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Home My WebLink About6038-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupsncy Date .............. THIS CERTIFIES that the building located at .~..2./..g.~..,, .~.~. !.~',,...~. 0.~. ~ Street Map No ...... -~ ..... Block No... ~ ..... Lot No ....... ~ ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... /.. f~/~.f~r, 197..~. pursuant to which Building Permit No..~.~)..~..,~' dated ............... ./...~...C~., 197..~. 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 ....... ~t~ ~ .~. ~'./~...'FT....~..~.0..~.....~..O.Q .~. ........................... The certificate is issued to ... ~/~..]..L-......~...~..07. .... .~i .~...~. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ./X/...~. .......................... UNDERWRITERS CERTIFICATE No ....... .'-'~..~../~ .Z~..,t../~...~.. ........................... HOUSE NUMBER..l~./. ~..~"...Street ...... .1~..~. !..~/ ...... '-~..t'~:) ..................... Building Inspector FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6038 Z Permission is hereby granted to: George ~h!e~s b-~iider Inc A~ Vail alterations on front &. side walls, win4ewe & ~ee.~.. . . at premises located at .......... ~./,~.-~ad...&..I~.~.coz~:L~,...LIkz~ ....................................................... ................... ~ .................................. ]?.~ .q.OI~l~. .......... ~..*~.A ................................................................... pursuant to application dated ......................... ..A..~ ......... ~ ........... , 19~. ..... and apprOVed by th~ Building I ~n~tor. Building ImpeCt/r 'rOaN OF SOUTHOLD Tm Cledm Of~ee S~dd, N. Y. 11~!1 APPUCATION FOR CERTIFIC~Tli OF OCCUPANCY 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 dispasal--(S-9 farm or equal). 3. Approval of electrical installation fram 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 df 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 o certificate. C. Fees: I. 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 pet, ............ ................ New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of PrOPerty ..... .~....q.(..:...,...~.....~..L~...,..~,.(/.. ....... ..~......, .~.C~...c~....q..~..c........~....C. ......................................... Owner Or Owners Of Property ........ ...~..~.(./. ...... ~).~...f.?..~.......~..~...c~.. ................................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...'~..~....~...~...... Date Of Permit ...../.J../..~./~..Z. Applicont ~ o(' ¢ .~..~/~'-,~ )~?,/o/cC _~ c, Health Dept. Approval ............. ..~....~. ....................... Labor Dept. Approval ............... ~ .............................. Underwriters Approval ........ .~..c..~..~..~.~ ........................ Planning Board Approval ...... ..~....~.. ......................... Request For Temporary Certificate ........................................ Final Certificate .......... ...v~... ........... ............... Fee Submitted $ ....... ..~.'.:...d~.. ................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .............. ~......~ ................................................. Sworn to before me this ....~.ff. ...... da~of ..~.~..~....%~..~.~...~..~..~1...~)~ (stamp or seal) Notary ................. ..~ County T£RRI LEE ELAK NOTARY PU,~LIC, State of New Yerk / : i/ ;/ ! FOB, M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined iiiii~.~..iiiii!iiiiiiiiiiill 19.?....'~.. Approved 19 ........ Pemif No ..................................... Di~ppro~ed ~/c .....-..........~....................._........... ......................... ..................... ............................ APPLICATION FOR BUILDING PERMIT Applicotion No ................................. INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Bud ng nspector, 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 pram sas or public streets or areas, and' gw~ng 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 perm t sha 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 necessaw inspections. (Address of applicant) State whether applicant is owner, lessee~ agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~.~.......~..(~ ....................................................................................... If applicant is a corporate, signature of duly authorized officer. 4~lame and title of corporate officer[ Ma NO.. 1. Location of land on which proposed work will be done. p : ................... Lo r~o ........... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~~-~O"~'.. .............................................................................................. b. Intended use and occupancy ....~./~. ............................................................................................... I~ature of wor~ (check which applicable}: New Building ....................... Addition ..................... Alteration..= ........ ~:. Repair ...... x ................. Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ...~..~-t-~ ........................... 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 ............................................... ;., .......................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ...~,~r,~.~.!...e~,~ 7. Dimensions of existing structures, if any: Front ........ ,,,~.....~'...~.. Rear .....~...,'~.....'. .......... Depth .....~,...~..i. ..................... I · 3-- '/ Height .......... ~.. ............................................. Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .., ...... ,J..: ........... Rear ...... ...~.....'~'-.../. ....................... r Depth ................. ,~.~ .~..,~. ................. Height ........... ,Z...,,7~,. ...................... Number of Stories ........ .,/., ............................ Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ........ .....~...~...~,-...~.,~,.~..... Rear ............... ~,~,~,,...'~..;..~.~..... Depth ..... ..-~.,.,,~'..~....-....~.. ......................... Height .................................................... Number of Stories ...................................................................................... 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: ............. ~..{~ ..................................... 13. Willl0tberegraded ...... '_-.~.~. ................ Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ........ ~'/~.. ....... J~[~,.,... ~ ......... ,¢~ff~. ,~. ~. · · · ,~ff~(~,- .............................. (Address) (Phone No.) Name of Architect ..... .~4~,~.d~c~...~.....~..g~x'~.~ ................... ~..~...,g~'.~gi~....x~[~.,. ....... ,¢'~..?....~ .~.~.~).. (Address) ~ff.~,~¢~ (Phone nlo.j Name of Contractor ..... ....~.....~.....~..~-.....~....../'4~,~..i..i~'~.~.~...~ ....... ., -~..'~...'....~...../..~.. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate ~heth- er interior or corner lot. STATE OF NEW Y,,i~K, /,,~ /~ _ ) SS ........... ~....~ .................................. being duly sworn, de~s and says that he is the a~li~nt abo~ named. ~ // {~nt~tor, a~nt, co~mte officer, etc.} o~ aaid owner or ownera, and i~ duly authorized $o ~orm or have ~rfor~d the aaid work and ~o makz and filz thia apoli~fion; ~at all a~a~n~ ~ntainad in thia apO~i~fion are true to t~,~at ~g~O~, and ~lie~; and that the work will ~t fo~h ~n the appelation filed therewith. No =~ , c~e o~ Ne,.- ~ - ~ ~m~ of ~pa~O ~L F ~/lA.uA h }! H tTO.O T,~ / A4 ~oo? 7op fill ¥