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Home My WebLink About7635-zNO. · TOWN OF SOUTHOLD BurLnlNG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No..Z67.~.7. ..... Date ............. 0et.....~0 ...... , 19..~ THIS CERTIFIES that the building located at . .Li.~tle. Peoen&a .~a.y..~A~. Street Map No. ~[&~. P~... Block No ........... Lot No...233..&. 23.~i.. gutChogu~ ....... conforms substantially to the Application for Building Permit ,heretofore filed in this office dated ............. I~QV. 2.1.., 19. ~. pursuant to which Building Permit No..~6.~. dated ........... lio.Y ... 2.1..., 197~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this cert'~ficate is issued is . .I~..~V~.t.e..~..s..~$~;!,1~. d~.e~.~Lng..~$th..~. &~d~t~.Q~ .................. The certificate is issued to .. ~/;I,]~l~ .Boll~an ..... .0wn~r. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...~.,.tt.., ............................. UNDERWRITERS CERTIFICATE No. ~$1~.~.~g ......... : .......................... HOUSE NUMBER .... ~ ~20 ..... Street... ,L~.tf~].®. ]~Ea~ .]~alr. ~a& .......... Building InsPeCtor [ IPOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P]~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHO~,IZED) N? 7635 Z Dote ........................ ik~Ov~.....~ ~, .... 19...7¥ Permission is hereby granted to: l~1.~.e~..~,..~:.t.o~..~.~....,~... ~n~ rn~n ...... ~o ..... ~.~,~..~.. ~.t~l.o~..~,..~,, ~ o~ .. ~3..~ ~e~t,~z...o~..e~& ..~z~e~,~l~ ............ at premises located at ...l.e~.~.~.~.....~e~u...i~~. ...................................................................... ................................... ~ L~L~1.e..£a~ ~ J,~ ..~,~...]~x~u~ ....... (,~ ..................................... pursuant to appfication dated ........................... ~G~'.....&.I ............ , 19..~.., and approved by the Building Inspector. Fee $..$.~0~ .......... I/ FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 1197] 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 .............. L~ation Of Proper~ ............................................................................................................... .~ .................... ~ner Or ~ne~ ~ Pro~ ...... ~(..~..(.~..~ .......... t~..~..~.~..~..~ ................................................... No. Z~:.... Bilk No. -- House No..l~.~.? o, .... ............... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .... .~....CT....~..g./..~......~7.... ............. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $ ~-~'~ nstrucfion on above descr I~/~pb:a~tng a~.~me2 al~c,,,,~,s .an~ regulati:n:. worn ,o before me this'"" .................... ............. o, Nota~ Public ........~/~ .......... Coun~ Dis~ppraved a/c ......................................... INS~ kUCTIONS a. This _ .ol~lication must be completely filled in I~y typewriter o~, in ink and submitted i~ tri~li~:~te to the Bulld~ I nspactor, with 3 ~ of pl~, Occurate ~ ~ to ~.ole. Fee according to ~chedule. b. Plot plan showing location, of lot and of buildings on premises, relationship to adjoining premi~e~ or public streets areas, and glv~a detailed clescnption of layout ofprc~erty 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. UP°n 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 impection throughout the work. e. No building shall be occupied or used in whole or in part for pny. puq~ose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. B iAIdPiPnLJ 'CATIC~I- .IS HEREB, Y..MA_DE to .the .B~.il~.ing_ .De.l.~...rt_ment for the issuance of a Building Permit pursuant to the~ ~u, a~r~.. ~on? u?. ,nance. or ..me ~,?n.,o.t. ~um?.~.,. buttOlk .County, New .York, and .other ~dlcab~ ~egumt..mm, .~or me C.onstruct~.on or. ou!!ain~.., ,a~a. i~ons or a. lterations, or ~or removal or demelitim, as heroin describec[~ aam t amnonzea i~oectore on premises ar~ in 13Mil~ln~ ~ r~e~ary inspections. (Signature of applicant, ~r n~n~, if a c:ol~orationj ~ ......... ............ ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· .... ................................................................................................................................ , ................ Name of owner of premises ../~./.~./,Z..~../1.....~,....../~.~/~i:~.~. ............................................................................................... If applicant is a corporate, signature of duly autherized Officer. - · ........... ....... (Name cm~ I~l~'of coq>orate officer) Builder's License No ...................................................... Plumber's License No ........ .~...~..~....~.. ......................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ....... L~.~.. ......................... Lot No 2;'~',~ State existing use and occupancy of premises and intruded use and occupancy of proposed construction: a. Exisiting use and occupancy ........................................ b. Intended use and occul~cy Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ....... ~. ........ Repair .................. Removal .................. Demolitior, .................... Other Work ................................................ ~. ~ ~ (Description) 4. Estimated Cost ........ ..~/..~..~...0.1....°~... ............................... 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 ....~.~..~...3:..~:. ............... Depth .~./..~.~..~.~ ........ Height ......3t.~,~ ............ Number of Stories ~- ' Dimensions of some structure with alterations or additions: Front .... ,~,,~,,,~-. .................... Rear ............................ Depth ........ .~../....~. ............. Height. ...... ;.~...~ ........... Number of Stories .....3=..; ....................... 8. Dimensions of entire new construction: Front ..~..~ ............................... Rear ~.'. ................... Depth ..~.~/.....~ ............ Height ...~/..7../. ......... Number of Stories ....x/. .............................................................................. i ...... Size of lot: Front ....... X..~....~. ....................................... Rear ....... .~..~).~. ........... ~ ............. Depth ................. .~.~...'.,~/.... Date of Purchase .....~..~.~../..&'.,~.~.~.~'.~. ....................... Name of Former Owner .......... ~.~...~...~..~,~. ................................... Zone or use district in which premises are situated .../~..~'/.A/F..~.T.Z,f~.. ..................................................................... Does proposed construction violate any zoning law, ordinance or regulation: ..~..f?.. ............................................... Will lot be regraded ~.A..~T.../~.~..A./~'.. ......... Will excess fill be removed from premises: ( ) Yes (X) No Name of Owner of premises .~..:.~/..,~...~..A/~....~/~.. ............ Address .1~7.....c~..~.~..~..~.. ......... Name of Architect .............................................................. Address .........................Phone No ...... Name of Contractor .~.../..~.~.~. ~..~......~...../'~...O...,~...~...~.. ............... Address ..~.~..~..~'..~..~.~..~.. ........ Phone No..?~..~....'~..~.~....'~.. PLOT DIAGRAM Locate clearly and distinctiy 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. 11. 12. 13. 14. ST^TE OF NEW YORK, COUNTY OF ................................ ........................................................................................ : ........ being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) 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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ ............................................ .,, ........ .............................. . Notary Public, .................................................... County .../~... '(S g · of appflca~[t~//