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Home My WebLink About7593-zTOVN OF SOUT~OLD BI~m.nlNG DEP~ To~m Cl~rk'~ O~im Southold, N. Y. Certificate Of Occul ncy THIS CERTIFIES that the buildin~ located at .E~.l$~h .&. ComfOrt .a~. ...... Street ~ No. ~ ......... BI~ No..~ ...... ~t No.~.. G~or~. ,N,~.. ......... ~ .......... 0c~..16 ...., 19.~ ~t ~ w~ B~ P~ No. 7~' · ~ ........... 0e.t..16..., 19..~, w~ ~ ~ ~o~ ~ ~ ~ ~ ~ m~ of ~e ap~Me pro~o~ of ~ ~w. ~ ~ for w~ th~ ~fl~ ~ ~ ~ .. ?~$V~.~. ~ .~?. ~.. (~eb~t) ........................ ~e ~c~ ~ ~ ~ .. E~e~..~z~fe~ ....... ~ .................... (o~, l~ ~ ~t) of ~ ~d ~. S~o~ Co~ ~~t of ~ A~v~ p~ .e~t~ .................... ~~ C~I~ No, . N2t~ ...~..~6.. ~ 9~-~ ............... HOUSE ~ .............. S~t .......................................... FORM NO, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7593 Z Permission is hereby granted to: at premises located at .~-I~/4 'r/~ ~'-/' ~' ~/~'W ! h/ ~"~ ~'EE 7 ..................................................... ~.~:.~..,:.~..~.!..e.~ .............................................................. pursuant to application dated ....................................... ./...~.......~..C.~ 19..7....~... and approved by the Building Inspector. F, .... Building Inspector 0..This ...a~l. icotion ,n(,ust be completely ill!ed i~_t~_v4riter or. in !rd< and submitted in triplicate to the Buildit)g inspector, w~ ~s sete at pm~s, accurate plot plan to scale. ~as according to schedule. b. Plot ~ showing location of lot and of buildings on premises, relationship to odjo n ng 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 cOWred by this application may. not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bu~ dng nspector w issue h Building Permit to the app cant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used ,n whole or tn part for any pl4rpose 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 Permit p~!_ .m~t to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and omer~ ~ ~ or Regulations, for the construction of buildings, additions or alterations, or for removal or, lan, as ~ described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, end ~, and to admit authorized inspectors on premises and in buildings for nec~e.s, sary insp~:tions. Io. S- I ~ ~ ?-----~o ~ '/~ ~' . (Signature of applicant,~j~ ~'r~ if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~ ~ / '"' ~ ' /: ~' '~ /~ :'/': /\ ' t ~ " If applicant is a corpor~fe, 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.: .................... : ................... Lot No. - ............................................................. ~ ........................ ~.....~.... ~...,~.,.l ...... ,.,..,.,~.,./.... MuniciPality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~'-7~ ~ ~ ..... ~ ~ . . ~. o. Exisiting use and occupancy ............ ~ b. Intended use and occupancy ..... ;...~. ,. .................... .~....~ j.. ~ ~ ..'.~ ~:~ ........... 3., Nature of'w0rk (check which applicoble)~ New Building.. ......... ~.. Addition ..................Alteration ........... ;~ .... .. Repair .................. Removal ............. . .... Demolition ........... z~ ....... Other Work ................................................ . .... ~ ~ '~ -~ ,. (Description) t f t f 7 4. Estimated Cost ...................................... ~ ..................... Fee .................... ~ ..................................................................... (to be paid on filing this application) 5. If dwell!ng,, 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 ............................ 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 .................. ./..~../...{.' ....... ;.i..?.. ............. Rear ..:,,..~ ....... /...z.;Z..../.L.,,, ..... Depth ..C./[/.,:.~ ...... z.~..,..,4,; 10~ Date of Purchase ....................................... ../...;!..:i.~/....Nome 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. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ~ 14. Name of Owner of premises ...~ ...... :~.:~..). ........ .~.~......~....':..:.,: ...... Address .../~.;........'.r.~..~,.~,.~.. ~ 'No'..~......~ ...... .~..~./.... Name ofrArchitect .............................................................. Address ................................ .Phone No. ...................... Name of Contractor ............................................................ Address ................................ Phone N° ....................... .. 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 corner lot. STATE OF NEW YORK, COUNTY OF ........ ;. ...................... ............ ; ............ ~..~..?..,~.,!.~.! ............ '.....;...;:;..~;...~..~.;.....~ ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract~ above named. He is the ..................... :.; .................. ; ........... ./..'.'..';....~ ...... !~.(....;.:....'~ ...................................................................................... (Contractor, agent, corporate officer, etc.) of said owneror owners, end 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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ .... ! ~ day of ..................................... ~...., Notary Public, . ...................... 'z.'_'~ .............. .......... C-~un~y '''~ JUDITH T. BOKEN NokJ~/Publl~ ~tate of New york No. 52-~J~ Suffolk County ComrnlsH~n ~[;~r~ ~ 30, ~9~ FORM NO. a TOWN OF SOUTHOLD , Building Dopor~ment 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 $1.00 New Building ................ Addition ................ Old or Pre-existing Building ...... ~ ....... Vacant Land .............. Subd v s on ................................................... Lot No ............. Block No ............. House No...~'~..z./ Underwriters Approval .~.......C.!~.5.~'..1~. .................... Planning Board Approval X~'. ........ Request For Temporary Certificate ........................................ FinoJ Certificate ..~..~../..../~....~...~.-~ .............. Fee Submitted $ .......~.....~. ................. Bar Harbor ~sq. ft. of Jiving area (first floor FEE - ED Amerk'a% all thn- /ay >rzr~- pensive, with a pleasant HOME S