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Home My WebLink About7559-zNO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificate Of Occupancy No. Z73~b~ Date NoV .3, 19,76 THIS CERTIFIES that the building located at .I~;.O.*.W;. Off. A~.Qr~. ~q .... Street Map No.N~q~..~'?~}Block No ........... Lot No..99 ...... q~}~9.~9.. ~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... 8~.. ~9. ~ pursuant to which Building Permit No.. ~.~. dated .............. 8~P~..~ 19 .~., was issued, and conforms to all of the req~ ments of the applicable provisions of the law. The oecup~cy for which this certificate is. issued is Private one famXly d~e.115~g wXth. ~dd~%ion · ~te~a~ion The certificate is issued to ~dvan (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval ~?~ ............................... UNDS~W~TS~S CSRT~F~CAT~ No.. P?a$~g. .............. .................... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 7559 Z Permission is hereby granted to: ..... ~..L.~:~ .......... ~.~.-.~......i ................. at premises located at ...................................... .~;t] ............. ..................................................................................................... :....~.~M. ......................................... Building Inspector. Fee $ ........................ ' Building INspector FORM 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-ex'st'ng ' 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 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 $I.00 Date ~'~.~?Z-//--~/~ / ~/~...~ New Building ................ Addition ..... j ......... Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property .,~..._~?.~.. ~ ~ Z~ ~~ ~C~ ~ ' ' Subdlwsron 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 aP~able codes and regulations. ..... ........ ......... , Nol~r~,~b c~L. ll .................. c~[v' - ~ /~ ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Examined ........................................ ' '"' ...... ................................... Approved ........................................ , 19 ........ Permit No ..................................... Disapproved a/c ............................................................................................ APPLICATION FOR BUILDING PERMIT ' Dote, ,, ........... INSTRUCTIONS (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No. ~/~/ a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationsh p to adjoining premises or public streets areas, and giving a detailed 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 issuance 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 ~r'"~ shall have been 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, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all appticable laws, ordinances, building co.de, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary,inspections. (Signature of ap a corporation) .............. State whether applicant is owner, lessee, agent, architect, engineer, gei~eral contractor, electrician, p umber or builder. Name of owner of prem ses ~..~.j~.~.,OJ ~..~.~~.~.~....~.~,. ¢-:~ ~ , If applicant is o corporate, signature of duly authorized officer. Other Trade's License No ............................................... ,~,~ /'~ ~~ , ~ Location of land on which proposed work will be done. Map No.: -- -- ~_ ~.~'~i.~.....~.~.~/kL~...... Lot No. '""'J"~';~'" "r Street and Number ....................................................................... ~..~..~.~...'...~....:~...:~.j~t..(~.~.:~.J~O.~..J~..~ ...... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~.~-~..~.c:~.~.~../Zk~.C4~,~.... ......................................................................... b. Intended use and occupancy ...................... ./.'/. ............. whether interior or corner lot. Nature of work (check which applicable): New Building'. ................. Addition .... t ...... Alteration ~ ....... Repair .................. Removal ........ ~ .........Demolition .................... Other Work .................................................... 4. Estimated Cost ,.(2...._~.. .... e .... ...................................................................................... (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, specifyA,._ J ~.nature and extent~ ~.°f~ach type of use ................... -.,I.I1....,¥"~'" H~h, ..... tm...~..... ,,mb~ of S,o,es ...m.~...~.~.e.~ ........... ...... s.~.~ ...................... additions: Dimensions of same structure with alterations or Front ...... ~..~.~. .......... Rear .3&.~ ......... ........... ....... ........... ? ..... ................................................... Fro~t 9. s~,~ o¢ ~o~: ..... ~...,..,....~.....~..~.~ .................. ........ L~.~..~ ................. D~ ..~,......., .................. ~1' of Former Owner/ j ~ ~ ~-- ,0. ~,~ o~ ,,~h~ ....... '~'*'~,.~.~. ................................... ~m~ ~.,.e....~.m.,.~,,.~.,.~.~.~..~ t ~. Zo,e o~ .~ ~i~r~ i. which, p,em~e~ ~r~ ~tu~ ...... .~.~.~.~.~ ............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ .~.~ ............... ...~.~..~.~.%.~., 13. Will lot be regraded ........ .~..~. ......... Will excess fill be removed from premises: ( ) Yes (~/'No ~4. ~me o~ Ow.~ o~ ~m~e~.~....,-- .......... ~ ....... . .................... ~e~ ~..C~o, ,o. ~.~.,~.~ ~me o~ ~r~,,~, ....... ..k.[.~J.~.O.....~~.. ~,~ ~.c,~ - ..................... ~. ~[.~.~7 PLOT DIAGRAM M ,~, ~ J m~ o, Co,,,~,o, ..... J. ........ ~ ................ ~ ........... ~.~ ~.¢.g~..~ ...................... Eocate cleorly and distinctly oll buildings, whether oxisdn~ or proposed, ~nd indic~to oll set-~ck dimensions from indicate property lines. Give street and block number or description according to deed, and show street names a ~ ,IJJJJ[j Sq'ATE OF NEW YORK, ~ c c COUNTY OF ................................. ~.I...@..~.~....N.. ............................ ........ ..(~.Z..(~....OT:..'....~.....~.....being duly sworn, deposes and says that he is the app[icam (Name of individual signing contract) above named. He is the ............. g'~'bJ"~'~","~dg~ff;;$g;L"&'~%~?~"&'g;~g;~$;'gTf[&g;'j';f~'Jf ............................................................... 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 foffh in the application filed therewith. Sworn to before me this ~ . .... // ~ day of - . -~-~ 19 ~/ ~ ~ /- ...... . ....... .......... ~*-- ~ '~ %~,o~,.~ew ¢ (Signature of ap~icant) ~o~ Y -963 Su ~oJ~ Count~/