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Home My WebLink About6537-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~t88 ..... Date .... $!m~t . 11 . , 19 THIS CERTIFIES that the building located at I~/S .14i¢Idle Road Street Map No. . y,X .. . Block No. ~1~ .... Lot No. ~ 14~ttit~i~ li,.Y, conforms substantially to the Application for Building Permit heretofore filed in this /~dated . 14ay 3 , 19 73 pursuant to which Building Permit No. 6537Z ted -t4ay .... 3 .... , 19y3 ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. PriYat;~..g&~o (A~eeslmz~r b~tlldillg) ............... The certificate is issued to .John Bz, cmm.. C'~r~er ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N ol~. ........................... UNDERWRITERS CERTIFICATE No. lt,R, ................................. ItOUSF. NUMBER. ~J .~,[~ ...... Street .. 14~Cl].t} l{cll~cl...(.{~P-~'.). .................. BLHldmg Inspector / TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION. OF THE WORK AUTHORIZED) [3uilding Inspector. FO~M NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opphcation must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate Iocahon 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 simdar buildings and installations, a cerhficate of Code compliance from the Architect or Engineer responsible for the budding. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buddings (prior to April 1957), Non-conforming uses, or buddings and 'pre-ex~sting" 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 <:nd condition of buildings 3. Date of any housing code or safety inspection of buddings or premises, or other pertinent in- formation required to prepare a certificate. Date ...................................... New Budding ~'/ Old or Pre-existing Building Vacant _L,~nd · .................... ~t~-~ ~7~ ,,~ C'~ ~'' ........................... ~ . ~ ' -~ ~~' ' ................ ~ ........ Locat,on Of Property ...... ~ .........~. ........ ~ ........................... ~~ .................................. Owner Or ~ners Of ~rope~y ...... ~.~.::.~.Z~. ........ ~.~...: .......... ~ ....... : ........................................... Subdivision ................................................................ ot No....~. .... Block No ............. House No,~ ........ Permit No. ~:~... Date Of Permit .~l~IZ~....Applicant .... ~.~...~~ ........................ Health Dept. Approval ....... ,.~ ............................ Labor ~pt. Approval ........ ~ .................................. Unde~riters Approval ............~. ............................. Planning Board ~provol ...... ~ ............................. Request For Tempora~ Ce~ificate ........................................ Final Ce~ificate ................ '~ .................... Fee Submitted $ ..~..~ ..................... Construction on above described building an~dffe~rm/.,t, meets all applicable codes and regulations. AppI icant ........ ~....1L..~.~~t ............................................ Sworn to before me th~s ............ L. ............................................ c ,o p ~,ARY P UBLIC, St~ 0t New Yor~ Corem ss on FOI~M NO. 1 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ..................................... .~ .............................................. (Buddir~/Inspector) APPLICATION FOR BUILDING PERMIT Da,e. r ........ .3. .................... , INSTRUCTIONS a Th~s apphcation must be completely fdled ~n by typewriter or ~n ~nk and submitted ~n trlphcate to the Building Inspector, w 3 sets of plans, accurate plot plan to scale Fee according to schedule, b, Plot plan showing location of lot and of buddings on premises, relationship to adlommg premises or pubhc streets or areas, - g~wng a detaded description of layout of property must be drawn on d~agram whmh ~s part of th~s apphcat~on c. The work covered by this apphcat~on may not be commenced before issuance of Budding Permit. d. Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the apphcant. Such permit,shall be kept the premises avadable for mspectmn throughout the work. e. No budding shall be occupmd or used m whole or m part for any purpose whatever until a Certificate of Occupancy shall have b- granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to the Budding Z, Ordinance of the Town of Southold, Suffotl~ County, New York, and other applicable Laws, Ordinances or Regulations, for the constructio~ buildings, additions or alterations, or for removal or demolition, as hereto described, The applicant agrees to comply with all applicable la, ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and m buddings for necessary mspect~o[ ~S~gnature of apphcant, or name, if a corporation} __ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Name of owner of premises ....[~,.C~.:......~.]:.....~'~_l_~..~~. If applicant is a corporate, signatuh~ of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's L~cense No ..................................................... Other Trade's License No ..................................................... / 1. Location of land on vVnich proposed work will be done. Map No....~..~.']..3..~... .................. Lot No ........................ Number ...r~ _~,, ': .... ........................... ......... Street and 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exi:;ting use and occupancy .... . ,~_~.~~ ........... ..~..~..../~-~......~../~......~. · ..................................... b. Intended use and occupancy ..... 1.~...~ ................................................................................. 3.' NatL[re of work (check which applicable): New Building .... ~. ............... Addition ..................... Alteration ............ :. Repmr ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Esti mated Cost .&....~....~..~..,...C)..0. ............... Fee ..~///..(~...{.0..~. ........................................................................... (to be prod on hhng th~s apphcat~on) 5. If dwelling, number of dwelling units ................. Number of dwelling units on each floor ......................................... If garage, number of cars .... .~j...,,...z.~.. ..................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..... ~ ...... Rear ..... ..~.....'~... ........... Depth ..~.e~ ...................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ........................................ Depth ............................................. Height ......................................... Number of Stories ....................................... 8. Dimensions of entire new~cpnst, ruction: Front ......................... Rear ............................ Depth ................................ Height ~,/./~././~../..~......./...~..-.~..~.~...... ...... Number of Stories~....,, ....... ~.../~..~ ................. ~ ................................... 9. Size of lot: Front ........ .~..~.~.~....~....] ......... Rear ............. ./..~.....-7...~.. ............ Depth .......~:~-'.~-).~..~..~....: ............... : 10. Date of Purchase ......... Z.%~.....~.... ....... Name of Forme~r O.~ner ..~../~...~ ................... 1 I. Zone or use district in which premises are situated .......... ,,:..J ................................................................................... 12. Does proposed construction ¥iolate any zoning law. ordinance or regulation: ................................... : ..... ~ ............... 13. Will lot be regraded ~.(..~.' : .......... Will excess fill be removed from premises: [ ] Yes '~No 14. Name of Owner of premises ..................................................................................................................................... (Address) (Phone No.) Name of Architect .................................................................................................................................................... ~'~j ' ~ ~ (Address) I ,, (Phone No.) .... ........ ..... Name of Contractor (Addr~ss)~ ~ (Phone N;,'~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Give street and block number or description according to deed, and show street names and indicate whet er interior or corner lot. STATE OF NEW YORI~ /~ C ~ OUNTY OF .............. ~ ....... ) · ...... ~ (Name ofindz~tdual s,gnmg'~'~'n~7) ..... be,ny duly sworn, deposes and says that he rs the applicant above nam; He ~s the (Contractor, agent, corporate officer, otc of sa~d owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and hie th~s apphcat~on; that statements contained m th~s apphcat~on are true to the best of h~s knowledge and behef, and that the work will be performed in the mar set forth ~n the apphcat~on hied therewith. ., ;'2;; ..............¢,,,,>::'' '-' ;' "" .......... ..... (Signature of appltcant)