The URL can be used to link to this page

Home My WebLink About6351-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~. ~.~. ...... Date ........... ~...1~.... 22 ...... , 19.73. THIS CERTIFIES that the building located at . .N/.~....l~.~.~..B.o..~. .......... Street Map No....ZX. ........ Block No.. ~ ..... Lot No. ~IZ ...~otatholxl...N~, .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... De~ .. 2.~ ....., 19..7.2 pursuant to which Building Permit No~.~17.... dated :....~.~1~.......I~......~>c).., 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 . .}~s~ess..b~L].~g...sto:e&ge .etx .................................. The certificate is issued to .. J~be~t .&. A,~e~..Allaertlal~ .... ~e~'a ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N oR, ............................ UNDERWRITERS CERTIFICATE N~i,~ ~ ......................................... HOUSE NUMBER . ~..~.~. ~ ....... Street..~...~..o~ ................................. ............... Building Inspector FORM NO. ~ 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 COMPL~ION OF THE WORK AUTHORIZED) 6351 Z Date ....................... .~ P, Zala.,~3'..... 2.°~......, 19..~.3.. Permission is hereby granted to: · ~J~aa:t,..L....;.;l,~I,c e...a,Lb~ ~;~oz~ ........................ ............ ~eu4~h~.d........:~ ....................... ~ ................ to ~i~l..~e~..~u~ines~..b~l~,&.ng...~ ~to~ge.) .................................................. : ................ .i~t(t~te~...h~..sat..~e£or~..~e~..1.~71.l ................................................... :: ................. at premises located at ....l[/.t ....... 1,'la.i~..~ad, ................................................................................... ................................... ,f~o~t,l-,e;l 4 .....I~...'~ ~...... .................................................................................... pursuant to application dated .......................... .Dee ....... -~t ........... 19i~.., and approved by the Building Inspector.. TOWN OF SOUTHOLD Building Department 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 II / 3. Copy of certificate of occupancy $1.00 ~)., Date ....~....~.~....~.....L ............ New Building ...... .~ ......... Old or Pre-existing Building ............................ Vac~it~'/Land ............................ Location Of Property .......... ./.'~<..~[ ....... ~~...~..r.....~.....: .............................................. Owner Or Owners Of Property ....... ..!....~.........~...'...~.//....~. Subdivision ............................................................... Lot No ............. Block No ............. I-~use No ............. Perm t No ~..~.~../..~. Date Of Perm t/...~'..~.//~.....'~..App cant .~. '....~...~....~..'~'..~'..~-. 'e-9/~ ................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........ Fna Cert f cate Fee Submitted $ ......~.. ............................ // Construction on above described building and permit,eats all,d~,pJ~able,,~f and regulations. Sworn to _b~fore me this Nolory Pubric, State of New York No. 52-034zt963 Suffolk Counl.~,~ Commission Expires Mc~rch 30, 19_~ TITLg #.~ 71-5-0444G 19..~.~.... Pemit No .................................... TOWN OF SOUTHOLD V / ~ BUILDING DEPARTMENT ~-'-.~ TOWN CLERK'S OFFICE . ,~ \ SOUTHOLD, N.Y. ~' 1 Application No ................................. Disapproved a/c ..... ~ ....... / APPLICATION FOR BUILDING PERMIT ~.~ Date ................ ........ 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 schedule. ~. b. Pict plan showing location of lot and of buildings on premises, relationship to adjo n ng pram sec or public streets or areas, cna' giving a detailed description 'of layout of property must be drawn on dia'gral~ which is part bf thi~ application. c. The work covered by this application may not be commenced before issuance of Building Permit. ~t'J 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 part for any purpose whatever until a Certificate of Occupancy shall have beep 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, fo/Jthe construction of buildings additions or alterations or for removal or demolition, as herein described. The applicant agrees to comply wi~ Jail applicable laws. ordinances, building code, housing code, and regulations, and to admit authorized inspectors on prem~l~s and in buildin, gs fo~ec~ssary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ....... : "_" "_" :"; ............................... ....................................... i .................... /IB ?cr 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 ................................................... 1. Location of land on which proposed work will be done. Map No ...................... ~ ......... Lot No.'~--"~ Street and Number ........................................... :s.. ~.* ~ .............................................................. Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................................................................................................................... Intended use and occupancy ....... ..~...~..~..,E. ........ ..t~...{.?..t~.. ............ ,,~...T...~...'~....~,.~....E.. ......... ~../.....~. .............................. 'k 3. Nature of work (check which applicable): New Building ....................... Addition ................... ./Altq~tion ............... Repair .......... Removal ................ Demolition ........................ Other Work (Description) 4. Estimated Cost ........~,~...-.. ~..~.~. ~..~. ~. ....... Fee ................................................................................................. (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 occupancy, specify nature and extent of each Wpe of use ...~ .~·~.~lg.~" ........... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ................................... Height ........................................................... Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ................................. .. ... ....... Height ..... .................................... Number of Stories .......... ......................... ..... 8. Dimensions of entire new construction: Front ....~ ........... Rear ....... ~'....~...'.' ........... De th ~ ~ I Height .............. .~.... ............................. Number of Stories ..................... .~.~ff. ~/~.. ...................................................... 9. Size of lot: Front ........ .~.~.,~,.Z~... ............ Rear .......... ~...~..~.~ .................. Depth ....... 4~...~..¢..~.~.....' ............... 19 10. Date of Purchase &:..:......:...:..~..z.....-=~. Name of Former Owner ..................................... 3 ..................................... 11. Zone or use district in which premises are situated ................. ~.M.~z~'~...~.~,,~ ............ ~,, ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .............. /x~....~..,~ ................................. 13. Will lot be regraded ........... ~t~.~?...: ........... Wil~l excess fill be removed from premises: [ ] Yes [:~ No 14. Name of Owner of premises ........ .~...~.~'..gg'..-~... b~. ,. ~i~.. ~ff.q~.~.P. ~.. ........................... ~. g~'~'~ ...~.. ,~. ,~ ....... , ~ , ~ __..., (Address) (Phone No.) Name of Architect/~"l~.~'~4.~.~...~...~'~..~l(.&lr~.~.....:.~'~r~-.,~RZ-,~..,/,~g.~., ......... ~'~.~...~:'~..Z....a/,~.....= ......... ,~ ~' (Address) (Phone I~1o.! Name of Contractor ....... .~J:'.....~... ............ ~.~'~L~...~.~I~.~.~1~.;, ................. .7~[..~...'...~...~...'~.....~...-- ' .......... 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.~.~.~.E....~..?..~..~`..~..~...~.~.~.~.~-~.-~.?.~.~..~..~....~.. ..... being duly sworn, deposes and says that he is the appli~nt above named. (Name of individ~l si~ing con~act} He is the .................................. ~.~..~..~ ..................................................................................................................................................... (Contractor, agent, corporate of~cer, etc.) of said owner or owners, and is duly authorized to ~rform or have ~rformed the said work and to make and file this ]ppli~tion; that all statements contained in this application are true to the best of his kno~d~e and ~lief; and that the work will ~ ~d~med in the ~n~r ~t forth in the application filed therew th , - .... ~'~ ~ ~ n '~ ,ou ........... .................................. U L ~ ' Ira. T5 w /lIND $~'DI'H'~. ~ '*¢" '" c .... TRUSSFAAMf ~, l,.ic~.Sl t ..... " ~' ' - P. C Box 877 po,~O~5 F1/../,-. ~e. ~,, 7OO5'