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Home My WebLink About6836-zFORM NO. ~ TOWN OF SOUTHOLD BURPING DEPARTMENT Town Clerk's Office Southold, N. Y. Certific;,te Of Occupnncy No. Z~f~ ...... Date .......No.v. embe~..7~ ........ , lg. 7.~ THIS CERTIFIES that the building located at .Wal~$. Raad ............... Street Map No .... XX ....... Block No .... ~c ..... Lot No...XX .... ~Lalll-al ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......AUgUS.t .29~ .... , 19..7.3 pursuant to which Building Permit No.. 6836. Z dated ......~ept,..~ ......., 19..?9 was issued, and Conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... Privata. (ae~essO~.y). atc~.age..bu/l~l~ng ........................ The certificate is issued to .. gtanl.ey. Rabso~, .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Nil UNDERWRITERS CERTIFICATE No.. IR.. HOUSE NUMBER ... 8.~ ....... Street . .l~el~ .l~oad ............................ Building Inspector I FO F~M NO. ~ TOWN ¢)F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI'IOLD, N. Y. BUILDIING PEIU~IT FI-HIS PERMIT MUST BE KEPT CN THE PREMISES UNTIL FULL CQMPLETIO~N OF THE WORK AUTHORIZED) N? 6836 Z Permission is hereby granted to: et premises located at ...~G1.~i.t$...~[~/~[. ............................................................................................... ................................................... · a~e-~'""'N'~'~'~ ................................................................................ pursuant to application dated .................... .~.....~ .................. , ]9.~.., and approved by the Building Inspector. ~\ FOlgM NO. 6 TOWN ClF SOUTHOLD Buildin~ Deportment Town Clerks Office Southold,, N. Y. 11971 APPLICATION FOR CEI~TIFICATE OF OCCUPANCY Instructions A. Th~s application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buddings, property lines, streets, aha unusual natural or topographic features. 2 Final approval of Health Dept. of water ,~,upply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Eoard of Fire Underwriters. 4. Commercial buddings, Industrial buildings, Mulhple Residences and s~mdar buildings and installations, a certihcate of Code comphance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable B. For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of property showing all l~roperty lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous ow~er as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspechon 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-ex~sting dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date New Building ....... ~ ....... Old or Pre-existina Budding ............................ Vacant Land ............................ Location Of Property ..... ,,,~,,.,,~,,.,/'7.,,~,,.,,J~.,, ..... ~,.,~,,~,,.,~.,.,,,.,~,,,,,,~,,~/,,.~.~,..,,~,,,,,,~,,, Owner Or Owners Of Property ....?..~.....f~.. ~--..'~...C. ~.....~......~ Z..J~.......~ ~.~......~... ............................. ..................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ~..~...~.~'~' Date Of Permit .~..~.../'.~...~ Applicant Health Dept. Approval ......... ..~...:...~:... ...................... Labor Dept. Approval ..............~....,~..~.. ........................ Underwriters Approval .......... ..~,,..r,..,,.~,, ...................... Planning Board Approval ...... ,~...:.~, ................... Request For Temporary Certificate ........................................ Final Certificate ......... .,~,,. ........................... Fee Submitted $ .~...'....0....,0. .................... Construction on above described building and,~permit meets all applicable codes and regulations. ........ ........... Sworn to before me this /~/L/~ ,_~'/ ~: 7~. .... ~day o~......~.......~. · .~.../~.....~... ............... (stamp or seal) Notary Public .................................... County Approved TOWN CLERK'S OFFICE Application ........................................ , 19 ........ Pemi~ No ..................................... Disapproved a/c~ ..... -x~L....~~ ................. ~ ................. ................................. APPLICATION F~R BUILDING PERMIT INS[RUCTIONS a. Zh~s application must be completely fdled ~n by typewr ter or ~n ~nk and submitted ~n tnphcate to the Budding Inspector, w 3 sets of pians, accurate p~ot plan to scale Fee according to schedule b. Plot plan showing location of lot and of buddings on premises, relationship to adjo~mng premises or pubhc streets or areas, ~ g~ving a detaded description of layout of property must be drawn on d~agram which ~s part of th~s apphcat~on. c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Bulld~ng Permit. d. Upon approval of th~s apphcat~on, the Budding Inspector w~ll ~ssue a Budding Permit to the apphcant. Such permit,shall be kept the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or In part for any purpose whatever untd a Certificate of Occupancy shall have b granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to the Budding Z,~ Ordinance of the Town of Southold, Suffolk County, New York, dnd other apphcable Laws, Ordinances or Regulations, for the construct~o~ buddings, additions or alterations, or for remova~ or demoht~on, ,~s here~n described The apphcant agrees to comply with all apphcable la' ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buddings for necessary inspectlo (S~gnature of apphcant, or name, ~f a corporation) .... .30~ Cl. in. ton A.¥.e.s..C.e.d.a..?.hu.~..s..t. ~ ..~. (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build .......................................................................... ........................................................................................................ Name of owner of premises ................. ~,~,~...;~.~L..~,~..l;~,..,,?,g~.~fit~ .......................................................................... If applicant is a corporate, signature of duly authorized ofi~cer, t ~Name and title of corporate officer) Budder's License No .......................................................... Plumber's L~cense No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ........................ Street and Number ~e~L~s Road "' ~- Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~.q~...~..e...~....~..e..s.;?~.?.c.,.~....C..o..~.5~ ...................................................................... b. Intended use and occupancy ..............~;~_..S~:c~e..S~e.e. ....................................... 7. .................................... 3. Natttre of wbrk (check which applicable): New Builc~ing ...... :\ ............... Addition ..................... Alteration ..... ~ ...... ,. Repair ......................... Removal ......................... 'Demolition ........................ Other Work ............................... (Description) 4. Estimated Cost .... ~.2..9..,..0..q ............................ Fee ....~'.../..O..:...O....O.. ........................................................................... (to be prod on fihng 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 occuDancv, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..... ~.(~ ............ Rear ....... 2.8. ................ Depth ......2,Q ........................ Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front .... J.fJ..E~; .......... Rear ....... ]-O,E.t .......... Depth ...J.Q..£.L ................... Height ......... .I~..E;I; ............................... Number of Stories .............. ; ......................................................................... 9. Size of lot: Front .... .1...0..0....F..,t.... ................... Rear .... ..1..0..0....F...~... ....................... Depth ....... ~.6. Q..?..t.... ........................... 10. Date of Pumhase ...6.~..~.2.~..7..;~ .................... Name of Former Owner ..... .(~.,:..~tD~$.~,[~, ................................................. 1 1. Zone or use district in which premises are situated .......... J.~,l~,iJ,~l.~,l. ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................... 13. Will lot be regraded ........... ~P. ................... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ~t~az~y~.~nd~;h~R~n~C[.~[~t.~n~Au~.~d~aa~mavs~*~:~¥~ ..... (Address) q 16 (~}~e Name of Architect .................................................................................................................................................... (Address) (Phone No.) Name of Contractor ................................................................................................................................................. (Address) (Phone No ) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. Kindly note that we do not have a survey as the lot has permanent concrete markers. STATE OF NEW YORK, ) SS COUNTY OF ............................... ) ........................................................... being duly sworn, deposes and says that he ~s the apphcant above name (Name of tnd~vtdual stgnmg contract) He ~s the (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly autho.zed to perform or I'ave performed the smd work and to make and file th~s apphcat~on; that statements contained m th~s apphcat~on are true to the best of hm knowledge and behef, and that the work wdl be performed m the man set forth m the apphcatmn hied therewith. ...... day of ........................... 19 ... Notary Pubhc .............................. .~ Coun,~