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Home My WebLink About6412-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy No..Z~.1.51 ..... Date ............ J. une...1~ ...... , 19. ~] THIS CERTIFIES that the building located at ... $/5..1~ ,. 2,Qad. t;~ .Bay~t~,e~treet Map No.. ~ ........ Block No..~ ...... Lot No. ~ .... 5ou~hold.. ~ ,X.. ......... confo~ substantially to the Application for B~lding Permit heretofore filed ~ ~is office dated ........... ~a.~ ... ~6., 19. ~]. p~suant to which Building Permit No...~12Z dated ............ Ea~.. ~6.., 19. ~.], was issued, ~d conforms to all of the requir~ ments of ~e applicable provisions of the law. The occupancy for which th~ certificate is ~sued is .. ~riva. te. o~ .~ily. d~elt~ng. · .with .a~d.itlen. ~. fete .......... The certifica~ is ~sued to .. ~i. lliam .Albi. nson ....... ~er ...................... (owner, lessee or tenant) of the Mores~d b~ld~g. Suffolk Cowry Depa~ment of He~th Approval ... N.,R, ............................ UNDERWRITERS CERTIFICATE No.. N,R, ........................................... HOUSH NUMBER .... ~ %~ .... Street... North. Road. to .k.a~&ew ..................... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHO/D, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6~1~ Z Date lg~reh 16 19..73 Permission is hereby granted to: ¢j ,'.,.~..,,.$.m .~..h...~..~..o.~.~....z.~.c......~...c....~ ,... ..... .S.~..u..t...h..o.l~ ........................................................ pursuant to application dated ............................. ..N~. ~'.0~......~.6......, 19~'4~..., and approved by the Building Inspector. TOWN OF ~OUTHO~.D Building Department 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 us~: 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 ?equirements 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 ail 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 $5.00 3. Copy of certificate of occupancy $1.00 Date New Building .................... Cid or Pre-existing Building ...... ,~...., .............. f/~ant Land ............................ Location Of Property r~/.~,J/~..~'/~....Z~.-x~!,~..~....'.'--/.-..~......~...~.7~..(:.~..~ ........................................... Ow,er Or Owners Of Property ............................................ Subdivision ................................................................ Lot No. Block No ............. House No ............. Permit No. ~.f/./.~'.~--, Date Of Permit '~.//..~y~..'Z.'~..Applicont Health Dept. Approval .......... '~.7....: .......................... Labor Dept. ,~pproval ................................................ Underwriters Approval ............... ~ ...................... Planning BoaPd Approval ...~ ............................. Request For Temporary Certificate ........................................ Final Certificate ..~ ................................. Fee Submitted $ .~,~......~...~...'. .................. Construction on above described building an¢ permit m.e, ets all al~pli~ble: codes ,p,l~d regulations. Applicant ../~//~~ .......... ~ ................ Sworn to before me this .......... ~..~., day of .., .~.....';7.¥...t.~.2.} ................. (stamp or seat) Notary Public ..~..'~.>..~...'-~..~..~,.,~.~,, County TERRI LEE ELAK TOWN OF SOUTHOLD Buildlng Del~rtment Town Clerks Office Southoid, N. Y. 11971 APPLICATION FOR CERTiFiCATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and su~bm tted 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 Hearth 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 R~sdences 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, o~cupancy 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 o~ pre~existing dwelling or land use $ .~0- 3. Copy of certificate of occupancy $1.00 ' --~ z --~ --,~ -.~ ....... ,,/.Rf..../..¢..2~ D~te N~ ,.,~.. ................... . :~' ' ~ ' '. .............. , ......... ~~ ........................ ::..:, ...... :..:.: .................... ............................................................ ~ o~ ~, ~ ~'~o~ ..~.~:.:,.~.L:..::....~.~..~..~.:~:~..M ............................................. Subdivisio~ ................................................................ Lot No .......... .. BloCk ~o ............. Ho~se Mo ............. Permit No. 6.,~.~ Date Of Permit al~t~,.Applicant Health Dept. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .................... ~.'~ ....................... Planning Boa~d Approval .,.......~ .............................. Request For Temporary Ce~ificate ........................................ Final ;Certificate ..~ ................................. Fee Submitted $ ~ ................................ Construction on above described building an~ermit meets all a~p~ble c~es~d regulations. Sworn to before me this t / ....... /~... day of .,~,,.,L,~,~.~ ................. (st~mp TERRI LEE NO[ARY PUISLiC, State of ~Jew York NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. If q I ~-~ Disapproved a/c .......~~ Oat . ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector, 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 property must be drawn on the 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 oppiic0tion, the Building Inspector will issue a 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 part for any purpose whatever until o Certificate of Occupancy ~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the isbuonce of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~rk, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or fer removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance~ building code, housin~code, ond,~gulations, h ~4S~gnatu~e/of applicant, or~na~e' if a corporation) .... State whether applicant is~r, lessee, agent,~architect, engineer, general contractor, electrician, plumber or builder. ........................................ .................................. ......................................................................... Nome of owner of premises ..~~.~../' .~....~ .~ ........................................................................... If applicon-ks o corpora~/~ signore of~dul~'_uthorized officer. ....... (Name and title of corporate officer~ 1. Location of land on ~w~h~roposed .work will be done, Map Na~.x~..; ....... :.~...~.,...~'ENo.: ....................... '~'~I Street and Number ~.c~.,~.'~"' '~....~?~.....~..'.: - ~Z 2. State existing use and occupancy of ?j~ises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~.~.~.~.:'.~ .............................................................................................. b. Intended use and occupancy ....~~?~--~ ~ ()6(]~ ' .. . 3. Nature of work (check which applicable): New Building .................. Addition .................. ~ Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost /.~r~ F .../..~...'.'..~...~...~. ...................................................................... (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 ........../...;T...~ ......................................... : .................................................................... 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 ....... ~...z'. .................................................................................... Dimensions of some structure with a.lterations or additions: Front ..... .~......~... .................... Rear ~...~.. .................... Depth .....~ ................... Height ...../.~.' ................. Number of Stories ................................ / ! 8. Dimensions of entire new construction: Front ..... /.../..~ ....................... Rear ......... ./.../. .............. Depth~ .................. Height ../~.... ......... Number of Stories .... ~ ............................................................................................... 9. Size of lot: Front ...../...~...~...~ ........... Rear ........ /...~ ................. Depth ...~ ................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 l. Zone or use district in which premises are situated ....... ~.~..., ...................... ~, ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....~ ................................................. 13. Name of Owner of prem,sesC~..;..'~..~...~......Address ..... ~.~.:...~.... ..... Phone No ..................... Name of Architect_..x~.~/. ~ ~./'"'~: .......... ~Y ......... ~, ..................... Address ii~~.'.'iiiiiiii Phone No ..................... Name of Contractu~.v...:.~.:-...~........=.......~2.......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 corner lot. /If STATEOF NEW~; ~ ~S ~ -- (~ame o~ individuol sionia~opplic~ion) ~ . ~c. - bow.. m.d.H. .......................................... .......................................................................................... (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 confined in this application are true ~o the best of his knowJedge and belief; and 1hat the work will be performed in the manner sef forth in the application filed therewith. Sworn to bef~e~, me thiSof ~.~ (.~-~ 19~ ~ ~~~ ' '" ............... ............. ..................... . ............. ............... Notary Public, . ........................................................... Coanty (Signature of applicant)