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Home My WebLink About6572-zFO~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. ¥. Cerli[icate O[ Occupancy No. Z8928 Febm~ary IO 78 .......... Date ..................... ,19 .... ~9~ Maple Lane THIS CERTIFIES t hat the buildingloc~ed ~ ..................... S~eet Map No. .... Block No ...... Lot No ................................ conforms substantially to the Application for Building Permit heretofore filed in this office May 15 73 6572Z dated ... 19 pursuant to which Building Permit No ......... May J " dated .............. , 19 ...., was issued, and conforms to nil of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is k PRIVATE SWIM/~ING POOL issued is ................................................................ Joseph H. Stern The certificate is issued to .... ............ (;~zner,' i~ ....... of the aforesaid building. Suffolk County Department of Health Approval ................... (Pending) UNDERWRITERS CERTIFICATE No .......................................... 49~ Maple La~e HOUSE NUMBER .... Street ........................................ Orient, New York Building l. nspee~or TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6572 Z Permission is hereby granted tO at premises located at pursuant to application dated Building In ,spector. Fee ... and approved by the Building Inspector · OEM ~TO. ~ TOWN OF $OUTHOLD Building Department Town Clerfa Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application 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 location of all buildings, property lines, streets, and unusual natural or topographic features. 2 Final approval of Health Dept of water supply and sewerage d~sposa!- (S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial budd,ngs, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the budding. 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, 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 inspect, on 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 7 Z . Date ................................................ New Building .................... Old or Pre-exishng Building ............................ Vacant Land ............................ Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ,.~,.~...~...=.,....'~.4.-:.~...-~...: ....................................................................... Suhdiv,sion ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval .......... L~..!.~ .............................. Underwriters Approval .,~,,.~3,.~.,/.?~.,Z,,?. ..................... Planning Board Approval .... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ described building and permit meets all ,~pplicable codes and regulations. Applicon .... : .............;. .................................................................... Sworn to before me this ............................... ~ .......... ~. ........... (stamp or seal) · FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted i I to the Building Inspec- tor 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 instaila- tions, 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. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pzoperty 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling ,/~'~-~opy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date....~.~.~...~?..~. ............ New Budding ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...~...~'.. ~l~?~-~. ,~_~...L~[.~. ................... (~.~ ~..~-..~.~ ........... House No. Street Ham/et Owner or Owners o f Property ... ~ .~.~..I..hO....~ .... I~...~-~..t)..~.,~....~. ~ .~.~..C~X.~.~. ~).S.: .~.~-.~. ~>.. County Tax Map No. 1000 Section ..... [.F~ ........ Block ...~ ......... Lot....~..'../ ........ Subdlvmsion ................................ Filed Map No ........... Lot No ............. PermiL No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit_meets all applicable codes and regulations. Applicant ............................ R~. 10-10.7e I!UILDING~ DEPARTMENT TOWN CLERK'S OFFICE SOUTH OLD, N. Y. '.~/~. ~proved ........................................ , 19 ........ Pem,t No...~-/~ .................. Di~rov~ a/c ....................................... ,; ..................................... / .......... ...... INSTRUCTIONS " I a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and,~. giving a detailed description of layout of properW must be drawn on 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 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 Ce,rtificate 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, Suffotk County, New York, end other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws. ordinances, building code, housing code, and regulations, end to admit authorized inspectors on premises end i_~l~ildings for necessary inspections. ,4Sigl3ature of applicant, "o';"n'~i; ';"~'c~;';~rati"o'~l ' ............ : ........... State whether applicant is owner, lessee, agent, architect, .engineer, general contractor, electrician, plumber or builder. . ~'~me of owner of pr~;~i~s ::/~Z::~..~"..~..~,,~....;::::::::: ........... : .............. :....:.:.::.:.:.: .... ,f.app. p.p.p.p.p.p~s_ a~o~orate~gnat4~,jjl~authorized officer. t~'-~(e and title of~orporate officer) .... Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map I o.. , N .................. .~,z~l,~.t No ......................... N u m bet ~ ,,~.,.,,'~... ,~.'.'.'.'.'.'.'.'~.. ~. ~ ~. ~."'~'..,~........../L/~ .................. Street and / ' '' ~' '~'-~ ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~ ~ a. Existing use and occupancy ................................ .............................................................................................. .../~-~..~ b. Intended use and occupancy ..................................... :... ...................................................................... . . . · · .... .......... 3. · I~ature of work (check which applicable): New Building ....................... Addition~...~l~..~x, Alteratio~-...,~'~'.~.., . Repair .... -~ ........ Removal ........ Demolition ........................ Other W o r k ..3~. ~.~1~'~ ~. ~J~ ........ ~ (Oescription) 4. Estimated ............ Fee. (to ................................. !5. If d~lling, number of dwelling units ....... ~ ..... Number of dwelling units on each floor ......................................... tf gara~, number of cers ........ ~ ...................... ;: ..................................................................................................... 6. If business, commercial or mixed occupancy, ~¢ify nature and extent of each ty~:~ of um ..................................... 7. Dimensions of e×i~ting structures, if any: Front .............. '~ ...... Rear ......... ..~.. .............. Depth ..~.. ........................... Height ............. .-:.......;'. .................................... Number of Stories ............................................................................. Dimensions of ~me structure with alterations or addition~: Front ...... JJ~ ................. Rear ......................................... Depth. ......... .............. .......... .......... . He~gh{ ......................................... Number of Stories ........................................ 8. Dimensions of entire new con,ruction: Front ....... .,~ ........ Rear ............................ Depth ................................. Height ..................... ;...-x:~, .....;.~ ......... Number of Stories ......................................................................................... ~9. SiZe of lot: Front ...t~.~t.~.~'.~....'~.... Rear .......................................... Depth .................................................. 10. Date of Furcha~ ..' ......... ~ ................... Name of Former Owner ...... ~ ............................................................... 11. Zone or use district in which premises are situated ........................ ;~....'~ ............................................................... 12. Does proposed construction violate 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 .................................................. (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-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. = b° 5 STATE OF NEW ' COUNTY OF ........ ......... · '.~..~., .~...~...~.........-.~.. ;.:........~....~...~...~.~..~.'~ .............. being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing con~act), He is the ..............~"~"..~.~..~.~"~.~w...~. O.~ .................................................................. :,.....i ............. i ................................................................ (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 that the work will be performed in the manner set forth in the application filed therewith, ~1 ~/LE~ ~L~.~ ,,_,., ~