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Home My WebLink About7611-zI~O~M NO. 4 TOWN OF $OUTHOLD BU~.nINC DEPARTm~IT Town Clerk% Office Southold, N. Y. Certificate Of Occupancy No. Z6~0~' ...... Date .............. J. une .... .~ .... , 19.?.% THIS CERTIFIES that the buildinl~ located at . Capt. KtAd. D~.lve ......... Street Map No..Capt .Kidct Block No ........... Lot No.. 162 ...... l~at~titucl~..N,N, .... conforms substantially to the Application for Building Permit heretofore filed in thi~ office dated .........0c.t .30 ...... , 19.7.1+. pursuant to which Building Permit No. dated .........0c.t...~CI ..... , 19.71+., was issued, and conforms to all of the require- ments of the appllcable provisions of the law. The occupancy for which thin certificate is issued is priva.~e · or~e. family- c~we!-l..i~g .wi%{~ -an- ~ddi%.ion ................... The certificate is issued to . OhrX,tos. · .Fleeeas ...... Owne~, ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N.,li o ............................... UNDERWRITERS CERTIFICATE No. Il,ii. ....................................... HOUSE NUMBER....~.~0 ....... Street .....Capt. l~tdd, l~iv~ .................. .... ........ ~ NO. ~ TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? Z Permission is hereby granted to: ....... X~..~ ...... lmg..aa~£o:LIt ........... to .....~.....~...~,$~....(~....t..$..o.....W/. J*...o~..~.)......q...e.~r;[~.t~tag..4~.e~[ ............................................ at premises located at ....],o.t,..~ .............. ~dltLK,tdiA..Fd:fr, at~ ................................................... .................................................. Ca~t..~..~zL.~ ............ l!a~t~ ........................................ pursuant to application dated ...................... O~t~ ......... ~ ............ , 19.~..., and approved by the Building Inspector. Examined . ~ Approved ........................................ , 19 Permit No. Disapproved a/c '"~'7-'""~ ............ (Bu,lding ,nspectorJ APPLICATION FOR BUILDING PERMIT ~'~ INSTRUCTIONS a. This application must be complete y filled in by typewriter or in ink and submitted in triplicate to the Building~ Inspector, with 3 sete of plans, accurate plot plan to scale. Fee according to ~chedule. b. Plot plan showing location of lot and of buildings on premises, re ationship to adjoining premises or public streets areas, and giving a detailed description of layout ofpreperty must be drawn on the diagram which i$ 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 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. I~ .A,P..PLI ~CATION IS HEREBy MADE to the Building Department f6r the issuance of a Building permit pursu..ant to the ~uaiar~tior~sC~. ~orO~hdler~connC~tmOtct~ho~ ~T~ov~.n.,o~__So_ut_h~o~L' Suffolk ,~ou.n. ty, New ,York, and .o. ther.appl.i.c, able Laws, Oral,nonCes The onnlic~'nt anrees t~ ~,~,1,, ,~y~..,__a~_~_o~.._s or a~jrera,ons/o.,r.Tor re .may.al or aemohhon, as herein described.~ j ._~'- _. . =, . ~ ~'"~"I -'--' ,u,, ul.~,m-uu:~ ~uws, oralnances, OUllalng coae, rlousJna ccKJe arid rm~dnt aamlt Qurrlonzea inspectors o~ premises and in buildings for necessary inspections. -- ' -'- '-" ....... ' ......... ....... ............... ~gnature of applimnt~r ~, If ~ ¢o~*orati~;~'i ........ ...................... '~^d~J~ o~Qpplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~ ..~...~ ..... If applicant is a corporate, 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.w bedone MapNo ./..~ 7~,.~ LotNo /~ ''~ Number .~f~.~ ~ ~ · 0 r, t ~'~ Street and ..... te ............. ~.. .~. .~... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructian: a. Exisiting use clnd occupancy ....... ~......~.~..~......~ : ...................... b. Intended use and occupancy ................................................................. ~ .................... : ................. 3. Nature of work (check which applicable): New Building.· ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... ~ (Description) (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 6r mixed occupancy, specify natUrb 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 ...................................................................................................................... Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ........... .~.....~. ..................................... Will lot be regraded ....~..~) ............... Will excess fill be removed from premises: ( ) Yes! ( ) No Name of Owner of prem,ses ...~....~....~. Address. , .~. ............. Pho~e No ....................... NOme 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-bock dimensions fram property lines.' Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 10~ 11. 12. 13~ 14. STATE OF NEW Y,,~I~I~'../".j~' icc ....... ~.-~.....:...._~ .............................. being duly ~worn, d~oses~nd say~ t~t ho i~ the opplicom ~ (N~vi~ning contmc0 aboge nam~. ~ He is the ............. ~ ................................................................................................................................ (Contractor, agent, corporate officer, ~c.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t all statements contained in this application are t~ to the best of his knowledge and belief; and tha~ the.work will be performed in the manner set fo~h in the application fil~ therewith. Swo~re me this ~ ~ ~ .................... ....... ... Nota~ Public,~.~...~n~ ...... ~ ...... ~....,.~ ............................. ~ (Sign~ of applicant) JUDITH T. BOKEN Notp~ Public, State oF New York N~. 52-~344953 Suffolk County ~ Commh~ion Expires March 30, I~ 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 end 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 Date .......... ./ New Building ................ Addition... .~.......,... Old or Pre-existing Bu' ding ................ --Vacant Land .............. Location Of Property ~5~..~.~...~..~!~.~..~.~...~D..~t.~¥~..~:~..~..~..~.~.x~{.~/..~ ......................... Owner Or Owners Of Property .~-~./~l..r:..~:.4~'~..4 ........ .~...~..~..4..~..~..~ ............................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.; .~/r././..':~,,~.... Date Of Permit ./...O./...~..*/.~.~.Applicant ...... .'~..?...~...~. ... .. ?../57.¢. ..o...~. ../.. ..................... Health Dept. Approval .... ,dZ.../~. .............................. Labor Dept. Approval ..... ...~...:..4.~. ............................. Underwriters Approval ..~'.;:..~ ................................... Planning Board Approval .... /..~..,....~......~. .................. Request For Temporary Certificate ........................................ Final Certificate ......... ~ ........................... Fee Submitted $ .....~'.~,.0...~ .................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .......... .~t<~,~-~.....~/or~...., ................................................ Sworn to before me t~'~ ~/ ~? ............ ~day of ..~;~/~, .......... (stamp or seal)