The URL can be used to link to this page

Home My WebLink About6811-zFOKM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. ~,'. ??. .... Date . ,T_~_nUal~..~.t .............. , 19.7.7. THIS CERTIFIES ~at the b~ding located at WZ~ .~. ~,. ~U~X.. Street Map No..g$~teS... Block No.. ZX ...... Lot No ...... ~ ........................... conforms subst~tially to the Application for B~lding Permit heretofore filed ~ this office dat~ . .~st. ~ ........ , 19.~. p~su~t to which B~ldin~ Pe~it No...~$~ ~Z dated . A~st. ~ ~ ......... , 19. [~., was issued, and conforms to ~ of ~e req~ ments of the applicable provisions of the law. The occup~cy for wMch this certificate ~ issued is . .Ut~22~..~to~e. b~[!~g ......................................... The ce~fficate is issued to . .~?r~. OO. abri~.ge~ .................................. (owner,~) of the aforesaid building. Suffolk County Department of Health Approval ........ NfR ......................... UNDERWRITERS CERTIFICATE No .... N./R. ..................................... HOUSE NUMBER . .~ ~.~ ......... Street .... . .I~...~. ~ .pr.ly.e. ~..~...ugh...1.~. ~.o..~. ? ..... Building Inspector FOR,~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6811 Z Dote .............................................. ..I..., ........ Permission is hereby granted to: ......... . ............................................................ ,,L,..¢....¢.~..~..~ ............. ~...'.~ ......................................... ,u~uant to application dat~ Z~ AO~ ~..., and approved by the Building Inspector. Fee $.....!...~. .............. Building Inspector TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, H. Y. 11971 APPLICATION FOR CERTIFICATE OF OCC:UPAN~*Y Initructions 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. Swum 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 $1.00 Date ......... New Building ....;~,~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..9/~.$..~.~.r..~;ff.,. ....... .~.~.?..e..:~...~.:....~..... .......................................................... Owner Or Owners Of Property ..... ~}P_.~,a~c]..~.Qe~.3~.~.~g~.32. ........................................................................ ~. Country. Estates t 1 XX Subdivision .................................................... Lo No ............. Block No ............. House No..1..~... .... Permit No..~.~.1.~.~ ....... Date Of Permit .....8./..~.2./.~.~Applicant ...... ~.~.a...]:..~.....G...o.e..~.,.~.~....g..e...~. ................... Health Dept. Approval ...~.~ ................................. Labor Dept. Approval ....... .~.../...~. ................................. Underwriters Approval ..... ~./..~.. ................................. Planning Board Approval N/R Request For Temporary Certificate ........................................ Fin~ Certificate ..................... ~ ................ Fee Submitted $ .~'.**QO .......................... Construction on above described building and p~mit me--codes and regulations. Applicant Sworn to before me th,s' '"~ ...... ~:~>~"'~""~""~'~'"~' .................. ................ dayo, ............................................ ,stamp or sea,/('~-.~t~ ~7~' ~.. '~/-~/ Notary Public .................................... County FORM NO, 6 TOWN OF $OUTHOLD Building Deportment Town Clerks Office Southold, N. Y. I]971 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: l. 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 $!.00 New Building ................ Addition ..~.. .......Old or Pre-existing Building ................ ¥o¢ont land Loi~tlon Of Property ...... ~........~.......~/.~.~g~..,~-...~.....~.~.~..._....~.../~.f.~.//~/~/~/'")/4/~_, ~/_ :'~' ........................................ .............. Ow er Or Owners Of Property .,~,~l-,u,~e~.../~r.......~z..~.~..¢~....kz~.~[,C~.~/..~,~".,,.t~,./. .................................. Subdivision '"'~'~"'~'"'~-~l°~'"'/""/~' '-~/~/~Z~ ............. Lot No ....'~..../.. Block No.~ House No ~/~'~... Permit No- -.Z.O.. '~"~r.. Date Of Permit/..~..~..~.~..J...Applicant ........ ff.. ~:.... __________________~ .................................. Health Dept. Approval ............................................ Labor D~pt. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and/'xp~rni. t me~ts/ol~p~bl~codes///~ .,4 // and regulations. Applicant .....7~.~,~~ ........... ~,. .................... Sworn to before me this ~ J/~/%'- lC/ ....... l' '~-'. day °~ .. ~g.....~.~.ZT.~. ....... . (stamp or seal)~/~1 / tJ [I No. 52-9t~!i75 [k:* : C/lunty ~.~. My commiszi.)n cxpi re. -' ~ ar.30,19 ~1~ FOiBf BO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Pemit No. ~// ~ Disapproved a/¢ ................. ~._ ............................................... Application No. ....................... APPLICATION FOR BUILDING PERMIT ...... INSTRUCTIONS a. This application must be completely rifled in by typewriter or in ink and submitted in triplicate to the Building Inspector. wit 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot end of buildings on premises, relationship to adjoining premises or public streets or areas, 8 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 not be commenced before issuance of Building Permit. d. Upon approgal of' this application, the Building Inspector will issue a Building Permit to the applicant. Such permit,shall be kept 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 thall have beel~ 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 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......Nam;'"';o ........ own;;"';"";;'"io p ms es .................................... ...~./,~r~.....,..~/J~..~...~...~...~.~.~~'"""~- ~'~ '~/~'"~'""'/'""~ ...... : ....................................................... ............................................. If applicant is a corporate, signature of duly authorized officer. Builder'~ Lieen~ No .......................................................... Plumber'~ Licen~ No ......................................................... Flectrician'~ I_icen~ No ..................................................... Other Trade's License No .................................................... · 1. Location bf land on which proposed work will be done· Map No .......... a...~ ...... .~.,..~ ......... L ,~?~J~,,~. ~... ........ Street and Number ..../.....~...~......~....~..t~/..../~....~'....~%.../.~..d/~.~.~_ff~/.~....~.*..~....~,,;~.__ .............................................. ~'-- ? -~'~-'~.~ Municipality 2.State existing use and occupancy of premises and intendec[.use, and _occu.pancy of proposed construction: a. Existing use and occUpancY ....~ .t~...~/..,~...~./..'.~. __~..~ ..................................................................... b Intended use an · d occupancy ............................... ~ .................... ~. ...... [~ ......... ~:.,, ....................................... ~ ............ 3. Nature of work (check which apl~licable): New Building ....................... Addi ion ..................... Alteration ............... Repair ............ Removal.. ................ .. ... .. D~molition ........................ Other Work ................................. ............. { Description) 4. Estimated Cost . .. ~ . . Fee .... ..~. ~ ........................... ............................................ {~'l~e I~';i'd'~"~iling this';~plication) ............................ 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 occunancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existin, g structures, if any: Front .....~..... ......... Rear ....~.;~.. ............... Del)th ..... .~.. .......................... //' / ....... / ............................... Height ............ /..~. ......................................... ~umDer oT ~[orms .............................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ................................... .. ... .. .. . Height ............................ ... .... ...... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...,/,.4~.. , ...... Rear ....../...~. ................. Depth .......~...../. ................... ~4einht ..... ~. ................................. Numoer oT ~orles ...... /. ............................................ .~ ........ 9. ~'iz; of i'~;;''Front ........~'. ~.~.'~" ................ Rear ............ .~...~..../. ................... Depth .....~.~?.~. ............... .; ........ , ..... 10. Date of Purchase . ~....~./.,~..../.. ......... Name of Former Owner .. ~...~~~ .................. 11. Zone or use district in whic~ premises are s~tuated ..,~. ....................................................... , ................................ 12. ' .... : .......................... 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 toolhead, a_nd show strppt names and indicate wheth- er interior or corner lot. ///_~d~/~'~ ~)~,~/Z~//~ COUNTY OF ......... .~'1~. ........... ;.) ~'~' ~ ¢ontractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to ~rform or ha~e ~rformed the seid work and to make and file this application~ that ell statements contained in this application are true to the best df his knowledge and I~}~]Sllll~l~{tthe-~erk will be performed in the manner set forth in the application filed therewith. /~ Notary Public State of New ¥or~ ............ · ,,~,.~. .............. ay of ..;. ...... 19 TM '~ No. 52-9703725 Suffolk · , ']" ............. ":' "-:~" ' ..... O:~m iq~lrse 1974. ~. Notary Pu_bl,c._.,.. ~' ..... ~'?'" ~ ~ df'_C°unt¥ ~