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Home My WebLink About6329-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z. ~:[~? ..... Date ............ l~y ..... 8 ...... , 19. '7'3 THIS CERTIFIES that the building located at . .~..Rel. & .lake -I)1' ..... Street Map No.. ~ ....... Block No..~c ...... Lot No. :K~Z.. tiOGt, hQ2,d...~ ,Y., ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... Je~-- -2- ....... , 1973.. pursuant to which Building Permit No.6~297.... dated ............. Jell. · - 1~., 1973.., 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 . Pl'~l. vat~ .dve/L1Zug..v:Ltl~ ~letached .&cceasor.7 .bu.tldin~ ............ The certificate is issued to Ga3..~adol~ &. Az~d&...l)®lpo~l.i.te ..... Ovne~l .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .NOR, .............................. UNDERWRITERS CERTIFICATE No... lq,Ilo .......................................... HOUSE NUMBER...31~O~ ...... Street ....Eenn),. l~.oad ................................. ................... .............. ..................................... Building Inspector · OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DIPAI~'rMENT SOUTHOLD, N~* Y. ~UILDIN~ PER~T (THIS PERMIT MUST BE KEPT ON THE PT~EMISES UNTIL FULL COA~LETION OF THE WORK' AUTHORIZED) N? 6329 Z Permission is hereby granted to: · .&G~mte~..&...An~cti.,i)eepee J/~e ............ ......... ~9-...~)eSeee3~'-.-.A~ ................ ~ ............ to ...... .]i~t/d,..aa..&eeeeee.~j,... (:etea~.e.).. ,td:l~.tal ............................................................ purSum~t to application dated .................. ~1'i1~[ ......... ~' ................. , 19.~.., mid approved by the Bl.dldi~. Inspector. FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING ,D~EPARTMENT TOWN ~LJEi~K'S OFFIGE SOUTHOLD, N. Y. i em No ....... Approved ............................ 19..~..~.. ~ Disapproved a/c ..... ~' ~' · ; "i' "'"", ................. : (B~utl~ling Inspector) I ............. ' ........ · APPLICATION FOR BUILDING PERMIT Dote .~..~, .................................... ' INSTRUCtiONS a. This application must be completely filled 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 schedulq. b. Plot plan showing location of lot and of buildings on premises, relationship tO adjoining premises or public streets or areas, and 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 approval 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 part for any purpose whatever until a Certificate of Occupancy shall have beech. 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 ~omply with all applicable laws. ordinances building code, housing code, and regulations, and to admit authoriZT~d inspectors on premises and in buildings for necessary inspections. .,~ (~J~n~ure (xt ~lppl[cant, or name, if a corporation) " ~ ,I~I~'B~O.L J. ekville (Address of applicant) State whether applicant is owner, le~.~e,'agent, architect, engineer, ~eral contractor, electrician, plumber or builder. .............................................................................................. .............. , ........ ............................................................. Name of owner of premises ..~...~...V.~..~...~...~...~....~...e.~..~..~ ............................................................................. If applicant is a corporate· signature of duly authorized officer. · CName and title of corporate officer) Builder's License No ......................................................... ,. Plumber s Ltcense No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ............................... .,,..,..:.;~,,l~.ot,: ,:~. Np ........ , ................ Street and Number ~~s~1~~;~.~1~1~)~1 ..................................................................... MLmicipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 8ea~ozml ~wellt~g a. Existing use and occupancy . .. ............................................................................. .. · ..,............ · · .. · ....... · b. Intended use and occupancy 8aBe ¸4, 3. Nature of work (check which applicable): New Building ............Z. .......... Addition ...~. .............. ~ Alteration ....... ; ....... ~ Repair ................... ...... Removal ........... ............. . Demolition ........................ Other Work ~.t~.~.~.l~...~,.~,, ....... (Description) -. _~., ,...; :l~lO. 0.0., ............. : ....Fee .....IL..1...O. · O0 ................................. (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 occuoancy, speci~l~neature and extent_o.f_each type of use ............: ........................ · · ._' 4a;~' 24 ' 7. Dimensions of exmt~ng structures, f any. Front ..................... Rear .......................... Depth ......... , ......................... · 1~' Height ...... , .................................................... Number of Stories ....o..?.?. .............................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ...................... Height Number of Stories ......................... Dimensions of entire new construction: Front ........ &~ ........... Rear .......... &! .............. Depth ....~ .......................... Se Height ..~..~. ...................................... Number of Stories; O~ ~.~.~...~..eel · . S,ze of lot Front ...................................... Rear .......................................... Depth .]~.~.~.~.~.~ .................. 10. Date of Purcha~ ~?.~.~.~.~.-- '--' .......... Name of Former Owner .~...~.~ ......................................... 11. Zone or u~ district in which premims am si~ated~~ ........................................................................... 127 ~D~s propo~d constructio~:~O~t~ any zonihg law, ordinance or re~lation: ....~ .................................................... 13. Will lot ~ mgraded ~ ........ : .................... Will ex~ fill ~ mmo~d from premiss: [ ] Yes [ ] No 14. Name of O~er of pmmi~ .~~..~..~.~~ ...................... 5~..~...~.~.1 .................. ~ ~looll Av~. ~l~d~,~,Y.115~ (PhoneNo.) (Address) (Phone No.) Name of Contra~or ....................................................................... * ..................................................................... (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 to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, COUNTY OF ..................................................... ............ ~.&~:l~g...~ ,..~.,~l~:)~.. ~rLt,~ ....................... : .............. ~ing d~l~ sworn, de~,s and says that ~e is the appli~nt abo~ named· (Nameofindivtd~lsi~ingcon~a~f,~ ~ .:,. ~ . r, . ;;'~; .~'.~J~-~ ~:'t:' ,:: He is the .....~ ............................................................................................................................................................................................. { Cont~ctor, agent, cor~te offi~r, etc.} of said owner or owners, and is duly authorized to ~rform or have~rformed the said work and to make and file this ap~li~tion; ~at all state~nts contaln~ n th s app cation are ~ue to t~ ~t of ~i~ ~d~ a~'~ ~ that ~wi0.~rm~ in ~e ~n~r ~t fo~h in the ap~ication filed th~ewith. Nata~ Public, Slate of Hew Yore .............. .............. ................... ..... FO~tM NO. $ TOWN OF SOUTHOLD Building Delm~tment 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 triplicate 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 os 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. Fees: - '- C'(~---Cer tl~ficate of-~cccu pancy $5.00~.~ "2. -Certincat~of occupancy on pre-ex~sting dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 14fl ~/ ~/ / f*7~ . . g'k 4&~ T~L J Ty Date ............................................ V New Building .................... Old or Pre-existing Building ............................ Vacant land ............................ location Of Property ...................................................................................................................... .. , .... Owner Or Owners Of Property ............. .~;..~ ....................... ; .......................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Perm, No. Date Of Perm,, ZLApp,,con, /Y/'~ L ' Dept. Approval ..... .~/.'~. ................................... Health Dept. Approval ............................................ aoor Underwriters Approval ...... ;z ...................................... Planning Board Approval ...~;.-.;.,.... .......................... Request For Temporary Certificate .......... ..~../..~..~ .................. Final Certificate Fee Submitted $ .......(..~........o~.. ................ Construction on above described building and geTmit meets all applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County