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Home My WebLink About6359-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificale Of Occupancy No. Z~.~09 ...... Date ........... .O~.t ...... THIS CERTIFIES that the building located at Lcm$,v~aw. ~ ............ Street Map No. Te.~.I'~'..~.8. t, el~lock No ........... Lot No. 72 .... ~ .O~.~;~0!-.5.. }~,¥, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ,Tala..22 ..... , 19.7.3. pursuant to which Building Permit No. 6.3~9~. dated ............ Feb .... .7.., 19.73, 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 .. i~'lLlr81;o, gAl~tgo..¢&ee~sso~r, lttlildlLn~)&. F~nee .................... The certificate is issued to Don.tit.to .... Cos~;elJ. o ....... 0vao~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~:.I1., ................................ UNDERWRITERS CERTIFICATE No .... p~p..d.,'i4', l:g ...................................... ttOUSE NUMBER...ltll'O ....... Street... ~a~l~tl-~t~' .~.~ .............................. Building Inspector FOB~ NO. 2 TOWN OF $OUTHO/D BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6359 Z Permission is hereby granted to: Date .......... ~/.c..~...~.~ ......... ~ ....... , 19...~..~ .... .~. .~..:..~.~.~.....~.:,~,.,.~,,.,., ...... ~.,~,~_~ .......... ........... · .~m-~.,...~...,~/..~.:...t./....~,.~.~... ........ ,o ..... ~.~.~...~.. ....... ~,..~_,..~ ....... ~.,~,~i~.,~ ............ ~.....~,.~ .... ~.~_...._~ ........................ at premises Ioca~l~-, .../~.,,~.:..-~..~ ........ .~......~.~..,-:.,....~,J.~ ....... ~.~.../~. .......... pursuant to application dated .................. .~;~,~..~ ............ , 1~..~...., and approved by the Building Inspector. ·OBM NO. 6 TOWN OF SOUTHOLD Building Depor~ment Town Clerks Office Southold, N. Y. ]1971 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: 1. 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 3. Copy of certificate of occupancy $1.00 $5.00 .... .................... New Building ...H...~..~ ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~)..qr.~'......~ ...... ~ ....... ...~...~...~.....~..~L~...l~.~ ......... ~,,~.~l.~.~..'~. , ..~ , ~ner Or ~ner, Of Prope,y ~tN~.~. ....... ~....~.~....~..t ........ ~..~..~.~.~ ...... / ..... .............................................. Lot ...... moc No ............. Ho,,e ............. Permit No. ~.~.. Date Of Permit .~:.~...Applicant ~.~~ ....... ~.~~ ......... Health ~pt. Approval ......... /.~..~ ........................... Labor ~pt. Approval ......... ~ .................... Unde~rite~ Approval .... ~~ .................. Planning Board Approval ...~~ ................. Request For Tempora~ificate ........................................ Final Ce~ificate ........~ ....................... Fee Submitted $~ ............................. Construction on above described building and permit meets all applicable c~e-e~egulations. Sworn to before me this Notary Public .................................... County (stamp or seal) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19....~/... Pemit No. ~.. ~...~. ...../.e Disapproved a/c .......... ................. Tm, .......................... 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, wit!~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocetjg~ of lot and of buildings on premises relationship to adjoining premises or public streets or areas an~ giving a detailed description' Of layout of property' 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 pert for any purpose whatever until a Certificate of Occupancy shall have been 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, an..d other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or fer removal or demolitibn, aa herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessarv inspections. (Signature of ~plicant, or name, iKcorporation) State whether applicant i~agent, architec!, engineer, general ~contractor, electrician, plumber or builder. Name of owner of premi~e~ ' .~J~/.~'..[t~erl, ........ .~.~.~.~ ...................................................................... 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. Location of land on which proposed work will be done. Map No ........ l~..~.,~...~..,.:, ................. Lot Nq;',.."~.r.~. .......... Street and Number ....~.....~..~.~..~Jh~.....~,'~.~l~' ............................................ i: ............ ;...~SI~IL~.. ~..~ ........ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... use and occupancy ....1~~~,.. ...... .~........~..1~..~,/~.~ ..:...!;....,..: .................... ; ........ ,! .............. ~} b. Intended 3. Nature of,work (checlc,which appl,c~b~le): New Building ...... ~ ............ i'Addition ............ ::~.:':. Alteration ......... i.i... Repair .................... Removal ......................... Demolition ........................ Other Work ~... ; ................ ..... (Description) 4. Ssti mated C~st ...~,~I~.Q..~. ........... :," ............... Fee...; ............................................................................................. (to be paid on filing this application) 51 If dwelling, number of dwelling units ..............,;. Number of dwelling:units on each floor., ...................................... If garage, number of cars ..... ...'~'...W.]~t .................................................. ~ ........................ ~ ............ ~i ............................. 6. If business, comme~.c~al or mixed occupancy, specify nature and extent of eec~h type of use ................. .~ ................. 7. Dimensions of ex~tih~] structures, if any: Front ...~..~..... Rear '"'~"~"~'"'ii: ~.D..e.~ iii--'e~............ · Q'~"; i Height ...... ~.,~....~'~. ......... ? ......... , ................ Number of Stories :..,~. ........ ~,;.. · Dirflensions of same structure with alterations or additions; Front ................ ,...,.~,,.. Rear ......................................... Depth ............................................. Height ................................. ; ..... N_U m~Ae~]~f Stories ................. ~...=,., ............. 8. Dimensions of entire new construction: Front ..... ~J'~.... Rear ...,.~....~'~,..,.. Depth ....~.~, .'~.. .......... Height ....... .~.~-..-~.....~w..: ........ Nu~l~r of storie~s ..;~:..~...~.:,~:--::.o:.~......,~ .......... .:.._...=..~_.....,~,, .................... 9. Size of lot: Front ..... .~.....t~.,~ ............ Rear ........ .~.I~......,~. ............. Depth .....=i',~l~.~{~....'......~r ....... ....... ...... 10. Date of Purchas~,,~/~.,~'.l~..~-.~- .~ .....Name of Former Owner ....~m.~-;~..~ '~'~{ 11. Zone or use district in which premises are situated ................................................. t~'~ .......................................... any zoning law, ordinance or regulation: ......... ~?~.. ................................ 12. Does proposed construction vi~pt,e ' ~l .............. 14. Name of, g~lll3,~Owner Qf premises ..... ~l~"~J~l" ~-'~"~'~I~'""~ -~*'*~'-~"~:a~l~' ~dd~k~,~ ......................... (Phone no.,:~"~' .............. Name of ~ofCo ........... ........ '.~.~'"" "' '~' ~~~' ~.~:"'"-- .,....~,,~"I~ ~., .... ',~(Addre ) ..................................... ~'~'e ~(Ph . Name ................. ~; ........ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or propose.d, 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. couNTy OF ....U[..~.~ .................... ) / ~ -~ -' ...... ~.?~..~....~....~:~... .................. being duly sworn, de~s and says that he is the applicant above named. ~me of in~id~l si~ing contact) He lethe ~ ~ ( Co~t~ctor, ~e~t, cor~rate o[~c~r. of said owner or owners, and is duly authorized to ~rform or have ~rformed the said work and to make and file this application; that all statements contained in this application are true to t~ best of his knowled~ and belief;~ ~~ mdor~ in the ~n~er set forth in the application filed t~rewlth. Nota~ Public. S~te 0f New Q~lified in Nassau Coun~