The URL can be used to link to this page

Home My WebLink About7530-zFOlh~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z73o? ..... Date .............. 0e~; .....1 8 .... , 19. g6 THIS CERTIFIES that the building located at .... Tl~aman. Path..(~v~. l~d) Street Map No.. ~ ....... Block No...xx ...... Lot No, . .-~xx.. Bast. t~ar~.o~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J~me...6..., 19.71,. pursuant to which Building Permit No..7.~'30Z.. dated .............. t~e~.~;.. 4.0 19.71+, 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 . Ae~e s so.l,y, bu-it(tin, g .'ce..one. :?am.~:ty. d~eJ.t.:Lng ...................... The certificate is issued to . .Gert .P.. $.¢hm~..tt .~. i~ife., o~ners .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N,~, ............................. UNDERWRITERS CERTIFICATE No. N .~.. ........................................ HOUSE NUMBER ...1 ~00 ...... Street ... ~ru~:arr .P~.tt~ .... ~ast. ~arion ....... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 7530 Z Date ....................... ~.~.....$ J) .............. 19.~4t... Permission is hereby granted to: ..~,.~...?..,...3.~,.~,~..&..,.q;~ ........................... ......... .~..~.~k*.~..~.....~. ............................. ........... .~.~...~.~.a.~aa~. ....................................... ~o ~..~...~.~...a.~..n.~.~f~a~..~a~a~ry..~h~i~.~g~.~L~a~;.`~:~.w`~.~.~.~`:.~.~&~1~) ...................... at premises located at ..t.~.O.0.....2~.~a~a..~.a.~ ............................................................................... ............................................ .~.a..a.~...~.~.~ ........ ~.~.~. ...................................................................... pursuant to application dated ............................ ~..tl~e..**.6 ........... , 19~k~..~., and approved by the Building Inspector. FOEM NO. 6 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 fallowing; 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 dispasal--(S-9 farm 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), Nan-conforming uses, or buildings and "pre-existing" land uses: I. 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 certificate of occupancy $1.00 New Building ....i..~... ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .... Fee Submitted $ ................................... Construction on above described building and oermit meets all opplioa~.~ 7es and regulations. ............................. Sworn to before me this (stamp or seal) .~ 7~'0 7 / 0 - ~' t'/'~ BUIL.DIN~ DEPARTMEHT · ~ TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ,_~ ...... ........... , ............ ........ ....... ......... ........ . ,,~,'~ ~~,~.., ...................... , k ~ . ~ ~ *~U~TION FOR BUILDING FE~IT ~,~;'.~ ,~----~:.~ ,. ~,~ ..:....~.:.~,. ........................... . ,~.~ ....... a. lhi~ ~lic~tion mint b~ c~l~l~ .~i!l~ in by ~writ*r ~ in i~ ~ ~i~ in tripl~t~ b. P16t plon ~h~in~ I~ti*~ ~{ Iotand o~ buildin~ on promise*, r~l*tion~bip t0'~dloinin~ premi~ or public ~r~*, ~nd Oivi~ ~ d~t~il~ d~rlpfi~ O~ I~ou~ o{pr~ mu~t be dm~n on th~ die,mm ~hich c. Th~ ~ork co~r~ by thi~ ~li~tion m~y n~ be comm~ed be{ore i~uonco o{ Buildln~ P~it. d. Hpon opprovol o{ thi~ ~pplic~t~n, ~ Buildin~ Ink, tot will i~u~ ~ ~uildin~ ~rmit to the ~ppllc~nt. Such permit ~h~ll ~ k~pt on th~ pr~mise~ ~v~il~bl* {~r in~ti~n thr~h~t th~ work. e. ~o ~ildin~ ~hall be ~cupi~ or u~d in wh*l~ or in part for ony pu~os* wh~r until ~ sh*ll h~ ~ ~mnt~d by th~ Bui.ldin~ Ink,tot. A~kl~ll~ I$ HfiR[SY ~Dfi to th~ 8uildinO ~ment {or th~ i~u~ne~ o{ o. Buildlnfl ~di~d~nO Zon~ O~[n~nc*. ~ ~ o* ~th~ld, ~_~k County, ~w Y~rk, ~nd ~h~r ~pplic~bl. ~, ~i~n~ or~ ~e ~ppli~an~ aq~es to c~mply wi~ all ~o~le [~, 0~s;~,dl~ c~, h~: a~ ~u~ti~, a~ to ~ auTnonzea ~n~ ~ pmm~se~ ~ m~uimin~ ~r~ i~i~' ~ ....... ~ ................ i '~'~ ~ . ........ ; ~ ..~[/. ,(Add~ of ~licant) S~ate whether applicant is owner, levee, agent, amhitect, engineer, general contractor, el~trician, plu~r 'or builder. ............................................................. :~. .......... ~-.;.%.[:.~:..~-~p ........................................................................ ~ame of owner of nr~-~, .' :~ ~. SCOtt & ~e If ',applicant is a cctrp0mt,~, '~taF~etUre of duly authorized officer. (Name and title of corporate off cer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Notes Deed va,, re~er4e4 Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Ntap No.: ........................................Lot No ......................... Street and Number ........ ~,~;.O~l..~L~g3111.1~.~.~b.,..]~s~l;..~az'/~a,~..]~.T .................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............................................................................................................................... b. Intended use and]~ ............................................ .~1~ ........................................................ 3. Nature of work (check which a able): New Building .................. Add .................. Alteration ................. Repair .................. Removal .................. Demolition.. .................. Other work ...................................................... (Description) 4. Estimated Cost ...... ~.~.~,.0..?..0~.. ........................... ~ ............ Fee ................ ~..~,....0~... ............................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floo~ ............................ 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, 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 ........ .7..~.o .................. Rear ....... .7..~,., .......... Depth ..~.{3.'.~. ........... Height ....~1~..~..~.o Number of Stories ...... ~, .............................................................................................................. 9. Size of lot: Front ................~.0...~.e...e~.. .......................... Rear ...... ~.0....~..e..e.~ ...................... Depth .......~.....~..e..e..f,. ............ 10.' Date of Purchase .....~.~...~j...]..~l.~.~. ............................. Name of Former Owner ]~.~...~..s...~..t..1.~.1..?.~1 ........................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .............. .~'~. ..................................... 13. Will lot be regraded'. ........ ~. .............. W~ excess fill be removed from premises: ( ) Yes l/& ( ) No 14. Name of Owner of premises .(~.~.&~....~...~.q..~..t}~...&....~...:~...q ...... Address .~1~.~~ Phone No.~-...6....~......0~ · , Ne~ Zork:1.1.5~j2 Name of Architect .............................................................. ~aaross ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly cfi buildings, whether existing or proposed, and indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YO~.,,- ~ ~ ~ S S COUN'I~Y Of ....... ~/..~......~..~...~. ...... ~' ', .......... ....(?Z~...o..~..,~..i~<. ...... .~...~ ....... .~. '~../D....')~/....~..../,. ....... : ........ being duly sworn, deposes and says that he is the applicam (Nature of individual signing contract) ,above named. He is the ............ 0..14~..~.l~.~, ......................................................... ~. .............................................................................. (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. Swam to before me this ............ ........ day , ,, Notary PubliC,. ....... ~.~ty ..... ..~/.. -,~.....~...-....,~'~ .: ............... I~/ ' ~' (Signature of applicant) ~!!o~ ~0~ NOTARY PUBLIC, State of New Yed~ Qualified In Ncmau County ~,~ni~don .,~Jdres J*(~rch ~0, IJ...~.-