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Home My WebLink About6894-zTOWN OF SOUTHOLD BIJILDING DEPARTMENT Town Clerk's Office Southold, lq. Y. Certificnte Of Occupnncy No. ~Z "/3_ 9~. Date (0F-'T I '[ 19.~./~ THIS ~ERTI~IES that the building located at ~o0 ~o~ ~ N~ Street Map No.. . ~ ...... Block No ........ Lot No .................................. confoms substantially to the Application for Building Permit heretofore ffl~ in ~is office .dated ...... ~E~.. ~E 19~ p~suant to which B~ding Pemit No. ~9~ dated ....... ~ ~ . ~., 19~, was issued, ~d co~orms to ~ of ~e requ~ ments of the applicable pro~sions of the law. The occupancy for which this certificate is issu~ is A CC ~ ~o~ -f ~u ~ u~ ~ N ~ ~e certificate is issued to ~ 0 5 ~ ~ a G. L ~ ~ E ~ 5~ ~ (owner, ~) of the aforesaid build~g. S~olk County Dep~tment of Health Approv~ N , ~ , ............. F.' .......................... HOUSE ~MBER . ~ ~ ~.O .... Street ..... ~. ~.~.... ~.~. ~'. ~- ............. B~lding Inspector FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6894 Z Permission is hereby granted to: .... J. oseph..Li~wski ....................................... ......... b~]aogtze~ ................................................ at premises located at ...~/~..~)~p4:lt;.. T.a~e ....................................................................................... pursuant to application doted .........................~....,~. .......... , 19~..~...., and approved by the ~uilding Inspector. Fee $~l.~O.e.O~, ............ TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation 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 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 site 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 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 inspechon 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 Date / New Building ....... .../...... Addition. ...... L//'......... Old or Pre-existing Building ................ Vacant Land .............. ocat on Of Property ...... ................. ...... ............. ....................... O~¥ner Or Owners Of Property ........ ..~...~....: ..... ..~..~ ........ ...,~....~...,'~...,.~r.,.~...?...,~..~..: .......................................... Subdivision ............................................................ ..l. Lot No ............. Block No ............. House No ............. Permit No ~..~. .............. Date Of Permit ....~. ....../:.?J~-~plican, .....~...~....'.'~..~ ................ ~ ~ ~-~ ' II u I/ V JvC ~, Health Dept. Approval ................ /.~.TZ?..: ................ Labor Dept. /~pproval .... ~.. .................... ;. ................... Underwriters Approval ................... ~..:..?....,, ............. Planning Board Approval ............................. ~ .......... Request For Temporary Certificate ........................................ Finczl Certificate .......................................... Fee Submitted $ ............ ~.....u..~ .............. Construction on above described building anc~pe.rmitm~eets ~l,...~plicabJe ~ode,s~.~'~/(~ i/ il~ ~,~~, and regulations. Sworn to before me this Applicant ......... ~..~.L¥~/.Y..2...j.'.... ~, .i..~. ~ ................. day of ............................................ Natary Public .................................... County TOWN OF SOUTHOLD BUILDING DE.P,A. RTMENT/~/"'/TJ" ~ ~'~--', TOWN CLERKS OFFIGE~ ~ , ~ ~UTHOLD, N.Y. ~ ~,~O~ ' ........... ..... I ~STR~IO~$ a. Thi~ ~plic~tion mu~t be compl*t~ly fill~d in b~ ~p~writer o~ in ink and ~u'bmitt~d in Inspector/with ~ ~t* o{ pl~n~, eccumt~ plot pl~ to ~1~. F~ eccordino to sch~ule. b. Plot plon *howin~ I~otion of lot ond of buildinos on pr~mises, relationship to ad oinino premis~ or public ~tre~ts o~ ~re~s, and ~ivino ~ detailed d~cription o{ I~out o{pr~ must be drown on the di~r*m which c. ~o work ~v*red by thi* applicotion may not b* commenced b~{ore i~u~nc~ of Buildin~ ~rmit. d. Upon opproval o{ this opplicotion, th~ Buildinfl Inspector will issue o Buildino Pormit to the ~pplic~nt. Such p~rmit sh~ll be k~pt on th~ premis~ available {or inspecti~ throughout th~ work. e. ~o buildin~ ~h~ll b~ ~cupi~d or used in wholo or in port {or any pu~O~* whatever until ~ sh~ll h~v~ b~n ~mnt~d by tho Bui~dino In*pector. 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 nec{ssary inspections. /~///~.(/'~ & t, or me, if a corpo ion) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ '"~ ~..~C~,..~ ...............~..~........~.L..~,.~,~...c~..~..I,. .................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Bu~ ers Li ense o ..................................................... Plumber s bcense o ................................................. Electric,an s L~cense o ............................................. Other Trade s License o ............................................... Location of land on which,proposed work will be done. Map No.: ..... ..~..~..~.,..~.....-'~....~....., Lot No. ~ ..................... Street and Number .~......~.~ ........... ~ ...................... ~ ................................. State existing use and occupancy of premises and in~ended use and ~cupancy of proposed construction: Exisiting use and occupancy ................... ....................... ................................................................... Intended use and occupancy .................................................................... ~ .......:~ .............................. 3. Nature of work (check which applicable): New Building ......~...... ..... Addition .................. Alteration .... ~.... Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... .0. ~ (Description) 4. Estimated Cost ........... J.,~,.~ .............................. i....Fee "I ............................................................................. (to be paid on filing this appfication) 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, speci~ nature and extent of each type of use .~ ..... 7. D mens ons of ex st ng structures, if any: Front ..........~. .......... Rear . ~ ..... Depth .~"~- Height ....... ,~.~... ........... Number of Star es /. ................................................... Dimensions of same structure with alterations or additions: Front ....... ;~.~. ..................... Rear ...... ~..~ ............. Depth ........ ..~...~... ............. Height .....:~..^.(.~.~.. ......... Number of Stories ....... /. ....................... 8. Dimensions o~ entire new construction:~ ............ .~....~. ........... ....~ear ....~ ................. Depth ....~ ............ Height .....~. ............ Number of Stories ........ ~. ............................................................................................... ~ ........... 9. Size of lot: Front ..:;.~,.~.~....~. ..................................... Rear ............ ..~..~.,..:~..( ............. Depth ....... .'~..(. ............... r' 10. Date of Purchase ...~....,~.......~~...~ ........... Name of Former Owner ........ ~,~..t~,,t,u~ ....... ..~.~.~'~.e.... 11. Zone or use district in which premises are situated ..~ .............................................................................. ~ ................... 12. Does proposed construction violate any zoning law, ordinance'or regulation: .~.el~.....T'.e...~....//~.(~,.~...~- regrade(~ ..... ~..; ......... Will excess fill be rem?ed from premiseS: ( ) Yes 13. Will lot be 14. Name of Owner of premises ..... ..~X::~.r~...~,,.....'~../,~'Address .....~..~... Phone No. 7~...~...~..~..~.;0 Name 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. STATE OF NDV J ,/J ................ ~..~~ .................... being duly sworn, d~oses ~nd s~ys that he is the opplicom ~ (~offi~ividu~l ~ning controc~) above n~. He is the ................................. ~~ ........ ~.~ .............................. j ........................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work ~d to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge ~nd belief; and tha= the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this Note~ Public,~~....~~nty ........ ~... ~.~.~ ....... ~.1.~.....~ ..................... JUDITH T BOKEN II ,/ H