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Home My WebLink About6767-zNO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ~6.1+38 ...... Date ............ ~Y ..... 2 ....... , lg.7~. THIS CERTIFIES that the building located at . .. ~.~.a~. D.r.$.~. ............. Street Map NoD.O~s.v~,e¥.. Block No ........... Lot No, . ~ ..... 9~.t. qh. 9~..e....~...~: ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated ............ .J..u~y. _~Q., 19..~.3 pursuant to which Building Permit No.. dated ........ July.... )~1 ..... , 19.7.3., was issued, and conforms to sll of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to ttexmch~l. Pa,.sons ........ w~er ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ).I :.R.: ........................... UNDERWRITERS CERTIFICATE No .... ~ :~: ..................................... l+a Dean Drive HOUSE NUMBER ...... -. ~ ......Street .......................................... ......................................... i : i : : : i'. i '. ........ Building Inspect~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6767 Z Date ......................... ~Tlil~' ....... ,~.$ ......... , ] 9.~!.~.. Permission is hereby granted to: %,~.~m..~,am~w~4......~/~O..iimm,~mlmm~,.....l~m~ ................ ~.vm~h~a~ .......................................... ~o l~l~..-~ ..a~&ttlon ..on..ax~at~Lu$ ..~ Lta$ ..~... rm~a~ ......................................... at premises located at ...I~t,..~....i~..~&e~. ............................................................................... ........................................................... ~.~l~.....~Jr~ ......... .Gg~t,~,o~,m ............................................ pursuant to application dated .........................~1~,~ ....... .~0 ........ , 19..7.~., and opproved by the Building Inspector. Fee $~J~eO0 ............ FORM NO. $ TOWN OF $OUTHOLD , Building Deportment 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 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), 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 $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date ........... .//=.? ./_ .Z .~.~. .................... New BHilding ................ Addition ...../~. ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .......... ..,~...~.,..~....~.(......~.....~G..~..~..~....~., ....... ~..~....~..C...~.~...C2..~..ZZ.C.,, ...... ....~....'...~.('ff..: ..... Owner Or Owners Of Property ......... ./..~ff...~...~.'.:........~....~....~.~.~...C.~..C.~. ........ ' .~..~.~..x~.."/'~...,~.'.~Z~..~. ......... Subdivision .... .~....'~..~../-~..'~.~.~.~....b/~...c~.. ................. Lot No....~.... ...... Block No ............. House No ............. Permit No. Dote Of Permit .................... Applicant ........ ................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate Fee Submitted $ ............ . .~... .................. Construction on above described building and permit meets all applicable ccx~s and regulations. Sworn to before me this~ ~..~ /,~7 -- '/ ~ r/z/' .... /./..~c'"" day of .~~.~.~.~ ..... (stomp or seal, Notary Public ....~.....6.'::.~..Z../~,,~,//.~..~'....... County RICH,~ fid' NOTARY PUBLIC, ;T~'! Examined :~ B / . FOILM NO, 1 TOWN o. UT.O,= SOUTHOLD, N. Y. 19 ........Pemif No .............. APPLICATION FOR BUILDING PERMIT - ~ Date ..... .~..:.; .................................... , 19....?....'~.. ~ . . ',,, INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in.triplicate to the Building Inspector, witl 3 sets of plans, accurate pl0t plan to scale. Fee according to sch&~ule,. b. Plot plan showing location of lot and of buildings on ~premises, relationship, tO adjoining premises or public streets or areas, ar giving a detailed description of layout of property must be drawn on diagram which is part of this application. c. The work covered by this application may net be commenced before issuanc~e of ~uilding Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept o~' the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pert 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 Zon~ Ordinance o:~ the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Or Regulations, for the oon~truction ~ ', buildings, additions or alterations, or for remo~Tal or demolition, as herein described. The applicant agrees to comply with Idl a~olicablelaw~ ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for neceslarl/inllsections. State whether applicant is owner, lesse~, architect, engineer, general contractor, electrician, plumber or builder. ...... :::::::::::::::::::::::::::::::: If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .. ..~...:~./.1~'....(~.. ......... Lot No. &~' Street and Number ............ .~......_4~../~......./~.......~..._~..../..~'.~. .......................... i ........... :'.,i.!.,;,..'...~_.~..~.~..~..~../~..~....:. ' Municipality 2. State existing use and occupancy of premises'and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~ ....... ~'.....~.../../~...~"a~'.C.&~. ...................................................................... b. Intended use and occupancy ............................ ~....,..; ................................................................. T~ .................... ~.... ~j~j · 3. Nature of work (check which applicable): New Building',~ .................... Addition ....,./%... ......... Alteration .......... :.... Repair ......................... Removal .............. "...~..... Demo~litip__0 ........................ Other Work ................ ; ................... /'"'" O_..,~* i~ .., ~ (Description) 4. Esttmated Cost .........~..~-~.~..~. ...................... Fee .~. ................................................................. ........... (to be paid on filing this application) 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... N o o .. If garage, number of cars ..?',k/~'~.<~.../.~.....~..!.~'.-~J~!...~./....../~...-~..c- ................. ~..!~......Z~...., ......... ~ ...................... 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 ....... ..5~.....c~. ................... ?' Height ..................... ..~.. ................................. Number of Stories ...........~....~...~... ............ : ........................................... Dimensions of same structure with alterations or additions: Front ...... ~c..: .............. R ........... .,.. ....................... ............. ~... ....................... Number of O o~ Stories ............ ~.. ........................ Depth ............. . .~;..: .......................... Height 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ...................................... Number of St ries · //o 2_ ?2.. 9. Size of lot: Front ........... ~...x... ................. Rear ..................................... Depth ...... :::::: ............................... , ...... .....,/...~J~.~.~~ . DateD, Purchase ........... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~. ~...'. ............................................. 13. Will lot beregraded ......... .~..~.......; ......... Will excess fillJ;te removed frompremisas: [ ] Yes [ ] No 14. Name of Owner of prem,ses ........ .¢..-..: .......................... ~..~.:.: ....................... ~:-.. .................. ................................ ddress (Phone No. E. .... Name of Arch~tact ............. , ..................................... ~....~.~....~..'. .................................... (Address) (Phone No.) Name of Contractor ............................................................. (Address) (Phone No.) PLOT DIAG RAM Eocate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-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 ................ ..~,~.. f~, .~7.../~...'. ................. ) ...................... Z~,/~.Z'~........~..' ..~~.~'~. ......... being duly ,,rn, de~.s and says that he is the a~li,nt abo. named. ~ i~ th~ ....~..~.:~..~ ................................ ~ ........................ ~; ............................................................................................................................ ' / (~n~tor, ~t, co~mte offi~r, etc.} of said owner or owners, and is duly authorized to ~orm' or ha~ ~or~d t~ said ~rk and to make and file this a~li~tion; ~ all statemen~ ~ntained in this appli~tion are true to t~ ~st of his knoWled~ and ~lief; and ~at the wOrk will ~ ~or~ in t~ ~r ~t forth in the ap~i~tion fil~ t~rewith. ' ~. 52~10 No.. Publi~~.~~ ............... ~ ,ff~ ~,.=..~~.~ .................... '0