The URL can be used to link to this page

Home My WebLink About5854-z FORM NO. 4 SOUTHOL~ TOWN OF BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .ll&~ .Ii~ ............. Street Map No.l~..~0~[~[80.. P~r~k No ........... Lot]~.~. ..~; 3. ...... 18Ol~t~[l! . .~Y... conforms substantially to the Application for Building Permit; here~'°£ore filed in this office dated ......... ~lOp~.. ~.~...., 1~..~. pursuant to WhiCh Building Permit No.. dated .......... ~8.~.... ~.... 1~..~.. was issued, an~ c~n~orms to all of the require- ments of the applicable provisions of the law. The oeeu~ar{¢y for which this certificate is issued is . ~l~..~.a.t;$. ~ .~. $,~. ....................... ;.... .......................... The certificate is issued to .. lt*l'l;ha .D&'I~8 .... 01~ ~, ......... ~ ................. (o~Wner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No...I~?.~. ............. I IOUSE NUM BF.R..~.e~ ....... Street ...................... : ..... , .................... · Building Inspector 1;'OI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEIqTi TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL 5854 Z Dote ............. ~.....: ....... ~r .......... ~. ......... ] 9.~1~.. Permission is hereby granted to: .............. ~.~.'..~s~.~ ..................................... ~o .~..~...~,, ~,:..,, .:~..~..~.:.!...,. .............................................. .............................---- ~-- ~-,,.~- ,~...~..~,.,~,~.,..~..~:.~..~ .................................................. at premises located at ..... ']~t~ .... &"~"~'~'"'""'"~ ' ~~t: ................ : .......................... ................................................... ....... .................................. pursuant to application dated .................... : ....... L]~....~i.!L,,~]9.,~I~;., and approved by the Building Inspector. ~" r Fee $..tt~ .......... ' ' PORI~ N'O. 6 TOWN OF $OUTHOLD Building Depa~menf : Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OC¢IUPANCY Instructions A. This application must be filled in typewriter OR ink, and su~mi(ted 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 b~ildjngs, property lines, streets, and unusual natural or topographic features. I 2. Final approval of Health Dept. of water supply and sewerbgel disposal--(S-9 farm or equal). 3. Approva~ of electrical installation from Board of Fire gncjbrw~riters. 4. Commercial buildings, Industrial buildings, Multiple ReSidences aad similar buildings and installations, a certificate of Code compliance from the iArdhitect 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 u, s,i or buildings and "pre-existing" land uses: . 1. Accurate survey of property showing all property lines, s!reeis, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, o~cupancy ar)d cond,t~on of buddings. 3. Date of any housing code or safety inspection of buildln!ilS .dr premises, or other pertinent formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land usei 3. Copy of certificate of occupancy $I.00 $5.00 ............. New Building ..... ~ ............ Old or Pre-existing Building ............r....i,....; ..... Vacant Land ............................ Location Of Property ...~tl~,.[;i~ ........... ~l~L~l~d,....]~...i ....................................................... Owner Or Owners Of Property .............................................................. ; ....................................................... Subdivision ..]~.~.ft..]~.~ItGt~ ............................ Lot No. ~i,.lk..~ck No ............. House No....j~. Permit No. ~ ........ Date Of Permit ....~i~.~...~.~.,~llcant .... ii~i~'~'"~'*'"'""*'"'""**'*"**' Health Dept. Approval ............................................ Labor Dept; ~Pprbval .... ~ .......... ~i~Jf.~ ....................... Underwriters Approval ...... ,~.,,..~,,i~ ............................... Planning Boo!d ,~pprovc{I ......... ~,~;e ..................... Request For Temporary Certificate ........................................ Final iCe~tificate . ........ ~ ......................... Fee Submitted $. ~ ......................... Construction an above described building and permit meets oll ~pli~,oble codes and regulations. Applicant Sworn to before me this .......... ~... day of ..... j~...~.9~v~ ................... ' (stomp or seal) Notary Public .................................... County TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,, N. Y. E×am,ned ...:~x/:~ ....... L.Z......, ~ .~ ~ ~. ~,,o~ ...,,..~...:..~ ......... ~ ............ , ,~ ........ ~,, ,o. .......... ,.....~ ......... : ~ ......... ::? ................. ~' t0 . ........................................................... .~.......~ .......................... ,>~t~- ' , ~ (Building Inspector) Application Ne....:.~..~..~...c/. ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink Ond submitted in duplicate to the Building Inspector. ~ b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagr~om which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector wilt issue b B~ilding permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progi'ess of the work. e. No building shall be occupied or used in whole or in part for any pu~ose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~issUonce 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 ~or ?emoval' or demolition, as herein described. The applicant agrees to comply with all applicable lows ordinances, building code, housing code, and regulations. ..... ....... .... (Signotu('e of applicant, or name, if o corporation) '~ ...,_~ ~..o..~.., ./t./.:..f ./.,.... . ./.,/.. ~ ~ / ' (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, generbl qontractor, electrician, plumber or builder. ..... ~e~..~ .,..~.Z.......(3~.~.~~. ........................................... ....., ..................................................................... Name of owner of premises ... ~..~..'~-~. /~.~L~.' ~..~-.~.~..~.C'?.....: ~/~,~£4',r,~ .............................................. If applicant is a corporate, signature of duly authorized officer. ..... ~_~z/..~c'..~.. ....... ~. xz2~z .:~.v......~./.~::,~, (Name and title of corporate officer~ ]. Location of land on which proposed work will be done. M~p No.: .~.~.::.~:':~..'/.:.'.. .......... Lo, No~..~.~.. Street and Number ...~.....~ ...... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ...................... "..... .................................................................... 3. N'ature ~f work (check which applicable): New Building ...... dditJon .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............. .'~,o.~l~,.....-;m... ......................... 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 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 o,,~,entire new construction: Front ..... ~-..~... ........ ....... Rear ~.~C~., ........ Depth ....~.~, . . Height .....~. ............ Number of Stories ........ [ ............................................................................................................ 9. Size of lot: Front ...... Z~...~Z.,.. Rear .......... ~J~...~.~..: ....... Depth ...~Z.~.: ............ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1,. Zone or use district in which premises are situated ..~:. ...... ~.~Z~.~.~.~:~.~ ................................................ 12~ Does proposed construction v~'olate any zoning law, ordinance or regulation? ..~;..:..' ........................................ 13. Name of Owner of premises .~.Y.$..,~..,.~ ........ Address .~.~...~]...~..m.~..~..... Ph~ Name of Architect ..~.~.~...~..: .......... Address ....~.~.~:~ ................ Phone ~C~.,~.~. ...... Name of Contractor ..~k.~..~....g~.~ddress ....~.~. .................. Phone No. PLOT DIAGRAM Locate cleorly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property line~. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 0 L~C~I ~ ~-- '-~ q STATE OF NEW,~Y~,~ , ~ S S (Name of individual signing application) abow~ 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 and file this application; that all statements contoined 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. Sworn to b~fore me this ~ ~ _