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Home My WebLink About6847-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ .... J~.O.L.o. rlg..C?.~e...k...I~.J...v.e ..... Southold, .N. :¥: ..... Location of Property Housa No. Stro~ ................. Hamlet County Tax Map No. 1000 Section .... 55. ..... Block ...... ~ ....... Lot ...... .~. ......... Subdivision .... Y0rl)qOCO.~.~..P.~.z'~ .......... Filed Map No...~..'I.SZ .Lot No....~?. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~O. ~.. ......... , 19 .~.~ pursuant to which Building Permit No..~.8.~.Z...&..~..8~. 7~' ..... dated .. JLLlle. 5 ................... 19.7~, was issued, and conforms to.all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ......... .v.~.~..a.~.h.e.q..~..o., .c.ar..q.ar.a.g .e..~..~., T.o.oA..S.he.4 .......................... The certificate is issued to ......... R..O.'O.~.r..~..L....B..oLRe. P. ................................ (owneq,Jm~m'm~ of the aforesaid building. Suffolk County Department of Health Approval ..... .' ......N.~. ........................... UNDERWRITERS CERTIFICATE NO ................... ~/.I~ ........................... Building Inspector Rev4ff9 FO]Ii~ NO, :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6847 Z Permission is hereby granted ?o: ..,~c~e =.1; ..~o g~ z,. ............................................... ............... ~-o~h~:~ ............................................. to ...hu J-!eL ~:~.. ~c~e ~so,x~y.../,~.~ogu ~...sh~/[ ............................................................................. at premises located at ..... ~0~.-~]~ ....... ]/'~'~e~'~-.-~et.~k ................................................................ ......................... : .................... 9Q.... ~s?~ g..Cx'.e, ek .~. ........... ~o~aJ;~o~d .......................................... pursuant' to application dated ......................~ep.~...,.~[ ................ , lg.~..~.., ~nd approved by the Building Inspector. Fee $.J.O..OO ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 disposel-(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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion 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 certificat~,,~, ,~ccu~p~ncy~ ~'~"~ $1.00 .~ .~.~/~. ~,~x.~_~ ~_, ~,~/~z~ Date ....................... New Building ............. Old or Pre-exi~ine Building ....... :~. Vacant Land ............. Loca[ion o~ Frope~ ............. ~ .~ ................... , .............................. HOU~ No. ~ ~ , ~ St~ Hamer Owner or Owners of ProperW...~~: .~. ~...~ ..................... C~nWT~ ap o. S ct'on~ .............. Block ............... Lot ................ Subd vision.. ~~... ~~ ......... Filed Map No. ~..Lot No...~ ....... Per . .. Date of Permit .~.~.~ .... Applicant ......... Heal~~oval .... ~ ............. Labor Dept. Approval . .~ .................. Unde~rite~ Approval ........................ Planning Board Approval ~. ............ R~ue~ for Tempora~ Ca,if irate ..................... Final Ce~ificate ....................... Fee Submitted $. ~ .................... Con~ructio~ on above de~ribed bu,lding a,d pe]~ ~eets all applicable codes and regulations. R~. 10-10-78 FOF,..M NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. Examined .... ~ ..... ..~. ........... 19...'~.....~ Approved ............... ~.! .......... ~ ......... , 19....~.~... Pemit No .... .~...~.~..~...../......,~.. .......... D,sapproved a/c ......_.~ ..... ~~ ...... (Budding Inspector) Application No.....~,~....~...,/-.~....~.. ........... APPLICATION FOR BUILDING PERMIT .... ................... INSTRUCTIONS a. Th~s apphcatlon must be completely filled m by typewriter or mmk and submitted ~n tnphcate to the Budding Inspector. wi, 3 sets of plans, accurate plot plan to scale Fee according to schedule b. Plot plan showing location of lot and of buddings on pram,sas, relationship to adlmmng premises or pubhc streets or areas, af gwing a detaded description of layout of property must be drawn on d~agram whmh ~s part of th~s apphcat~on c. The work covered by th~s apphcatlon may not be commenced before ~ssuance of Building Permit. d. Upon approval of th~s apphcat~on, the Budding Inspector wdl ~ssue a Braiding Permit to the applicant Such permit ,shall be kept o the premfses available for inspection throughout the work e. No building shall be occupied or used Jn whole or ~n part for any purpose whatever untd a Certificate of Occupancy shall have be granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to the Budding Zor Ordinance of the Town of Southold, Suffotk County, New York, and other apphcable Laws, Ordinances or Regulations, for the construction buildings, additions or alterations, or for removal or demolition, as herren described The apphcant agrees to comply with all apphcable law ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m buildings for necessary inspect~on- ...... : {S~gnature of apphcant, or name, ~f a corporat~onl ,,/.. -!../ ,/ .{'Address of apphcant) State whether app.li~t is owner, lessee~agent, architect, engineer, general contractor, electrician, plumber or builde .............................. ..... ...... :. .......................................................................................................... Name of owner of premises .............. 7.~.~.R%-;.-'..~ ........................................................................................................... If applica, nt is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Budder's License No .......................................................... Plurnber's L~cense No ......................................................... Eleclrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work w:kll be done. M~p No ....... ~..~.~.~..~.. ................. .../..Lot No..~:~,.. ............ ...... ........................................................... .......... Street and Number 2. State existing use and occupancy of premises and intended use and occupa ~nc.~g~f propq,sqd construction: ~ · b. Intended use and occupancg .................................................................................................................................. / 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... 4. Estimated Cost ............................................. Fee ............. ; ................................................................................... (to be pa~d on hhng thru apphcaBon) 5. If dwelling, number of dwelling units .................Number of dwellin, g units o_n.?ch floer ......................................... If garage, number of cars .........~~.~.'.~'~...~.~. ....... ~.£~. ........ .~..~...-~.~ ................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. D~mens~ons of emstmg structures, ff any. Front ..... ..ZT~...; ......... Rear ........................... Depth ................................... e' ht .~..~ Number of Stories ~..~ Dimensions of same structure with alterations or additions: Front ..... ~'~.z../~.z~...~. ..... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ....................................... 8. Dimensions of entire ~)ew construction: Front .... ../...O.. .............. Rear ~ ........ , ................. Depth .......~..i ..................... 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 construct~gj~, violate any zoning law, ordinance or regulation: .... '~...'~=.. ....................................... 13. Will lot be regraded .... ..~.....~.. ................... Will excess fill be removed from premises: [ ] Yes [;.~ No 14. Name of Owner of premises ..................................................................................................................................... (Address) {Phone No.) Name of A¢chitect ........................ .~..'~ ............. : ............. , ................................. ~ ................ "'7~"'; ~,~ "~,' (Address~, '..~' )i' '- :'"' ~'~"~:i ...... ;' ...... Contra0tor ................ ...... Name of ~' {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. STATE OF NEW YO~K'~ y'~./y/~' ) SS He ,s the ..... ~~ .............................................................................................................. (Contractor, agent, corporate officer, etc J of said owner or owners, and ~s duly authorlzeO to ~rform or ha~e performed the said work and to make and fda this appheation; th statements contained m th~s apphcaBon are true to the best of h~s knowledge and behef; and that the work wdl be performed in the m set forth m the apphcat~on fded therewith ............ .......... Notary Pubhc ................................... County TOWN OF SOUTHOLD ~ -- ?~ (~~"', TOWN CLERK'S OFFICE Exomined ......... ~....~. ........... 19...?.,,~. ~ . ~-_ ~/.~ ~plicotion ~ ........ ^pp o e ........................................ , ....... ................................................ :..::: ..... APPLICATION FOR BUILDING PERMIT_~ .,,/'/, INSTRUCTIONS ' ~ a. This application must be completely fiJled in by typewriter or in ink and submitted in triplicate to the Building Inspector,~ll~it~t~ 3 sets of plans, accurate plot plan to scale. Fee eecording to schedule. b. Plot plan showing Jocation of lot and of buildings on premises, relationship to adjoining premises or public streets or 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 kel~t~o~ 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 necessary inspections. :, . . ::.: ....................... (Signature of applicant, or name, if a ¢~orporation) ......... ....................... State whether appl~Js owner, lesse, e~agent, a~rchitect, engineer, general contractor, electrician, plumber or builder. .............................. ...... .................................................................................................... Name of owner of premises ............... .~....~ ....... ~~'-'"'..: ..................................................................... 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 a[oposed, work wiJl be done. M~p No .................... ./. ............... /~.......Lot No ..................... street and Number ~ ~.~' ~.~...~....~,. -~i~"-'*~ ..~,,,;,~,.4,,,~,,.~,~."~"~?,.~:..,.~,'.',/~,,',' ........ ..................................................................................... ................ i';, i i ........ 2. State existing use and occupancy of pre.rn/jl~es and intended use and occupar~//of proposed construction: a. Ex~st~ng use and occupancy ............................................................. ~ ............................................................ b. Intended use and occupancy .................................................................................................................................. 3. Nature of work (check which apolicable): New Building ....................... Addition ..................... Alteration ............ ~... Repair .................... Removal ......................... Demolition ........................ Other Work (Description) /z ...................................................................... 4. Estimated Cost ............................................... Fee .,, (to be I~aid on filing this application) 5. If dwelling, number of dwelling units ............. ~ Number of dwelling ur)its on each floor ......................................... :-, . ...................... If garage, number of cars ........... ..--~.....~./.~Z'-.;¢:?.~-...~. ....... z..; ............. 7..~ ............................................... 6. If business, commercial or mixed occuDancy, specify nurture and extent of e,ach type of use ....,.~ ...... 7 .................... 7. Dimensions of existing structures, if any: Front ..~; ............ Rear ,.....~..?. ................ Del)th ......c~...~.. ....................... Height ............. ..'~..-~-..;.- ................................... Number of Stories ....... .~.. ......... .~. .................................................... Dimensions of same structure with alterations or additions: Front .... -.~...~.... Rear ........... ~ ............................. D -~ H~ oht Number of Stor es ..... ep~n ................................................ ~ ............ 7--: ........... ' '" ~ 8. Dimensions of entire n,~w construction: Front ......~...~...~ ............ Rear ...../....~...~. ............... Depth .....~ ........................ Height /' ....................Number ot Stones .................................................................................... 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former O~her .......... .................................................................. 11. Zone or use district in which premises are situated .......... ~~ ................................................... 12. Does proposed constr~zc~.n violate any zoning law, ordinance or regulation: ...~..~....-~?.. ........................ ..,~ ................. 13. Will lot be regraded /~....~.:. ....................... Will excess fill be removed from premises: [ ] Yes [~j No 14. Name of Owner of premises ......................... .. ................................. (Address) (Phone No.) Name of Architect ........ ../~..: ......... ?..~....~,~ ................ '~;""?~;t~,~;j~'~ ........... ~'~ ................... i~'~;{~"l~'~'.~'~'"'~: ...... Name of ............... .~/ ~Kddress) (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 wheth- er interior or corner lot. COUNTY 0,~. ~- .......... ~'//~.--].~.( ............. ) .......... ~~.~~ ........................... being duly sworn, deposes and says that he is the applicant above named. He is the ............. ~.~.~,~,'~.,,'~...:..~Z ........................................................................................................................................................................ {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 and file this application; that all ~tatements 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 apl~Lication filed therewith. .......................... ~ ........ dayof ...... .-. ........ ~ ........................... ~ nt -' 19'"~" ........ Notary Public ...................................................................... tJou y ................................ ,~;.~l'~¥.~O'/'~>i;;'~l';)'~ ...........................