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Home My WebLink About6763-zFO~3[ NO. · TOWN OF SOUTHOLD BUILIHNC, DEPAR'I~fl/NT Town Clerk's O~ice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at I¥~ ~? 7:f~oN/~ .~.~ ~k~Otreet M pN ~-- B1 ckN ~- LotN ~ a o ............. o o ........... o, ................................. conforms substantially to the Application for Building Permit heretofore ~ed in thl. office d.te~ ............. ~...~...-~., 19...~. p~t ~o w~h ~u.d~ ~'er,~t ~o......r'~. z_ dated ..... . ........ .~....'~..~., 19.?'.-~., was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occupancy for which th~.~ certificate is issuedis ~cc ~ S~ o~'f. The certificate is issued to x/6 H *,/ "~ U (owner, of the aforesaid building. Suffolk County Department of Health Approval .... so ............... ................... HOVS~.Ntn~zR /~.~ Street ~r~,~ Building Inspector FOEM NO. Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6763 Z Permission is hereby granted to: at premises located at ...~.~..~.~lail~..J~...~.~ .................. ; ..................................................... pursuant to application dated ........................~..~,1'..,~). ............... , 19..~..~.., and approved by the Building Inspector. Fee $...'~ss,(~O .......... Building Insl~ctor { FORM NO. 6 TOWN OF SOU~'HOLD 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 location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposoI--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Mu!tiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. S.Submit Planning Board approval of completed site plan requirements where applicable. ~. Far existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" Jand uses: ! 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 pe~inent formatio~ required to prepare a certificate J. Gertificate of occupancy $5.00 2 Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 Date ~ ~'1 ~dew Budding ....~ ...... Addition ~ Old or Pre-existing Building ................ Vacant Land !¢,~ation Of Property '~7 ~:O¢~/C ~'( ~l V' Owner Or Owners Of Property ~Mt ~/ ~(¢ ~¢ ~'ub~Wis~o~ .................... ~;~ ................................... Lot ~o ............. Bloc~ ~ .............~ouse ~ ............. Permit No ..~.~. ate O P rm~t ...... ~r~{?~...App cant ............ .~ ................... .................. z ......... ~e3hh Dept. Approval ................. ~....~ .............. Labor Dept. Approval ................... ................. t~nd~rwriters Approval .......... .~...~.f...[...~..~ ............ Planning Board Approval ~,, ~u~t ~r ~r~W ~rfifi~t~ ........................................ ~ ~rti~ic~t~ .......................................... Fee Submitted $ ~ ~- Canstruction on above described building and permit megts alt applicgb~e codes and regulations. App cant .~.,/..~.~...~..<.~ ..~<;! .,."....z~;~.::~%¢~ ................. // ,'/ ................. (stamp or seal) )~ ~ ~ TOWN C:LF.J,K'S OFFIGE /~.~ '~' .~UTHOLD, N. Y. Examined ............... , I ..~...... Approved ........................................ , 19.?..~.... Permit No..~....~...~'...~...~ ............ l~O]g~ NO. 1 TOWN OF SOUTIIOLD BUILDINg DEPARTMENT Application No~.....?...~...~.. .............. ....~ Disapproved a/c ...... ~ ........... ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter aP. in ink and submitted in triplicate to the Build|ng~ 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 premisesj relationship to adjoining premises or public streets of areas, and giving a detailed description of layout ofpreperty 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 Building Inspector will issue a Building Permit to the applicant. Such permi 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 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 thl ~uildlng Zon? Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or# egu ations, tar the construction of buildings, additions or alterations, or for .removal or demolition, as herein descrJbed.~' 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. (Sig)~f/~'re of applicant, ;r name, if a co~rati;n) . .... (Address'of applicant) .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of orem ses ~ 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 prc~psed/.~,~ /<'~ /~, '-,w°rk willie done. Map No.: ........................................ ~' ,, Lot No ......................... Street and Number ......... ~.'.x<~......~.~..~.....~...~....~.....~ .................. ~.~ ................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .........................~7~;~e~O.~-:: ....... ~.~.~Z..~} ............... i .................................. b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check,which applicable): New Building .................. Addition ................. Alteration ...ZT~,~ ..... D Repair .................. Removal ..................emolition .................... Other Work .. ~ ..~..... [Description) 4, Estimated Cost ............................................................ Fee ............................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on ~ch flo6r ............................ 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 ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 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 .............. ~.....j~... ~/~1 excess fill be removed.~,r~om ~e~s~es..'~J~Yes ( ) No 14. Name of Owner of premise~ ...~.J~.'~ . Add~~l~l,,,,~ ~J~-~-OOO~ S Name of Architect /~7 ......................... ~-"7' ....................................... ....... .............................................. A re. ................................ Ph . ,o ....................... Name of Contractor ~ A r ............................................................ dd ess ................................ 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, rear names and indicate whether interior or corner lot, ~ __ STATE OF NEW YJ3RI¢. COUNTY OF .... .~]..~r..~..~.~'~ .~..... I' "'" ............................. .....~.0.~.~....~..~ ............................... being duly (Name of individuol signihg 'c0ntrocf) above named. He is the {~.~..'~...~..~'~ ' , (Contractor, agent, corporate officer, etc.) of said owner or owners, a~:l is duly adthoHzed to' perform or have performed the said work and to make and file this application; that all statements contairied 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 inthe application filed therewith. sworn, depos, es and says that he is the applicon~.,~,, Sworn to before me this ..................... d..d_ay of ,.......~...,.:.~..~ ........................ , 19...~... Notary Public, ~....~-...;..'.,~.... County ..~.. ............................................................................. ~ (Signature of applicant) TERRI ItrE IIOTA~' PUbLiC, St~t~ ol Mew York No. 52-616~295 ~ualilied in Sm~m~ County Commission Expires FAa~ch 30, 19~