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Home My WebLink About6832-zFOIt~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O/[ice $outhold, N. Y. T~MPORAR! Certificate Of Occupancy No.Z.~.8.8~'.. ...... Date ............ . .~..Y...3. ........ , 19..~'., THIS CERTIFIES that the building located at .R.;0.*~. 0.f~ .¥.~.l.l.a.~.e...~... Street Map No.. XX. ........Block No....XX. ...... Lot No.....X)~....0 .~.i.e.n.t...N.o.Y.; ............ conforms substantially to the Application for Building Pemit heretofore filed in this office dated ...........A.u~...~.0..., 19..79. pursuant to which Building Femit No... 6.8~2.. Z dated .........A~ig.. 30 ..... , 19.73, was issued, and confoms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~.~,?.a.~...on.e..f..~. ~.y..d.w.e..1~..i~ ..................................... The certificate is issued to ...Ed. ga.~....8~...th...~...1/$.~. ...... .~...e.r.~. ................... (owner, lessee or tenant) of the aforesaid, building. Suffolk County Department of Health Approval .. p.e. nd..~n..~ ......................... UNDERWRITERS CERTIFICATE No.. p.~,ll.d..i~.~ ................................... HOUSE NUMBER . .6.00 ......... Street .Py.T...1~., .~.. ~..1~. ............................ FORM' NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6832 Z Date ............. 3 O A U ~ 19.-~..'~ Permission is hereby granted to: ........ ..?...~.,~. .......... ~..,.,..!~.. ~...~...u..~ .................. ........ ...... to. ~ ! ........ I.: ............. ~.3. ......... L?..~.L:.. L L, ~, ~-- at premises located at ~>V7 ~0~ .P ~/~' J"'{~ L/~ ~L-- /_./~ pursuant to application dated ................................. ..°°....~....~...~J....~..., 1~7-~...., and approved by the Building In~:}ector. Fee $../.,,~,,,.~ ........... FOB,~ NO. B TOWN OF SOUTHOLD Building Department Town Clerks Office Sou~hoJd, N. ¥. 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, o 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 aT 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ............................... /. ............. ,-:- New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .....~...~...,~....../~../...~........~~...~.;.~~ ,'7 /-' ,-.'"~"~ ................ Owner Or Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No....~...~..?...~=...~.. Date Of Permit ?.~..~...~../.?.~...Appllcant .'..~...~,....~./..~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters APproval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....... .................................... Fee Submitted $ .................................... Construction on above described building and p. ermit meets all applicab[e~codes~ ~- and regulations. Applicant .....~....~;......~;../. ......... :...i ............. ~ .................................... Sworn to before me this Notary Public ......~'...~.~...,~.....~....~....~... County .... (stamp or seal) N~ARY PUBLIC, STATE OF NEW YORK ~52-73~925 SUFFOLK COUN~ ~mmi~on ~pires March 30, Z~ Approved ...............................e., 19..¥~... Permit No. ~.C 7,2- Disapproved a/c ................... i...i~. ...... ~ ....................................... (Building Inspector) TOWN OF SOUTHOLD BUILDING DEPARTMENT ,~/ -jo ~,._ /. ~ ~/'~' ?" TOWN CLERK'S OFFICmm/ c~-"~-~r~.~ ~ ~~/ ~ SOUTHOLD, N.Y. ~~ ~ APPLICATION FOR BUILDING PERMIT Date .............................................. , 19 INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applJcatien. 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~k 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. ^PPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Bud ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appl cab e Laws, Ordnances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo t on, as here n described. The applicant agrees to comply with all applicable laws ordinances, building code, housing code, and regu at ens, and to admit author zed nspectors on premises and in. buildings for necessary inspections. (SignatuJ/e of applicant, or name, if a corporati~n'i ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner of premises ..~......~...~....~...~.........~....~ ..................................................... Name of If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. ~'~' ~ Electrician's License No....~..~...?....~.~. ........................ Other Trade's License No ............................................... Location of land on which proposed work wilL be done. Map No.: .................... Lot N~. ...... Street and Number .~~ ~ ........ .'./..~......,?.'.~......,~......,~..... . ...... 4~'~ .................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~...'. b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ..~..~..~ ~ D D Fee - (to be paid on filing this applic,atj~n) ? ...... ! ..................... Number of dwemng un ts on eoch 5. If dwelling, nurt~er of elling ._ . ........................... If garage, number of ca/'l~ ............ './. .................................... -/'....~......~..~!../~' ................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..... ~...~...t ............... Rear ../...~...r. ..................... Depth ..~.../'/..../ ......... Height ...... /.~..../. ......... NumbeF~~ .~... ...................................................................................................... . . / / ~ / Dimensions of same structure with alt~a~ns or a~.~_Fronxt, ...... .~..~.. ....................... Rear ..../...~.. ................. Depth ........ ./'L/..~.. ................ He,cjht ..~...Z~. ............ ;;..~lun~ber of Stories ................................ 8. Dimensions of entire new construction: Front ...../....~..f ........................ Rear ..../...~. ................. Depth .....~....~..~ .......... Height ........ ~. ......... Number of Stories .... ~ ......................................................................................................... 9. Size of lot: Front ....... [..~..~..[ ...................................... Rear ..... /../.~....I. ............... ,. ,:4z, .::~'x" Dep~x" '/'4~'"'~"~'"::'~/ .: ........ Date of Purchase ........................................................ Name of Former O ner 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 ..... ~ ............ Will excess fill be removed from premises: ( ) Yes (J(') No Name of Owner of premises ~..~~ ............ Address '.~..~ ........... Phone 14. Name of Architect .............................................................Address ................................Phone No ....................... · ...~..~...~ ............ Address .....~...~-- '- ' ....... Phone Nome of Contractor PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oll set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicote whether interior or corner lot. STATE OF NEVi/YORK, t-- COUNTY Of .~:~./~'...,_,_,_~..~...Z...~-~. ...... ................. ./....~...~...~/....~..~./~.x~..xC/,~..~.~ ............................. be'lng duly sworn, deposes and soys that he is the opplicam (Name of individual signing contract) above named. He is the ........... .~.~..~..~./~.4~..~..~...~'.....~. ............................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .... .,~...~....Z-,Z~...... day of ........ .~..-~..~.~..~..~/.. ......... , 19,,~.. ~' MARY 0. KLOS $ ~' (Signature of applicant) NOTARY PUBLLC, STATE OF NEW YORK :~52.7306925 SUFFOLK COUNTY C~mmiSsion r~ires March 30,