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Home My WebLink About6926-zFOEM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupency No. Z.582.1 ....... Date ........... Ear...%i+ ........ , 19 THIS CERTIFIES that the building located at . .Wes~tvle~..1)ri.v.e ......... Street Map No.. J,~esen ..... Block No .... mx .... Lot No..xxx .... ~,'a.btituc~ ·. N.,Y, ....... conforms substantially to the Application for Building Permit heretofore fried in this office dated ........... 0c ~; .. · ~ 6., 19. ?.~ pursuant to which Building Permit No.. 69262. dated ............ Oct.. ~6 .., 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 .. Fzivmte. acce s $oxy. b!~ild~ n£. .¢ storage..etc) ...................... The certificate is issued to .. Anthony..~[i~... [~wr~e~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ...N. ?.R.. ............................ UNDERWRITERS CERTIFICATE No. I~,M, ....................................... HOUSE NUMBER . .. 1780 ...... Street ...~es.tview..Drive ...................... .... ........... FORM NO. 2 TOWN OF SOUTHOLD BUILD, lNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 6926 Z Permission is hereby granted to: .~~..~~. ....................................... ...... W~,~.'t~F~t~..,D~. .............................................. ........ ~a~t£tue~ .................................................. t o~,;IA ..~.ew...a~e.~ z.e~... ~t,~=~e.) .h~::l.~l ~ ...................... at premises located at ...,]~,..~...~..,,~.~.,~..¥,,.,.D..~.,.~.,,~.. ....................................................................................... ................................................... I~;.tl~ll~ ........ N.,~, .................................................................... ?urs~uant to application dated ........................... ~])~....L~I~ ......... , 1~.~...., and approved by the Building Inspector. Fee ~,OD ............. ~'Ol~'Vi NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector w~th the following; for new buildings or new use' 1. Fmal survey of property wtth accurate location of all braidings, property hnes, streets, unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage &sposol--(S-9 form or equal) 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial bmldings, Industrial buildings, Multiple Residences and s~milar braidings 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), Non-conforming uses, or braidings and "pre-ex~sting" 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 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 / -- Date ~//~/~ ~: New Building. .............. Addition ...... ( ....... Old or Pre-existino Buildin~ ................ Vooant k, nd .............. Location Of Property ....... ~.~.~ZZf..~...~ ..... l~.~r~.~.r ............................................... Owner Or ~ners Of Drapery .................. (..~ .................... (.~f~Z.~.~ .................................................. Subd,vision ................................................................ Lot No ............. ~lock No ............House No..~.~ Perm,t No~ ................Date Of Perm,t .~...~..~.Appl,cant ..... g ................ ~. ..... ~....~x ...... ~... Health Dept. Approval ............................................ ~bor ~pt. Appr~al ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......................................... Fee Submitted $ .................................... Construction on above described building and,l~lll'm~t meets all_.gpplicabl~codes and regulations. Applicant ..................................... Sworn to before me this . Public "~"~i'~ . ..'County Notary ~? ~, ~.,e. eJ~ '.. 52.6~94030 Csta p or sea ) I Permit No. ~oprovea .............. ',: ....................... , ........ $OUTHOLD, N. Y. ..... Application No ................................ Disapproved a~.~~ .. APPLICATION FOR BUILI~ING PERMIT / / "~ ..... ..................... ", '~.,, INSTRUCTIONS ' . a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Build,ng~ Inspector, with 3 sets of plans, accurqte plot plan to scale. Fee according to schedule. ~ b. Plot plan showing location of 10t and of buildings on premises, relationship to adjoining premises or public streets or ,,~. areas, and giving a detailed description of layout ofproperb/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 o Building Permit to the applicant. Such permit~ shall be kept on the premises available for inspection throughout the work. e. No bui!ding 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessa.r~, inspections. /_ _., / ~i~r~~..no me, i~ ~"~rpon3ti~i'"'" '...~..~..._~t/. (Address of applicant) State whe~p, licant, is~wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. '; ........... ;' "~;'~f remises '~~~"~ ~ ~ ................................................................ ~lame o ow p ...~.~r...~..z/...~ ............................................................................................................. If opphcont ,sa corporatef/slgnature of dulY[/authonzed off,cer. (Name end 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 whlch pr, opose,d work will be 9~one. Map No.: ......... .~.~,_.'?. ....... .......vr.....~Lot No...;....%. ............... Street and Number ..... ~..~ .~...-~-,e,,~......~ ............... ...'~.~J,~~ ................................... Municipality 2. State existing use and occupancy of premises and intended use and OcC. Upa~cy of proposed construction: b. Intended use and occupancy ....~~ .............................................................................. 3. Nature of work (check which applicable): New Building .................. Addition Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... 4J Estimated Cost ...~.~...._~.....~...~....: ........... Fee / ~ '~'~'--- (Description) (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. Dimension~o~xisting structures, if any: Front ........ .~.,.~...%..~..~..~" Rear .....~...~..,..?..~..7. ............. Depth ....~J~.~..'..'. ..... Height .....v}...o...... .......... Number of Stories ....... ...~.. ............................................................ " ............................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front . ........ ./.....~: ................. Rear ..../......~...[. ............ Depth ...../..:~....[ ......... Height 7 Number of Stories / .... 9. Size of lot: Front ...... .~....~¥......~ .................................... Rear ........... .'~.......~.... ............ ~ ...... ~Depth ..;..../..L~....~..: ........... 10. Date of Purchase ...~.../../..~.../...~...~.. ............................. Name of Former Owner ..~...~.~.~..~...~....~.~..~.~...~...... I 1. Zone or use district in which premises are situated ................................................. 12. Does proposed constructio~Tiolate any zoning law, ordinance or regulation: ....~....~ ............................................ 13. Will lot be regraded! ....... .../~/..~_~. __ ,,~- ~-- ,~/~Will excess_~il, I b,e removed from prem~iseS: ( ) Yes, (v~ No 14. Name of Owner of premises ..~....'~..~...~..~.....~~..~. ,~ress ..~....~.~...?...~......~. ~o' / Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... DIAGRAM Locate clearly and distinctly all buildings, whether dsting or proposed, and indicate oil set-back dimensions from property lines. Give street and block number or according to deed, and show street names and indicate wheth STATE OF [ (Nome of incji~/iduol signing controcf) above nomed~ / duly sworn, deposes and soys that he is the applicant He is the ................................................................................................................................................................................. (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 his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to he,re me this ..- /~ ) __ / ......... of ................. ....... , ,,.2...s. ,:,' · Notary Public, ....~. ~,~~... County ......... .(::..~'~...~..:.,'~.~::.......~./...;....:.:.~..~.. ............. .os~m' G. ~.S' .U_~ ~ (Si~Kature of applicant) No. 52-6894030