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Home My WebLink About5712-z1N~M N~ % TOWN OF SOUTHOLD BU~.nING DEPARTMENT Town Clerk% Office Sou*hold, N. Y. Certificate Of Occupancy No. Z6361 ...... Date .............F~ .....t3 .... ,19. ?~ THIS CERTIFIES that the building located at . ../~assau. P~t~nt. Road .... Street Map No..1 ~6 ........Block No ..........[Lot No.. ~.~ .... C.tl'cchp~e.. ~. ~.. ........ conform~ substantially to the Application for Building Permit heretofore filed in th~ office dated ...........~:eb...~.., 19.~.~. pursuant to which Builglng Permit No..~[~.12?~. dated .........Feb.- t.7 ..... , 19.72., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which iht, certificate is issued is . .gr£~ate..ane. £a~il,~: .dwelling. w~th. an .&ddit~ul ................. The certificate is issued to .... Be=nard .Qoe~le~. ~ .Wo ....O~mlns ................. (ow.er, lessee or tenant) of the aforessid building. Suffolk County Depa~ient of Health Approval . .~.. .............................. UNDERWRITERS CERTIFICATE No..De~4~E ................................... HOUSE NUMBER ..... 2~ .... Street .. ~ssau. · .~e~rst · Roed .................. ....... ....... FOEM 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) 5712 Z Permission is hereby granted to: .~ ~, .~ .e ~-. ..... ~ ........... ~:~..~...~~-~- ...~.~.::..,~...~ ~ , ~ ~~ · o, ~r,~,,, ,~,,,~ ,, ., ....... : ...... ::.:.:...: ...... ~.~ ....... ~ ....... ~.~.: ............. ............ ' .......................................................... ~~.~...,.../~.~. ....... .............. ,~ ................................ ~ ....................................... ~ ........................................................ Building Inspector. F e $....~.: ........ : ....... Building Inspector FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Sou,'hold, N. Y. 11971 APPLICATION FOR C,C-RTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and sdbmitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of all ~buildings, property lines, streets, and unusuat natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispQsal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire U~derwriters. 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 plar~ 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, ~treets, 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 New Building ................ Addition .....~ ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... N~.~s.~a~....L'.cdLn.t, .................................. ; ............................................................... Owner Or Owners Of Property Subdivision .......L~nn.e ............................................... Lot No ............. Block No ............. House No ............. Permit No ......~.??:.2 ...... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval .... Z~.~...~.;.: ......................... Labor Dept. ~pproval ................. ../.~...~....(.~.. .................... Underwriters Approval .....~..~;....~...~ ......................... Planning Boo, rd Approval /~' Request For Temporary Certificate ........................................ Final Certificate ........................ Fee Submitted $ ........5.~.~?.0. .................... Construction on above described building and per~.~t meets all a~pplic.~bJe codes and regulations. Sworn to before me this ......... Z... day of x~_: ................. s ................ hlotar~ Public ....~ aunty FORM NO, 1 ·OWN OF soUTHoLD BUILDING DEPARTMENT TOWN c-.,,'s omc. SOUTHOLD, N. Y. · . .............................. x~.., ~ ........ Dimpproved ~/e ............ ~~ .................. .......... .................... .. . .... (Building Inspector) Application No. ,,,,~..,i,?,(,~, .......... APPLICATION FOR BUILDING ~ER~I'~ Date ... ......................................................... , 19 ............ INSTRUCTIONS a. This application mus~ be completely filled in by typewriter or in ink und 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 or areas, and giving a detailed description of layout of property must be drawn.,en the diagram which Is I:~rt of this application. c. The work covered by this application may not be commenced befoie 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 prog~ss of the Work. e. No building shall be occupied or used in whole or in part for any parpose 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 Work and other applicable Laws Ordinances or Regulations, for the construction of buildings, additions or alterations, or i{or removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signc~Jre cf applicant, or name, If o corporation) ............ ...... ................. (Address O~ applicant) ~J State whether applicant is owner, lessee, agent, ar_chit~neer, general contractor, electrician, plumber or builder. If applicant is a corpor~} signature o~f duly authorized officer. (Name and title 'of corporate officer) 1. Location of and on which proposed work w be done Map No.', ..... ./.;?.~.~, ........... ................................ Lot No ' // . . ....... .......... 2, State existing use and occupancy of premises and intended.fiHse arid occupancy of proposed construction: E st n use n" cu an a. x g a a ac p cy ....................... ; ......... ;~ ........................................................................... Ii b. Intended use and occupan;? . ............................................................................................................................... Nature of wo~'k (check whicl~ applicable): New Building .................. Addition ..... ~ ...... Alteration ............. Repair ................. Removal .................. Demolitian .......... ~, ..... Other Work (Describe) .................................. 4. Estimated Cost .................~.../.?..O...O..,.¢~. ......................... Fee ....:.-../..:~.~......'~.-.~.. ........................................................... (to be paid on fi~ing this application) 5. If dwelHng, number of dwelling umts ...........................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 st~ructures, if any: Front ......~,.~, ................ Rear ......... .~..~ ................. Depth ...:~ ...... Height ...,,~.~ ............ Number of Stories ..... ~..~& .................................................................................. Dimensions of same structure with alterations or additions: Front ......... ~.,~ ..................... Rear ..... ~..;~ ............. Depth .......~..~.~.'.~ ............... Height ........... ~1 ............ Number of Stories ..........C.?.~ ............... 8. Dimensions of entire new construction: Front ............. ~ ...............Rear ......... ~.~[~. ............ Depth ...~,~.~.~ ............. Height .................... Number of Stories ..................................................................................................................... 9, Size of Jot: Front ......... ./..~,~. ............ Rear .............. ./.~..~. .............. Depth ............. ;'.3...Z.,.O.. ......... 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... ! 1. Zone or use district in which premises are situated .............................. ~.. ................................................................. 12, Does proposed construction ~iolate any zoning law, ordinance or regulation? ..... ~ ................................................ i3, Name of Owner of premises ..l~f.~r.~.....~..~,'.¢.£~/tcf......Address .~...~.~...~..f...~..~¢.~...C?./~.. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~...cR......~.....~.~!./.~(...~.-.~/~,...Address .~..~.~......~..~.4..~.~,.....C..~.~ ....... 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 ,vhetber interior or corner lot. STATE OF NEW YORK, Icc ............. .................................. .~.,'...~...~ ............. ' being duly sworn, deposes and says that he is the applicant (N~'~Cof?;~'i~idual signi ng application) ............... above named. He is the ..................................................... ..~.... .............................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to pe~rforrn 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 ti,ar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ ............................................ , hlotan! 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