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Home My WebLink About6344-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .~/S .RocKy. Point;. Road.. Street Map No. ~ ......... Block No.. xX ...... Lot N~.. ~,ltSl;. }~tl'iOl~..1~,~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ gal~:..19., 19~.~. pursuant to which Building Permit No. 63.1~. ~.. dated .......... J~t....1.9..., 19.~3., 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 l~ivate, one .family. ct~felltxtg ....................................... The certificate is issued to .. Alago. Pallagopou.lous ....... .0wnal~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval liaR, ............................... UNDERWRITERS CERTIFICATE No...])01Ild..~.~ ....................................... HOUSE NUMBER..19~1 ...... Street .... BOOk~..POin% .1"0~,~ .......................... Building Inspector FOBS[ NO. ~ TOWN OF $OUTSOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT '(~THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6344 Z Permission is hereby granted to: to ..~u~..aa..aa4~aa..~l)~.~..em..ead,,tlal;.A~.laj ........................................ at premises located at .......................... ~S..JJlJtl~-.Jql~. ~--~lllJ, ................................................. ......................................... ~...Jal~t..i~ell ....... i1,,.~, ................ -~-..~ .................................................. pursuant to application dated ........................~1~ ......... '~ ......... , 19...~;~, and approved by the Building Inspector. Fee $.~ ........... FORM NO. 6 TOWN OF SOUTHOLD Building Depmtment Town Clerks Office Southold, H. ¥. 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 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 New Building .................... Old or Pre-existing Building ....X ................... Vacant Land ............................ Location Of Pr~e~ ~.. ~ner Or ~ne~ Of Prope~ ....~.. ~ ............................................ ~ .......................................... Su~JvJsion ................................................................ Lot No ............. Bilk No .............House No ............. Permit No. ~.~..~.~... Date Of~,~Permit ~J~'...(~.L~Applicant '""~ 'A ....... ;IT~':"~'~c~C~"7' .................. Health ~pt. Approval ............................................ ~bor ~pt. pprova ............... ~ ............................... Unde~rite~ Approval .............................................. Planning B~rd ~proval ........................................ Request For Tempom~ Ce~ificote ........................................ Final Ce~ificate .........~ ................ F~ Submitted $ ....~.:~ .............. Construction on above described building and/p/.~,'t~zets all applicab~ codes and regulations. · Appl,can, ......... ~.~* ............. '~""9 ............................................... Sworn ,o before me this J // ~~ ........................................... ~/'~ ...... ~dayof ~(~ 7~ (stomp or sea,,~~ Nota~ Public .................................... Coun~ TOWN OF SOUTHOLD ^ppii¢c:tion No ................. BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined .......... 19...~.....~. .............................. Pemit No ..................................... Disopproved a/c ............................................................................................ (But APPLICATIONFOR BUILDING PERMIT : Dine .......... ~. / ~f 19....)~....~ INSTRUCTIONS '~' .......................... ' a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witla~ 3 sets of plans, 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 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 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 beert~ 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, Suffo/k County, New York, and other applicable Laws, Ordinances or Regulations, for the construction 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 inspectionslr .... ............. ~ (Signature of app', ol//~l~le, if a corporation) '\ .............. r ........ i:~'~'~';;';;';¥';'~;;;;~;'~'[i ............ ~ ............ State whether applicant~is owne. r, lessee, agent, architect, e~gineer, general contractor, electrician, plumber or builder. ................................. Z..~..~..ZL'.2..~.~- ................................. , ..................... .: ........................................................ : .......... Ueme of owner of ,remS,, ......... Z'L..., ...... ..ZC.~..~.....~...n..~.~..~..~..:: .......................................................... : ........ 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 ................................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · . ~,~-//..: . a. Existing use and occupancy .......... Z...~..~./~.. ...... ~ ............. .;.....'.~ .................................................................... b. Intended use and occupancy ./~......~...~...'~...:......~......~.....~.., ,/../...'~..).: ............................................................. 1. Location of land on which proposed work will be done. Map No ....... ~ ............ ~ ................... Lot No ......................... Street and Number ..... / .~..~... ......... ~ ...... ./.(.. y ......................................................................... ...~../. ........................... Municipality 3. Nature of work (check which apl~licable): New Building ....................... Addition ..................... Alteration ............ IZ.: Repair ..................... Removal ................. Demolition ........................ Other Work .... ............ (Description) (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, specify nature and extent of each Wpe of use ..................................... 7. Dimensions of existing structures, if any: Front ........ .~...~. ...... Rear ....... ~..~.:..~ ........ Del~th ......... ~ ....................... ~,,ht 0 ............ Number of Stor es. /. ~..,~...~.'.. .......... Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ........................................... He ght ........................... Num .bar of Stories .................. ... ................... 8. Dimensions of entire new construction: Front ......................... Rear ......~.~ .................... Depth ......~.~ ........................ Heiaht ................................................. Number of Stories ......................................................................................... 9. Size~of (ot: Front ..... ~.L..~.. ....................... Rear ..... .~.....-~... ........................... Depth .....~....~7.....~... .................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated .......... .~....~.(.~..~....c.. ......... ~;7~.~ ............................................. 12. Does proposed construction vio(~/~ny zoning law, ordinance or regulation: ...... ~.~...: ........................................... 13. Will lot be regraded ............ ~ -- ~ - ~-._ ~'~/~"~ ........... Will_excess fill be removed from_ premise, s: [.] Yes [~ No 14. Name of Owner of premises .....~....~f.y~..~...~..~.....~..~...~..~...~.~..~..°...q./'...~d..~.;.....~..~...~....~...~.°..~. ......... .~...~.~...Z ............... (Address) (Phone No.) Name of Architect ..................................................................................................................................................... . , // z / (Addless) ~ z'~ (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 .................................................. ~//{~-~' [ ~/~F~ "J k//Z~C t0~ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ............................... ..~7...~.....~(.,:Z../'.,~.~.~.~..../..~. .............................................................................................................................. (Contractor, agent, corporate officer, etc.} of said owner or owners, and is duly authorized to perform or have 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 therewith TER~I' kl~ ELAK ............................... · ,,,~.... y ...... ~.. - ........................ . ............ Notary Public..~~...i~.:~,~..~0%%~ ..................................