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Home My WebLink About6436-z FOI{,~I 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 AUTHOP, IZ£D) N? 6436 Z Permission is hereby granted to: to ..~. ~ i id ...~..~.O.~g ~....(..~.~e~so~.y...b~i3J~l.~) ................ : ..................................................... et premises located at ...??]./.~....~..~..~.~E,~...~.~ ......................................................................................... ................................................... .C~t;cho~a ...... H Jf.~ ...................................................................... pursuant to applicatlon dated .......................... ~,;~h.....~..~ ....... ., 19...~.~., and approved by the Building Inspector. Fee $~..0..,..0...0. ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ... t!I~'8.. Y~rldge .La ...... Street Map No. ,XX ......... Block No...iCg ...... I,ot No... ~... ~.a!ChOW40 . )~Xy ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ i, la~ .... 2~., 19,~. ~ursuant to whi0h Building Permit No. dated ............ ~da~ ....26.., 19.7~., 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 .. P~iva'ga .aoe~.ssory .Dutl. di~tg ~ ~..ba~ .&. s~.~rag~. ................. The certificate is issued to . .~llr~a. D~reg~&o... ~.=. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of ;lealth Approval ...}~?~ ............................ UNDERWRITERS CERTIFICATE No. ~. H.,~, ............. ............................. HOUSE NUMBER .... 1.120 .....Street ....~ldg~. ~. Building Inspector TOWN OF $OUTHOLD Building Del~r~ment 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 Cdp~h~ote to the Building Inspector with the following; for new buildings ar new us6: 1. Final survey of property with accurate location of all ~uildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form ar equal). ,3. Approval af electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple ReSidences and similar buildings and installations, o 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), N~-conformin9 uses, or buildings and "pre-existing"~ land uses: 1. Accurate su~ey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as ta use, o~cuponcy and condition of buildings. 3. Date of any housing code or safety inspection of buildinbs or premises, or other pe~inent 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 us~ 3. Copy of certificate of occupancy $I.00 $5.00 // Date ....... .~../~.l .~.~.. · .................. New Building ...~... ............ Old or Pre-existing Building ............................ Vacant Land ............................ //zo. C Location Of Property .................. ~ · .~ ................ .~. ..~. "~ ........................................... Owner Or O ners Of Property ....... ..................................................... Subdivision ....................... ...~.. .................................... Lot No....~'. Block No ...... .~.'.... House No..../..J.~..O, Permit No......,... ~ ~y/~ ....... 2.... Date Of Permit ..Applicant .... ;.~..¢~..~.~..~.. ......................................... Health Dept. Approval ................ ~ ........................... Labor Dept. Approval ................................................ Underwriters Approval ......... .~.::...,,~,. ........................ Planning Boai'd Approval .......... ..~...f....~. ................ Request For Temporary Certificate ........................................ Final', Certificate ...~,,~ ................................... Fee Submitted $ ....~...~ ..................... Construction on above described building and perrr~ m~,t~all a~licable c. odes and regulations. Sworn to before me this ~ ~x/~//~ °7'-- ........................ I ........ ..~.....~C~day of .~...~.. (.~.. 7~... (stamp or sea ) ~'~ ~J/ Notary Public .................................... County Approved FOI~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. Disapproved a/c ............................................................................ q... APPLICATION FOR BUILDING PERMIT ~ Date ......('~ .~.~..q,.~ ....... ~..~... ............ , 19..7.~..... ~ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or ~n ink and submitted in triplicate to the Building Inspector, wit 3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~z~ of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, anc~ b. Plot plan location 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 ~)f 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 shah be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have bee granted by the Building Inspector. : APPLICATION tS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of SouthokJ, 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or na~d, if a corporatio ) ...... ................ kJ (Address of applicant) ~ State whether applicant is owner,, Ii~ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................ ? ...................... Name of owner of premises .............. ~.~.~. ................. .O.,?.~.p.. .............................. I~ applicant is a corporaLe, 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. M. ap No .......... i ................................... Lot No ......................... Street and Number .j.t ~..O.......(~.~.~..~..~.....L.~..:)/ ......./"~ t/ .~...g..~.C..~.C~ ~kb~ ................. ; ...................................................... Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................................................... i ........................................................................ , b. Intended use and occupancy ..... ~,~.,~ ......~ ................................ NatUre of work (check which applicable): New Building ..Z ................ Addition ..................... Alteratio~ ......... ~. .... Repair ......................... Removal ......................... Demolition ............. ~ .......... Other Work (Description) . 4. ~:stimated 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 cars ............................................................................................................................................ 6. If business, commercial or mixed occuDancy, 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 ........... He ght ............. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... ~.,~ .............. Rear ....... {.~. ................. Depth ...... ~..~. ...................... Hei ht ., L~. ..... Number of Stor es ~. .................................................................... g ................. ~ ~ 9. Size of lot: Front ....... ~...~..~..~ ..................... Rear ....... ~.~,.~. ..................... L~ o. ~. ~0. D, ~, t /'3 ~, ~3,~"'"' De, pth ~......~..!.I ....... ,. ........ ~';~"'~'A' .......... 10. Date of Purchase ..... /..~./~././Z./. ............. Name of Former Owner t'l,.w.{{~'.~'.flllfi~).~....~fl[~.)~).C,l..~....~.~.~.~.~. 11, Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulati°n: .''''l~'l~ .................................................. 13. Will lot be regraded ...... 1~..~. ........./~L r-~ t, _ ¢) _~ ~ ~,..4~.t. _: ............ .Will excess fill be re.~oved ~rom Qrer~i~es: [ ] Yes D('J No 14. Name of Owner of premises ....~l~l,5......~J.L.~.f.~.~.l~':~..~.....~...t'.~g~....b~:,..¥.~.x~.\tw.~· ...... ~..~..~..'~..~ .......... (Address) (Phone ~o.~ Name of Architect .............~..~...~R.~. .......................................................................................................................... (Address) (Phone No.) Name of Contractor .......... O..t~...~.e~.~. .......................................................................................................................... (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 wheth- er interior or corner lot. ~?~/~ 18' STATE OF NEW YORK, ~ ~ ~ ) ~ COUNTY OF .................... .~...XD.).~ ............. ) ....... ......................................................................................................................................................................................... (~bntractor, agent, cor~rate officer, etc. J of said owner or ~, and is duly aothorizo6 to ~rform or hav~ Derformod tho said work ~nd to make and file this a~Dlication; that all statements contained in this application are true to the best o~ his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. ...................................... ......................... ; ........................ ,. ........ / uo,,,.v ~,ui~ ...................................................................... co,,tv ........ ~_..:~¢~....~~ .............................. (Signature o~plicant)