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Home My WebLink About6885-zFOR~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z550~- Date ....... 0~t; . t~ , 19 73 THIS CERTIFIES that the building located at 570 Pacific B~; Street Map No. ~ Block No..~ Lot No.. XX M~ttittl~k lq ,¥, conforms substantially to the Application for Building Permit heretofore filed in this office _____~dated ~el~t p~; . , 19 '/3 pursuant to which Building Permit No. 688~. -dated ...... ~eDt . 2~ . ~, 19.?~., 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 .. A¢¢es,~ory ~tora~e &..tool .shml ......................... The certificate is issued to . .Franck of the aforesaid building. Suffolk County Department of Health Approval UNDI;RWRITLRS CkRTIFICATE No IIOUSI. NUMBFR (owner, lessee or tenant) Street Pacific St. Building hr, pectin 17~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPART/vtENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST 13E KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6885 Z Permission is hereby granted to: .............. l~a.~t~.t~/~ ........................................ to.. ]au~,~...~e.~...~c.~.~.~.~ g.v.X....( .s..~.o...r.a.~.e..).....b. ,~...~.~.~; .............................................................. et premises ~ocated at ..... ~8~ ....... ~O-~;L~..~,t, ................................................................................. ........................ ~ ....................... l~%~*,ae~ ......... ~* ........................................................................ puts. ua, hr to applicatio_n da.ted ........................ ~i~....,~. ............ 19.~.3..., and approved by the B{Jilding Ins?ector. TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled m typewriter OR ink, and submitted in DUPLICATE to the Building Inspector w~th the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, aha 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 buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses' 1. Accurate survey of property showing all property lines, streets, buddings 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 Dote ..... .......... New Building .... ~/.E.~.... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locot,on Of Propert~ .......................................... ~....~..~....~.~. ........... .~..--¥ .................... : ........... Owner Or Owners Of Property ........................... ~..~.~.~/./~...-~..~...~'.~.~/~.~'J..~ ........................................ Subdivision ........................... ~ ................................ Lot No......¥. .... Block No.....~.. ...... House No.~-.~.. Permit No ~2~9..~...Z... Date Of Permit ~'~,-~/.~./.:~-,.-,4~.....Applicant .................................................................. Health Dept. Approval ........... .~......~..: ..................... Labor Dept. Approval ......... ..~..:.!..~.. .......................... ,~, Underwriters Approval ............. ..~.......~..[ .................... PIonning Board Approval .... ~ ............................... Request For Temporary Certificate ........................................ Final Cerhficate ..... .~. ............................... Fee Submitted $ ...~ .................. Construction on above described building and permit meets, all applicable codes and regulations. .................... Sworn to before me .......... do~ of .................... ...... .................................... co. Examined ...... ,~....'~..~..("' ~' ......... Approved ........................................, TOWN OF $OUTHOLD BUILDING DEPARTMI:NT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. .... ....... (Budding Inpector) Application No. ~., .9 0~'-~ J APPLICATION FOR BUILDING PERMIT Date ....... ~ ............................ 19..'~....-~.... INSTRUCTIONS a. Th~s apphcatlon must be completely filled m by typewriter or m ink and submitted m tr~phcate to the Budding inspector, ~, 3 sets of plans, accurate plot plan to scale. Fee according to schedule b. Plot plan showing location of lot and of buddings on premises, relationship to adlommg premises or pubhc streets or areas, g~wng a detailed 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 issuance of Budding Permit. d. Upo. n approval of th~s apphcatzon, the Budding inspector wdl issue a Budding Permit to the apphcant. Such permit,shall be kept the prermses available for ~nspect~on throughout the work e. No budd*ng shall be occupied or used in whole or In part for any purpose whatever until a CertJfmate of Occupancy shall have b granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to the Budding Z, Ordinance of the Town of Southold, Suffotk Count,/, New York, and other applicable Laws, Ordinances or Regulations, for the constructlm buddings, additmns or alterations, or for removal or demohtlon, as herein described The apphcant agrees to comply w~th all apphcable la, ordinances, budding code, housing code, and regulations, and to admit authorized ~nspectors on premmes and in buddings for necessary mspectio[ (Stgnature of-~ppha~nt, or name, ~f a corporation) ./(Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises ................................... ..~./~.~.,~-~ ...... Z./_,Z...~./~./~:L~. .................................................. If applicant is a corporate, signature of duly authorized officer. .IName and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's L~cense No ................................................... 1. Location of land on which proposed work will be done. Map No ............................................... Lot No ........................ ....... ~. ¢~--,¢J..~. ~..F.z.c. ..... ~.. ,F.. ......... z~..r, z:.. z. r. zz..Cz,¢. ........... '~i:;;:i;:g~'ff~; ......... Street and Number 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................ ~..T..Z./~,/.3=.~. ....... ~./-Z./Z,.;[2//ff.m~. ................................................. b. Intended use and occupancy ....................... ..~z~,d~2; ....... ~..,~.~.~. ........................................................................ 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... { Description) 4. Estimated Cost ........~'....;..~-.~... ...................... Fee ................................................................................................ {to be pa~d on flhng th~s apphcabon) 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 struc~res, if any: Front ..................... Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same ~ructure with alterations or additions: Front .......................... Rear ........................................ Depth ............................................. Height ......................................... Number of Stories ....................................... 8. Dimensions of entire new construction: Front ...~..~ ............. Rear ...... ~.~. .............. Depth ......~..~ ................. Height ............ ~..~. .............................. Number of Stories ..........~. .......................................................................... 9. Size of lot: Front ......~. ......................... Rear ............. ~ ........................ Depth ................ ~.~ ...................... 10. Date of Purchase .......... ~.~ ............... Name of Former Owner ..... ~. ....... ~.~Z~ ................................ 11. Zone or use district in which premises are situated ....................~/.~.~.~ .............................................. 12. Does propo~d 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 ................ ~~. ...... Z~.~.L~ ............................ ~.~...~ .... {Address) (Phone No.) Name of Architect ........................................................ ................................... .............. Name of Contractor ....... ~ ................................................................................................................................ / {Address) (Phone No.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimens~s~rc property lines. Give street and block number or description according to deed, and show street names and indicate whe~ er interior or corner lot. STATE OF NEW Y~B.,K/..~% ~/ ) ~ 7~ / COUNTY OF...~-~/'~-~ .......... ) Notary Public .......................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duty authorized to perform or have performed the smd work and to make and hie th~s apphcatlon; tha statements contained m th~s apphcat~on are true to the best of h~s knowledge and behef, and that the work wdl be performed m the ma, set forth m the apphcat~on hied therewith County duly sworn, deposes and says that he is the applicant above nam