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Home My WebLink About6873-zFOR~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~//L i r~ f~ £ ]_ ~ ~vi; Street Map No ............. Block No ........... Lot No .................................. conforms subst~tially to the Application for Building Permit heretofore filed in this office dated .......... ~.~...~t.~., 19~. pursuant to which Building Permit No. ~.~.~.~ dated ......... ~.~.. ~.~.., 197~., was issued, and conforms to all of the require- ments of the applicable previsions of the law. The occupancy for which this certificate is issuedis ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ L~ ~ ~ The certificate is issued to ~1 A i~ d 0 ~ I ~ ~ II ~ ~ ~4 ~ ~1 (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No. ~' ~ ' HOUSE NUMBER ~ ~ ~ 0 Street V ~ L L ~ ~ g k )1 ~ ~f Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6873 Z Date .................... JJ4J[~ .......... ~J ........... , 19.~.. Permission is hereby granted to: ......... O~'ez~t ........................................................ to .. ~*1% .-~-'a~'~i~--&' ~-~e~a~.~o~. 'o]~' .ez~i~. ~et-t~ .............................. at premises located at .... ¥'~'~&~.'~u~t~e ......................................................................................... ............................................... O~.t~t ....... ~,~.. ................................................................................. pursuant to application dated ..................... .~..e.~.~. .............. ~...0. ..... , 19...~.~., and approved by the Building InspeCtor. Fee $-'-~GO ......... Building Inspecyr FOI~M NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office 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 Inspector with the following; for new buildings or new use' 1. Final survey of property with accurate location of all bulldmngs, property hnes, 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 installer,on from Board of F~re Underwriters. 4. Commercial buddings, Industrial buildings, Multiple Residences and similar buildings and installahons, a certificate of Code compliance 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 buildings and 'pre-existing" land uses: 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buddings 3. Dote 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 $I .00 ................... New Building .... ~ ...... Addition ................ Old or Pre-existing Building .... ~ ........... Vacant Land .............. Owner Or Owners Of Property ................................. ~ ......................~ , Permit No ..~....~...~,~...~'.. Date Of Permit .?Z.~...~.L..~..~.Applicant .. ,.~...~.....~...~-/~,x~/,~. ....... Health Dept. Approval .................. -..:......~ ................ Labor Dept. Approval ........................ ..., ................. Underwrmters Approval .............................. ~ ........... Planning Bo~rd Approval ........... ~. ............... Request For Temporary Certificate ........................................ Final Certificate .....~ ............................ Fee Submitted $ ....... .~..~.. .............. Construction on above described building and permit meets all applicabl~¢odes and regulations. Applicant ... ~:.~..., ,,~., ,~, ,.,',~,~~ ................................ Sworn to before me this ~--~ '~' Z ~' t/q_. Notary Public b~b Fb'O ~/~ County (stamp or seal) FLOYD F. KING, JR, , Notary Public State of New Yore No 52-7267800 SuffoikCount]/ ?erin Expires M, arch 30, 197'i[ " ( e7 Approved ............... '.: ....................... , 19 . Permit No. ~ ~ Disapproved a/c ................................ : ....................................................... APPLICATION FOR BUILDING PERMIT TOWN OF SOUTHOL~ BUILDING DEPAI~'MENT Town CLERK~ OFFICE SOUTHOLIZ, H. Y. Application No ................................. INSTRUCTIONS~ a. This application must be completely filled in by typewriter or~ 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 o~ areas, and giVing a detailed description of layout ofproperty must be drown on the 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 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)ordinance's, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ' (Signature of app~cont, or name, if a corporatio~i ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. "'" j, .... Name of owner of premises ......'. .................. ~.:..:.:... '......~.Z ..... "" ': '~'~ ~ 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. Locat on of and on whLgh I~r.op, osed w~rk will be done Map No · .... . Lot No . - ' .......................... ......... -, ........................ :~treet and Number ............ ~ ...... ~,~ ....... t.~-~ --~-~,...x Municipality 2. 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 ..'~...~....~.o,~3 ~) . Fee Z~''-~'''~-~) (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 c~rs ............................................................................................................................................. 6. f business, commercia or m xed occupancy, specify nature and extent of each type of use ........................... 7. Dimensions of ex st ng structures, ff any: Front ............................ Rear .............................. Depth .................... Height ....../..~..../ ........... Number of Stories ...~ ............................................................................... Dimensions of same structure with alterations or additions: Front :~'~ ' Rear '~ · Depth ~> 0 ' ./....~.. (. ................................ Height ................... Number of Stories 8.Dimensions of entire new construction: Front .................................... r~eer ............................ Depth ........................ Height ..... . .~....~ ....... Number of Stories ! 9. Size of lot: Front .............~..~.. ...................................... R ~' ~c~' ear ....X~. .................................. Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. 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 (~ No 14. Name of Owner of premises ~;...~'~ ........... Address ...~..~ ........ Phone No ....................... · Name of Arch tect Address Ph-nA k,-.~'.~--~' ~-~/ Name__ '~°f/~C°ntract°r .. ~..~..~......~...~ .......... Address ...~...~ ......... Phone No.~....~..?..~...~....~'..=.../. - 4-~-~,~T~/~\ PLOT DIAGRAM Lo{~ate clearV and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propert,),l lines. Give street and block number or description according to deed, and show street names and nd cate whether~Tint~erior oLc~r~er Iht STATE OF NEW ~'ORK, -- I S S COUNTY OF ...-~..~.,,~...~..~.~.z~...~' · ...................... ~.~.~.~,....~~. ........................... being duly sworn, d~oses and says t~t he is the oppiicam (Name of individual signing contrac~ above name. He is the ............. ~.~.~.~n...~. ........................................................................................................................ (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 fife this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ...... ..... of ......... .............. , ._ _ ........ ........ ....... ........................ ~ ..... ff {Si~noturo o{ opplicont) N~A~ PUBLIC, STATE OF N~ YORK ~52-7306925 SUFFOLK ~UN~ Commimion ~pir~ M~ch 30, 1~