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Home My WebLink About6507-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.z~2~O. .. Date .. j'az:te. ~ , 19.73. THIS CERTIFIES that the building located at ~e~t ~---~eek. Ave Street Map No. ~ Block No. XX Lot No..X~...Otl~.~hoglle N,Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated l~.][pl'~ ~?~19 73 pursuant to which Building Permit No. ~5~~F' dated . ~j[~ri~(~ .21~1~,~ 19~/3.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate ~s issued is . Private .O~.e fam.i.],~r. The certificate is issued to o£ the a~oresaid building. Suffolk County Department of Health Approval Owner .. (owner, lessee or tenant) UNDERWRITERS CERTIFICATE No pe~ldi~g ............ ttOUSt:. NUMBER ~'2~' Street ~$~, ~reek ~O. Btuldlng Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PER,MAT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 6507 Z Permission is hereby granted to: .... b'm~..;Cacohs.....A/.C.....Eawa~..~Xie..Jr ................ ~t,~8~e .......................................... to ...... h~ :l~L..~,.ac~d:Lt&on...o~..e.x~.s~,~.ng..~we~.~4~:E ........................................................ at premises located at ....1.b~.].~.....We.s~;...CE,.ee.~..A~e ......................................................................... ........................................................... ~tchogue ................................................................................ pursuant to application dated ........................... -Ap:P.;[.]-...~b~ ....... 19..~j.., and approved by the Building Inspector. Fee $...t.~..?...0g.. .......... TOWN OF $OUTHOLD 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 Buildlng 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 cerhficate of Code compliance from the Architect or Engmeer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildin, gs (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buddings 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 inspechon 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 ' t ~, Date ..... ,~,/..~,". ........ ;....." ................. New Building .................... Old or Pre-existing Buildmg ..... ~ ..........31- Vacant Land ............................ Location Of Property ......... Z..~.,..,,~,..?. .......... :,~,,..,"....,.~,.~,~,,.~,,~.,~ ..... ,,~,'.' ;~,,, ........................................... Chimer Or C~ners Of Property . ,~,~,,,.~,.:~,'~,,,.....,~,.,~,.~,f.~,/~,././,:;~:.: .............................................................. ................ ~6.,.~.Lot No ............. Block Nc~ ............ House No ............. Permit No .~.~-.<;...-,~ Date Of Perm,t .~(4~ppl,cant ................... ~.. .......................................... Health Dept. Approval ...... .~...:...~.. ........................... Labor Dept. Approval ......... .~....:,..~,. .......................... Underwriters Approval ...~.....~.....?.~.~...L~.. .............. Planning Board Approval /k/,~_ Request For Tem~ary Ce__~ificate ........................................ Final Certificate ............. ~ .............. Fee Submitted $ .~. ....................... Notary Pubhc .................................... County Sworn to before me this ~ (stamp or seal) FORM NO. $ TOWN OF $OUTHOLD Building Deportment Town Clerkt 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, aha 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 Underw,ters. 4. Commercial buildings, industrial buildings, Multiple Residences end similar buildings and instollahons, a certificate of Code comphance 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-ex~sting" land uses: l. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy end 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 ~.~..~..~., Date ...... ,... ......................... New Build:rig .................... Old or Pre-existing. B~ildin~L ....................... ~.. Vacant Land ............................ Location Of Property ....................................................... ~ .......... ? ................................................................. Owner Or Owners Of Property F/~)~-"//~'~ ~//C,~/I ~' Permit No. {5.¢.o,,-~,.~,,. Date Of Permit ~:;,~¢.~pplicant ...... ' '~"U "'"~" "~ ............................ Health Dept. Approval .... :~J.:.~ ............................ Labor Dept. Approval ........ /~..,.(}. ............................. ~) -- - Underwriters Approval ....~... ....... ?.../...~....J....~'... .............. Planning Board Approval ..~!J,.~... .......................... Request For Te,m~Ce.~.~ificate ........................................ Final Certificate ............ ~ ............... Fee Submitted $ .................................... Construction on above described building aj~l/p~m~eets otJ/~p~YcYc~le code~, and regulations. Sworn to before me this ........ day of ..... ......... <stomp or seoI Notary Public .................................... County ~0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ....................................................... ,,. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ~- a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witha~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule; b. Plot plan showing location, of lot and of buitdingS, od premises, relationship to adjoining premises or public streets or areas, anc~ giving a detailed description of layout of property must be drawn on diagram which is pert 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. ~ e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have bee granted by the Building Inspector. ' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building 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, eddJtJons or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all al~plicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for nece~ary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, amhitect, engineer, general contractor, electrician, plumber or builder. ................................... ................................................................................................................. .............., E- ................................... 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 ......................................................... Electrician's License No ..................................................... Other Trade's License No ......................................... ~"~1 __f J ! 1. Location of land on which proposed work wil/be.done, Jvlap No....[.../..~.../..v..~.__ __,_,~...._ ~,,,,~,,~, ~,,.~,~ ....... Lot No ......................... Street and Number ../..~.~....~.........~..f.....~..~ .......... ~7 ....................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ./......~..~....~....,,....~...~..L~...././..R...4~..~. .................................................................. ........ -- .................................................................. b. Intended use and occupancy / Itl n 3. Nature of work (check which applicable): New Building ....................... Add' 'o ..................... Alteration....: .......... Repair ......................... Removel ..................... '... Demolition ........................ Other Work .................................... ( 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 ......................................... If garage, number of cars ........................................................................ .*...i ............................................................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use .................................... 7. Dimensions of existing structures, if any: Front .....~.....~.. .......... Rear .../..~..~../..~.. .......... Deoth ,~...~......~.........~......~. .... Height ...l~.. ................................................ Number of Stories ..... ,~..~ ................................................................. .... i' · o D~mens,ons of same structure w~th alteret~ons or add t~ons. Front .....~... .................. Rear ....~..~ .............................. · / ,~ Depth ....~..~.......~(....~...~ ................ Hmght ..... l.~...., .......................... Number of Stories ....... ~...~.. ........................ 8. Dimensions o.f en ire new construction: Front .................... Rear..L~....~ ............ Deoth _H.e~ght ....... ~.Z.. ................................... Number of Stories ..... ,.~.. ............................................................................. · · 0. o /~/ ~4 /7/ 9. S~ze of lot. Front ...~'~. ....... , .................... Rear ...~.~ ................................. Depth .................................................. 10. Date of Purchase ..................................... Name of For~er Owner ............................................................................ 11. Zone or use district in which emises are situated ..f..~.~.~..~.. 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be re~'aded ...... ~ .................. WillexCesefillberemo.~vedfrompreJ~nises;.[ ] Yes [ ] No 14. Name of owner of premises ....~..~.....~.~.....c~...~........~.,~../...~...*..../'.~.~.'._,~....C~..t...~.~.....~......A~.~. ......................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... · // . ,* ,ame o, Contractor ............. , .................... ................ .................... ......... PLOT DIAGRAM Locate clearly and distinctly ell 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 wheth- er interior or corner lot. [O O, STATE OF NEW YORK,__ ~ ~ ' ) COUNTY OF ........ ..~...%J ..~ .~.~ .~ ~ .'..~ ................. ) S~ ...~..'.3.'~,..~..~.<~..K~,~...~ * ~.1~)..C-~.~. ............. being duly sworn, depo,s and says that he is the appli~nt above named. (Name o/individual signing contract) . , {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 conteined in this application are true to the best of his knowledge ,and belief; and that the work will be performed in the manner set forth in the application filed therewith. r') ~ ~ ~'~ ' -NOTARY PUBUC; StatLQf,~4ew york ............ ,~r~...; .................. day of ......................... Ng,..~;Z-ll ~ 8..2~.~ ..... .otary ................ (~qgrmtur~ ~at,ptic~nO