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Home My WebLink About7538-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icate O[ Occupancy THIS CERTIFIES that the building located at . .0.r. ch.a.r.d...S~r.e..e.t .......... Street Map No.X.x. .......... Block No...~. ....... Lot No.. ;r~ .... Qr..i~.n.t... N.,.Y.: ........... conforms substantially to the Application for Building Permit heretofore fried in this office dated .............. .S.e.p.t... !,~19 ..~.. pursuant to which Building Permit No. ?..~.8.Z.. dated Septt 16 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 The certificate is issued to .D.q.n.a.l.d Boerlm. Uwne~, (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~...R.: ............................. UNDERWRITERS CERTIFICATE No. p.e..n.d.~..g .................................... HOUSE NUMBER 1000 Street Orchard Street Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN ~LERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PEP~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7538 Z Permission is hereby granted to: pursuant to application dated' . ........................... ~,]3.~...,..:J~l ...... , 19 ......... and approved by the Buil~ing Inq3ector. uildir;g ~ ' BUIM)IHG DEFART*r~IT · )UTHOLD, N. Y. Application ................................ Examined ........ .~..../..;..~....., 19..~.~ .............................. Disapproved a/c ..................................... .................... Date ~ / 4: INSTRucTIONS a. This application must be completely filled in by typewriter oe in ink and Submitted in triplicate to the Building.~, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accord ng.to schedule. b. Plot plan showing location Of lot and of buildings on premises, relationship to ndj0 n ng prem ses or public streets or areas, and giving a deta led description of layout 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, i~uance of Building Permit. d. Upon approval of this applicatiOn, the BUilding Inspector will issue o 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 been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Bu di.ng Perm t pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk cbunty, New York, 'and other apphcab · 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 inspections. (Signa~6re of applicant; or nome, if a corporotior~ ........ (Address of applicant) State. whether applicant is owner, lessee, agent, architect, engineer, genera contractor, electrician, plumber or builder. Name of owner of premises .......... .~....~.......~....~ ............................. . . If applicant is a corporate, signatare of duly authorized officer. /~,~(/~_ .................. ......... ', - -- ' Builder's License No ..................................................... __~lf I Plumber's License No .... ..~....?...~.......~.. ') I I:~'" Electrician's License No. ~ ~ ~- [~ ~'" ' Other Trade's License No ............................................... , D I-~ ,~,~,~ ~. Location of land on which proposed work will.be done. MoD_No.: .............................. ;. ...... ~. 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 -'~--/'~ · ' .. ............. .................................. ' ..................................... b. Intended use and occupancy ..:,,c......~ ~ 3. Nature of work (check which applicable): New ~uilding' Addition ..... ~ ....... Alteration .................. Repair .................. Removal .................. DemBlifion ........... ~ .......Other Work .................................................. .... (Description) .. o .................................................................. 4.Estimated C-.t .................... ~ ...................... ~ ........... ~...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 c~rs ........................................................................................................................................... :. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ........... ,1_7'"~"'~ ....... Rear ....7...~..f. ..................Depth ....~......?.~ ..... Height ...]..~.../.,..~ ......... Number of Stories ......... ./....~-, ............................................................................................. Dimensions of same structure with alterations or additions: Front .......... Z.~..~. ................Rear ....~....~.. ................ Depth ....... .~.~..~ ...............Height ...... ..?r./...~. ........... Number of Stories ..... ./....j~,- ................ 8. Dimensions of entire new construction: Front ...... /...~'...~ .................... Rear ...... .~.....~...~. ............ Depth ./....~'T.....~ ............. Height ..... .~.....v. ....... Number of Stories ....... /. ............................................................................................................ 9. Size of lot: Front ...... /...~.']~......* ................................... Rear .... /... .~....~....~ ........................ Depth ...-~:...°....O'....~ .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ~.: ..................................... 12. Does proposed construction violate any zoning law, o~dinance or regulation: ~ ........................................... 13. Will lot be regreded .,..~ ......... Will excess fill be removed from premises: ( ) Yes (JO No 14. Name of Owner of premises .. .~..*.......~....~ ............... Address ...~...~ ....... Phone No ....................... ....... Address ................................ Ph°ne No ....................... Name of Architect ............................. '7'"/~-~ '~'~'~Z ....... Address .....~...~ ..... Phone No..~".....~..'...~'...~...~... Name of Contractor .~...~...-.~..~ 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 whether interior or comer lot. ' ,. /5']' L ,I I 5'0' STATE OF NEW YORK, , I S S .............. ~..,~...~'.....~../?.,A~>,~../w.~...~... ................................. .being duly sworn, deposes and says tha~ he is the applicant (Name of individual signing controcf) above named. of said owner or owners, and is duly authorized to perform or have performed the said work and to rn~ke 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 to before me this ],~,/ /~ "2~,/9 ~ [31gnature Or oppHcanu MARY O. KLOS NOTARY pUBLIC, STATE OF NEW ~52.7306925 SUFFOLK COUNP/_,, CommiSSion Expir~ Ma[ch ~0~, 19~ .... 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 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: 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 Date ........................................... New Building ................ Addition ................ ~ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....~.Z.~......~~.:.._~.:~ ...~...~ ......................... Owner Or Owners Of Property ................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Date Of Permit .................... '..~...~ ~...~...~..~.. .------ ~/1~/7~.. Applicant ................... Permit No. 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 permit meets all appli~cable codes and regulations. Applicant ..:~.......~..~ ......................... ../¢ ............... Sworn to before me this ~ /r /~./.~ ~/~ · ~... day of .~.....~Z~].. (stamp or seal) ~,