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Home My WebLink About7644-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. g66.8.0. ...... Date .............. l~ep.~.....~.~..., 19..?~ THIS CERTIFIES that the building located at P. Vg. :~oad. ~. 12 ............ Street Map No.. ~ ........ Block No.. XX ...... Lot No, .~..8o~ghol~L..N,~/., ......... conforms substantially ~to the Application for Building Permit heretofore filed in this office dated ...............Nov~,..2919. ~.~ pursuant to which Building Permit No.. 76.b~Z. dated ........... .~.o?... 29...., 19..~.lf., 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. rivate, one. family. ~lwellimg.. with.,addition. &.alter. atlon... The certificate is issued to H...~..~. ~i.~ .~.V.O.i$ ..... .~.~.r.a .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~.,.R.,. ............................... UNDERWRITERS CERTIFICATE No. P.~g .................................... HOUSE NUMBER ... ~2~ ....... Street ...P~,..1~4. ~..t~ .... 80~.t~l~t ............. Building Inspeeto~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OF~elCE SOUTHOLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 76~4 Z Permission is hereby granted to: .... ~L.~...~~. ....... .,.:..,..~.,.~..~.~..!..?.. ............ pursuant to application dated ............................. ,~...?........~...~...~.i...., l~...t./. , and bpproved by the BuildincJ Inspector. Fee $ ....... l...~ .......... Building Inspector, FOI~ NO. S TOWN OF $OUTHOLD , Building Department Town Clerks Office Soutbold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfrucfions 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 Beard of Fire U~derwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installatlons, a certificate of Code compliance from thee 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 $1.00 Rte ..... ~(...:../. · .S..T. :..~ .~ Zi ............. New BHilding ................ Addition ................ Old or Pre-existing Buil?ing ................ Vacant Land .............. · ocatian Of Property ...... .......... ................................... Owner Or Owners Of Property ....,.,../....?....~..,.......'~...Z.?.$..c..'./.....~...~...~..J... ........................................................ Subdivision ................... .7.~..T ...................................... Lot No ............. Block No ............. House No...,......... Permit No...~...(L.f/....~/;...Z. Date Of Permit/./..T.?'..~T..7..~,Applicant ,'~...~.....~.../..~/..¢~...~....~...~..~.i.:. .......................... --" Health Dept. Approval ........................................... Labor Dept. Approval ................................................ Underwriters Approval ..... /J~./..../..'.~. .......................... Planning Board Approval ............ -::~ ........................ Request For Temporary Certificate ........................................ Fin~ Certificate Fee Submitted $ .......I ......... L ................. Construction on above described building and permit m,eets all applicable,codes and regulations. Applicant .... ./,~..~1 ............................................. Sworn ,o before me this Y71/>71 (stamp or seal) Y.~~C~ 8k THE NEW YORK BOARD OF FIRE *UNDERWRITERS. BUREAU OF ELECTRIC~I~, ~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 ~,.,ovember ~3, ~v7~ ~,,~.,,o.~o.o.~,,~ 75~,~T ~ N 193897 THIS CE~IFIE$ THAT ,e~be~t ~lnOVel~s F~. ~Qs opp.~ate~lew ~rives uay~ Rd. 8mlth & Ced~ Rd., Sout~ld,L.I. inth~foll~ing~at~n; ~ ~,~t ~ i,tr~. ~ e~ r~. outs/de s~io, ~ exami~ on ~ovembe~ 11, 19 7~ ,~/oun~ to be in complia~e ~ith the ~qulrements of th~ ~. RXT~ RXTU~S ~ ~1~ D~KS O~S DISH W~l~ *~HAUST FANS ~T~S I~A~S SWITCHES ~DE~ FL~RE~E~ ~ ~T, K, W, ~T. K, W. ~T, K,W. ~T. K. W, ~T, H.P. I M~ER 1 100 CB x 1 3 1 3o~t~ld, L.~. 11971 am,n .................. '7...Z.. Approved ................... ~.~---~'--...-.!./...., 19....Z Permit No..Z. ................... L ......... Disapproved a/c [ APPLIGATION FOR BUILDING PE~J~IT ~,, Date .................. ' ........................... INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building"~ Inspector, with 3 se~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, re at onship to adjoining premises or public S~reets or areas, and giving a detailKI description of layout ofproperty 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. Upon approvaJ of this application, the Build!ng Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspechon throughout the work. e. No building shall be occupied or used in whole or in pa rt 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 Permit pursuant to the The a--licant --r ............... -qr;,: --. · o a.. rat ons/ or mr mmovm or aemolition, as herein described. , *. w , . ~. ~ ,~ comp*y w,m a. appncao,e laws, ora, nances, r)uildlng code, housing code, and regulations, arid to onm~t autnonzeo inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ~ / / . (Address of applicant) . ,.., State whether applicant is e~ner, lessee, agent, architect, engineer, ge eral contractor, electricmn, plu/m~er or builder. Name of owner o~ premises ........................ ' /L If appf~a~t is a c~Prporate, signature of duly authorized officer. ........... r(Narne end ttle of corporate officer) '~uilder's License No. Plumber's License No. !Etgetricion's ~c~nse No. /' ~'~ Trade's License No ............................................... 1. L~ation ~f Ipr~l~ on whiCh proposed ~ will be don_~. Map No .. ...'~. ....... ~. Lot No~ '- Street and Number ~..~...,-~' .. ~ ~ ..... /~ ~U'~I~ · ~li~ State existing use and ~cu~ncy of premiss and intended use and ~cu~ncy of p~d c~tion: b. Int~d~ use a~ ~c~ncy ~' ' ~t~ t'~ A~ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .................. Repair .................. Removal 7 ................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ............................ :. ......................... ......Fee ........................................... ~ .............................................. (to be paid on filing this application) / 5. If dwelling, number ef dwelling units ............................ Number of dwelling units on each floor ............................ if garage, number of c. ors ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............. ~ ............ 7. Dimensions ~of~ex~ting 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 ........................................... '~ ............ Nome of Former Owner ...... .f../i..~ ....... ~.~..~. .......... /../.~.....:?././.: 11 Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13 Wil lot be regraded ................. .; ........ Will excess fill be removed/frclfn premises: ( ) ,Yes ~ ~1'~o 14. Name of Owner of prem ses .................................................... Address../ ................ ~ ....... ~... Phone No. ...................... _ Name of Architect .............................................................. Address ................................ Phone No ....................... 'Nar~e of'Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or omer lot. STATE OF NEW YORK, / COUNTY 9F/ ................~., ............. .................. r ............................................................................... 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 ~aid 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 Jn 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 JUD,rTH T. BOKk-N (Signature of applicant)