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Home My WebLink About6484-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .Ole :81r~le.~..Ave..&. tt~..Et.. Street conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... &p~.ll...~.6, 1973.. pursuant to which Building Permit No. 6¢.8~.Z.. dated ........... Ap.~.~,...1.6.., 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 . !~.r.~..v.~.t.o...s~;.o.r~g.e' .bU!~ .~. g .......................................... The certificate is issued to . .J.o.s.e.p.h..D.~..n..o~.s.k..J. ........ . ............................ (owner, lessee or tenant) *~"~-~o~"the aforesaid building. Suffolk County Department of Health Approval ... la/.l~/ ............................ UNDERWRITERS CERTIFICATE No..}I.o.U.s. ....................................... HOUSE NUMBER .............. Street ............. ............................. FORM NO. 2 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) Permission is hereby granted to: pursuant to application dated . /~ ~, ]~.~.., and approved by the Building Inspector. Fee $ /'~9 ~ Building Inspector TOWN OP 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 duplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate ~ecation of aH buildings, property lines, streets, an6 unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and seweFage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Undierwriters. 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, s}reets, 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 buildln~s or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy SB.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 .....?.~.~,., ..... Old or Pre-existing Building ............................ Vacant Land ..'~f~ ................. Location Of Property ..... ...... ~ ~. ~. ~...-:~,~c~-,.... ~~'-~ ~ Subdivision ................................................................ ~ Lot No..e~..~..i. Block No ............. House No ............. l/'1~,,1.~ Permit No. /.~.~../L.~'.,~,... Date Of Permit .................... Applicant ...; ..~./~.~:'.~-..~ ...... Health Dept. Approval ............................................ Labor Dept. Approval ....~ ........................................... X/, it_ Underwriters Approval .............................................. Planning Boa~d Approval ........ ~,"7 ............... Request For Temporary Certificate ............................ : ........... Fin~aJ~:Certificate .......................................... Fee Submitted $ ~ .............................. Construction on above described building anf) permit meets all al~fi¢~ble codes and regulations. Sworn to before me this Notary Public .................................... County FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. Examined ......................... ........... ~ .... 19 ...... '.. Approved ........................................ , 19......~.. Pemit No ...... Disapproved 0/¢ ............................................................................................ / Application No ....................... ~/. ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT / Date .......... : ..................................... , 19.....: ...... INSTRUCTIONS ~h~ se of lans' accur tePJotpantoscale e~smh!spapp/icati°namUS? bejc°mpletel'yi-ce ce ral gzoscneaulefi~lJedainob'Y'nty'pewri't~r'°'r-in ink and s~ubmitted in triplicate to the Building Inspector, 3 b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, JBnd ~ giving a detailed description of layout of property must be drawn on diagram whidh is part of this application, rq c. The work covered by this application may not be commenced before issuance df 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 throaghout the work. e. No building shall be occupied or used in whole or in part for any purpose w~atever until a Cer. tificate of Occupancy shall have been 3~ granted by the Building inspector. ~ ~ ~ r~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Buildi~qg Permit pursuant to the Building Z~he 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, and to admit authorized inspect(~rs on premises and in buildings for necessary inspections. (Signature 9f applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene?al contractor, electrician, plumber or builder. Name of owner of premises ...................................................................... ~ ......................................................................... If applicant is a corporate, signature of duly authorized officer. IName 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 ...........................J 2. State existing use and occupancy of premises and intended use and occ~upancy of proposed construction: a. £xistin§ use and occupancy ........................................................... ! ........................................................................ b. intended use and occupancy ,.~ Nature of work (check which applicab e New Building.. ....... ' ............... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demblition ...................... Other Work .................... ..~...'.....~... 4. Estimated 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. ~f business, commercial or mixed occuDancv, 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 ............................ Depth ................................. Height ...................................... . ........... Number of Stories ..................................................................................... 9. Size of lot: Front ............... i.. ~ ................. Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former, Own,er ............................................................................ 11. Zone or use district in which premises are situated ............................. ; ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................................................ 13. Will lot be regraded ................................. Will excess fill be removed from premises: [ ] Yes [ ] No 14. Name of Owner of premises ....................................................................................................................................... (Address) (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 wheth- er interior or corner lot. STATE OF NEW YORK ) COUNTY OF ..................................... ~ ............... ) SS ............................ ~'~'~'~'~./~;'~/~;~/~).~;.~;~.~;/~.~;) .................... being duly sworn, deposes and says that he is the applicant above named. He is the ................................. ' ........... ?. ................................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to ~rform or have performed the said work and to make and file this application; that ail statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the marmot set forth in the application filed therewith. TERRI LEE ~ ...................................... ~Y_.g~, ~LtO..S~U. ~. H~..Y~[$ .................. 19 ............. Notary Pub c, aa~h[,e~ m Su t0lk ?~[ ta lq Cou t ............. ~[~a.~m~..~ .' ............... n y ................................................................................ ; .......................... (Signature o~ app/iccnt )