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Home My WebLink About6027-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certific~le Of OccUpancy No. '~ z/7 ~ ~,- Date ~ /. 19. ?. l.. THIS CERTIFIES that the building located at .e.~.'.~'.'?..~.:..<Y~.... ~ .: Street Map No. ~ Block No. ~ . Lot No. ~ ~ ~ ~ fc~ conforms sub~tanti~ly~to the Application for Building Permit heretofore filed in this office dated ....... ~ ...... , 19 .... pursuant to which Building Permit No.~/?.O..~.. ~. ....... ~ ........ ,~9....., was ,ss.ed, and conforms to ail of the r~r~ dated ments of the applicable provisions of the law. The occupancy, for which this,, certificate is ~ (otvner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approvai /~/ ' ~ Building Inspector ~0~ NO. :~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6027 Z Permission is hereby granted to: ..~a~at:h~...~x~::~'.m:~t ...................................... ~o ..... ]~,,~ ~.~a~..~:e~aox'Ir...~..~o~l.&.~.te~.ag, e~...~mi~2al[ ........................................ at premises located at .......A~.~"¥-~:~v~,-'~,'V~. ..................................................................................... .................................................... ~;~-~.~ ..~;~]:~Lo~. ...... N.,,., ................................................................ pursuant to application doted .................... ~...~ .............. ~.. ............ , 19.(.?~...., and approved by the Building Inspector. Fee $..~J~.QO ........... FaBlE 1~'~ I TOWN OF SOUTHOLD Tm Cle Office W, H. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY InM'md'iEml ^. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispcsal---($-9 farm 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 C~Je compliance from the Architect or Engineer req~msible 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: I. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam statement of owner or previous owner as to use, accup~ncy 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 3. Copy of certificate of occupancy $1.00 New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .................................... ~....~L.~. .................... ~.~...[ ...... .~.~ ..................................... , ......... ~er Or ~e~ ~ P~ ..~ .................... c....~ .................. ~ .................... : ................ ,;.~.~ ................. Subdivision ................................................................ Lot No. ............ Black No ............. House No. ............ Permit No...~..~.... ~te ~ Pe~it ~F~. ............. ~licam ............................................................... ~1~ ~t. ~p~al ............................................ ~r ~t. ~1 ................................................ Unde~ritem ~p~al .............................................. Planning ~ ~p~l ........................................ R~uest For Tem~m~ ~iflcate ........................................ Fi~l ~ific~e .......................................... F~ Submi~ $ .................................... Const mctioa on above described building ~d~,pe~,,rmci~,iL.~Ts ~,!,,,qppi~,~b,~le ;.c._~,_,,,ond 2ulatlom. '....~...:.....~'-day ~../~X~ (~ or .') Public ........................ ~ Noto~ Public, State of New York No. 52.0344963 S~ffolk County Commission Expires March 30, 19~~ Approved ..~..........~.... ..................... , i opproved o/c ............. ................................................... TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN CLERKS OFFICE ~UTHOLD, N. Y.d. ~ ~ - 197.~.. Pemit No...~.~..~....~...~.....{.. APPLICATION FOR BUILDING PERMIT ~ Date ~ k) t.'l' ~.~ 19.~,/,.~,..... 0 INSTRUCTIONS '3~ 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 Jot and of buildings on premises, relationship to adjoining premises or public streets or areas, and~J~ 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~t 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 beene_ 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~/~' ~)rdinance of the Town of Southold, Suffolk County, New York. and other applicable Laws, Ordinances or Regulations, for the construction oj~ buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws.~J ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~licant, o~ t State whether applicant is owner, Ieee, a~nt, architect, engin~r, general contractor, electrician, plum~r or builder. ........................ Name of owner of premiss ...................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.,,: ..................................................... Lot No ............. I. Street and Number (02,0 /:::} ~ L~ ,.,~. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... b. Intended use and occupancy ...... .G...~..,~..~.~....~..o.?.~....~..~..E..~ .................................................................................. :~. Nature of work (check which applicable): New Building ~/~ Addition Alteration ............... ............. .......................... R , Demolition ........................ Other Work .................................... Repair ~' o_o 0em°vel (Description) 4. ~stimated ~ost ............................................... F~ ...~..~ .................................................................................... (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 ......................... S. Dimensions of entire new construction: Front ..... .~..,.~..O.. ......... Rear ........ .~.....~ ......... Depth ...... ~.0..~.-.....~. ............ Height ...... .?....~ .................................... Number of Stories ....... /. ................................................................................. 9. Size of lot: Front ...................._................ Rear .......................... ..... ...... . .... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ............................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....~.....0. .................................................. 13. Will lot be regraded ................................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ~0£o-rHY lC C,~/}OJFo~O G'~ g)eUR VI£~U h~& F~Tm~le~ ~77-/C0~°) (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor ...................... (Address) (Phone No.) PLOT DIAGRAM I.ocate 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. COUNTY OF ...~~.'~'~......L.~ ............ ) ...................... '...--~~.~..~... ....... being duly sworn, deposes and says that he is the applicant above named. He is the ................................................... ~.h~....';..-...~..w; ............................................................................................................................ (Contractor, affent, 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 contained i~ 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 therew~.