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Home My WebLink About6961-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O]~ice $outhold, N. Y. Certificate Of Occupancy No. Z6.1+23 ...... Date ............ Apb'il. · -2g- ·., lg.?~. THIS CERTIFIES that the building located at ... North' -Road..~¢R2.~) .... Street Map No. ~x ........ Block No. x~ ...... Lot No, .~... G~.eemport .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 0~t... 26 .., 19. -7.3 pursuant to which Building Permit No... 696tZ c[ated ........ 0nt . 3(] ..., 19 .7~, was issued, and conforms to all of the require- raents of the applicable provisions of the law. The occupancy for which this certificate is issued is P.l~lva.te · one .£a~$ly. ctwekLin~ .~h adc~.~ tion ..................... The certificate is issued to . l~argaret. Gazza ........ owner. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N ~H, ............................ UNDERWRITERS CERTIFICATE No...~; o ~, ~ ...................................... HOUSE NUMBER . ~7. Q6~ ..... Street ..... ~o~tb .Rea~ .. (CR27) ............... -- Building Inspector (f TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6961 Z Permission is hereby granted to: · .~-~a~.~..~ ............................................ ......... ~.~...R~a&..{~?.)&.~...C~eae.nt D~ .............. ~en~o~,t ...................... 02u~..~Se.Chpage L,I, 1180~ ~o ..~:~l~....~..~fl.(titi/~n...~..e~is.t!n~..&~e.:.~J~ ............................................................. at premises located at .~/h..:kQ~...~.~..~.~a~J....(~!~,,¢~.l ........................................................................ ............................................... .~.~.en~.~r.t ......... ~T...~.. ......................................................................... pursuant to application dated ........................OP~t.....~ ............... , lC~..~..., and approved by the Building Inspector. Fee $1.5]:.2Q ............ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southo~d, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A Th~s apphcahon must be filled ~n typewriter OR ink, and submitted in DUPLICATE to the Building Inspector w~th the follow~ng, for new buildings or new use: 1 Final survey of property w~th 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 d~sposal--(S-9 form or equal) 3. Approval of electrical installation from Board of Fire Underwriters 4. Commercial buildings, Industrial buildings, Multiple Residences and s~mdar buildings and installations, a cerhficate 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 exishng buildings (prior to April 1957), Non-conforming uses, or buildings 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 cond~hon 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 Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date New Buildm§ ................ Addihon ....~.. .......... Old or Pre-existin§ Building .....~. .......... Vocont Lond .............. Location Of Property ............... ~.~;....~,.., ~ ............................................................ o, Owne, O, ..... Subd~wsion ............................................................. Lot No ............. Block No ............ House No ........... Permit No ~..~..~..~.~. Date Of Permit .~....(¢v.2~.Applicant .~C~::~...~...~.~i, ~ ....... Health Dept. Approval ...... ~-Y..J-~ ......................... Labor ~pt. Approval ......... lZ...l~ ....................... U~rw~,~ ~o~, ....... ~.:..~ ........................ ~,~..,.~ ~oor. ~ro~o, ....... ~.& ...................... Request For Temporaw Ce~ificate ........................................ Final Certificate ......~ ............................. Fee Submitted $ ~..~. ...................... Construction on above described building and ~r~t meets all app~ical~e~ codes and regulations. ..... .................................... Sworn to before me this ~ ~. cJ SOU'mOLD, ,4. Y. Examined ~'~'/~ 19..'.'.~.~. Application proved .......... '.:. ........ :.! ................ ,,9 ........ " P.rm,tNo ....... D .pproved INSTRUCTIONS °ate ...................... a. This application must be completely filled in by typewriter o~, in ink and submitted in triplicate 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 adjoining premises or public streets or areas, and giving a detailed description of layout ofpraperty 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. In e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinonc..es or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil oapllcoble lows, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for ~,essary inspections. -'"' ~,~,~ '" / (^~ress 5f opplicon'~ / '~/ State whether applicant is .~ , lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... ~.~.C~ .................................................................................................................................... Name of owner of premises ..... .~.L..~. ~...~...~..~ ................................................................... 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 Licens~q~.. .................. ..~...~.....~... .............. Location of land on which proposed work will be done. Map No.: ........... ~.O.....~....~. ............. Lot No ......./~....e../.:,.~..,,.. ~..2......~,. Street and Number ............... .............. ...... ~., ................... ............... ,,. .......................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: / E~ ~w_x o. Exisiting use and occupancy .............................................................................................................................. b. Intended use and accupancy~4~..H...E....~.!.~..?.../~.. ~ ~ / ~-/~/~/ ....................... Nature of work (check which applic~iHe): New Building .................. Addition .................. Alteration ............... Repair .................. Removal ..... ~ ............ Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ........ .~..~.....IZ~.....~.~.. ............................... Fee ..~.....-~....O.....~..... ................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... '..1 .................... Number of dwelling units on each flobr ......................~: .... If garage, number of cars ............................................................................................................................................ 6. f business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existings_tructures, if any: Front ............................ Rear ............................... Depth .................... Height ........................ Number o~ Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ....................... ,Depth ................................ Height ............................ Number of Stories ................................ Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ........................................................................................... . ........................ Size of lot: Front ....................................................... Rear .......................................... Depth ................................ Date of Purchase ....................................................... ~.Name,,, ,~ -~°f F?rr)er Owner ~.~.J/'~.. ,~..~.W~.~./~F.J~-.-.~. ................ Zone or use district in which premises are situated ....J~."'.....~.~ ........................./... ............................................. Does proposed construction violate any zoning law, ordinance or regulation: .....~.....~. ............................................ Will lot be.:regradec~ ........... ~. ....... Will excess fill be removed from p. remises~ ( ) Yes ( ) No Name of Owner of p'remises ..~..~..~..~-....~..~.... Address .~..~~.. Phone NO. ...................... Name of Architect .............................................................. Address .............. [ ................. Phone No ....................... Name of Contractor ......................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from proDerty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. o I"-' 10. 11. 12. 13. 14. 'STATE OF NEW Y. DRK. . COUNTY ..... ....... ...... .'.~'.~.~/~ ~. -- ~ ............ being duly sworn, d~oses and says t~he is the applicant .................. above nam~, ~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 and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner ~t fo~h in the application filed therewith. Swam to ~ me this ............... ............ ~oto~ ~ublic, . ..................................................Count~ ....... ~.~r.r...~.~...~J..t.~~.....; ................... ~ ~ (Sig~ture of ~ppli~n~ '