~&Y SERVICE 3wl~,~:nin[: ¥,. - ''hi:: ce~tJfica.se -~ove~s Gompll['.nce at Lne c:~.~e ~c · fnspea~ion ~, .~y. ~c~use of unusual envi~on.~zen~s !~. is 5&visabi~ have f~.. ,:cn~ %e.~t a~Ki/O1- ~epai~s ~]ade by a gu::.l!£ied ?,?.?son. AMOUNT ~ I~¥ CH~CK OR MONEY