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Home My WebLink About7007-zFO~e NO, 4 TOWN OF $OUTHOLD BI.IH.DING 'DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z..~..~.. ..... Date ............. April.... :111.., 19~. THIS CERTIFIES that the building located at . P.a~ .La~ .&. L~I,ltol~s. Street Map No...x~. ......... Block No...X~. ....... Lot No. lcx ...... P®e~n:l.o...No][~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .........lion,.. ~9 .... , 19.. 73 pursuant to which Building Permit No. dated ..........N.0V... ~9 ..... , 19. ?~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which $1~is certificate is issued is .. ?.o.t.a..~.o..s.t..o.r~e., .a..p..~.~..k~..1~..b.~...~...S~. .............................. The certificate is issued to ....1[..1'~...ak..i..B..~.~.s. ....... . .0~..e.r.a. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N oR, ................................ UNDERWRITERS CERTIFICATE No..N. :.R... ...................................... HOUSE NUMBER ..... 32.~..~.... Street ...(l~.?t....1~..off. .C. :.R.:27) ................. ~ Building Inspector I TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~oo~ z ~,~ .................... ~..~......, Permission is hereby granted to: ........... ~'~.~.!.i~.5..~:'. ...... ~.?.Z~...~ ................ pursuant to application dated ................................................... L..., ]9.?...,, and ~pproved by the Buildin~ Inspector. Fee $.:,,..' .................. Building Inspector 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 s~bmitted in DUPLICATE to the Building Inspector with the following; for new buildings or new qse: 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 Boord of Fire Uhderwriters. 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 1957), 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, bccupancy 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 Building ................ Addition ..... /X~.....,. Old or Pre-existing B6ilding ................ Vacant Land .............. Location Of Property ..... I..(..(.:.C'.?..~..;~.,~.~w~.....~....]~':~.%.C'~.......~...:...~....' ............................ Owner Or Owners Of Property ....... ..... ~ ....................................................... Subdivision ~ ..... ,~ ............................................... Lot No ........ ,... Block No ...........House No ............. /( .~.. Date Of Permit ..~../......~ .o~..~pp man C~..'. ...... .~ ~.Tb~.'~ ' '~. '~ ................. Permit No. Health Dept. Approval ..... 1.~...:..~,., ......................... -- Labor Dept. ~pproval ....6/:..~...~ ............................... Underwriters Approval /~..,..J.~ .................................... Planning Board Approval ...~.:/.~.., .......................... Request For Temporary Certificate ~ Final Certificate Fee Submitted $ ...~-~.:....~...-~,~ ................. Construction on above described building ancJ. per~it meets all (~pplica/~l,e codes and regulations. Applicant ....... .~,~...~,~g~,~ ~.....k~,,~K 4..-7~'w~(~ .................................... Swam to before me this ......... ........ ..... Notary Public .................................... County ~stamp or seal) lt'OlBM NO. 1 TOWN OF SOUTHOLD SUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disal~roved a/c / ~ Application No..Z.~....0..Z ................ /(Building Inspector) APPLICATION FOR BUILDING PERMIT ..................... . ,,Z..3. ..... INSTRUCTIONS e. This al~ication must be completely filled in by typewriter or in ink end submitted in triplicate to the Building Inspector, with 3 *ets of plans, accurate plot plan to scale. Fee according t~ schedule. b. Plot plan showing location of lot end of b~ildin~ on premises, relationship to edjoinihg premiges or public streets or areas, and giving e detailed description of layout of propertY must be drawn on diagram which is dert o~ this application. g. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon al~c~'ovel of' this application, the Building Inspector will issue a Building Permit to the applicant. Such permit,shell be kept on the premises ~veilable for inspection throughout the work. e. No building shall be occupied or used in whole or in pert for any purpose whatever until e Certlfic~e of Occupancy' shall have been ~ by the Building Inspector. APPLICATION IS HEREBY MADE to the B~ild~'ng Department fOr the iuuanca of a Building Permit purruant te-t~e Building Zone Ordinance of t..be Town of Southold, Suffolk County,iNew York, and other ~l~licable Law~, OrdJnancas or RegUlations for l~he cmtl.t, ructJon of buildings, eddlt~ons or alterations, or for removal or demolition, as herein described. ~ applicant agrees te comply with I~11 ~.~lic~ble law~, ordinanee~, building code, housing code, and regulatJonq, and to admit authorized inspectors on premises ~nd in buildings for necl~Jt ,~"~nspections. (Signature of applicant, or name, if · corporation) State whether applicant is owner, lessee, ageOt, architect, engineer, general contractor, electrician, plumbe~ or builder. '. .................................... .......... .......... : ....... : .............................. ....... Name of owner of prem ses : [ ....... : ............................. If applicant is a corporate, signature of duly authorized officpf. , (Name and title of corporate offiCer) Builder's License No, Plumber's License No. Electrician's License No ....... ' ..... ..-T~.... . Other Trade's License No ....................... 1. Location of land on which prop~_sed worl~wHI be done. Map Nc~.M)d,O(...~..,~/~.'..,'~ot ~i~ ./..!.....:~ ............ Street and Number ....P...~$....../~.~ ............ .~..~....~..,..~ ........................................... Municipality 2. State exi_~.ing use and occupancy of p~remi~d~l~ use end ,o,ccupancy of proposed construction: a. Existing use and occupancy ...,..1~...~4~ .................................. ; ................................... 3. Nature of work (check which applicable): New Building ....................... Addition ......~. .......... Alteration ............... Removal ............./.-. ........ Demolition ........................ Other Work .................................... Repair ................ ......... (Description) / 4. Estimated Cost ......... .-~...(~3) ......................... ;°° ~ ~ ~ .................. ................ i~;;'~;'~a%" '~ ';;d;~*~'~i;';'~;[i'~Z~on) '" 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 occuoancy, specify nature and extent of each type of use ..................................... c/A-c ...r ~..e... .. ' 7. Dimensions of existing structures, if any: Front ..... ~ ....................................Depth ..../..~;~. .................... Height .......... ~ ....................................... 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 .................... Number of Stor es ....................................................................................... ...... '-'" '-' ...... ~ '~ '~- n~,r ~.. ~ ~ ....... Denth .. ,;TA~...~...~.. . .' ............... '... 9. Size of lot: I-fonT ...... ~m.~=;~....,,,~..,~. ............................ ~ .....,_~,,, .... ~ '~"~'"'; ........ :2j~""-~:jJ: .... 10 Date of Purchase ......../....~...-'~.-..~. ............ Name of Former O~wner ....~...~~,r~.l~..~ · · · ~ ........ ..'~...T.'... 1 1. ,, Zone or use district in which pre, m~ses are s~tuated ....~ ...................................................... 1:~ Does proposed construct on vlo ;~te any zomng aw, ordnance or regu at on .... ~ .............................................. ~;, t~, ~ ~araded .... ~ ............... Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ... ~ .I..~ .... ' {~g'~;;~'~'~;I ............ Name of Architect ..................................................................................................................................................... (ddress) (Phone No.) PO, ......................................... Name of Contractor .......... -..e~v~-- ................ [~,~i~{~')' .............. ~.. {Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proPosed, and indicate all sat-baCk dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YO.~,~ /~ COUNTY OF ~ He is the ~ ......................................................................... ' .......................................................................................... (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly aut~orize~,l~Ti~q,~'fo~i(~t/have,performed tbe~.said work and to make and file this application; that all ar~o°!~.P~u°~o~~W~wled and belief; and that the work will be performed in the manner statements contained ................... :~,. ......... :..d.~2~ ....... Z/~....,~/..-.'. ....... ft.)/ t ~ I1 ,, ,