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Home My WebLink About6125-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~1~52]~- ...... Date .............. 5el~t ....19..., 19.9~. THIS CERTIFIE~ that the building located ~t . ~p~. ~ .......... S~reet M~p No.~ .... Block No ........... Lot No.. conforms substantially to the Application ~or Building Permit heretofore filed in this office dated ..... ~iT]..~l ........ , 19. pursuant to which Building Permit No.. . dated ~ 1~ , 19.~., was issued, and conforms to all of the require- '"s~t .... ~9 ......... ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. l~inte..el~e..~L....!.3.~..drillerS, and .,~..pl'i.~lte. f, lr~& .......... The certificate is issued to . .~'01~ .&. Cl~r&. I~fer ........ 0~nerl .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N,IR, ............................. UNDERWRITERS CERTIFICATE No... pOlld~.tl~ ....................................... ItOUSE NUMBER... I,~O ..... Street .... ~,l'l~(ll~O. &~'O .......................... ..................... 3~ ........... !~ppa.d.r~,. !~z .............................. Building Inspector FORM NO. ~ TOWN OF SOUTHOLD 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? 5884 Z Permission is hereby granted to: .... ll~m~A ..!,/~,~1.~L,1~.....~...~ ..~..~1~1~. ~ at premises located at ...... ~..~.....~e~ ....... l~e~ll~~U ............................................. .......................................... ~.~p&dz~m ..&..&z~l~. &~e .............. Ilmt~e:l~ ............................... pursuant to application dated .......................... II~r .......... t.~[ ....... , 19...~, and approved by the Building Inspector. Fee $"'"1,~'&~ ...... ~ I~uilding ~nspector I I~ORM NO. ~ TOWN OF SOUTHOLD 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? 6125 Permission is hereby granted to: ,, ...... .............. ~..,..~ ................... .b/. ...... .................. i.~.?..~...~.~...~~-..~.~....~..: ............................. ~ .......... /...~ ........ ~,........d....~.~ L 19~....~.., pursuant to application doted .............. ~j.~.~ ............ .......... , and approved by the Building Inspector. Building Inspector( FOBM NO. * TOWN OF SOUTHOLD Building Department Town C:ledcs Office Southold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opplicetion must be filled in typewriter OR ink, end submitted in triplicete to the Building Inspector with the following; for new buildings or new use: 1. Finel survey of property with accurate location of oil buildings, property lines, streets, end unusual natural or topographic features. 2. Final approval of Health Dept. of weter supply end sewerege dispcsol--(S-9 form or equel). 3. Approvel of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences end similar buildings end installations, e certificete of Code complience 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 end "pre-existing" lend uses: 1. Accurate survey eT property showing ell property lines, streets, buildings end unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy end condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepere e 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 D~te New Building ....... ~. ........ Old or Pre-existing Building ............................ Vacant Land ............................ ,~.~ ~, o,~, /~~_ ~;. ,_ ~ /~~ ~,.. ........... ~.,~ ................. ~...~ .......................... ~....~,.~ .......................................................... ~ner Or ~ners Of Property .~.....~~ .............................................................. ~. ..... ............. .ous. ....... ,~th ~,,. ~,,ro~ ...~. ...... ~ ........................... ~or ~,~. ~,~o~ ..... ~.~.: ............................. Underwritem Approvol ............. ~ ....................... Plennmg B~rd ~prowl ~' Request For Tempom~ Ce~ificete ........................................ Finel Ce~ificete ...... ~ ........................ Fee Submiffed $ ~ ~ Construction on above described building and.permit meets all appli~cable codes and regulations. Applicant ! .~.,...~.~.~..~..~ ............................................... Sworn to before me this ......... ~../~. day of ...... ~......~.?...~......~.. (stamp or seal) Notary Public .................................... County ~ ~c~ FOR~I NO. 1 TOWN OP SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Examined .......... .~-~.-.r..2. ....... 19...~....Z~'· Approved ........................................, 19 ........ Pemit No .............................. Application No. , .~.....~....~-'- Disapproved o/c ............................................................................................ (Building Inspec~6r) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing 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 on 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 been,. 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 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ........ ........... (Signature of applicant, or name, if a corporation) .............. (Address of applicant) 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. ~ .~ ocationo and on which proposedt[ ~ A / I _ \~ .~, ~[/w,°r wi be done. Map o ............... ct o ..... ..~ ........... ~ .......... ~ ...... ./~. Street and Number ....C.P..~...I?;~.. ....... ~L~P~dJ~w~;~)~/~D~J~9~9~C~~~ - / ~'~ O ~-~' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~...~..(~Z~..v.~....~.~.J.l.!..~.l~....~ ................................................................ b. Intended use and occupancy .............................. ,~.~.c~..~ .......................................................................... 3. 'N,a'ture of work (check which applicable): New Building ....................... Addition ..................... Alteration.;......'..,;~ Repair ............. ............ Removal ........ {jT~/r~ Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost J~ o po · 0o 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 .~. ~'~ ~' ~ zJ~,zJh ................... Near ....! ...................... Depth ....~:,..,~..~..,.~..~.¢. ................. Height ....... J..~. ............................................... Nu ' mber of Stones ............................................................................. Dimensions of same structure with alterations or additions: Front ..~ ........... Rear ..~ ......................... ! . Depth ....... ,~ ....... ,~. ......................... Height ........ /../~m. .......................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front / ........................ Rear ...... ~/...?. ................ Depth Height ......... ~.,~ ................................... Number of Stor es . 9. Size of lot: Front ..... ~.~.: ...................... Rear ...... .'~..J.:..!..O..~ ..................... Depth Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..... ~...L,~.C..~.h.t~. ...................................................................... 12. Does proposed construct on,v o ate any zon ng aw, ordnance or regulation: ..... ~...~.. .............................................. 13. Will lot be regraded,__~___~...°. ....................... Will excess fill be removed fr°m premises: [~ Yes [ ] No 14. Name of Owner of premises ........................ .z~....~.~..{....f....~..~...,..~.~..~..~...~ ........................................................ (Address) (Phone No.) Name of Architect ................................ -, (Addressi Name of Contractor ................................................................................................................. ..~).~...~.; .................. (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.~ , .~..~_ J -~! _ STATE OF NEW YORK, ) COUNTY OF ...................................................... ) .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named, (Name of individual signing contract] (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or ha, ye performed the said work and to make and file this application; that all statements contained in this application are true to the best ~frbia I~ne~le~l~e and belief; and that the work will be performed in the manner set forth in the application filed therewith. Notary Pubhc, Ste!,~ o~ ~Jev¢ York Notary I{~ b,II':~ ..~~,~unty ..... ~ ..~.,....t~.....~...., ,~....., ..~, ....~ ~,,~.., ................................ : ~.:~, :: (Signature of applicant) c o~ P~¥ L~~r PRAWN