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Home My WebLink About6917-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No.Z~?.0.~ ....... Date .......... Dec,..'lit. .......... , 19. THIS CERTIFIES that the building located at ...0rch~.d. Df. ire .......... Street Map No...B~t;t.d(~t... Block No...~[ ....... Lot No.. l ..... ,°~autho].d.. ltoYo ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~)~.~; ..... ~.., 19.7.3. pursuant to which Building Permit No. 69177... dated ............. 0.Ct...ll.., 19.7.3., 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 . ~.ri~te. one. fa~ily. ~lwe~ lin§.. ~r~th. additAon. (~a~,a~e) ......... The certificate is issued to . F~.. ?,..~arpsmter. ....... O~n®r ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N, R.o ............................. UNDERWRITERS CERTIFICATE No.. pending .................................. HOUSE NUMBER .~3~. ......... Street .... 0racha~.Dl,..(.read.) ................. .......... .......... / FORM 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) N? 6917 Z Date ..................... .(~¢I.~ ......... J.1 .............. 19..~3. Permission is hereby granted to: ~.~.o~7~a r~..~.~dg~.. ~¢.. AZ~ ..................... Ca rpent~ r to ~.~.o.......~....~,~.~,,n~..~r~..ee ........ ..o~......e. ~.~,~.~:l,~.~...~.e..:~. ~.t~ ......................................... aK premises located at ..J~J~l~'~..~'_.t, ltr~ ......... .J~4~3~t,~Lol3,..eJt.t ......... ~O.~..~. ................................ ........................................ ~o'wL~o':l.d · · · ..I~.~,.¥-~, ...................................................................................... purSUant to application dated ........................~....~.. ....... .~. ................ , 19.?.~. .... and approved by the Buil~ing Inspector. Building Inspector · / ~/ ~ J TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19... Permit No.. . Disapproved a/c ..~..'..~ Date .....Q~7~..~......(~....../..~..?....~......, 19 ........... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 or areas, and giving a detailed description of layout ofproperty must be drawn 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 a~terations, 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. (S'gnatl~fe of applicant, or name, if a corporahon) .............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... m ....... Name of owner of premises ...~..~,',~.,P:.O/~-~~ ...................................................................................... 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. Location of land on which proposed, work w~l be done. Mqp No.: ................. ,, .................... Lot No ......................... Street and Number ...... ~.~.~.....~..~.....~~J~..~...% ....................... i ................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...~~ ............. ~"~"~"i ......... ii ....... iii'"'iiii ..... b. Intended use and occupancy ......................................................................................... 3. ~etu~ of work (check which applicable): New Building ~/ Addition Alteration ~ ' Repair .................. Removal .................. Demolition ............. :: ..... Other Work ..................................... : .............. (Description) 4. ~tim~t~d Co~t ................ .~.~. ............................. t .... ~ ................................................................................ ~,., (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 ~ ...... ~ ..................................................................... 6. If business, commercial or mix~ ~cupancy, speci~ nature and extent of each ~pe of use .............. ~ ............. 7. D mens ons of ex st ng structures, f any' Front ~ ~ ... R~r ~ ~ De th ~ ~ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ ~ ~. · · Rear ~ Dmth ~ 8. Dimensions of~entire new construction: Front ....... ~ ......................................................................... He ght ~ Number of Star es ~ ............................................................... ~. 1' ~ ~ /~ ~ -' ............ 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 ........ ~ ......... Will excess fill be removed from premises: ( ) Yes (~) No 14. Name of Owner of premises ...... ~.~.....~~. A~re~ .~..~.. Phone No ....................... Name of Architect .............................................................. A~re~ ................................ Phone No ....................... Name of Contractor .~~.~~ ............... Address ~...~ Pho~ No..~~ PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oll ~t-~ck dimensions from prope~ lines. Give street and block number or description according to deed, and show street names and indicate whether Jnt~rJot Or corner lot. STATE OF NEW YORIO~ Jr /0] ~_ COUNTY OF .......~~/Z-~.~:~/.~.'~'~ ................................................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contracfl above named. He is the ................................................................................................................................................................................. (Contractor, ogent, corporote officer, etc.) of said owner or owners, ond is duly authorized to perform or have performed the said work ond to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ........................ ............................................ ........ Notary Public, . ................................................... County .......... (Signature or appdcant~ FOP,~ NO. 6 TOWN OF SOUTHOLD Building Department 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 Budding Inspector w~th the following, for new buildings or new use: 1. Final survey of property with accurate location of all buddings, property hnes, streets, and unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal) 3. Approval of electrical installation from Board of Fire Underwriters 4. Commercial bu,ldmgs, Industrial buildings, Multiple Res,dences and s~milar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the budding. 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 buildings. 3 Date of any housing code or safety inspect:on of buddings 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 $1.00 Rte ...... ..... ....... j. 73 New Building ................ Addition ..... ~ ......Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....CI~2~a~..c~..~:~ZL.T~ .............. ~OI~.J3~I.Q]J;1......~...~'.. .................................................. Owner Or Owners Of Property ...... .~...~........P..;....O...8:.z'.D.~..rt..~..e..~. .......................................................................... Subdivision ......... ..~..e...~..Jr.cl...o..rJ.......~.~...~..~...e.~ ................ Lot No..~ .......... Block No ..... ~. ..... House No......~.~.~. Permit No. ~..~)..'J.~7~ ........ Date Of Permit 9..~..~...~..~7-~.Applicant ...G..~..g~g.~...~.~..?.D...]J~...~..3...~.e..~....$..~..9 .... Health Dept. Approval ......... .~...*.~.." .......................... Labor Dept. Approval ...~.*.~.*. ................................... Underwriters Approval ...,g.~.~, ......................... Planning Board Approval .~......R..... .............................. Request For Temporary Certificate ........................................ Final Certificate .......~ ......................... Fee Submitted $ ..~...,...0..0. ......................... Construction on above described building and permit meets all applicable codes and regulations. Apphcant ......................................................................................................... Sworn to before me this J~-~ 7 73 ......... ~..br.... day of ...~..e..~ ....... .~.~ .................. (stamp or seal) ~7-~ 0 Noto Pub ,c .................................... Cou.t ,1