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Home My WebLink About6812-zFO~M NO. 4 TOWN OF SOUTHOLD Burr.r~ING DEPARTMENT Town Clerk'~ Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the buildln~ located at Ed~e,~era .A?a. (Itd)..~.'~..~..~Street Map No..~..~2 ........ Block No ........... Lot No.. P.t~2 .&. _~ .... ~v-r~J... N...T/, .... conforms substantially to the Application for Building Permit heretofore filed in ~i.~ office dated ............. Aug...22., 19..7~ pursuant to which Building Permit No. 5812Z.. dated ............A.u.g...2.2...., 19.73., was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occupancy for which thl, certificate is issued is . .P..r.~.v.a.t..e..o.n.e...ff..a~../.ly..d.¥.e.l.1..in.g..~.l.t.h...a.d.d.~..t.~.o.n. ..................... The certificate is issued to .A.r.t..h.u~...&...~a..r.~. ~Ly~ .~.t;l~ .... .o.~er~. ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N.:i~.: ............................... UNDERWRITERS CERTIFICATE No. ~ ~]~ · ....................................... HOUSE NUMBER ..... lL~. .....Street ..... .Pxt...Hd. .~..2. ......................... Building Inspector TOWN OF SOUTHOLD BUILDING B~fARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, I*L Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6812 Z Permission is hereby granted to: pursua~ to applicatic~ dated .................... t~.....~ ................... , 1~ ......and approved by the Buildi~ Inspector. Fee I1~.,~,~0~ ............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Buildina inspector, with 3 sets of pla~s, 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 of areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is port 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 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 pa rt for any purpose whatever until a Certificate of Occuponcy 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 f~uildlng Zon,e Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or egu ations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descr bed 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 inspqc_ tions. - Z ! ' .- (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..,~...~.~.. 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 ............................................... ~.... . · ~ ~e Street and Number .....~..~....~...~'...~....~..~/..~.........~....~..~...' ............ ~..~.....~...~...~..~. ....... ~..'...~'.,.. ......................................................... Municipal 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended uSe and occupancy ~ · · ~ 3. Nature of work (check which applicable): New Building .................. Addition..................~ Alteration' ........ .- ........ Repair .................. Removal .................. Demolition .................... Other Work ...................................................... 4. Estimated Cost .~....~....~....O. ........................................... Fee / ~ ~ (Description) (to be paid on filing this application) ~5. If dwelling, number of dwelling units ..... .~ .................... Number of dwelling units on each f oar ....... ../.. .. 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, ifan~Front /~'~/" Rear /~'5/'* Depth Height /~t" Number of Stories / ~/~7'-7'~_ ...... . Dimensions of same structure with a|ter~'ions or additions: Front /~'' z/'~ Rear / ~ /4/" Depth ....~....~.. ..................... Height ............................ Number of Sto~ries .../....~....'~..~.~.:. ....... 8. Dimensions of entire new construction: Front ....../.?..~...~...~. .................. Rear /JP ' ~-e Depth ...... Height ..~...~ ............. Number of Stories / 9. Size of lot: Front ..........~..O~ ......................................... Rear ...... .?...O..:..?..~..~ ................. Depth ...... ../..~....~...~. ............. 10. Date of Purchase ........ P/../.~./..~...?. ................................ Name of Former Owner .....~....:.....~./~.'~....~..~ ................. 11. Zone or use district in which premises are situated ~..~..~..~. "~"'~'~ o ,,c 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regraded ....... ../~....o...~._....., Will~exc~ss.,f~_ll be removed from premises: (_) Yes ( ) No 14. Name of Owner of prem.ses ..~...~Li.~'.:.n~.~.~..~'.~ ......... Address. Phone No. ~.~.,.~../...~..0 Name of Architect .............................................................. Address ................................ Phor~a No ....................... Name of Contractor ............................................................ Address ................................ Phone No .........~ ............. PLOT DIAGRAM Locate ¢.lljarly and distinctly all buildings, whether exist ng or proposed, and indicate all set-back dimensions from property lineS. Give street and block number or description accord ng t° deed, and show street names and indicate whether interior or corner lot. STATE OF NE~/V ~OlilE... ~_ J S S COUNTY OF~.....~ ' ~ .................... ~.~~ .............. be.rig duly sworn, deposes and says that he is the applicant (Name of individual signing above named. ~ He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file 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 therew!th. Swam to I~ef~re,n~ this ~ -- k_~ - ~ I ' . ......... o, .... ~./ - . · ............................ i~'i'~'r~'~¥ ~'~ · ~i..~,~ ~. ,. ¥i- -- ~--- .............. flUDITH T. BOKEN ~. ,4 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. ¥, 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 alt 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. $. 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 3, Copy of certificate of occupancy $1.00 $5.00 Date ....... y.'...~/...~... ........................... New Building .................... Old or Pre-existing Building ...~... ..................... Vacant Land ............................ Location Of Property ...~..~./..~.~....7~......~..~.~ -- ~ner Or ~ners Of Properly ~.~ ............................ · j ?~;~,~ ....................................................... $u~ivision ................................................................ ~ot No ............. Block No ............. Ho~se No ............. Permit No. $~/~ Z Date Of Permit f/~......Applicant Health ~pt. Approval ............................................ ~bor ~pt. Approval ................................................ Underwritem Approval .............................................. Planning B~rd ~proval ........................................ Request For ~empora~ Cedificate ........................................ Final Certificate .....~ ................................. Fee Submitted $ ..... .~.~ .................... Construction on above described building and permit ,m~ets all applicablp code~and regulations App cant ....~....~ Sworn to before me ~s / ~ day of [ ~ ~ ~ (stamp or seal) ;1~ .................. ........................ Nota~ Public .................................... County