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Home My WebLink About6840-zFORM NO. 4 TOWN OF $OUTHOLD BUI~,IIING DEPARTMENT Town Clerk's Offiee Soutbold, N. Y. Certificate Of Occup;,ncy No. ZS?~O Date Feb 5 19?~ THIS CERTIFIES that the building located at .. ~/.S...S..o~t~..~.~.~. .......... Street Map No. xx Block No.. ~ ...... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... .,~.qp.t .... ~ ......, 19.7.~.. pursuant' to which Building Permit No...6.8~..°Z. dated Sept 5 19.7.~.., was issued, snd conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....~..~.,.~.t. :. ~.~..~.~.~.o..~..~..~.t.o~:~..~..~..~..~...~. .......................... The certificate is issued to . .J..a~e...~..~a..~..z~f..?.r?.o. ..... . .1~.~..~ ......................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval N oB · UNDERWRITERS CERTIFICATE No.N.-.I~, .... .................................... HOUSE NUMBER ..... .~. ~.0. .... Street ....S...o~1.~...A.?.e ............................ FO]tM NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AU YHORIZED) 6840 Z Permission is hereby granted to: · .~.P,~..~t:,aZ~a/'.e z~ ~. ................................... }'ia t t ituck S/S Sound Ave at premises located at .......................................................................................................................... ~attituck pursuant to application dated ....................... ~.,~J;...,.~ .............. , 19~.3...., and approved by the Building Inspector. Fee $.. J.Q~.Q0 .......... FOBM NO. 6 TOWN OF SOUTHOLD Building Depa~tment Town Clerks Office Southold, iq. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be fJJled in typewriter OP, ink, and submitted in triplicate to the Building Inspector with the following; for new buiJdings or new use: 1. FJnaJ 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 disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buiMings, 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), No~-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 ;..~)i~ ./....~.~ c// Date ............ .~..-.. ................. / New Building ...¢~.'.~ ......... Old or Pre~e.xisting Building ...~t ...... "~" ............. Vacant Land ...... .~....~. ............... Location Of Property ....St ........... ~.~..~f ................ ~ ........... /...-./'~'~'.'/~"-~ ..................................... Owner Or Owners Of Property ...... '.~.'~.....~ ............ ,4//.//. ............ ....~....~. ................................................. ................................................... ~.~,.~,.....Lot No ............. Block No ............. House N~ ............. Subdivisi°n .~.~.~...c!..~.-~-... Date Of Permit-~./.~Z...Applicantpermit No. :~'""~"~': ....... /'Zi'~'"'~¢"~'""~'"~'"'~'"~'"~"~ .... Health Dept. Approvol ............................................ Labor Dept. Approval .................. .~..;, ........................ Underwriters Appravol ~/~ Plann og Board Approval Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .~~ Construction on above described building and, permit meets a~ applicable codes and regulations. Applicant ...~;~;......~. t~ ~.......~ .................. Swo~ b;:~fm~., ,, / .~..~ ,~.~,.. ..... (stamp or seal) ~.~._i ~/ Examined Approved BUILDING DEP*RTMENT ' - / ' TOWN a. ERK'S OFFICE SOUTHOLD, N. Y. ,.rm,,.o ..... APPLICATION FOR 'BUILDING PERMIT ~. ~ ~ a. This application must be completely filled in by typewriter o~ in ink. and submitted in triplicate to the BuildingS- Inspector, with 3 sets of pla~s, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n ng prem sas or public streets of areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this app cation. c. The work covered by this application may not be commenced before issuance of Building Permit. ~ d. Upon approvo! of this application, the Building Inspector will issue a Buil~ling 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 pa rt 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 necessary inspections. ........ ~- "c~A'~r~ss 6f applicant) ' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................... .................................................... 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 ............................................... ,~ ,,~ 1. Location of land on which pposed ark ' be done No Street and Number ....... ~...d~...:.~ ......... .~.....u~...~.~ ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........................................................................................................ .. u,e / 3. Nature of work (check which applicable): New Building ..,(Y~, ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . ..... (Description) / 4. Estirr~d C. nst ............................................................ 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 Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................................ Pear ........ /. ................. Depth ..../. .................. Height ........ ~..r. ...... Number of Stories ............/.. ............................................................................ 9. Size of lot: Front ................. _--~" ..~....~,___, .......................... Rear ..........~....'~...~. ..... Depth ..... &~...o_,.~.[ .............. .. Date of Purchase ........ 7./.~.../~...~.... Name of Former Owner ~ ~/ ~. ,W~.~ ~ ..... ". 10. 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... /~...~?. .......................................... 13. Will 10t be ~regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nameo~C~%~ner of premises .......... ~..~ .......................... Address ....~ ............ Phone No~.~....~.../.?..~.. ~ ~ 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ........................................................... ~ ..................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make end 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 ........................ day of ............................................ , ~ ........ ~) ~ ,~ ///, / . Notary Public, .................................................... County ..... ~.......~.....~'/...~ ........... ~// (Signat6re of~161El~nt)