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Home My WebLink About7654-zI~.M NO. 4 TOWN OF SOUTHOLD BI.11T~DINC, DEPARTMk'~IT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupnncy THIS CERTIFIES that the buiJd,ng located at. ~p. F~tneol&. ~4. ~~) Map No..C~ .M~ No ........... ~t No.. ~... ~tti.tu~.. ~,~.~ ....... co~o~ subst~y to ~e AppHca~on for B~g Pe~t he~fore ~ ~ t~J, o~ da~ .............De~..9.., 19.~. p~t ~ wM~ B~dlng Pe~t No...7~ da~ ........... Dee...~2--., 19.7~., was ~su~, ~d ~o~ ~ ~ of ~e ~ men~ of ~e app~b~ pro~o~ of ~e ~w. ~e ~p~ for wM~ thi~ c~ ~ ~u~ h .~rlvate. ~e. f~lF. ~e$$~. ~. a~ition ...................... ~e ce~ca~ ~ ~u~ ~ Ric~ond. D.o~ .Jr ..... ~e~ ....................... (o~, le~ or ~t ) of ~ ~o~d b~d~g. S~o~ Cowry Dep~ent of Hed~ Approval .... N.~, ........................... ~~S CERT~ICA~ No..~ ................................... HOUSE ~ ...... ~6.~... S~t..C~p .H~eol~ .H~d ................... ........... FORM NO, 6 TOWN OF $OUTHOLD 0 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 disposol--(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 os 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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Location Of Property ,~,=-~ ,~'-: ,4//,'f,~ )~,~ (,4,~), / ,~,~ 4?) J~-~T~ J~ ' Owner Or Owners Of Property ~ ~c/~ ~ ~ ~ ~ ~ L/~',,-,~ ..... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. .L/: ./. ' ' ' Permit No. ,.~..~A~.~. ........ Date Of Permit ,./. !. 7,~.~,,...,Applicant /)[.~./:.~....~.,t.~..~.2..~..~.~..~..g..~.'.~,,~.~..7£,.>.[ ......... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate Fee Submitted $ ~ ~ Construction on above described building and pe~:;it ets/q11 applicable codes and regulations. _ Z_J ....................... ,7 ..... ............................ Applicant Sworn to before mo this /~ff_30 If?3- ........ day of .~.~.~e... ~'.~..2..~.....~' (stamp or ,eo,, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PEWIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL EOMPLETION OF THE WORK ^UTHORIZED) Ne 7654 Z Permission is hereby granted, to: ..... ~..~......t...o...3 .................................................. ............. ~..¢o.>.[~.,~ .......... //~.~.! .............. to ....j~?.!.? ~ ~..~. ...... /~.~.~ ~ ~..~.~... 0 ~..... ,4 ~ L'.X.,.~ rz. ~ .~. ~.u;.~ ~.u ~ ~ at premises located at ;..~/..~......~..~.(~..~../~].~./).~-~.---.5~-.~7.r-~.....~O-J~:~· .......................... .................................... ~.~..z.....z...~..~...~. ............ .~..~, ........... ~ ............................ : ....... pursuant to apphcat~on dated ................ ~ ~., .......... 19 )~ and approved by t e Building Inspector. FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........................................ , 19 .... Permit No .................................. Disoppr~oved a/c .... · ', ............... : ..... ' .......................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date December gm ,, _ 74 ~ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the BuildingS, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot I:fi'an showing Jocation of lot and of buildings on premises, Felationship to adjoining premises or public streets or areas, and giving a detailed 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 approval of this application, the Bdild]ng 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 the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings additions or alterations, o¥ for removal' or demolition, as herein described. The oppl cant 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 inspections..: (Signature of applicant, or name, if a corporation) B & G Builders & Contractors P.O. Box 103a Rfverhead, N.Y. 11901 (Address of applicant) (Name and title of corporate officer) Builder's License No. ~.f~,11~..~.p~l..f~.d. .Q~ ............. Plumber's License No ................................................. Electrician's License No ............................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... .u...J,..Z...d..e. .................................................................. ; ............................................................................................ : ........... Name of owner of premises ...~..'.%.g..h..~..o...~...d.....S...*....C...o..~...~..~...~..L.~.~..... .......................................................................................... If applicant is a corporate, signature of duly authorized officer. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: ........................................Eof No ......................... Street and NumberP`.~.f~.Y.f~;.~.Y..~.*~...~.`1.~.~.~....~.~..q.~.~...~$....C...a`..m~.~.~.~..~.~.~.~.~...~.~.~..~.~z ..... ~ ~6"~) Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~.~...~9~e .......... ~' ~ .............. b. Intended use and occupancy ...~r..~.~ ~0~.~ ~ ~ :~ ~ ~::~: :~: ~j~:~:~:~j~ .............. ~ ~, Nature of work (check which applicable): New Buildings. ................. Addition..............._.XX Alteration .............. Repair .................. Removal .................. Demolitio~ .................... Other Work ................................................ - d~ (Description) 4. Estimated Cost . . .$. . .1: ~. . .5. .0. .0. . :. .0. . .0. .................................... Fee ..... L~. ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on 'each floor ............................ [f 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 ..... :3.0. .................. Rear ...... ,303 ................... Depth ....~.! ......... Height 23t Number of Stories ...... ],~ ......................................................... Dimensions of same structure with alterations or additions: Front ........ ~Q ........................ Rear ....... 30.! ............... Depth ...4~.~. ....................... Height ...... 2.3. ................. Number of Stories ........ .1~ ................... 8. Dimensions of entire new construction: Front ..... .5..~ ........................... Rear ..... 5.! ................... Depth ....~Jl~... .... .,~..~_. Height ,,~11~.,.....~...,/. Number of Stories ..... · ............................................................................................................. 9. Size of lot: Front ..... 6ID.! ............................................. Rear ....~t0.~. ................................ Depth ..:LT.Q.~. .................... 10. Date of Purchas~ ..~.¢;.¢..~,...,1,.9."L4 .............................. Name of Former Owner 11. Zone or use district in which premises ore situated ...... .~. ............................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ....N..o. ................................................. 13. Will lot be regraded .......~.0. ................ Will excess fill be removed from premises: ( ) Yes ( ) No · · it' 98-4920 14. Narne of Owner of premisesg'~hm~D.d.~`q..~C~.~w.1~n.~J~`ddress~vI~.~$~.u..c..'k.~.N.~t~ ,Phone ~o ....................... Name of Architect ....... .N...o..n...e. ............................................. Address ................................ Phone No ....................... ' B & G Buil- r P,O. Box 103, 727-4631 Name of Contractor ........................ .q.~,..~ ....................... b~kJress ............................... P, bgne No ....................... '" Kzverne&dt N.~. PLOT DIAGRAM Lo,ate clearly, and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from propcrty 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 .~OP~'.///~.4/ . lc ~ ................... ,.'~ ........................ . ................................................... being duly swom,~deposes and says that he is the applicant (Name of individual signing contrac¢ 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 ali statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to b~f~ me this .... ~ .s ~arct 30,