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Home My WebLink About6906-zFORI~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southola, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .E./.8..B.a~.ggw Ave .... Street Map No.Stt~. 0.r.haVenBlock No ........ Lot No.. 1 lJ.t! 1 2.tl 13 ,.. Gr.e. enp.ort...~.o~ · conforms substantially to the Application for Building Permit heretofore filed in this office dated ... 0c~.. I , 19 75. pursuant to which Building Permit No. 6906Z. dated Oct 1+ 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 priva.~.e g.a~.a, gg..-.agqo, s..~9.~.y bl. dt[ .......................... The certificate is issued to ~.r~.. R.o.~.a.].~p ....~..u~. cy. .. caener .... (owner, lessee or tenant' of the aforesaid building. Suffolk County Department of Health Approval . .I~ ,R, ....... UNDERWRITERS CERTIFICATE No. . .N. :.1[: ................ HOUSE NUMBER ... J 350 Street .... B.~lry..i.eM...Aye ....................... FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 6906 Z Permission is hereby granted to: ...................... ~.t..,.~.o...~... .................................. to ..~.~l]A..ne~..p~i:c.a.t.e...~az.~ag~ ............................................................................................... at p~emises bcated at ...... ~.o..t...s....t.t..1.,..J..1.;~.~...t.!3......?.~.~.b~g.~: .......................................... ........................... ~ ./~ ..~..a ~ .~.:~ ~..~¢ga ......... .6re eztpa:.~ ...... ;}~.~Y~ ................................................ pursuant to application dated ............. ~ .............. ..Qg~. ....... .~ ........... , 19~...., and approved by the Building Inspector. Fee $~.0.. DD ............ TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 cemficate of Code comphance from the Architect or Engineer responsible far the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. TZar 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 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ...~....~'..../. ...... ..~....~....t.....~....~..--~'.. .... New Bu:ldmg ...... .~.. .......... Old or Pre-existing Budding ............................ Vacant Land ........................... Location Of Property ........ ~..~...~. ................................................ .~,,.~.~..~.,7.~.~.~,~., ........... ,-,.~.~ ........... Owner Or Owners,Of Property ..:~.~,-~.~....~.~C~..~../.7..~..~/,./~2...C.Z~ ..................................... Subdivision .,~.Z29~~.t~' ( .I,~ ............ Lot No. !,::~ ..... Block No.....~/· ....... House No ............ Permit No...~..~.~..~-~Date Of Permit ~..~.~....Z ...... Applicant ,~.~.....~I,Z .............. Health Dept. Approval ...... ~.~ ................. Labor Dept. Approval ............................................... Underwriters Approval ........ z:~...~ ...................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ F,nal Certificate ......~ ............................... Fee Submitted $ ,,..,'~,,..~J~. .................. Con.,,truction on above described building and permit meets all applicable codes and regulations. Sworn to before me this /'~dT~'~ / ~: Notary Public .................................... County (stamp or seal) /~~/~/ 0~ 14053 Examined ....... LZ....~...~....../... ........... , it It Approved ........................................, TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN UTHOLD, N. Y. 19~ ~Je~ ,, 19 ........Pemit No...~..~.~..~..~ Disapproved o/c ......................................................................................... ........................ ............................................................. / APPLICATION FOR BUILDING PERMIT Date~/2C>7/ ......................................../,~/..~'.,.~...~... . , 19 ........... INSTRUCTIONS w~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 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 or areas, al 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 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 ben'tx granted by the Building Inspector. ~,~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zor~e 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 corporation) ¥.....:..: : L :.L.. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. ~(Name and title of corporate oftTcer) Location fl ' ' ~ ' I/J/l~-/_~ 1. o and on which proposed work wdl be done. Mal;LNo.:~ .................................. Lot No...z..../.... Street and Number ......... ,~,~/,,.~/,,~Z,'~..~?~_.../~,~,,,...~--~,,~,~....N~~ ........... / ( /~-)-AVlu n icipa lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. [xisting use and occupancy .~..1..~,~,/,~,~. .......................................................................................... b. Intended use and occupancy .... ~..~..~.,~'.,~.~:~. .............................................................................................. -3. Nature of work (check which applicable): New'auildirfg ....~,.,, .............. Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ~ ....................... Other Work .................................... /~) c~O {Description) 4. Estimated Cost ...~....~.~.'.~..4:D/~. ................. Fee ..................... ~.~ ........................................................................ (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 cars ..~/ ........................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ....~.~. .......... Rear ...... '~.~.. .............. Depth ...,~...~ .......... . .............. Height ...... ~ .................................................. Number of Stories ..... l. ...................................................................... Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....... ~.~. ............ Rear ...... ~,4. ................. 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 construction violate any zoning law, ordinance or regulation: ........................................... ,~ ............. ~.. 13. Will lot be regraded ~-*-~'m-~' ........................ Will excess fill be removed from premises: [ ] Yes [v1'No 14. Name of Owner of pre~nises/' '/"~'/'~'~'""'~"""~/'/'/'/'/'/'~ '~'~"~"'~;~';;i~ ~' ~Ad ................................................................ {Phone No.) ' ' Name of Architect ........................... (Address) (Phone No.) Name of Contractor .~,6~E,'~r~... '"~ ................................................................... {Address) i~'l~;~'~'~J;;i ............... 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. STATE OF NEW YORK, co . YO ............... .............. ................. :~~..~..:~ ......................................................... bein§ duly sworn, deposes and says that he is the applicant above named. {Name of individual signing contract} {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 statements contained in this application are true to the best of hisClJ~l~::~lf~M belief; and that the work will be performed in the manner set forth in the application filed therewith Nofew Public, Slate of New Yor~ · ~. "". No. 52-~)344963 Suffolk Count~/.~ - ..'~..da,, of ~ Comrni~o~ppir~s Mgr, h 30, 19,~ Notaw Public~.=........x....~n~./-4u~County ................... ~ ~..~~. ....................................... ~ ~{Signa re of pp' } D. 4053