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Home My WebLink About6987-z1~0~ NO. 4 TOWN OF SOUTHOLD BUIT.r~ING DEPAR'I~tt~:NT Town Clerk's Ofiice Southold, N. Y. Certificate Of Occupancy Map No...~ ...... Block No .... :eX ..... Lot No. xxXX.. I~attilmek.. ~,~... ....... co~o~ subst~y to ~e App~ca~on for B~ng P~it h~fo~ ffl~ ~ th~ o~ dat~ .......... ~...1~..., 19..7~ p~t ~ wM& B~ P~t No...~ dat~ ......... N~.. 1~ ..... , 19..7~ was ~u~, ~d co~o~ ~ ~ of ~e ~ men~ of ~e app~cable p~io~ of ~e ~w. ~e ~p~ for wM~ th~ c~ ~ ~ ~ ... ~ ta. ~. ~. d~ ~. ~ ~..a4d ~. ~. ~q~l~ .... ~e ce~ca~ ~ ~u~ ~ . ~O~ .S~e~ck ........ ~e~ ........................ (o~, 1~ or ~n~t) of ~e ~ores~d S~o~ Co~ Dep~ent of He~ Approv~ .... ~.~ ........................... ~~RS C~T~CA~ No...app~l. by. J, .[~a~$...~/~ ..... HOUSE ~ER .... 1~. ..... S~t .. 0~ .J~ .~ .......................... ................................ ¢~. ~,~ .~ .... , ............. ............ ..... .... FOBM NO. ~ TOWN O~ ~OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6987 Z Date /Z/ /Ifil'. 197~) Permission is hereby granted to: pursuant to application dated jo/ /Vi)b~ 19 and approved by the Building Inspector. Fee $../...~.r..~. ...... Building Inspector INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildi~ Inspector, with 3 set~ of plans, aocurate plot plort to scale. Fee according to schedule. b. Plot plan.showing location of lot end of bUildin~ on premises, relationship to adjoining premises or public streets areas, and giving a detailed descriptiOn of layout ofpraperb/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 perr~ 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 Occupan~ shall have been granted by the Building Inspector. R~ul~'~nn~ z-- .L- _,,__~_e. u ~ne I, ,o~vn..o~ ~utno. i,a.,, buffalo, .~.ou.n. ry, mew YorK, and other applicable Laws, Ordinances or --o ........, .ur m= cons~ruc,On o~ ~u.mngs, aaaihOns or alterations, or for removal or demolitiOn, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housfng code, and regulations, and admit authorized inspectors on premises and in buiJdJn~ b necessary inspections. . ...... ............ ~q;~.~ ' /~'~ ~Signoture of'applicant, or na~ne, ifa 'cOrporation) " .......... of app,, nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .(t !" l.. Name of owner of premises ...~. . - ~__ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ......... ...:~-~.-~...;L. ......... Electrician's License No ...~...~ ..... .~.~.~"r~""'.~- t4 Other Trade's License No ............................................ ~.. Location of land on which proposed work will be dOne. Map No.: ~ Lot No Street and Number ............ .-........,.; ...; .......................... State existing u~ and ~cu~ncy of pmmis~ and intended use and ~cu~ncy of p~ c~ti~: a. ~isiting u~ a~ ~cupon~ . ( ~: ~ ~: ' ' ~ - I T / ~ ,, b. Inten~u~and~cu~ncy ....... " j~ )~ i ~ , ~ll~: ~ture of work (check which applicable): New Building -.,.~ ............ Addition .................. Alteration ....... ~ ........ Repair .................. Removal .................. Demolition........"i .......... Other Work .................................................... ~ , - (Description) ..... 0 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, specify nature and extent of eac,~,type of use ...... ;~..~ .............. 7. Dimens~ons of ex~shng structures, if any Front ................... ~ ...... Rear ................................ Depth .................... Height ........ ¥,...r~.,..~ .... Number of Stories ........................ ~..~T. ................ ;...~.~. .................................... ;~.(,~ .............. Dimensions of same structure with alterations or additions: Front ................... ~,~ ............. Rear ............................ Depth ............... ~....4 .......... Height ................... ;..:~...Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories .............................................................................................. .~i/.;'.~'.. ............ 9. Size of lot: Front ...~.J..~.l'.~.....~ ..................... Rear ................................. .~:ji.,...~L~Pt~ .~..~.,.J....~..);~,-- ........... 10. Date of Purchase .............,4 ............. )../.~...r...: .......... ./.2~.Name of Forme~l~C)wner ........................................................ 11. Zone or use district in which premises are situated ............................................................... A....~ ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................... .~...... ........... 13. Will lot be regraded ............................ Will excess fill be removed from~pre~mise~: (, ~ ;-Yes 14. No'me of Owner of premises .....~]. ....... I...t'. ....... ~ ......................... 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-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. '. : ,-.,,., .'I' STATE OF NEW YORK, I ¢ ¢ . . COUNTY OF ................................ I' ''''~ ..................................... ~.~.L.L'..~ ......... ,., .................................. be ng duly sworn, deposes and says that he is the opplicom (Name of individual signing contracf) above named. He is the ................... F.l.....~,~..,..l.k. ........................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the appliCatiOn filed therewith. Sworn to before me this ' / i ~ ' ' ' ........................ of ......................................... ........ , . / ./4, ota Pubhc ............. n /, , , ~' ~ ~/'t N ry ', ....................................... Cou ~ ..i .......................... :.~ ....... J.: ...... :.;;;::;.!,;;.!.,....:L..:' ................... (Signature of applicant) FOEM NO. $ TOWN OF SOUTHOLD , Building Depertment Town Clerkc 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 Residencies 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 oil 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 occuponcy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ~....../...~..~.../..~..?.~ ..~.. New Building ................ Addition ~'~ Old or Pre-existing Building ................ ¥ocont kond Property ........ /..f~...,~..~.. .......~...~..~.. .......,,~....~...~....(~. ...... /~1.,.~,..~..~.~. ........... ,~..~.....,~.. ~. ~..~....(~. Location Of Owner Or Owners Of property ......... .~ .q..,:..~.....~../.~.(.C...(..%.,........;~ ............................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~.}..~..~..~....~.. Date O{ Permit ,(/:./..~.r.?~..~Applicant .................................................................. Health Dept. Approval .......... ..~..~.~.. ......................... Labor Dept. Approval ......... /~..r....~..,,. ........................ Ur~derwriters Approval ........... ~...~..~. ........................ Planning Board Approval ..... .~..:..-~ ........................ Request For Temporary Certificate ........................................ Fincd Certificate ............ ~ .............. Fee Submitted $ ........ .~,~....~..~ .............. Sworn to before me this Applicant ........... ..,,~...,.L..v.= .~_. ~_ ..~.~.~.~.//..,~,,~/~/~ ~ /¥~,~"c~J /~ ~z/~'~ ................ day of ..'..'~.../ ................................. (stamp or seal) Notary Public ........... ~_ ..................... County APPI~OVED AS NOTED DATE: 755-266{) 9AM TO 4PM FOP, REQUIR. ED hN£?ECT ONS: 1. BLFO~E BACKFILLING FOUND^~ TI~,,~ C.R START FRA;..ING 2. gE?O,q.k CCVERiNG PIP~LINE 3. FINAL WHEN JOB COMPLETED --~,~-[-kESF~Oh+~tBt~ F'~R DESIGN OR CON- I, ii ,{ ~ J '~'~'---~ARC EL Z MAP OF,,, P=EOP,EETY SUI~VEYED FOP~ CATHEI INE SIMtCICH STOUT ~ VAN DEN 805CH 4.98,71 5HED5 PAI~CEL ICO~O ~I~EI'4LE~ 509.99 ^._5.~U P..V E ¥ E D I~ODE~ICK VAN GUABAINTE~D TO I'i-IT TI'FLE GUAI2,ANT'E~ COMPANY TUYL, E~,