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Home My WebLink About7603-zNO. 4, TOWN OF SOUTHOLD BUH,BING DEPARTM~.NT Town Clerk's Office $outhold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the building located at 'Ack,fly' 'Pond' 'I~1~' ' . .- Street Map No. ~ ........ Block No... ~ ..... Lot No.~xx. '8out;hold' · .l~ ,¥.o. .......... conforms substantially to the Application for Building Permit heretofore filed in tht.~ office dated ............0o'~. · ~.~., 19. ?b~ pursuant to which Bailding Permit No... ~60~Z dated ..........0c~..2~ ....., 197~., 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 . Ag~ieutt~tr~t · acee s so~y(ta, bo~ 'e amp .bX~g). ~mildi~g. w~. a~d !tio~ The cert~icate is ~sued to. S~eve. Doroak~A· Pz~xtuoe .Ine' - · O~me~ ............... (owner, lessee or tenant) of the a~oresaid building. Suffolk County Department of Health Approval . .N...R.: .............................. UNDERWRITERS CERTIFICATE No. M.~ ....................................... HOUSE NUMBER .............. Street .......................................... Building Inspector FOU.M NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIC~ SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7603 Z Permission is hereby granted to: pursuant to application dated ~ ~ 0~ 19ZL./.., and approved by the Building Inspector. Building Inspector TOWN OF SOUTHOLD BUILDING DEFAtiTMIHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 7 z_ ........................................ No ..... Disapproved o/c~.., ........................... ................... · ....... ~' CBuildi~ Ins~ctor) APPUCATION FOR BUILDING PERMIT INSTRUCTIONS Application No. 7& ~'~ a. This application must be completely filled in by typewriter o~ n ink and submitted in triplicate to the Building Inspector, with 3 sm of plans, accurate plat plan to scale. Fee according to schedule. b. Plot plan showing location of lat and of buildings on premises, m at onship to adjoin na premises or pub lc streets o~ areas, and giving a detailed description of layout ofpmperty must be drawn on the diagram which is port of this application. ¢. The work covered by this application rnay not be commenced before issuance of Building permit. d. Upon approval of this application, th.e Building InspectOr will issue a 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 t~e .issuance of a Building Permit pursu..ant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, 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 applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ir-~oections. (Signature of applicant, or name, if a corporation) ..... ....... , ...... (Address of ~pplicant) ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises. ~ [/~- -~0-('~ 0--~ If applicant is a corpa/bte, signature~of duly authorized officer. (Name and(J~tl~of corporate officer) Builder's Liconse No ..................................................... Plumber's License No. ,,,JOHkl ~V'/tLTE~-~ Electrician's License No ...... ...~...~..,~.~,~. ......... ..~....)~....L.....Lrr~. Other Trade's License No ............................................... Location of land on which prop?~_d work will be done. Map No.: ................ ~ ....................... Lot No.......~... ............... Street and Number .............. /~(,~..~...~....L...~.. ......... ...~..~....~..1~. ...... ..~.....0...~....~..~. ............ ...~...0....U...T..~,~..~.....~.. ............. / Municipality State existing use and occupancy of premises and intended use and occupancy of propased construction: a. Exisiting use and occupancy ........ ..L:...~.....-'~...0.....~... (~1~-~ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... / .~ ~ (Description) 4. Estimated Cost .................................. .-...'".-'.'..............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 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 ................._~..~.....?.....A.~ .................... Rear .......................................... Depth ................................ 10. Date qf Purchase ........................................................ Name of Former Owner ....;~yg ................................................ 1 1. Zone or use district in which premises ore 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 " ~' ~ ~,O0 14. Name of Owner of premises .......~....~..~...'~....0....-~...~...l ........... Address ..~......~..,.~.....~ P~ No. ...... ~ ............. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... 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 NE~V YORK, I ¢ c COUN** OF ............................ ...................... ~.,~,..:.....~.....~...(~,.......~...U....../......~.....'~.. ................ beir;g duly sworn, d~es and says t~t he is the applicant (Name of i~ividual signing controcO above name. ~o~ ~ OPFI~ E~ He is the ............................................... ;~ ........................ y-.~ ........... W: ......... 7"~ ............................................................... [~ontrector, Qg~, corporate OTTICer~ of said owner or owners, end is duly ~uthorized to perform or have performed the said work and to ~ke and file this application; t~t ~11 statements contained in this application ore tree to the best of his ~owledge end belief; ~nd tho~ the work will be performed in the m~nner set fo~h in the application filed ther~ith. Swam to ~fom me this .................. o, .................................. Nohow Public, .......... · : ....................... ...... ..... ............................ 02b ' Sar olk C I~OR~I 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: 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 .............. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ............. ..~....~ ............................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Finctl Certificate / Construction on above described building and permit meets all applicable codes and regulations. Applicant .....~....;;~....7~....~.~.....%/"~...~...r,~.....,~...~....,~....~.../. ..... .~....~...~...~...4~...~...~.~.~./...../. ~..(~. ,. Sworn to before m is ~ ~ ~_~, NoraW Public