The URL can be used to link to this page

Home My WebLink About6371-zNO, 4 TO~I~I OF $OUTHOLD BUU~DING DEPARTI~.~ Town Clerk's O~ice Southold, N. Y. Certificate Of Occupancy No. Z%9~8. ..... Date ............May...,.31 ...... , 197~. THIS CERTIFIES that the building located at ...W/8- .First .~treet ......Street MapNo. xAx ........ BlockNo. ..XX ..... LotNo. ~i~X..l~ew.S~.f Lk...N,.Y.,.~ conforms substantially to the Application for Building Permit heretofore~ filed in ~.hi~ office dated ..........-Feb- · ,2- -. 19.73. pursuant to which Building Permit dated ..........-Feb.-.21 .... , 1973.., was issued, and conforms to au of t~ require- ments of the applicable provisions of the law, The occupancy for which thi.~ certificate is issued is .Prt.~ate. oae. E~mil.y .dw~lling~ ......................."" i ........... The certificate is issued to .Salv~tere..Ler~ ....... -Uw~e~ ........................ (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval .N,R., ................ 11'; ........... UNDERWRITER~S CERTIFICATE NO...pend.~Ag .................... .... HOUSE NUMBER ..... 11.7.~ .... Street ... F.l=st..Street ......................... FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Yo BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6371 Z Date ....................... l~J~ ....... ~'1 .............. , 19'~3" Permission is hereby granted to: I~I~..~ ~,k.....&/.~ ..1~,..~1~ .~ ......................... .... · ~.~...~.~,~m.....~t ..................................... ......... ~.o..,~.~ ~.l.l~ ................................................... to .....~J.~J;.~...~.].:t~r~l~ rm..~,...~.ni,l.~,...~ r:.~ 1.t.ioJ ..~.. ®~l~..~t~ ..................... at premises located at . ~v/~..~".~'F1~t-.'[i~ ........................................................ ........................................................ ............................................................................. pursuant to application dated ..........................~;~J) ....... ~.~ ........... , 19..~:~.., and approved by the I~uilding Inspector. Fee ~.~, .Cf..' ............. APPLICATION FOR BUILDING FlrRMIT ....... ................ . INSTRUCTIONS e. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wj 3 sets of IMens, 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, 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 ke the premises available for inspection throughout the work. ~ e, No building shell be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shell have ~rlntad bv the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction, 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. .State whether applicant is owner, I~, engineer, general contractor, electrician, plumber or builder. Name of owner of prom,sos ~~ii~~ ................................................................................... If applicant is a corporate, signature of duly authorized officer. ~J CName and title of corporate officer) Builder's License No ................................... ~.. ................ Plumber's License No....~:~..(~..~.~...: ..~....'...~.~L~-~ Electrician's License No. ~..~...~_....~:.....~....~.~[.~_ Other Trade's L cense No ........................... [ ..................... 1. Locat on of and on wh ch prol:~osed work w be done. Map No ..................... ~ ............... :....Lot No......~..... ; Street and Number .............f.~. ......... .~../.. ....... ~.. ............ ' ..~'... ............ ~ ....................... .~.~...:.~. .......................... Municipality 2. State existing use and occupancy ~f premises and intended use and occupancy of proposed construetion: a. Existing use and occupancy ......~......c~....~....~../~...L,~...~. ............................................................................................ .................. b. Intended use and occupancy ................. ~,.,,l~J..~': .............. ~ ........... ~'~..,.~,., ............ 3.a' ~Nat~re of work (check which apolicable): New Building ....................... Add.t.on ........... ~A teret o~...~... Repair .......... Removal... ............ ... ... .... Demolition ........................ Other Work .................................... ............... (Description) 4. Estimated Cost . ~ ..~...~.O .._~... Fee .,.....1. ....................................................................................... '"' ..... ' ................... (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 ........................... Del~th ................................... Height ................ .... ...... ..... ..... ... .. Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... D~., He nht ..................... Number of Stories ...................... ,~ ............... 8. Dimensions of entire new construction: Front ...~..,/.z/.~....~.... Rear ...... .~ .................... Depth ...... ~...~......~. ........... I-I~iaht ...................... Number of Stones ...... ~'... ...... .~.....~.. ................. :,......~......~ ........................ 9. Size of lot: Front ..... .~....~'...0.,.,..~..; ............... Rear ................. ./'...~....0........'~.. ....... Depth ....../....0.../......~.. .............................. 10. Date of Purchase ................~ .................... Name of Fol;me~r Owner .,......~, ................................................................. 11. Zone or usa district In which pram,sas are situated ..... ~. ......... ~.. ....... .{.. .................... _......~ ................................... 12. Does proposed construction viOlate any zoning law, ordinance or regulation ............. ~ ................................ Will lot be regraded .......... .~ ....... ,~a~Wjll excess fill be removed~fr, e~ prerrjj~es~ ]~ ~l~s [ ] No 13.. .... ¢. ~... ~7~ .{~...~......~.~ ........................ 14. mame or uwner oT premises ....,.~..[..,..-~aw...~..nw~. ............................... /.~...,.= ...... ,~...-..-.....~ ..... (Add~ess) /~/ (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 sat-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 ............... ~~ ..........................................................................................................~' being duly sworn, deposes and says that he is the applicant above named. (Name of indiv~ ' Ha is tha ................. 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 a lication filed therew;th T£RR L~ ELAK PP -~'N' ~N~y PUBLtC. ~te 0f _New~Yo[~ ....................... ...c~...]. ....... day of ....... ;.~....~....?'. ......... Notary Public, ~ ~ ~ County ~.: ........... .',.,,,;,,,.,~ ............... ~'--~ ..................... (Signature of applicant) FORM NO. 6 TOWN OF SOUTHOLD Building Depa~tment 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. Approva~ 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 19§7), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings end 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 Date .............. ~. ........................ New Building .................... Old or Preexisting Building ...... ~ ............ Vacant Land ............................ ,' /?/ Subdivision ................................................................ Lot No ............ ~Block No ...........House No,~, ......... Permit No. ~.~.~./.....~... Date Of Permit ..... ~.~.Z]Applicant ../~~..-~.. ...... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval .....-7 ............................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and perrrfi~, rr~ets a~gJ~pplicoble e~les and regulations. Applicant ~~.~..~ ...... ~..~ .................................... Sworn to before me this /~'~t -~O~ Notary Public .................................... County (stomp or seal) KIKIG JI /~/:bL:~/,'T'/Oh/ ,,,% 7-0