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Home My WebLink About7536-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupancy No. ~687:1 ...... Date .............. ~T~,..29 ..... , 19. THIS CERTIFIES that the building located at . ~. ~ .~. ~8, (~-~/~ Map No..y~ ....... Block No...~ ..... Lot No, . ~ .... ~t.it~ek. · .~,~., ...... '~ conforms substantially to the Application for Building Permit heretofore f~ed in this office dated ............ ~g' '3 .... , 19 '7~' pursuant to which Building Pe~it No. ~36~' ' dated ............ ~P~' '~3' ', 19.~., was issued, ~d con~o~s to all o~ ~e require- ments o~ the applicable provisions o~ the law. The occup~cy ~or which ~is certificate is issued is . .Pr&rate..o~e, .~il.y. ~tl~ng. w~- ~lteration-~, addition ..... The certificate is issued to . Henr:~ .He~ ....... ~e~. ........................ (owner, lessee or ~n~t) of ~e aforesaid building. Suffolk County Departmem of Health Approval . .~,g, ............................. UNDERWRITERS CERTIFICATE No..pending ................................... HOUSE NUMBER ...... ~... Street .. P~I~ .~ .~. ~B... ~t~k ..... Buildin~ InspectorI m irr (THIS PERMIT MUST BE KEPT ON ~ PT~MISES UNI~IL FULL COMPLETION OF THE WORK AUTHORIZED) 7536 Z ~ p~ ~ ~ .g.~.~...~.~..~.J.~.....~.et~.aZ.~....~.e.~.....~..~.....~..~.e.~..~ ....... ............................................... 1~.~1~....~.~.~ ...................................................... ~ ..................... pu~lent to application dated .......................... ~eFt,..3 .............. ~ 19~.~...., and ~:~'i~'- Building Is'~or. Building In.tot ~ ~ FO~F~ 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 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" bnd 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 bulldings. 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.O0 ? /!~ /~x Date ......... ,. f.,..'~.....' ........ :,~.~ ........... ' . New Building ................ Addition. ...... /,......., Old or Pre-existing Bu Iding ~[~..L,~.L.. Vacant Land ............. . Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ..~..,,,~;~.Z~?.Y.f,k~:[.~ .............................................................. Subdivision ..... .~ ...................................................... Lot No ............. Block No ......... House No ............. Permit No...i. ,............., ate Of Permit ...... Apphcant ....................................................... Health Dept, Approval ............................................ Labor Dept, Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and~ -~prm~l~ me'ts all applicable Sworn to before me this ................ day of ............................................ Notary Public .................................... County Examined ........................ Approved FOBM NO. 1 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. 19 .... Permit No ........ ~ ..... Application No ................................ .-~ Disapproved o/c ~.~. -- /2.. ~ .~ . -/.-~ .............. 7....~ ........ ~,..-~.. ................. .1 ............................... ~z.~ r~ ~//~//~ ~ / ......... ~ B ~¥1~li'r~'-I ~tor) ' .......... / APPLICATION FOP/BUILDING PERMIT INSTRUCTIONS Dote ..... 9 ~'.3/..~..~ .............................. 19 .............. a. This application must be completely filled in by typewriter o~' in ink and submitted in triplicate to the Building Inspector, with 3 sate 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 o~ >~ areas, and giving o detailed description of ~ayout ofproperty must be drawn on the diagram which is part of this application. ~ c. The work covered by this application may not be commenced before issuance of Bu Iding Permit ~ d. Upon approval of this application, the Bui d ng Inspector will ssue a BUd ng Permit to the appiicant. 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 o Certificate of Occupancy~ shall have been granted by the Building Inspector. O~ 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, end bther 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 comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspect, ions. / , (Signature of~l~c~nt, o~ a corporation) ...4 ~]: i~l r~ ..~]a .y..,Di~.. t{i~3~'~., .~ ^ .~., ............................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...... H.,.I4~..~,.~h ...................................................................................................................... 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.:T.~U~.el..T_~, .............. Lot No ......................... Street and Number .................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy S~0.e~: home b. Intended use and occupancy ........ ~e~oe..~e.'e.~.ecl..c~e¢~}; .......................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair × Removal Demolition .................... Other Work ~-- ~ (Description) 4. Estimated Cost "I'5'00';'0~ .......................................... Fee ,...l,.,7,.,.,.'"'""" .................................................................. (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 type of use ............................ 7. Dimensions of existing structures, if any: Front .,4.§.t .................... Rear ................................ Depth ...,~ ............. Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .... 5~.~ .......................... Rear ............................ Depth ....1.0.r ...................... Height ............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories .......................................................... : .......................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ................ .1...9.~.Q ............................... Name of Former Owner "~d,~r~oo~ ................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~.O. ................................................ 13. Will lot be regraded ....~o .................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .~.~Z'£.tzZ'.~.b. .......................... Address ~..o~:j~l~..Ig~..~g J~J'~rt~fa~J.S ..................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate dearly and distinctly ali buildings, whether existing or proposed, and indicate all set-/~ack 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 Y~-~,.I~L~, ,~ ~ S S COUNTY C)~L./ ......~J(~"~]'i~"J~~ ......... ~ ' .......................'""' ~"'7~'~'~'"¥"~'"~"~i'~ ....... ~'t~'""f' .................. being du,y sworn, deposes and says that he is the app,ican~ (Nam f ' ividual s'g ' g co ac) above named. He is the ................................................................................................................................................................................. (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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn t~ before me this ........... ...... ................. , ,. / ub,e,. ......... ......... ........................................... ~'~ (~ignatL~/of applicant) No. 52.45049].! (~uahfled j~ Suffolk C;oant~ .. Term Expires March 30, ].~r~_~