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Home My WebLink About6363-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. z51+80 ....... Date ............ Bept... 25 ..... , 19. ?3. THIS CERTIFIES that the building located at .. Pa~lo~a-y ................. Street Map No.. $¢~;hVO~[ Block No ........... Lot No. l0 ..... S~l~;ho~,d ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... l~eb ..... 8.., 19.~3. pursuant to which Building Permit No.. dated ......... Peb .... 8 ..... , 19.7.3., 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 .Pr±rate..Qne. £mnily..dYe~IAJ. ng ....................................... The certificate is issued to l~Idval-~. Lad~mm~ .,l'lt ......... .c.~elr ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval S~I~t.. ~1~.. ~73'' by.R,. I/:[11~ .... UNDI~RWRITERS CERTIFICATE No..l~. ~6808...temp ............................... IIOUSI! NUMBEI~O[) ........ Street...P&I'~ .¥&y ..................................... Building I n.,,i)ector ' FOEM NO. ~ TOWN OF SOUTHOLD 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) N? 6363 Z Date .................... F~.b. ....... 8 .................... 19.~... Permission is hereby granted to: · '-~k~'~ ~-.. ~.de~ ..~....;,.~.Fe .......................... .................. ,~;~u. th~l.d. .......................................... to 'i~u~'~"J ..-ne~.. '~n'a.-._.: w~_..lF .-dwe - .~:[tig ..................................................................................... at premises located at ..... '~0~..."t~. .......... :~e~:~w,.o~ ......................................................................... ............................................ $~4~.....~.~:.~.wey ................... ~ut:L~ o.]:d.....,% ~.~.~. ................................ pursuant to applicotlon dated ............... &~l~ ......... ~ ..................... , 19.r/.,~.., and approved by the Building Inspector. Fee ~.,~.., .~.~ ............. FOItM NO. 6 TOWN OF SOUTHOLD Building Depaftment 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 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 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 fram 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 safeb/ 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 .... ~, f~..~:~ ...'~. I..~ ... 1 ..~..3..~ ..... New Building ..... ~ ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property I-)O o P~'~.~...'~'""~'"~..1 ...... "~"Q"J"-['x~Q~'I~" Owner Or Owners Of Property ~.~..~J.~.~).....[~'.,...~....~-~.I,.Ia.~-.'['.Fr-.-..t-~.~E. YYJ..YJ.~ ............... Subdivision ....~....o.~..q'~.l~...~....~..~...0. ......................... Lot No....~..~.... Block No ............. House No ............. Permit No..(o.~..(~.~...~... Dote Of Permit ..O:t.~.l..'[~....,Applicont ...~.~,.~,~w~w,,....~n., ..... Underwriters Approvol~.. ............................................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ...~..:.~..13. .................... Construction on above described building and permit meets all applicable codes and regulations. f r · th~s Applicant ...~.C,-~.~.~~-e~'~.~(~ Sworn to be o e m ' ~-~,,~ '~ do-of ..... ~ ....... .~.~...~ .... (stomp or seal) ~. Approved ........................................ , 19 ........ Pemit No ..................................... FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. Disapproved a/c ...~ ...... ~ ......................... ~ APPLICATION FOR BUILDING PERMIT Date ................................................ , 19 ............ INSTRUCTIONS This opplicetion must be completely filled in by typewriter or in ink and submitted in duplicate to the Building c Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc streets or areas, and giving o detailed description of layout ofproperty must be drown on the diagram which is part of this applicotio1'E~. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this opplicetion, the Building Inspector will issue o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until o Certificate of Occupancy shall here been grented by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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, 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. ~.~..:...~- .................. (Signature of applicant, or name, if a corp'bration) (Address or, applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~---o. ~..,~..e,-~.....t~...-...~..A.l).~.~..~.~.~.~.....~....~. ................................................................... If applicant is a corporate, signature of duly authorized office.r. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: .....~..~...~.l ........................ Lot No....,I..O. ............... Street and Number .i.~L~....7../~.e`K.b~./~..~...w.~.~.~..`~.~.~`D..~.~.~.~}.T~.~.~.....~.~.~..~.~.~.~..~:.~.~ ................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...........L~..,~k..~.~..~.q....~. ............................................................................................. b. Intended use and occupancy ..... .~[.,~..JJ2..~.~.~.F-,, ............................................................................................. 3. Nature of work (check which applicable): New Building ...... ~ .......Addition .................. Alteration .................. Repair ............... ~, Removal ..................Demolitian .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... ~.c~.~.o ..................................... 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 each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... /'-~. ..................... Rear ...... g.~. ................ Depth ....5..'1. ............... Height .....J.~ .......... Number of Stories .......... I.~.~, ..................................................................................................... 9. Size of lot: Front ...J.D.~ ................. Rear ....~..~..O ...................... Depth ........ I..~.~. .............. 10. Date of Purchase .L.~.-ID_ Name of Former 11. Zone or use district in wl~ich premises are situated ...~.~,~.l~.~rt.T.~. ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~.c~ ............................................... 13. Name of Owner of premises,E..,.~,~,~me~r~..~r~.....Address '~.~.~..~'.~.¢~.~,b~.,...~....~ ....... 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 whether interior or comer lot. STATE OF NEW YORK, ~ c c COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 ore 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 ........................ day of ............................................ ,19 ........~ ~.~.. ~:~..~.. Notary Public, . ........................................................... County (Signature of applicant) DEP/~R'FtfiENT oF HEAN R!"/ERHEAD, N.Y. · APPP. OVED AS NOTED~ , '