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Home My WebLink About5993-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z ~7~8 Date ........................................ , 19 .... · ~ C~E5 ~a~ ~e bui]d~ ]oea~ a~ ............................ ~ee~ Map No..~(~ .... Block ~o ........... Lot ~o .................................. conforms substantially to the Application for Building Permit heretofore filed in this office ....... J' Y.Z z. dated ........... 5..,JUI..~,, 19. ??'pursuant to which Building Permit No ...... ... dated & ,JlJL~' 19..~..~, 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 · he certifieato is ~u~ ~o ................................................... of ~e ~ores~d b~l~g. Suffolk Co~ty Depa~ment of He~ Approv~ ............................ UNDERWRITERS CERTIFICATE No .............................................. .... NUMBER /7~ Street ~L~-~ ~A~E ~ k~ ~ff ' HOUSE ............................................ ; ............. ~ ..... Building Inspector FO~ 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? 5993 Z Permission is hereby granted to: Gee &l~e,~,e...~u~d.e~..~c ....... ............ 4~tt~e~o.,~e ............................................. to .~.~&..e~..~d~ ~.~o~ c~r.~m...e~,~ e~., ~g..~e~- ............................................................... at premises located at ...]~O~c~...ee~,~..1~{O6 ....... ~q~a:S~.t~..~O~t,..~Z~. ......................................... ................................. ~O, ea~r...~ ............. :.~&s.s~..~.~....~t. ebo~.e ................................ pursuant to application dated ........................... ~,y ........~ ......... , 19.~.., and approved by the Building Inspector. Fee ~ .~-. O0 ............. FORM NO. a TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted 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 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 . ~ ........................ New Building .................... Old or Pre-existing Building ....... ~ ............. Vacant Land ............................ Location Of Property ..~....~....../...~...~..~/..~...~......../~....~.~..~C.....~..~:./..~..~..~....~':~.~.~:.~.~...~,..,-~.~~/'~' Owner Or Owners Of Property ...~...~.........~./~'..~."~i~..'~/....~--,~....~.j~ ........................................................... Subdivision .... ~..~ .......................................... Lot No. /....~....,. Block No ............. House No ............. Permit No...~.~.~'~.~.~... Dote Of Permit .'J.~.?./.~...&.l/..~.7..'?'Applicant ....~.~'..~..,~,,..,~-~...'~....~.,~......./..~/.~. .............. Health Dept. Approval , .~/A.. .................................... Labor Dept. Approval .... J~.l..~. .................................... Underwriters Approval .....~./.~ .................................... Planning Board Approval ....Nt.~ ............................... Request For Temporary Certificate ........................................ Final Certificate ......... ..Z.........z'~'....Z.....z~...~... ........ Fee Subm'~ted $ ......~....~ ............ Construction on above described building and permit meets all applicable,codes and regulations. Applicant ............................. ~ ....................................... Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County Examined ....... . .~...~.....'~.......~.. ......... , Approved ........................................, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.~.[ ....Pemit No..,~...~....~....g....-~'... ......... Disapproved o/c ............................................................................................ Application No (Building Inspector) APPLICATION FOR BUILDING PERMIT > ~ Date .............. ~.. ............. , I~.~...'~...... ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 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, an 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 beeKh 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, Suffotk 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. ..................................................................................................... ............................................................ Name of owner of premises .................................... ~..,~.. ...... .~.~7.~...........~..~-~...~..~/.jl[ ......................................... If app~orpo~re of duly~ized officer. ................... ..................... Location' of land on ich ro osed work will' be done Ma No t /4),.5"~ /~ 1. ~J~' p p . p .: .................... Lo No ..... ... ....... ~... ............................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .............................................................................................. 3. ~ature of work (check which applicable): New Building ....................... Addition ........... Alteration.......~.....'..? Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 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 ......................................... 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 ........../.....Z~7~.... ........................................................ 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 ............... ..ff..~...~ ......................... Number of Stories .............. .~. ........................................................................ 9. Size of lot: Front ....... ~.~,,.~ ...................... Rear ................ ..~....~.. .................. Depth ........... ..~..~'...~.. ............................ Height .................................................... Number of Stories ...................................................................................... Date of Purchase ..................................... Name of Former Owner ............................................................................ 10. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... ~...~'.. .......................................... 13. Will lot be regraded ............ ../~...D. ................ Will excess fill be removed from premises: [ ] Yes :~No 14. Name of Owner of premises ~/~..77~/~/g'~-~....~../,~'/~......~.~t~.~'/~......~81~.~;.~..~.:~ Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ....~....~....~..~...~:...~..~...~....~.~[.~.....~-&v...----~...A~..~.i....../~..~...~.~....'~...°~..° (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.aqcording, to deed, and show street names and indicate wheth- er interior or corner lot. ' ~.//~/~7 ' STATE OF NEW~OR[~ / ~ ) ~ ~ / ...... ~.~ .............. r(: .......... ::: ....... : ........ ............................. .~.,7......;~ ......... ;.~.~...:~.~.~,..,~ ............................ bein~ duly s~orn, d*po~ ~nd ~W that he i~ th~ ~lic~nt abo~ nam*d. (~me of.individual si~ing con~act) .. He is the ................................................................................................ :.~; ....... (. ................................................................................................ {Contractor, ag~t, corporate officer, etc.} of said owner or owners, and i~U~ ~d to ~rform or have performed the said work and to make and file this application that all t~f~,~:~best..___. ~,__~._. _t.,_ v_~ of his knowled~ and belief; and that the work will be ~rformed in the ~nner statements contained in ~t forth in the applicatiO6~ flied t~e~ r~'~''~" ~ ~i~mre of applicanO 0