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Home My WebLink About6728-zFORM NO. 4 TOWN OF SOUTHOLD B[r~I,DING DEPARTMENT To~n Clerk's Office $outhold, BI. Y. Certificate Of Occupancy ]~].9 ......... Date ......... ~)gtOh~. ~1~ ..... , 19.73 THIS CERTIFIES that the building located at . 0~pre¥..~es~; ~.. ..... Street Map No..~,?~:,. ...... Block No.. = ...... Lot No.. 8 ..... ~... conforms substantially to the Application for Building Pemit heretofore filed in this office doJ~d ........ JuO.~, .16., ....., 19. '73 pursuant to which Building Permit No. - ~ated ........ Ju3..¥ .~.6.! ...... , 19..?~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .. Pr-~.vate .one..Easily. d/,mX~L~ng ..................................... The certificate is issued to ...],eater. E, .~ud .Frallee8 · ~ltap~,~ .... otlllez,$ ........ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Heaith Approval . .N. :R.*. ............................. UNDERWRITERS CERTIFICATE No...~:.R.o ...................................... HOUSE NUMBER .... .~..~ ....... Street ..... 0s..p.r.e.y.. ~.e.s.t;...R.o.a.d. .................. O~eeapo~ Building Inspector IFOB31[ NO. '~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW'II CLERK'S OFFICE SOUTHOLD, Nu Y. BUII~DING PERJvUT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6728 Z Date ........................ j'~, 5~.....1.(~ ............. 19...~.~. ~ ~A..~x~..a~.~J,~...(~e~...o~..~l~t~u~..~e~ ~ ~ -~_ ............................................... at premises located at ~;~..~,.~ ......... ~48..P.t~..$~I~.....;Z ......................................................... ............................... .o..e~ .~..~v...~.e..~..t....8...~.~ ......... ~'.e.e~ ~.~.....~. ~.~ ............................................. pursuant to application dated ..................... .~u].~: ....... .~..~. ...... ..~: 19r~3..., and approved by the Building Inspector. Fee $.~.~.0~ ........... ( ~/ - Building \lh~spector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clarke 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 location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal--(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 Cede 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, 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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 ! / 3. Copy of certificate of occupancy $1.00 t,i" ~ f /._7./ .................. b. ......................... New Building .................... Old or Pre-existing Building ..... ..~.:'~. ........... Vacant Land ............................ Location Of Property ~' ~/)5/~' ~'~-"~ . I""[~/o ,.~"'" Owner Or Owner,,,,O,~ Property ..~.~..,...?...~..~..~...../.~....~...~..i....~...... ~ .. 5/'/.~.~...] ~ ~ .... ~'- Permit No...~..~.'./..~....~... Date Of Permit ..'2/!~/~.~..~.Applicant .... .~.~.~',..~......~.(./..~:.~./..~.o.. ................... Health Dept. Approval .......... :.;....?. ....................... Labor Dept. Approval ................~..v..:..!..~. ................... Underwriters Approval ........ l..~ ................................... Planning Board Approval ........ ~ .......................... Request For Temporary Certificate ........................................ Final Certificate .......... ~ .................... Fee Submitted $ .~.. ............................ Construction on above described building and permit meets all applicable codes and regulations. ............ ....... ........................... Sworn to before me this · · ~--"~'./.-...~.~. day of_ ...~?/~..../.~..~... Notary Public ..~.~.~./~.... County Nota~, Public, Slale of New Yor~ No 52-0344963 Suffolk Counl-~ Commission Expires March 30, TOWN OF 5OUTNOLD BUILDING DEPAf, TMENT TOWN ~RK'S OFFICE .................. Disapproved o/c ...................................................... . ......... (Building Inspeotory APPLICATION FOR IUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Bull. InspeCtor, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of bUildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofpraperty 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 application, the Build!ng Inspector will issue a Building Permit to the applicant. Such perm t~, shall be kept on the premises available for inspechon throughout the work. ' e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable La~s, Ordinances or TR~gulati.o. ns, for the construction of buildings, additions or alterations, or for removal or demolition, as here n described.¢.~ · applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regu at OhS, and t~ admit authorized inspectors on premises and in buildings for necessary inspections. -. ................... ......... ........ ~,~ ,~ (Address of applicant) rchitect, engineer, general contractor, electrician, plumber or builder. State whether applicant is owner, lessee, agent, c Name of owner of premises ~lt~,~ ~,~.~ll3lJ..J~i~lll~'~J.~ ................ ................................................ 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 ............................................... 1. Location of land on which proposed work will be done. Map No.: ..J~.~ ............................. Lot No...8.. .................... Street and Number ...~..~6.gJ[~l~...~.q.l~.t~..J~.~.~....~..J~J~..~...~..o~.. ..................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... .~ ............... b. Intended use and occupancy ................ ~..I;JelJJ[ .......................................................................................... 3.: 'Nature of work (ch whiclj applicable): New Building ..; ............... Addition .Z .............. Alteration .....~. ........... ,' Repair .................. Removal ..? .............. Demolition.' ................... Other Work .........· ....................................... .... (Description) 4. Estimated Cost ..J~O ................................................. 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 occupanc~,~ specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..... ~..;J~ ........... Rear .,,~.....f~.. .................... Depth .l~.......J~.. .......... Height .,J, ll,.,J~t,e ......... Number of Stori& ..... ii ................................................... Dimensions of same structure with alterations or additions: Front -..~..J~IL ..................... Rear ............................ Depth ................................ Height .~l..~e~.~. ............. Number of Stories ...~ ...................... 8. DimenSions of entire new construction: Front .................................... Rear ............................ Depth ........................ HeigJ~t .................... Number of Stories .......................................................................................................... !~r' 9. Size of lot: Front ........ '..&~..~ ................................. Rear .............. ~g..£~ ....... Depthl.?~ ........ F 10. Date of Purchase ~..~Ll~ ...................................... Name of ormert~l~J~llll~J..J~J, zkt~..C,~z~ ........................... 11. Zone or use district in which premises are situated ..... ~ ..... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~O ............................................... 13. Will lot be regraded ..Jl~ ..................... Will excess fill be removed from premises: ( ) Yes ( ) No · 'tar 1~. . 14. Name of Owner of prem,ses~JffiJ~.~ ................ Addre~ .JJlllJlk~...lJJttJt~. Phone No.~...~ ...... Name of Architect - ,. ' .............................................................. ^c~ress- ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW .~)l~J~,. (Nome of individual signing controcig above named. (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 fife this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be .performed in the manner set forth in the application filed therewith. Sworn to before me this (Signature 6f applicant) TERRI L~£ ELkK NOTA~qY pUBLiC, St~te el!5 Hew Qu~ ...... s ~arch 30,