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Home My WebLink About6390-zFORM NO. 4 TOWN OF SOUTHOLD BUII,DIN(~ DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..~...f.~. I.~. Date ......... ~....~{.. ~.~.,~.... THIS CERTIFIES that the building located at .~.~ ~ ~ ......... Street ~,~ ~o. . .~ ....... ~o~ ~o. . .~ ..... ~o, ~o. . .x ..... ~u~o~. . . ~.t co~orms subst~ti~y to the Application for B~d~g Permit heretofore filed in this office dated ............ ~...~. .... , 1~., was issued, ~d confo~s to ~1 of ~e req~ ments of the applicable provisions of the law. The occupancy for which this certificate is of the aforesaid building.(~/] - 0 - ~ -" ~ ~(-~wfl~r, lessee or tenant) Suffolk County Department of Health Approval .... .~.,. ~. ........................ UNDERWRITERS CERTIFICATE No ......... ./~/,.. ~ .......................... HOUSE NUMBER. ~.~..~'..~'..~.~... Street..../;~/.~..~.~... (~ j~.O~7) TOWN OF SOUTNOLD 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) 6390 Z Date ...................... Mild. oh ....... 5' ........... , 19.~.~.. Permission is hereby granted to: *~) 3oseph D~'oskoski ........ .~o.~..~a~ ............................................... .................. ~.~.~.~.:L¢ ......... ~....t.'.,. ....................... to .~.9......~.~.~...OA ..~:l..~,~.~...~n ..e x~ s.t,~.r~ .. e.e ,-.e ~o =~.. h~ ............................. at premises located at ..... ~/.~,......~.g~..~..~O.~,~...(.C.J~.~.~ ................ : ................................................. ................................................ .~.o.~.o..~ ......... .~ ...~.., .......................................................................... pursuant to application dated .................... .J;'!~,~.,~. ......... .'Z ........... , 1~.~...., and approved by the Building Inspector. Fee $~...O..j..,,C~.. ............. Building Inspect7 FOB, M NO. 6 TOWN OF SOUTHOLD BuiJding Deportment Town Clerks Office SouthoJd, N. ¥. 11971 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 .~..').~ ..... Old ar Pre-ex~g Location Of Property .......... ~..¢...,~¢..~.~...../.~...~.... .......... SZ~...~...~_~..,..Z..~. ................................. ~ner Or ~ners Of Prope,y ...~.~..~ ......... ~..~.~.~: ........................................ Su~ivision ..................... ~ .................................... Lot No....~.... Bilk No...~ ....... House No ............. .~ No....~.~Z.e.~,te of ,~rm~, ..~/.~/l~pp~i~nt .................................................................. .e.,,~ ~,,. ~,,~v., ....... ~...'..~ ...................... ~or ~,,. ~,,row, ......... ~.:.....~. .................. U.,e~.,. ~,,.ov., ......... :.~..~ ...................... ,,~n.,n, ,o0~, ~.row, ...~.:.~ ....................... Request For Tempora~ificate ........................................ Final Certificate ......... ~ .................... Fee Submitted $ ...~ ........................... ~,~ .~.~.~~ ........ ~~....: .............. Sworn t~.before me this .......... Nota~ Public .................................... APPLICATION FOR BUILDING FElt. MIT INSTRUCTIONS a. This application must be completely filled in by tYpewr~t~ ut-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 location 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 applicatidn. 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 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 bee~ granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuenee of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffotk Count~, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions Or alterations, o~ for removal or demolitioo, as herein described. The applicant agrees to comply with all applicable laws. ordinances, building code, housing code, and regulations, and ~co admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is~,wner, lessee, 'agent, amhitect, engineer, general contractor, electrician, plumber or bu der. '. ..................... i .................... ...... , ........ :... ....... ...................................................................................................... Name of owner of premises . .~.,g..~.~.....,~..~.9..~..,,,~..O..'S....~...tl ................................................................. 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 ............ ~ ......................... !....Lot No ....... ~. .............. Street and Number ..... ~...~./~./.--.~......~...O...a.....e/./ ...... ..~.~.~...u:.....~2../~,..~.,.....~..:...~..__ ............................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex sting use and occupancy ....... .~...~. i. ~..~...."~...~....~..~....~.Z/. ,:.~....~.... ..... ,, ,, ..... ....... : ............................................ : ....... . ................ In,nded use and oecupancy .....r....~. ~ ..V....~.../. ~.~...., ,~..~.~:..~..~ ,..~.:. ,~-..,,~:~ ...../~.....~.....o~..[,::~ ..................... b. ° ~ I,/- ~ s 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ................. Removal.... ......... .......... .. Demolition ........................ Other Work .................................... ........ (Description) 4. gstimated Cost .................................... 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 .... / ...................................... 6. If business, commercial or mixed occupancy, specify nature and extent of ea~ch type of use ..................................... i ! r 7; Dimensions of existing structures, if any: Front ....... ~.~). ......... Rear ......... ~.. ............... Depth ...~ .......................... / Ho -ht .... Number of Stories ............................................ ;..~-..) ......................... ......................................... Dimensions of spme structure with alterations or additions: Front ....~.. .................. Rear ......... =. ............................. Deoth .~...U .... He ght . ~ . . Number OT btones ..................... ., ........... 8. Dimensions of entire new construction: Front ........... /~ ............ Rear ......... ./.~.. .............. Depth .......~...~.. .................... Height .......... Number of Stories ...i.../. .......................................... .~.~ ................................. 9. Size of lot' Front .............. ~ .............. Rear .......... ~..~ ........................... Depth ....... ./..?'...~. .................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are s~tuated ............ ~ ..................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. .~..~) ..................................... 13. Will lot be regraded ~..~..~ ......................Will excess ill! be.r. emoved from premises: [ ] Yes [ ] No 14. Name of Owner of premises ....~..p.,S~.~.~.,._/~.~..~...~.~.~..~...~J~.~...~/,~.~..~?,.?~4.~.~ ......... ~.~'~:.'. ....................... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Name of Contractor -~'~ ....................................... ................................ [~dress) (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. - {Na~eofindividualsigningcontrac,} . . {Contractor, agent, corporate of]~cer, etc.} of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applicatidn; 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 i. set forth in the application filed therewith. T[ERI I. El[ F, tAK ~ - da of ...~..,..l~..?flt~"52.616 5/.....'~.., ...... .................. .......... ............... / / Notary Pu i=, .................... ... Countv ..................... ............ i:~. ~ (Signature ol appttcanrl ~ ~ ~0qq~