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Home My WebLink About6878-zFOB,~ NO. 4 TOWN OF $OUTHOLD BU1LI~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the b-tiding located at . .~.a..sg.n..D..r ................ Street Map No.. xm ........ Block No..xx ....... Lot No, . xx .... Cui;ehogue...2g,~, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Se.pi.. 2~ 19.. 73 pursuant to which Building Permit No. 6.~7.~g... dated ....... ,~.qpt...2~ .... , 19.73, 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 b . .private .accessory.. (s.%orage)..building ........................... The certificate is issued to . .John .De!ency. ...... Owne~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~{ :l.q.. ............................... UNDERWRITERS CERTIFICATE No..~;.,E ......................................... HOUSE NI/NIBER ............. Street .......................................... ................................................... · '_z/ ........ ..... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFiGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 6878 Z Permission is hereby grapted to: ~.o....~.....~......~.e...z. ~.e. z .......................................... ......... D~,~_h~ag~ ............................................ ~o '..~.~ ~!~ ..~.~ .. m~.c.~ ~.~r3:....{~ ~.t~r.~ g.e. ~...]~.~IA~t M3g ............................................................. at premises located at ...... ...~t.~.~.....~.~. ....................................................... ' ........................................... ................................... .~.~.~.~.~e......~.,.~.., ......... ' pursuant to'application dated .................. ~.?.P.~...'...~.,~.. ................. , 19~.~....., and approved by the Building Inspector. Fee $...IlD:.,dDD ......... FOE1YI NO. 6 TOWH OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcat~on must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector w~th the following; for new buildings ar 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, 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), Nan-conforming uses, or buildings and "pre-ex~sting" 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: I. 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 New Building .......... ff.... Addition ................ Old or Pre-existing Building ................ V*cont l..ond .............. Location Of Property ...~...~~ ...... ~ '~.~...,,...~.'... .......... ,~./..~...~...~... ............. Subdivision ............................... ~.. ........... 1%.; ......... ~ot No~-~_y~lock No~._;/~..,House No ............ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Su m,, e * Construction on above described building ,/~bnd permi~ meets all_applicable codes and regulations. Sworn to before me this / , ... ,~..~, ...... day of ...,,,~,~,,~.,.~:~....~,..?..,~,.,.!/ (stamp Notaryt~~=~Public .... ,~,~,..~., .~.,,~,.,.,/~,.~o ~ ......... County, , Approved ........................................ , FOR1V~ NO. 1 TOWN OF SOUTHOLD OF.= .... / · Application No ..... ,~,~,., .~..,.Z..~..' Disapproved a/c ................. ...-~.,,, ~.-.~........ ~~ (Bui ding nspectof) APPLICATION FOR BUILDING PERMIT Dote ~- ~ .......... .......... (. .......... INSTRUCTIONS a This application must be completely filled m by typewriter or' ~n ~nk and submitted in triplicate to the Buildin 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, relahonsh~p to adjo~mng premises or pubhc streets c areas, and giwng a detailed description of layout of property must be drawn on the diagram which is part of this applicotio, c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Building Permit d Upon approval of th~s apphcot~on, the Building Inspector will ~ssue a Building Permit to the apphcont Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used ~n whole or m pa rt for any purpose whatever until a Certificate of Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in buildings for necessary inspections. ..... ...... ............................ (Address of apphcant) State whether opphcont ~s owner, lessee, agent, architect, engineer, general contractor, electnc~on, plumber or bu~lde Name of owner of prem se ....~... ...... .~. .~ ....... ~'~"~ If applicant is a corporate,~J~l'nature 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 p~.9~osed~-----__ ___w°rk w, II be~dor)e~ap~No .............. .x~ ....... ~t _No ~ ................... Street and Number ..... .-..~...~.~...~,...~~ ............ .(,.~....~ ......................... Municipality 2. State exist,rig use and occupancy of pr~m~ises/g~l, re:ended./~./, '1/~// '~ useond occupancy of proposed construction: · ' ' n ~'~"~'~-- o. Ex,s,t,ng use o d occupancy .... ~.~f4. ................ .J ................. ~.. ................................................................ b. Intended use and occupancy ........... .:~...~ ...... ~...~.~. ' .....~ ...................... 3 Nature of work (check which applicable): ~.....' ............ Addmon ................. Alteration Repair .................. Removal .................. Demoht,on .................Other Work .............. ib'~'~'r'ip't i~n) 4 Estimated Cost~...~.~....c:?.....-=.~.......~..~'~.~. .........Fee .//7...~...~ ................................................. (to be paid on fihng th~s application) 5. If dwelling, number of dwelling units ........................... Number of dwelhng umts on each floor ......... If garage, number of cars .......................................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type af use ............... 7 D~mensions of existing structures, if any: Front ............................ Rear ................................ Depth ............... Height ........................ Number of Stories ................................................................................................ D~mensions of same structure with alterations ar additions: Front ................................... Rear ........... Depth ................................ Height ........................... Number of Stories ............................ 8. Dimensions of entire new construction: Front .................................... Rear ........................... Depth ............ Height .................... Number af Stories ............................................................. 9 S~ze of lot' Front ..................................................... Rear .......................................... Depth ......................... 10 Date of Purchase ................................................. Name af Former Owner .............................................. 11. Zane or use district in which premises are situated .................................................................................. 12 Does proposed construchon violate any zoning law, ordinance or regulahon ................................................... 13. Wdl lot be regraded'. .......................... Will excess fill be removed from premises' ( ) Yes ( ) No 14 Name of Owner of premises ~,/'"~.~.~/~...~....~"'..~4,4~.6/~..~... Address 4'Z'.,f.-~'.~/.e4...~.d',, ....... Phone No.~.~..~..-..Y..'..~..~ Name of Architect ........................ ..'~'_.......~v~.~.~.. ............. ~ Addr-ess~.z'.~-~.~.~..~.. Phone No ...................... Name af Contractar ..................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions fror property lines. Give street and black number or description ac~.~mg to deed, and show street names and ind,cat whether interior or corner lot ?r~ '} ' 4'41 STATE OF~~, COUNTY (OF] L...~ ..~.. ............. ~..~.J..r......~~ ............. being duly sworn, deposes and says that he ~s the apphcar ( above nm-d'ed. He ~s the .................................. ~~ ........................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and this apphcat~on, that all statements contained m this application are true to the best of his knowledge and behef; an that the work will be performed in the manner set forth m the application filed therewith Sworn to be_fore-me this ~-. JJ /ri /.,.//~ .............. ..... Notary Publii/[ ................................................... County ..// .../ ............. ~ ......................................................... -- f~ ,.x (Signature of apphcant)