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Home My WebLink About6723-z FORM NO. 4 TOWN OF SOUTttOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. ' Certificate Of Occupancy No. Z5.~9.~. ...... Date ..... ; .......0e~:oher. 23,.., 19.7.3. THIS CERTIFIES that the building located at ... P~on],C./Bay. tl].wt., ..... Street Map No... ~iX ....... Block No...X~ ..... Lot No. X~:.. l~lll'oJ. .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~hl'ty. X.3,~ ....., 19.79 pursuant to which Building Permit No... 6?232; dated ....... ~.uly. J~l~ ...... , 19. :~-3, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is i§~ed is .. Aecea.so~y, .s~;oI, a§e. b~Ldg o .......................................... The certificate is issued to ..... ~al¢oMn. Adamson ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. N.~icl, ............................. UNDERWRITERS CERTIFICATE No.. ?t...l~ ~ ................................. ,. .... Building Inspe}~tor / FOI~M NO. ~ TOWN OF SOUTHOLD ~ BUILDING DEPARTMEI~T TOWN CLERK'S OFFICE SOUTHOLD, N', Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH.E PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6723 Z Permission is hereby granted~/· -- ' ../~j.~c.~ ~'~.6~:.~ ............ --~ ........ ~. ......... ~...~/ ...................... :..,~.: ................ ~,~ ~. .......... ~..~.~,~ ...................... : .................. at rem,ses located at ~ ~' ~~ ~ ~C' ~A~'~ ~V~ ~ ~ · . ........................ .~ ............................. ~.:;...: ......... ~ ........................................ Building Inspector. - Building 'Inspector APPL~CA~O~ FOR ~TIF~AT~: OF: O~GUPANGY A. This application must be filled in typewriter OR ink, and spbmitted in duplicate to the 5uilding inspector with the ~olJowing; ~or ne~ buildings o~ new u~e: 1. Final suwey o~ property with accurate location of oil 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 Udderwriters. 4. Commercial buildings, Industrial buildings, Multiple R~sidences and similar buildings and installations, a certificate of Cade compliance fram the Architect ar Engineer respansible the building. 5. Submit Planning Baard approval of completed site plan requirements where applicable. B. For existing buildings (prior ta April i957), Non-confarming gses, 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 condffion of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pe~inent in- "--~. formation required to prepare a certificate. C. ees: ~* ' ' 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land us $5.00 3. Copy of ceFtificate of occupancy $1.00 . / / ~ ~ i~,f ~//~ ~:~.~.~ Dote .....L.~..{.t.L(..2 ...................... N~w ~ildin~. ................... Old or P~-pxis~l~Buddmg ...... ~ ....... ,.~ ...... Vacant Land ............................ Subdivision ................................................................ Lot No.....,....,... Block No ............. House No ............. er it o ~'?'~ ''~ Date Of Permit ?/~(-)-~ A licont~.~ P m N ......................................... pp ................................................................ Health Dept. Approval ............ ~.J.~ ...................... Labor Dept. Approval ~1 ~, Boa~d Approval ....... ~.:~ .................. Underwriters Approval .............................................. Planning Roquost For Tempnror,~ Cerfi{icote ........................................ Final Corti{ic~to .......................... Feo Submitted ~. ............................. Notary Public .................................... County Construction on above described building ~ permit meets oil applicabJ~ codes and regulahons. Applicant ....... ' .............. Sworn to before me this /rT~/x~.~ [~: '/3 (stamp or seal) ~ ¢: f ~ No, 43-7834650 ~ ~i~ Hatch 30, '~ FOI~I NO. I : · TOWN OF SOUTHOLD " BUILDING DEPARTMEN'I~ TOWN CLERK'S OFFICE: Examined ........ 19.~.~.. Approved ........................................ , 192.3.. Permit No Disapproved a/c .................. (Building Inspector) Application No...~..~.....~Z...:.~. ............. APPLICATION FOR BUILDING PERMIT Date ' ' INSTR. UCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building'~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according jo schedule. b. Plot plan showing location of lot and of buildings on practises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty muot be drawn 6n the diagram which is part of this application. c. The work covered by this applica~'ion may not be commenced before 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 part for any puipose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the jssuance of a Building Permit pursuant to the Building Zone 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, buildfng code, housing code, and regulations, and to admit autboriz~ed inspectors on premises and in buildings for ,~e~essary inspections. ~, (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gener61 contractor, electrician, plumber or builder. Name of owner of premises ...... ..~./~...L...~....O....L....~..~.. ........ A.~...~.~.~....~,...~.. .................................................................... 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 ............................................... Location of land on which proposed wo~rk will be done Mop No ' ~ Lot No Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .~...~..~..e/_J_~ b. Intended use and occupancy .?..~; ~/~.'~.. ~.~ .Z./~ ..~_.~...r~ ~...~....~.~../~(~/~.~/ 3. - Nature of work (check which applicable): New Building .................. Addition .................. Alteration ...... Repair .................. Removal .................. Demolition .................... Other Work ......................................... 4. Estimated Cost ............................................................ Fee .../~O o~ (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 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 construction: Front ............... ~ ................. Rear ......~.. ................... Depth /'....Q ..... Height .................... Number of Stories ...............C. 9. Size of lot: Front ........................................................ Rear .......................................... Depth 10. Dote of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are sffuated .....~.".....~..(..~.....Z.. ..... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~-0 13. Will lot be regraded ............. ,~,..... ....... Will excess .fill be removed from premises: ( ) Yes ( ) Nc Name of Architect .............................................................. Address ................................ Phon~ No. Name of Contractor ...... .~..f:~ ......................... Address ................................ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensk,ns 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 NEk'~-~YO~IJ~,~/~.~ I'S S the --(N'~(Nam o inaivi ual signing contracf) above named. He is the ....................................... ...~..~ V(Contractor. aaentc( tractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make this application; that all statements contained in this application are true to the best of his knowledge and be that the work will be performe, d~n the manner set forth in the application filed therewith. Sworn to before me this ( \ rq __ .... (Signature of applicant) TERRJ LEE [IAI( ~OTARY pUBLIC, State o[ New Yolk ~piicanl and file ief; and