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Home My WebLink About5839-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.z..~-L, St ...... Date ......... S~l~t. · 2~ ......... , 19.73. THIS CERTIFIES that the building located at .. 39~' 0.)al~ .Dr&ye ......... Street Map No.'::l~ ......... Block No. ~ ....... Lot No..:11~: .....~.1..t.c?)0g~..0 .. !~...y .. ........ .~,..~.~._'c-6nforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Apr~.l...20., 19.72. pursuant to which Building Permit No. ~839Z.. dated ............ Jtl~l'l~.. ~]., 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 . .?l'&vate..one. £am:l. Zy..dwe~.l~.nj ...................................... The certificate is issued to gh&r~ea. J....l~cl~Jao~ ...... 01~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N. ~R... ............................ UNDERWRITERS CERTIFICATE No... l~.D, Cl:},.lrl~ ...................................... ItOUSIi NUMBER... ~c)~ ...... Street...Oldie. 1~1"I¥~ .................................... Building Inspector lVORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 5839 Z Dote ........................... ~Jfl~lJ......~i;.h., 19.Jr2.. Permission is hereby granted to: ...... ~m...~a~o~:m....J,~/C.....Ch&r. Zes..#dialtmn pursuant to application doted .................. .~;~.....~-0 ............... , 19...~., and aP~'~/ed by the Building Inspector. Fee $...~..~.....~, .... · OR3~ 1~0. 6 TOWN OF $OUTHOLD Building Delmr~ment Town C:lerk~ Office Southold, N. ¥. 11971 APPLIGATION FOR CERTIFICATE OF OCGUPANGY 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 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 ......... ~.....~...~.. Z...~..,c. ...... /..~. i~/~;~o/ New Building .................... Old or Pre-existing Building ............ .../... .......... VQcant /Qnd ............................ Location Of Property Owner Or Owners Of Property ...... ..~.'.~../)../.~.~....~:J~ ....... :..~....../~....?...../~.....~....~....~.(~....:~.e........./~.../.....,~...~. ........ Subdivision ............................................................... Lot No ............. Block No ............. House No~ ............ Permit Date Of Pe..it e . App,icont ..... ...... .... Health [~pt. Approval ........ ~,,.:L ............................. Labor Dept. Approval ........ .~d. .................................... Underwriters Approval ........... ~..~ .............................. Planning Board Approval ..... .~.;~ ............................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and re_c~lations. Sworn to before me this / /~ /6 g~Z AG day of...5 ......... ........ Notary Public ./?..'~..?..'./~/GQf.~..P~.. County £×amined .... ~ ................... TOWN OF SOUTHOLD /.../ .... . ~ ~ /~. ~ BUILDING DEPARTMENT ,~/~'C,~ /~,~/ ~/~/~.~C,~/~ - ~ TO~ ~LER~'S OFFICE ~ _~ ~~/~ ~ U HOL ,N.Y. ~ ~ ~. ', ~ ~ /; ~ Application No ...... ~..y ............. ~ (Building Inspector) % 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, wit~? 3 sets of plans, a.ccurate plot plan to scale. Fee according to schedule. b. Plot plan;~how~ng 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 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 bee~ 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 o~' the Town of Southold, Suffo~l~ 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. (Address of applicant) State whether aj;N~Jic.ant i~ own_er~,lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ut lC) ...... ........................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on ~JJi~',J;I J3i;gpqsed work ~ I~ done. Map No~., ................... Lot No .............................................. o¥5 o4-1 Street and Number ............................................................. ~/ ..................................................................................... MunicipaliW 2. State existing use and occupancy of pl;emisP, s and iatendecLu~e and o~ccupancy of proposed construction: Z a Ex sting use and occu-anc' .~.~.....~.J../..J. b' Intended use and occuPpancYy'""~.. ~/.'..~..'""~"~'l~'~~.. ...................... 7' ......i ........................................................ / 3. Nature of work (check which applicable): New Building ....................... Addition ............. Al~eratior} ......... ~ ..... Repair ............. ............ Removal ......................... Demolition ........................ Other Work ................................. . .. (Description) ~ .~ 0 o ~/£~ ~ ~ 4. Estimated Cost ;... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~.. ....... Number of dwelling units on each floor ...... ..~....O~'...../....,~....~.~..., ........... ~t~ ................................................................................................................ -- If gara~, number of cars ................... 6. If busine~, commercial or mixed occupancy, specify nature and extent of each Wpe of um ..................................... 7. Dimensions of existing ~ructures, if any: Front ....~..~---- .........Rear ..... ----~.~. ............. Depth......................~ ........... . . Height ...... [~..[..a~.~.~...~.~.~ ...... Number of Stories ..... 4.~ ......................................................... ~imension~ of samo structure with alteration~ or addition~: Front .......................... ~ear .................................... ~epth .~..~.gl~......~..~ei~ht ...~.~..~.~~umber of Stories ....~. ................................ ........................ t~ ~-t~ ~ ~ 8. Dimensions of ,ntim new construction: Front ~ ~ ~oar ............................ ~ n ................................. .~.~ ....... t..l~...: ............................ ~m~o*S~o~ ...... ~ ................................................................................ 0. ~,.o,,o~: ~o~ ..... z~. ......................... ~.~ ........ ~.. .......................... ~,...~ ...................................... Height ............ ~.~ ............ ~ ................... ~um~r of Storie* ................t..,~., ............ ~.~ ........................................ ~0. ~te o~ ~,;~r:.-a~ ................. ~o~ ~o~o~ ..... ~.~,~.~.~.....c.~.e~.: ............................ Z ne or u~-istrict in whi ' i i' ' - I 11. o e cn pram ~s are s zua~ee ................................................. ..~.~ ............................................ 12. D~s propo~d constructi~violate any zoning law, ordinance or regulation: ........ ;~.~ ............................................. 13. Will lot be regraded~/V~ ....................... ~ ~ ~ ~Will excess fill be remove~ [rom~r~mi~[ ] Yes [ ~No 14. Name of Owner of premiss "'~'~'~';~'C~~'~"~~;"~;~(Address)~ (Phon ............. "" Name of Architect ........................... -* ~ ~ ....................................... 7T~a~;;;~ ................................. ~;;~"'"T~' ~o o, ~o~rac~o~ .._._._._..._.____.____~.:. {~., .......... ~,o. ~o., ' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street andblock nu_~J)er or description according to deed, and show street names and indicate wheth- er interi°r °r c°rner I°t~ ~;~ i ~ [~IU~'' STATE OF NEW YORK, SS COUNTY OF ...................................................... ) - .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................................................................................................................................................................................................................. (Contractor, agent, corporate offwer, 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. ...................................... day of .................................................. 1, ............. .~ .~I~'~7~*'~Y~.~.~ ~' ~ {Signature o~ appli~(t } I' C~