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Home My WebLink About7566-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's O/~ice $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at . L.ul~.t. 9.n..P..t. ~o.ad .......... Street Map No....x~. ........ Block No. ~ ....... Lot No...x~......~..t..ii..tV.c.k...N: .Y.o ........ conforms substantially to the Application for Building Pemit heretofore filed in this office dated ........... .S.e.p.t...~.0., 19...~. pursuant to which Building Pemit No .... ~. [.6.67, dated .......... .$e.p..t...~.0...., 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 .P.r..i.vAt. e. i[!r. age..(..a.c.c.e.s..s.o.r.y..) ........................................ The certificate is issued to . .B.e..r.t...I~..s.o.n. ..... ([ .~n..e.r. ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~ ;~.° .............................. UNDERWRITERS CERTIFICATE No..E.. ? ?.6..~).... D. ee...~...1..9..~. .................. HOUSE NUMBER ...... 1..2.5:.0..,. Street .... .L.u.p.t.o.n,..P,t. ?.9.a.4 ..................... Building Inspector (THi~ PERMIT/~AUST BE KEPT ~)N THE PREMISES UNTIL FULL (~IiI~q~ETION ~ TH~WOI~ AUTHORIZED) Pmm~ is hereby gren~d to: ~ ~t...~....AJ~..~=.t ..1~ ~m~ .............. to.. ,~'e~.,la,~...e z,l j~ ~.~.~,zts,~,ta, .~jnz, n~.., ......... : ................................................................ ......... :: ......................................... ~t~J~....~.~.:. ................................... £ ................................. p.r~ to qeq:,U,::aflon dohKI ..................... .B..p:l;.....,,',',',',',',','~O ............... . l~J'l,.....~I ~ !~ t~ Building Inq~ctor. Fee $.1.0~J30. ........... ','OWN m, SOUT. OLD BUILDING DEPARTMENT//~,_ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PEP. MI? INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Impactor. b. Plot plan showing location of lot and of buildings on premises, relationshia to adlolnina ommleee or Ixlbllc streetl m area~, and giving a detailed descripti°n of layout of property must be drOWn on th~dlagr~m ~h'~c~t Is part of thll al~llcation, c. The work covered by this application may not be commenced before issuance of Building Permit. d. beU~ptapp.,mval of this application, the Building In~pactor will I~ue a Building Permit to the applicant. Such permit shall on me premises available for inspection throughout the pragmas of 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 issuance of a Building Perm t pumuont to the >~ ,Build!ng Zone. Or~. inance of the Town of Southold, Suffolk Count, New York, and other applicable Lawi, Ordlnoncee or ~l<.hegeUlot .I..on. s, .tar the c.onstructl.on of bu!l. ding~, additions or al.terat~ons or for removal or demollt on, as hem n described. app.com agrees to comply with a appl cable laws, ordmances, bui ding code, housing code, and regulations. (Signature o~,~Pp!lcant, or name, If a corpamtlon)- ...................... i~';;~l'' ~' ~j~), e e ~ J~i ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, Rlumber ar builder. .......................... ..................................... : ........................................................................................................ Name of owner of rem m. ~...~ .~.. x~(./~;~.. ~. ~ If Ii I ..................... app cant s a corporate, signature of duly authorized officer. .................. ................... 1. Location of land on which proposed work will be done. Map No.: .................. ' ............ Lot No.: ................ and N,,mber . e-C- Municipality 2. State existing uae a?d occupancy of Preml~and~,,,,_.. ~t;:ded use and occupancy of propaled comtructlon: a. Exlsttng use and occupancy ..............¥.~..~.L. ............................................................................................ b. Intended use and occunan~v' ...~...~~ 3. Nature of work (check which applicable): New Building ~ ................. Addition .................. Alteration - Repair ............ ~ ....Removal ......./... ........ Demolition .................. Other Work (Describe) .................. i ..................... Estmated Costr /~.1.~..~ . . Fee ,/...~.~ . ' (to be paid on fi!lng this application) 5. If dwelllng, number of dwelling units ............................ Number of dwelling units on each floor ............................ If gorage,~ number of ~. ~'... ~. ~' ~t -,S .'/~..(...~....'?~.- :..~'...2..~...~=.. ............ i~' 6. If business, commercial or mixed occupaocy~ ~peci'fy nature and exten,'t 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 ............. ./.~...' ............... ~ Rear ........ ~ ............... Depth ....~...~.. ............... ,,~_ ' / Height ..../......~'.. ..... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 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,~ ordinance or regulation? ............................................................ 13. Name of Owner of premises .~.~..,~...e.~.. .......... Address .~l~..:.e~..~ ...... ..~.~.~..'.. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~..Ji~A~ .~....~.~.~ ........... Address .~.~. ~cr......~..f.... Phone No.-~'~..,~'.....~.'.~.. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat.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. ................ · ;;.~~.....~; ............................. being duly sworn, doposes, and says that he is the applicant [marne of Jndlvidul~slgning appllcg~ .,~D above named. He is the ......................... " ..~.~ ..................... '~ ....................................................... (Contractor, agent, corporate officer, etc.) or have~ ~ the said work and to make and file of said owner or owners, and is duly authorized to perform performed this application; that all statements contained in this app icatlon ar~'i~e 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. Swam to before me this ~ ? ............... o, .............. Noto Public,. ........................ ....... ............................ FORM NO. 6 TOWH OF SOUTHOLD Building Deportment 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: 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 certificate of occupancy $!.00 Date ~ ,~ , l ,~,-c- .~ x r S T-r ~, New Buildihg ................ Addition .d....'.. ......... Old or Pre-existing Building ................ Vacant Lend .............. Location Of Property ....~...b.J~..t2.,Z. ...... / / Owner Or Owners Of Property ....... ~.~'..f'....'~.........../~....~...~.....~... ...................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~7.; .~...~;.~.....Z=.. Date Of Permit ~//..~.~/'.;7...~.....Applicant .~_.~./~..~.£..~......./~..:....¢~...~....~...c.~....~. ............. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ...~..!=./..~..E....Y...~..f,~' ............... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......... ~ .......................... Fee Submitted $ .................................... Sworn ~.~ before m e~i s.~ ........ ~. ..... day of~~..[...~.i,~ ~... .... Notary Public ...~.'.'//.~/..'~. County Construction on above described building and permit meets all applicable codes and regulations. Applicant . ~.~...~....~......'~:...:~?..~ ....................................................... (stamp seal) THE NEW YORK BOARD OF FIRE ,UNDERWRITERS 8, k BUREAU OF ELECTRICITY I~ 85 JOHN STREET, NEW YORK. NEW:~oRK 10038 N 196740 THIS CE~IFIES THAT ~y t~ ~t~ ~u~nt ~ ~sc~ ~ ~ int~ ~ t~ ~t ~ ~ t~ ~ ~ numar ~ t~ p~m~s of Bet~ ~son~ s/side Lup~on~s Poln~ ~.. ~500' e/o ~a~oo~ Ma~tttuok~ L.I. in the fol~ing l~at~n; ~ ~e~nt ~ 1st FI. ~ 2nd FI. ~t~n B~k ~t ~,,~o, ~vembe~ 25, ~97~ ~fou~incompli~cewiththerequire~ntsofth~B~. 3 3 2 3 I ~RVI~ B~N~ ~.~ ' S S E V I C E W, B. Ruland, ~attStuek~ L.I. ~...~TT_TT:.' .. . - . - .... ~ - - COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE ~ST NOT BE ALTERE0 ~ WY ~NER.