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Home My WebLink About6716-zFOH~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~/ice $outhold, N. Y. Certificate Occupancy THIS CERTIFIES that the building located at !1~6 Main Street Street Map No ..... ~ ...... Block No...X~. ....... Lot No .... ~.X~......G.r.~.e..rt.p.o.r.t. ?. ?.,..~: ...... conforms substantially to the Application/or Building Permit heretofore filed in this office -"-"--"~!e~ .......... ~.~.l.y..9., .... , 19.7.~.. pursuant to which Building Permit No...6.7.1.6. Z.. ~-~kted .......... ~l.l.l.y..,.q~ ..... , 197~., was issued, anal conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ?.r.i.¥.a.t.e...a.c.c.e..s.sg.r.Y.. building The certificate is issued to Patricia Heeke:P . .:. (o~vner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N.,I):., ............................. UNDERWRITERS CERTIFICATE I~o.R.· ........................................... HOUSE NUMBER ]~1..1.6. ......... Str~i.n.. ~.t.r.e.e..t... ............................. Gr~enport~ FOF,~ ~NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT! TOWN CLERK'S OFFICE ~ SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL CQMPLETIOIq OF TH£ WORK. AUTHORIZED) ,"'~ / Permission is hereby gron~ .... :'"'" ............ :: ............... ................................................... :7 ..... .................. : ....... ; ...... ::'"': ........ :":: ......................... ~, ~i,e, ,~,~ ~.:~ ......... .~ ............. , ........ ?~.-~.: ................................................... ......................................... ~~::.:.::: ..................... : ......................................................... pursuant to application dated ............... ~.~-~[ ....... p~'"'i ......19..~..-~, and approved by the Building Inspector. ' L.~ Fee $...~ .................. ............ :-~.:-~(;~:; ...... ~,. ............................ g Inspector OCCUPANCY A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building inspector with the foilowing; for new buildings or new ustC: 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 sewe(age 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), Nomconforming ulses, 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 B , ,n ~ Pre , , New u'ld' g .................... Old or -e×'sting Build'ng ................ vt_./i ........... Vacant Land ............................ Locatio, of Property .... /././..~.~../...~.'~,~....~L.., .............. ~.'...~.~.~.. .............................................. Owner Or ~ners Of Property ........ ~.....~,,,.~..~.e:~..~ .................... Su~ivision ................................................ .~ ........... Lot No .......... i-Block No...~. ....... House No Permit No ~7/~ Z Date Of Permit ?/~ ~ Applicant ~.[~.~ .......... .................. ~"~ .......... tv' ,~.,th o.~,. ~,=~, .......... ~.;~ ....................... ~.~o, ~p,. X,,=o, ........... ~.....~.";.~? ..................... ........... p..z. ...................... ,,=.,., ..... ....................... Request For Temporary CeNiflcate ........................................ Final Certificate ..e S~m,.~d * ....~...~ .................. Construct on on above descr bed bu Id ng and per~ t meets al~ ~p ica~ c~s a~d regulations . ................. .............. s~o.~ ~o b~fo~...~ th~ ' ~ ~ / ~C~ / Nota~ public .................................... county ~/q" J BUILDING DEPARTMEN~ / ~/d~ ~ ~ ~ ~ Examine Approve~_Z~ ........kL...~ ........ ~.~ .......... , 1~.'~... Permit No.f~m~/~....~: .... Disapproved a/c ....... '.yT'l' .......... ~~ ............... ~~/~' (Building Ins ': '~,. APPLICATION ,IG PERMIT ...................... ,, ..... Date INSTRUCTIONS~ o. This application must be completely filled in by typewriter or! in i~k and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according t~ schedu e b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. " APPLICATION [S HEREBY MADE to the Building Deportment for the )ssuonce of a Building Permit pursuant to the Buitding Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or o[terotions, or for removal or demolition, os herein described. T e opphcant agrees to comply w~th all applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for n~~ ~ignoture of applicant, or name, if a corporation) (Address of applic~) ~ I~'~ State whether applicant is owner, lessee, agent, architect, engineer, generoI contractor, electrician, plumber or builder. Name of owner of premises ...... ~.~..~,..~/.~..~...~'. ...... ~.~.~'/~.....~..~.. ~..~...~. ~. ................................... If applicant is o 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 Zrade's License No ............................................... Location of land on which proposed work will be done. M~p No.: ' Lot No ......................... Street and Number ....~.~.~..~....~.~.t .~.....~,~.~..~.,~.~'..~.. ........ ~'[~'.~.~.~'~1~...~.....~..~(.:, -- / ................................. Municipality State existing use and occupancy of premises and intended use and': occupancy of proposed construction: o. Exisiting use and occupancy .... I~..1~ ................................................................................................... use and occupancy ...... ........................................................ b. Intended 3. Nature of work (check which applicable): New Building ...... I~.......... Addition ...~.... Alteration ~ .. Repair ~" Removal '"-'=~ Demolitian....~.~... Other Work ................ ;.%';. .............................. (Description) 4. Estimated Cost ....I.~.~. ................................................ e ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...J'k¢~. .................. Number of dweIling 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 ................................ 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 constructioD: Front ...I.~..~.~) ................ Rear ............................ Depth ........................ Height ..~..*..~..!.!... Number of Stories ..1 ................................................................................................................ 9. Size of lot: Front ..... I.l..IJ..f ......................................... Rear ...... ........................Depth ./~.~...~ ................. 10. Date of Purchase .......... LJJ.~..~I ................................. Name of Former Owner 11. Zone or use district in which-premlses are situated .~..(3. ............................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~.~. .............................................. 13. Will lot be regraded ........~.~. ............. Will excess fill be removed from premises: ( ) Yes (X~ No 14. Name of Owner of premises ...~/.~'.~./~'.~'.J],..'..,lll~./~.l~/.r.~./~.~'. Address .lll.~.,,t~iJ.l~...,,~.. 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 whether interior or corner lot. · / STATE OF hlE,W Y,.O/I~K ' ~S S COUNTYCF/, .:.; ,,//,:, ....................... ,' , :J' ' ............ ,...¢~ ........... ~ .......................... :'. ........................................ being duly sworn, deposes and says that he is the applicam ',, (Nar4e of individual signing contract) above named. He is the ................................................................................................................................................................................ (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..................... :.. day of ............ Notary Public, . .................... ;r.E~RI..LF.f,.[.L.A..K ,t ,, ,, County ........... ' :: : ; .............................. NOTARY/~tJBLIC Sta e of aw ~or~ ......................... ¢ ~o, b~-61~ ..... ' (Signoture of oppiicont) k