The URL can be used to link to this page

Home My WebLink About6986-zreNO. 4 TOWN OF $OIJTHOLD BUll.DING DEPAllTME. NT To~n Cle~k'~ Of[ice $outlaold, N. Y. Certificate Of Occupsncy THIS CERTIFIES that the building located at ...... ]lm~'~ .]~l. ve~/.' lk~l. Street Map No...31~ ...... ~. Block No ..... ~...Lot No. l~X.. O~'len. t;..~]~, ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .' . .~P.~... ~.~., 19 .?3. pursuant to which Building permit No. dated ...... :.~.o~.....~.1%. ...... , 19.73., was issued, and conforms ~o ~ of the require- ments of the applicable provisions of the ]aw. The occupancy for which ~this certificate is issued is .. PrJ. va~;a .olde..family. dw. m3.1il~. ~.~1% ,,ddi~i01~..~m~'a~e~ .......... The certificate is issued to . .~e~l~. ]i~ooh;Lo .... ~/lle~' ............. ............... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ....... 1~ o11o ......... , ............... UNDERWRITERS CERTIFICATE No }I R ' HOUSE N BER . .~ ~ ......... Street. Nar.~ow. ltiver..~0~1 .................... FO]II, M NO. '~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6986 Z Date ......................................................... 1 ........ Permission is hereby granted to: .............................. ..W...Cf.~:.:(...L.V..~! ................... ........ ~,. .......... ~C.-f.&~ ......... ~.~..q...C~.!...~ pursuant to application dated / ~ /~/0~'/ 1~....-~....., and approved by the Building Inspector. Fee $ .. ~, ."~.,, .,.0,~... ....... Building Inspector FOBJf NO. 1 TOWN OF SOUTHOLD BUILDING DEFAIrrMINT TOWN CLERK'S OFFIC~ SOUTHOt. D, N. Y. Examined / Approved / ~/ '~ iK '/.,~ ........................................ , ........ Pe . t No. .......... Disapproved a/c ........... '.~ .................................. . ............................ ~ (Buildin~ 'lmpector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ^ppl co.on ........... a. This application must be completely filled in by typewriter oe n nk and subm tted in triplicate to the Buildin Inspector, with 3 sete of plans, accurate plot plan to scale. Fee according to schedule. ~ b. Plot plan showing location Of lot and of buildings on premises, relationship t.o. adjoining premises or pu.blic streets al areas, and giving a detailed description of layout ofpraperty must be drawn on the d~agram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. . d.. 'U.pon approval of this application, the Building Inspector will i~sue (3 Building Perm t to the app cant. Such perm t snau be Kept on the premises available for inspection throughout the work. _~_e;, ~_N..o_ b~u_i_lding sh._al~l ,be .,occ?i.,ec{, or u. sed in. whole or in pa rt for any purpose whatever until a Cert f cate of Occupancy =,,u,* r,uve ueen granma Dy me Duilaing inspector. ^PPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Building Permit pursuant to the ~Build n.g. Zon.e Ordinance of the Town of Southol.cl., Suffolk County, New York, and other appl cab · Laws, Ordinances or ~egu ahons, tar the construction of buildings, additions-or atterqt, ions,, or for removal 'or demOlltli~n; OS herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regul~lons, and to admit authorized inspectors on premises and in buildings for necessary inspections. ,(~gml~un of opp, icant, or name, if a coasting) ....... (Address of applicant) State whether applicant is owner, lessee, agent, archite~t, engineer, general contractor, electrician, plumber or builder. Name of owner of premiSes .................................................................................................... If applicant is a corporate, signature of duly authorized of.ricer. (Name and title of corporate officer) Builder's License No~; ...~.....~.. .................. Plumber's License No...~.2,~.......~... ....................... Electrician's License No..:~....~...?~.;.,...~..i: .................. Other Trade's License No ............................................... Location of land on which proposed work will be done..Map No.: .................................... Lot No ..................... Street and Number "~'~"~'"~ ............... .~.~ ............. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...g~., '~*'~ b. Intended usa and occupancy....~x ........ ~.a~ ................................................. ~'~ ..................... 14. 3. Nature of work (check which applicable): New Building .................. Addition 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 ............................ If garage, number of cars ..........~. ..................... 6. If .... business, commercial or mixed occupancy, specifyf nature and extent of ~each type of use ............ ~.~ ......... 7. D mens ons of ex stmg structures, ,forty: Front ....... ~..~.. .............. Rear ...~..~.. ..................... Depth ....?. ............. Height .....L.?....* .......... Number of Stories ..... ~. .................................................. ~ .............. D mens ons of same structure w th a terat ons or add t OhS: Front ..... .~....~. ....... Rear · I ............................................ Depth ...... ~..~,, ................. Height ..... ,/. ..................... Number of Stories ................ ~.. . 8. Dimensions of entire new construction: Front ...... ~ .......................... Rear .......... ; ................. Depth ........................ Height ....... ~f...l~'..~.... Number of Stories Size of lot: Front ........../...~....~...~ .................................. Rear ..... /....~?.(~ ........................... Qeoth ...../...L..~....I. ............. Date of Purchase ........................................................ N~q~le_ o,f Former Owner ..~..?......~...~ ............. Zone or use district in which premises are situated ....~ ............................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ Will lot be regraded ...... ~~--. Wil~,~x.cess fill be removed from_ premises: (~ Yes (~) No Nome of Ow~ of premises :~ .~.f...~ ........ ~...,. Address ,...~..~~ ...... phone NO.~.~...--...~..jl'~? Name of ArChitect Address ................. . ....... ,, ..... Phone No ....................... Address ....~..~ ..... Phone No...~.....~...'.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed~ and show street names and indicate whether Interior or corner lot. STATE OF NEW _YORK J c: c: COUNTY OF .....'~.~.~..~..~.!..~. .......... ................. Z~.~ ......... ~.~.~.~ .................................... being duly sworn, d~oses and says t~t he is the applicant (Name of individual signing contrac~ above name. He is the ~ ............................................... (Contractor, agent, co~0r~e officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file ~is application; that all statements contained in this a~lication are tree ~ the best of his knowledge and belief; and thru the ~rk will ~ performed in the manner ~t fo~h in the application filed therewith. Swam to before me this ................... ,.. of ............. ................... , .... Nota~ Pub lc, ..... ~X6/.~ C~n~ Z ....................................................... ~" ' '"~;~;';;' ' o f applicant) ...................... ~ ~ No~ Public S/Glo of No. 52-7267800 Suffol~ FORM NO. 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 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. 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 Building ................ Addition ......~.... ...... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~...~~.....~~....~ ............ ...~...~.~ ................... Owner Or Owners Of Property . ..~/...~ .~ ........................................................ Subdivision ................................................................ Lot No ............. Block No ............. I~'[ou~e No ............. ~ ?....~...~. ~ Date Of Parrot './Z./.~//?.~ App cant /.. .'~...~...~...~ Permit No .................... ~.. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate / Fee Submitted $ .................................... Construction on above described building ond permit meets all a/p~, licable codes and regulations. App,icont ............................................ Sworntobeforemethis~,~ ~Ar /~?~ .~[ 7 y · .~.../.-....:~. day of ............................................ (stamp or seal) Notary Public ..........~..6'. ~.7'. ~ .~. ff. ........... County FLOYD F. KING, JR, Notary Pubflc State of New York No. 52-7267800 Suffolk County Term Expires Mc~rch 30, 197~