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Home My WebLink About7655-zNO. 4 TO~//N OF SOUTHOLD BUF~.BINC, DEPARTMI~NT Town Clerk's Office Southold, N. Y. Certificete Of Occupency No...~. 9~.~. ..... Date ...............~..1'.....~ 9. .... , 19.~.6.. (Pvt.~ ~) THIS CERTIFIES that the building located at ....C~-y. Czeek. ]toa~ ..... Street Map No. II.okra. 0.,~ ,A l~lock No ..... ~ .Lot No, Zxx...6~Lthold...11 ,]~.o. ......... conforms substantially to the Application for Building Permit heretofore filed in thj.~ office dated ...........Dec..l~ .... , 19. ~. pursuant to which Building Permit No..?6.~g. dated ............D.e.q..9 ..... , 19...~., 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 Private..one..femaLe..~I~.~I:LZUl..~Zth. ~L.t~tem ....................... The certificate is issued to . Ch~.~,e~l..&...Cta~.. ~31~;. .... 0~1~$ .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N..,.R.,. ............................... UNDERWRITERS CERTIFICATE No...II.,.R.,. ...................................... HOUSE NUMBER ....67~. ....... Street .... ~,.e~..C~.e.e.k.. ~.e~l..(..l~t..BAt. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7655 Z Permission is hereby granted to: .......... ~Wz~. ~. z ~;-~. . . . . . .,a ...... ~ ~. .Ae. ~ . .T. . ....... to ..~.~).; ....... O~,~..7.a......A.....,.~..~i.¢,~.-i~E ...... d)~ ~..-... F;a+q -~ *~'f ........ ~ t~E"kc't'tv'm ...... at premises located at ......... ~,7-.~.- ......... .~.~>.t,I/-.~.~. ...... .~4.~) ....... J,~- ......................................... ............................................................. ~.t~..C...T..~ 0.~.~.>. .......... At....Y.: ............................................. pursuant to application dated ..................................... .~....~)/.~_~..., 19~..~.., and approved by the Building Inspector. Fee $.../~....;~... ......... TOWN OF $OUTHOLD , 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: ]. 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 oil 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: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existim:j dwelling or land use $5.00 3. Copy of certificate of occupancy $l.00 ................................................ / 76 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...q.o...~.~..?...?...~.?...e.?...~. ....... .~..~.~'.~.~..~..[.`.~.~..~.e`..~.?..~..~..~..~..~..~`~...~..~..~..?....~..~.?~ ...................... Owner Or Owners Of Property ....... ?..~?...~..e...e....~.C..§.?...o.~...~..~.~.'9. ............................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit N .d~..?.....~.~.~',.~... Date Of Permit ...~-8~.~..]..Z~.~App icanr .~?~..~.~,~.l.~...~..~..~.~:..~.; ...................... Health Dept. Approval ...... .~.../...~2. ........................... Labor Dept. Approval ......... ~.:...~.. ............................. Underwriters Approval .......... .~:. ................................ Planning Bo~rd Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate Fee Submitted $ ....:~.....,~..~C~,~ ................. Construction on above described building a~e:~, m~eet:l aP!~odes and regulations. App,,cant ...... ...................................... Sworn to before me this ........ day of Notary Public ~~~. ~',~..._.. County (stamp or seal) ....................................... :, 19 ........ Pe~it No ..................................... (Buildi~ In--tar) APPLI~TI~ FOR BUlLDIN~ PE~IT ' . Thi, must completely fill~ in by ~ewriter o~ in ink a~ s~m Insp~tor, wi~ 3 ~ of pl~s, ~curate pl~ plan ~ ~ale. F~ occo~i~ to ~h~ule. b. Plot plan ~ing I~ati~ of lot and of buildi~s ~ premiss, re at ons~ip to ~joining premi~ areas, ~ givi~ O detail~ d~cripti~ of l~ut ofpr~e~ must be drown on the diagram which is c. ~e wo~ c~er~ ~ this a~lication may n~ be Gommenc~ before issuance of Building Pe~it. d. U~ appeal of this application, ~e Buildi~ Ins~tor will issue a Building Permit to the o~licont. shall ~ k~t ~ the premis~ available for ink,ion th~ghout the ~rk. e. No building ~all ~ ~cupied or u~ in whole or in pan for any pu~ose wh~er until ~ ~ific~e of ~cU~ncy s~all have been gmnt~ ~ the Building Ins~tor. of ~plicant, or ~me, if State whether applicant is ~ner, les~e, agent, a~hitect, engineer, general contractoc electrician, plumber or builder. Name of owner of premis, .~:~.....5 ~- '' ' : ....... . If applicant is a co~orate, signature of duly authoriz~ 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 I ,be done. Map No.' .. Lot Street and Number ........ ................................... , ........ ..... ............................................... 2. Municipality State existing use and occupancy o,f.~remises~ ~ ~. 'and intended use~ond occupancy of proposed construction: Ex st ng use and occupancy ..~.....~ -- . ............ b. Intended use and occupancy ~ ° ,, .i ......................... 3. Nature of work (check which applicable): New Building.. ................. Addition ............. · ..... Alteratiork ................. Repair .................. Removal .................. Demolition Other Work ..~.~....~..-:'. ........ ". .... ~,/ ~ (Description) Estimated Co~ .~.,,,~,,,..,,~, .............................. i..: .......... Fee~4~...j.~ ...... ?. ....................................................................... (to be paid on filing this application) 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 .(..O..t.~......~..~ ........ I~ear ............................ Depth . .. Height .~..Number of Star es c - · 8. Dimensions of entire new construction: Front .~.....~'..~...[ ...................... Rea~ ............... ;.... Depth ........................ Height ......~. ........... Number of Stories ....... ~ ........ ; ....... ;.....;'.;.;';;..; ...... ;;.....; ................... ; ............................................ 9. S~ze of lot Front ........................................................ Rear ...~ ...................................... Depth ................................ 1Q~ Date of Purchase ...~... ................... ..~ ........................... Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...................................................................... ' ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~ ................................................ 13. Will lot be regraded ...... I~ ................. Will excess fill be removed from premises: ( ) Yes (~) No ~ ~"~ A r .~.L~'~r.~.'''~'' t 14. Name of Owner of premises ....~. ............................................. dd ess .-1.., .......... ~-. Phone I~.~.~ ..(~...~-.: ..~-.~...~'~ ~ 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-bock dimensions from Prope~ 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 yOJ;~, I c c COUNTY OF ........ ...... ~..~.~.~...~...:...~...~..~.... be ng duly sworn, deposes and soys that he is the ~pplic~nl (~eme of i~ividuel signing c~trec~ above nom~. (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e performed the said work and to ~ke and file this application; t~t all statements contained in this application are tree to the best of his knowledge and belief; and · thaz the work will be performed in the manner set fo~h in the applicatio~ filed t~rewith. Sworn to before me this ~W~ROS. L~ ~ ~q~ (Signature aT applicant) ~0TARY P ..... State 0f ~ J~J