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Home My WebLink About6950-zFOKM NO. 4 TOWN OF SOUTHOLD BUH,DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z ~2~ Date ~ ~ 19.~.. THIS CERTIFIES that the building located at ....~..~1...R.o.~.d ............... Street Map No...~. ......... Block No. ~ ....... Lot No. ~ .... qF.~.e.~.t... ~.:Y.:. .. / conforms substantially to the Application for Building Permit l~eretofOre filed in this office dated .......... .0.~.~. .... ~..~.., 10.~.. pumuant to which Bl!ilding Permit No...6.~..~. dated ........ .0.~.~.... ~.~. ..... , 10.73., was issued, and confoms to all of the require- merits of the applicable provisions of the law. The oeeupane7 for which ~ eer~ffica~ is issued is ....P.r.~.Tg.~.~..o..n.~..~.~..t..1.1r.. ¢.~.~..1.1..~. ~I ................................... The certificate is issued to . .~..lr~..~.J~...~.~..~..~.~.~..~ ........ .~..~.~ ...................... (owner, lessee or ten,iht) of the aforesaid building. Suffolk County Department of Health Approval N off ° UNDERWRITERS CERTIFICATE No. ??.n.d.~Z. ................................... HOUSE NUMBER ..... .~.'1.o.~.~... street ...~..t,~...a..~t. ........... .. ................. %... ....... , ..... Building Impee~:~r I~OB,~ NO. ~ TOWN OF ~Ma'TMOLD BUlL,DINE DEPARTMID4T 'tOWN CLERK'S OFFICE SOUTBtOLD, ~. Y, BUILDING FliP, MIT (THIS PEPu~AIT MUST BE KEPT ON THE PP. EMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) 6950 Z Permission is hereby granted to: at pmmleee located at...]~a~... ............B°&.~....... ................................................................................................ . ............................................................. O~.&el~ ........ I~.*. ................................................................. pu~.~nt ~o al~lk:~'ion do~l .................... G~,.....~!~. .................. , 19.~.., ami approval I:~ the Building Impector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFI~,E SOUTHOLD, N. Y. Examined ........ ~.....~.....~'... ........ 19...Z.j ........................................ ,, ,73 Approved 19.....,.. Fei;mit }No .... ,... ............................ Disapproved a/c ............................................................................................ ....................... i;;i ........................ APPLICATION FOR BUILDING PERMIT Application Ho ................................. T~.,i INSTRUCTIONS a. This application must be completely filled in by typewriter o¢, in ink and submitted in trip icate to the Building.< Inspector, with 3 set~ 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 adjoin ng prem ses or pub c streets o~ ~ 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 applJcotion, 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 pa rt for any purpose whatever until a Certificate of Occupancy~' shall have been granted by the Building Inspector. APPLICATION I.S HEREBY MADE to the Building Department for the ssuance of a Bud ng 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 applJcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ih buildings for necessary inspections. (Signature of applicant, or name, i~' a co~o~i~;i ........ ....... ....... ......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of 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 ............................................... L 1. Location of land on which proposed wQrk will be~.Ad°ne' Map No.: ~ ......... '...~...; .............. Lot No ...... ~ Street and Number ..~ ~ Municipality 2. State existing use and occupancy of premise/~n,cl, i~n. cl;d/use and occupancy of propased construction: a. Exisiting use and occupancy .............. /. ................................ ,..,. ................................. b. Intended useand occuponcy .............. ~........~../j~../~ ............................. ii....i ...... i..i..i. 3. Nature of work (check which applicable): New Building .................. Addition..................~ Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ................................................. ~ .... . .~....~..~..i ~t~~ (Description) 4. Estimated Cost .............................................. Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ~.. ............... Number of dwelling units on each floor ..... Z ................... If garage, number of cars ............................................................................................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ ' ........ ............. De h ....4£! ........ 7. Dimensions of existing structures, if any: Front ...... .~.. .................. Rear Height ....~.....0...~ ........... Number of Stories ...../.. ................................................. ~. .......................... ~ ............................ Dimensions of same structure with alterations or additions: Front ........ ~.. ........................ Rear .....Dm .~).. ................. Depth .....~a°....t. ................. Height ....~/~.'. ................ Number of Stories ....... ../.. ..................... 8. Dimensions o~/entire new construction: Front ........ ~...~ ..................... Rear ....... .~...~. .............. -/ Depth ..-~ ................... Height .....~.~.~,./. ...... Number of Stories ........ /. .......................................................................................................... 2_x / f w 9. Size of lot: Front ........... ..~.. ........................................ Rear ......... ~......~. ............... ~ ..... Depth ....~.~.~.. ................ 10. Date of Purchase ....................... ~...~..?.....~Z. ................. Name of Former Owner ..~....,~-~ ................... 11. Zone or use district in which premises are situated ....... /~. ......................................................................................... 12. Does proposed construction violdte any zoning law, ordinance or regulation: ..~ ............................................... 13. ~Vill lot be regradecJ ...... ~x~ ............Will excess fill be removed from premises: ( ) Yes (~"No 14. Name of Owner of premise~.~ ............. Addr~~..~.~. Phone No.~-.~.......2~...JD.~... NameName of°f ContmctorArchitect ........................ ...~'...~,....~.~~' '~'"'"-'""~ ....................... ............. ' ............ Addresl~.....Address ........ ....... ~:.~ ............... PhonePh°ne N o.~....~...~.....~..~..../../zN° ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior\4or comer¥~,,/,~-~.-~l°t' ,~ ~7~<-------~ _ ' ~'~_ '~ 7~...= re 4~ Z)~ ~7 STATE OF N~R~,~ tc~ -- ~ COUN~ OF ,~..J°'~ ....................... ....................................................... e,ng swo ,, sa s the (Name of individual signing contrac~ above name. He is the ................................................................................................................................................................................. (Contractor, agent, co~orate 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 and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Notary P u b I ic/./~--,~,,F_,~.,~.. ~ ~~ou nt y ~fU~ITH T. BOk'EN J~8~8~J ~UJglie, State of New ~: ~:~d4963 Suffelk Coun~ ~m~,~ ~ ~ar~h 30, · (Si~'nature of applicant) ~ORM NO. 6 TOWN OF $OUTHOLD 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 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 ]957}, 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: I. Certificate of occupancy $5.00 2. Certificote of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ~ '/,' n~Date ..... .~.,.~ ....... ?....~... New Building ................ Addition ................ Old or Pre-existing Bu' d' g ................ vacant Lana .............. Location Of Property ..~.../~/~'- Owner Or Owners Of Property ....... -- ~.~...~...~....~...~....~ ........ ~ --~..~..~..~..~.(~.~.' ................................................... Subd'v's'on " ' Lot No ~ ~' --'- ~'- ~'- .... ........................................................................... ~, ~ i,~o ............. mouse mo ............. Permit No. ....Z:... Date Of Permit Applicant ........................... Health Dept. Approval ........... ~'.] ....... : ...................... Labor Dept. Approval ........ ./~........./~... ............................ Underwriters Approval ............ Z.~.'...~...~ ...................... Planning Board Approval Request For Zempo~rYc~rtificate ........ :. .......... 2 .................. Final Certificate Fee Subm tted $ ............................ Construction on above described building and pe~it meets all applicable codes and regulations. Applicant ~ ....~....~ ....................................... Sworn to before .m~ .......... · ..'~.. day of~.~......~...~.Z..~... (stamp or seal) Notary Public .....~ ............................ County