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Home My WebLink About6930-zFORM NO, 4 TOWN OF SOUTHOL~ BUH,DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupnncy THIS CERTIFIES that the building located atSterling Road ............. Street Map No. I~S$,. ~m$. Block No .......... Lot No, .~0&~.l. .... .C~cho. gB.e ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Dct. .1.~, 19 73 pursuant to which Building Pemit No. 6930Z.. dated .Oc.~ ............ ~.~., was issued, and conforms to aU of the req~!re- ments of the applicable provisions of the law. The occupancy ior which this certificate is issued is ,. t:x'ivate, one. family..d,~e;lf~g .wi.th ~ .a,'di.tlo~ ................. The certificate is issued to Joseph l~ell,y ....... Ywnen ........................... (owner, lessee or tenant) of the aforesaid b-ilding. Suffolk County Department of Health Approval ...~. :R; ............................ UNDERWRITERS CERTIFICATE No. pending ................................... HOUSE NUMBER ....~.~.7.~ ..... Street ...~te~'.~,~g..l~6.d. ....................... FOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6930 Z Permission is hereby granted to: ....... .c.~.~.e.?.~,e. .................................................. to Build ap addition on e.~.i~t~ng ~t premise~ located at .... .~..0..~,...~-0.....~..o.~.~ ..... ..~..~..~...~i.,~,.~.....~...~..~,...~. ............................................................. ..................................... ~eX~_~ng..RO~ .............. autehogue.....K,Y,, ......................................... pursuant to application dated ..................... J~q:l~; .......1.~'. ............ , 1~.~..., and approved by the Building Inspe~ctor. Fee $.?..~..,...0..0. ............ FOR3~ ~0. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled ~n typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. 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 cerhflcate of Code compliance fram 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 end "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 $5.00 3. Copy of certificate of occupancy $1.00 .... ...... New B[tilding ................ Addition ................ Old or ~re-existing Building ................ ¥~cont Lond .............. Lacation Of Property ...~ ..................... ................................................. ./~ ........ .............................. Owner Or Owners Of Property ........ .Q,...O..~.,~....'~....~.! .............. ..~,?...,~.-~.,L.../~..¥. ..................................................... - t v.... ....mock . .......... Subdivision ................................................................ LO N . · No. House No ( Permit No ................. =.. L~ote Of Permit ........... ./ ....... Applicont ................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. ~',annmg Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ ......... ¥,~ ............ Construction on above described building and permit meets all applicabl.e codes and regulations. .... r et'i / ' >' /'"'//,07/7Y .... ~day of ..... .~(~L..V...~. ........ .~-...~./. ......... (stamp or seal)~' .~. xom,ned ...... ...... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N, Y. Application No ~ ~ ~ ?.... . Disapproved o/c ............................................................................................ (Building InspeCtor) APPLICATION FOR BUILDING PERMIT 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 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 Ixzrt for any put, pose 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 Buildina Perm t oursuant to the B I u~ drag Zone Ordinance of the Town of Southold, Suffolk County, New York, and other app icabe 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, a.n:d regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .. ...... ....................... (S'g aturt~'o~ll~dicant, or name, if a corporation) If applicant is a corPorate, signature of duly authorized officer. (Nome and tit e at corPorate officer) (Address of applicant) Builder's License No ..................................................... Plumber's License No. ................................................ Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proppsed Work will.l~e'done. Moo No.: ..... /.../....~....~.. Lot No. ....... State existing use and occupancy of premises and intended~use and occupancy of proposed construction: a. Exisiting use and occupancy ....v ~....~...~~ b. Intended use and occupancy ............... ~...'. ........................................................................................... o 10. 11. 12. Nature of work (check which applicable): New Building Addition . ~ ' ~ ' ................................... Alteraflo~;r'/..: ............. Repair .................. Removal Demolition .................... Other Work ' ~/ (Description) · ~**~...~ ("] ' Fee ~d~, .'~ ~, ~ Estimated (to be paid on filing this application) if dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................. : ............................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... ~ ' ':L"'?'" Dimensions, ,^tar existing structures, if any: Front ...... ~.....~.. ........... Rear ...... ,~....~.. ................. Depth ......~...,~. ...... Height ...../...~...~ ........ Number of Stories ~ .. Dimensions of same structure with alterations or additions: Front ........ ~...~'..../. .............. Rear ....~....,~. .............. Depth ~ ............... Height ........ ~...~. ............ Number of Stories ...... 4. ........................ Dimensions of entire new construction: Front ~ ............... Rear ............................ Depth ..................... Height .................... Number of Stories ................................................ r ................................................. F ~ ' ~ Size of lot: rant .... 4(.../..~.,.~..~. ............................... Rear. ~'../..~t.-'/-.~. ................ Depth ....~.....~.~.. .............. "~-- -- -- *~ (-~/~..-.~...~....~./..~.-- .~....~--. .............. Name of Former Owner ...........~ ............................................ Date of Purchase Zone or use district in which~"premises are situated , ,/~ ...,.~.~...trb~. ....................................... Does proposed construction violate any zoning law, ordinance or regulation: .... .~...~. ..................................... W~II ,lot be regraded ............................ Will excess fill be removed from premises: (_,_) Yes ( ) No Nome of Owner of premises .~/~J-//'~. Addres~'~.~/~'~;x/'~ ' ................... ss~.~..~.~. ...... Phone No~,..,~...A~.~.' Name of Arch fect,,~. - ~, ,~,' .;~....~..../.. .............. ~.- ~ .............Addre;~...~...E{ ...... i~ ..... Phone No ..........~...~.,9"~. Controctor-~././~l~,.~.~:~a~ .............. Addresr~..~...--' --- Phone No. Name of PLOT DIAGRAM ~vhetner ex,rnng or pr,~,-_-~-a,~,,G;~a;~ u;; a~;-L~. ~. ..... ;o~.s from or~description~according to' deed, and 'show street name~}~/ and indicate Locate clearly and distinctly 'all DU~la~ngs; property lines. Give street and block number whether interior or comer lot. STATE OF'N~ YORK, , l SS ' ~ ~- - ' '-' ~ ?' J COU~OF ~ .f '-~ ~ ~ --. _ ....... ~'~"~'~ "~i~'~ ................ above n~. ~:~ ~ He i~ the ..... ~.~ .......................................................................................................................................... {Contrector, afl~nt, corporate officer, etc.) of said o~ror owners, ond i* duly outhori~ed to p~rform or hove p~r~ormed tho ~oid work ~d to ink* ond lhi~ opplication; that oU statements contained in this ppplication om tm~ to th~ best o{ his knowledge tha~ t~ work will be p~rformed in th~ m~nner set fo~h in th~ ~pplication fi~ed therewith. Sworn to b*~or~m~ thi* ............... ......... , ~o~a~ Public, Sl~to o~ ~ow Yor~