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Home My WebLink About6634-zFO~,M NO. 4 TOWN OF SOUTHOLD BUW,BING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z 996 ..... Date ............. J:-IG7 .... 1G..., 19~. THIS CERTIFIES that the building located at . J/8' Sotl~d' 'V~e~' 'A~e ..... Street Map No..~ ....... Block No .... ~l~...Lot No.. ~ .... 8~t$,hold...]i.~., ....... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............ Apl''' '1 $, 19 .~. pursuant to which Building Permit No.~l~Z~.. dated ........ ,T%t~e...~ ...... , 19. ~.~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .l~F~.,e&~..~Jl~. ~o9]...¥~.$,h. ~'~Qe. ,t~ ............................ The certificate is issued to . .]FtaOe. T~Fl~el' ....... 0Vllel* ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... I$..R, ............................ UNDERWRITERS CERTIFICATE No..pelid,~ug ................................... HOUSE NUMBER . .$~ ...... Street .... ~tlld .¥~,~ .A~ ..................... Building inspector / FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6634 Z Permission is hereby granted to: at premises located at ............................................... .................................................... ~o~tl~l~....~I..¥~ ........................................................................... pursuant to application dated ............................... kp~..1......1.~..., 19..r~., and approved by the Building Inspector. Fee $ ~ .~..e....O~.. ............ APF~OVED AS NO'~ED UATE: F,E: BY biu,~FY BUtL~;ING £E::Arq'Mk:NT AF izL,266~ 9AM 10 4PM FO~( KEQUIR- o~g~ ~ACKFILLING FGLINOA- o~'~t~z C~V~RING PIP~LtNE 0t RESPONSIBLE FOP DkSIGN OR CON- RUCTION. ERRORS ~ : .,p~OYAL J PERF43T r ~ ' / rILL ,.'.. SOUTHOLD, N.Y. ~-,-~ · ,..~..n,...~ ..................... · .......... /-- ,"~PP"car'on .....~.....~'..~ Examined ..~ I~ '~"~'~ - ' .... No. ..'..~ ............ --,<' ' .m,, - Approved ........ ~ ............... , 19.?~./~' 'No ..... ~..~. ......................... ..'-- ........ sapp /c ................... ..%...-....~ ....... .:._..: ..... .~,.~ .... ........ · ....... ........................ ...... ~t U*~ ~/ (Building Insp~or) Z- o -- _. ~ ~ APPLICATION FOR BUILDING PERMIT Date ....~......./., ............. ,19 ............ INSTRUCTIONS a. This Ia~ication must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, w 3 sets of ~ ~ 'plot plan to scale. Fee according to schedule. b. Ptot~ d~ locltion of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, an giving I ~ ~ of layout of property must be drawn on diagram which is pert of this application. c. The wodc~ by this application may not be commenced before issuence of Building Permit. d. Upofl ~ ~JJlis IlXdication, the Building Inspector will issue a Building Permit to the applicant. Such permit,shell be kept on the gl~llJl~ ~'~ ~ion throughout the work.be~'~ e. Ne tl~Jd~d~lt bt occupied or used in whole or in pert for any purpose whatever until a Ce.rtificats of Occupancy shall have APPLICATION IS HEREBY MADE to tha Building Department for the issuance of a Building Permit pursuant to the Building Zone O~dinanee of the Town of Suuthold, Suffolk County, New York, and other applicable Law~, Ordinances or Regulations, for the construction of build~, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with M! applicable laws. ordirmncal, buUdln~code, housing code, and regulations, and to admit authorized inspectors on premises and in buildin~ for neo~ry inegectiom. (Signature of applicant, or name, if a corporation) (Address of applicant) S'mte whether applicant is owner, lessee, agent, amhitact, engineer, general contractor, electrician, plumber or builder. ~./~X~ ~'' ,~'.....~. '~ T,~,~,~ T~ vL Name of owner of premises .... ,....~.,~...~../~....~.......C.:.....: .......................................................................... .~. ........ 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 Trede's License No ......................................... 1. Location of lend on which proposed work will be done. Map No ..... Lot No ......................... Street end Number .....~..~.~.~,..~r..."~.~.... .......................................... Munioipality 2.State existing use end occupancy of premises and,intended use and occupancy of proposed construction: e. Existing use and occupancy ...~.~~-- ...._....~...~...~ ................................................................................................. · Nature which apl~ble}: New Building ........: ................ Action .......... ': ......... Repair ......................... RemovaP'T ........................ Demolition ...~ .................... Other Work ~~ 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 occuoancy, specify nature and extent of each type of usa ..................................... 7. Dimensions of existing structures, if any: Front ..................... Rear ........................... Del~th ................................... 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 ..... . .~...~. ............... Depth ..... ~ ................ , ....... Height ....................................... ;; ........ Number of..Stories ........... .y ............................................................... 9. Size of lot: Front .....~..~.,.~..., ......... Rear .........~...~..~'... . .. nanth /~ ~-7 ! .... 10. Date of Purchasa ..................................... Name of Former Owner ................................... 11. Zone or usa ~district in wh ch premisas are situated ................................... 12. Does proposed construction violate, any zoning law, ordinance or regulation: ..,~ ............................ 13. Will lot be re~a~.~ . ........ ~L-,:;L~/-Z-._--_~/ill_excess,~fil_~l be, removed~from prenljsas; ,[r~Yes [ ] No 14. Name of Owner ~f Prem!?~.' ....~.~..~A~..c~...~....f~,~,~.~...~~..;.~,Z~ .................................. ~,~)/Cc~.~_ ~ ~'(Address) (Phone No.) Name of Architect .................... (.,Address) . (Phone N~) Name of Contractor-~.~.~-~=~.'~..~.~.~.~`~x~`~.~.~"/~~.~./~/~ -- ,-(~ ~-- ~.....- .,... ~--...(Phone No.) PLOT DIAGRAM Locate c early a~d, distinct;l¥ all buildinas, whether existina or nronosad an" :-": ..... " .......... property lines. Give street anti I)lock aumber or description according to deed, and show street names and indicate wheth- er Interim or corne~ i0t~ ' STATE OF NEW YOR K: ,~ ,. /_j ^///_ ) cou. T OP ........... ....... ..................... .~..,.~....~.....,.O:q~..~....~....~.~... being duly sworn, deposes and says that he is the applicant above named. of .............. He is the .............................. ~---.C:~:~ .~t=,,. ......................... .............. of said owner or owners, end 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 themwith. T;RRI LEE ~ ............. ~¥. .... ..day of ~ ~" ~ ~ NOTkRY pUBUC, State et . .......~. ,o. - '"'"~(i~fl ~ ga~l~lf. 0eunty otary rubhc, .~.~?~.....~~ ........ County ........ ...-~..~ ......... FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Clerks Office $ou~J~old, N. Y. 11971 APPLICATION FG~ C~RTIFICATE 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 comp[eied 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 3. Copy of,q I/certifica/'9 of occupancy $1.00 ~ // ~ "~'/~ /]U Date ...... ~....~ ........ New Buildn~/~U..~J ........Ad ton OIdor P xstn Bu dn ................ g ................ d~i~_~,..~....; ~ ' ' g ' ' g .......... f. Vac~d .............. Location Of Property ..~~ Owner Or Owners Of ;~operty ..........~ ~~.~~.....~....~~~ Subdivision ................................................................ Lot No ......... Block No ......... House No ............ Permit No ..................... Date Of Permit .................... Applicant ~:.~ ~?'}~ .... ~.~.~.~ ..... Health Dept Approvo ~ ...Labor ~pt Approval~ ..... ~.& ...................... Underwriters Approval ................................... Plannmg Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ........ .~.. ....................... Fee Submitted $ ~ .................................... Construction on above described building ~ nd regulations. Applicant . ...~w..z... :.~..~... ~k~~~ .......... ~......~. ............ Sworn to before me this .......... ~ day of .....~...~..~.~.~ ...... (stomp or seaD