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Home My WebLink About7665-zFORM NO. 4 TOWN ,OF SOUTHOLD~ BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z6628 ...... Date .............. ~l.u.g. ~..] ....... , 19 .?~. THIS CERTIFIES that the building located at ...P.r.i.¥ .a.t.e..R. 9.a.d' ./,.~..] .3. .....Street Map No. ~J4 ......... Block No.. XX ...... Lot No..XXX..$0.~thO~..d,...~...~.. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .D.e.e... 2...., 19..?.l~. pursuant to which Building Permit No. ~...?.6.6~Z dated ........... P.aC .. 2.Q..., 19..?.g, 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 £amily ~welling with an addition The certificate is issued to . .N.a.r.y..0.b.a..r ..... .0.~..~.? ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N :.R.,[ ............................ UNDERWRITERS CERTIFICATE No. N oR, HOUSE NUMBER ...... .~. .... Street .... .r,J:.¥.a.~.e.. t.t.o.a.d...~. J.~. ................. / :,.... ......... Building Inspecto~ 1~0~ ~0. ~ TO~ OF SOfT,OLD BUILDING 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? 7665 Z Date ......................... :.De~ .......... ~-0 ........ , 1P...~.~. Permission is hereby granted to: Ra~et~:~.. ~..¢ ~.s e-h .....A/~)..~a-~y...Obe~ .............. · ...1.~;.%l...~,~t.l~1~l~'.J,~e...;Ro~d- .................. ........ ~¢.....~.,.:~.,......1f~.6.1 ............................. to .lluitd.. ~. ~d Jut io,u...o~_e., e.xSs .~Jmg-.. d ~ ~,ti~g.. ~:alte~.~ti o~,s....tm.. ~am~ .......... at premises located at ~..~.,~..~O~.O...,~....~.~......(2,.~).,:¥f.,...l~/.~...~l~,~Cglft.~...~O.B!t~ ........................... .............................................. ~.~.~tm~.~ ......... ~,.~., ............................................................................ PUrsuant to application dated .........................D.e.~, ....... ~ ............. , ]9..~..'~.., and approved by the Building Inspector. Fee $~ ~.,,.QO. ............ FOI~ NO. ~ 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 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 .............. Location Of Property ....... ,,~.,.~....7...../~,./~.. ...... .,/,~'.: ....... /~..,O,.l.,f'~: ......... .,~,.,/,~, ,,~.~.~ ............................ Owner Or O ners Property .................... ............ .................................................. Subd~v,s on ................................................................ Lot No ............ ; Block No ............. House No~..:...~..... Permit No .............. Date Of Permit . .~.,...Applicont .................................................... Health Dept. Approval ............................................ Lobar Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ...... ~.~:;z:~ ........................ Request For Temporar~ Certificate ........... ~ ...................... FinoJ Certificate .......................................... Fee Submitted $ ......./.~.: ..................... Construction on above described building and permit meets all applicable cedes and regulations. App,,cant ..... Sworn to before me ~is ~ ~ ...... ~ ..... ' .,~~~;.i"~::~ (stamp or seal)~<',~__ LO~ Io3c10 Disapproved a/c~.....~ ....... / tDullalng lnepector~ f~ ~ APPLIGATION FOR BUILDING PERMIT ....... ...................... INSTRUCTIONS o. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to the Builldlng~ Inspector, with 3 ~ of plans, accurate plot plan to ~ale. Faa according to ~chedule. b. Plot plan showing location of lot and of buildings on premises, relat onship to adjoining, premises or public streets or areas, and giving a detailed description of layout ofproper~ 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 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. n .A,P..PLI ~CATIO~N .IS HEREB. Y MADE to the Building Department for the ssuance of a Buildina Permit oursuant ~ui,a!n.g. ~on,e u.r.aJnance, at .t. he '1',o.~ o.f. Southold, Suffolk County, New York, and other appllc~able La~. Ord nan~es"~r~ r~egulat~ons, tar me construction at ouddmgs, additions or alterations, or for removal or demolition, a~ h~rein descri[~ The applicant agrees to comply with all applicable laws, ordinances, building code, admit authorized inspectors on premises and In bullding~ fo~ necessaryj,nspections,houslng code, and regulatlor~, and to CAddress m' oppli~'ant) ...... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of remises .~ ~ .......... If applicant is o corporate, signature of ~uly authorized officer. Builder's kic~n.~ No ..................................................... Plumber's License No ................................................. £1~ctrlclan% kicen.~ No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. ~."~. ..... 3,...~...o....~ ................ L-~ ......................... Street and Number ..d~.~...,~v. ...... ,~...~..~.....~..~..~ .......... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and'occupancy ~.. b. Intended use and occupancy ..X..o ~ ~.-- , ~, ~.~ / .~ ~"~_~ , '' 3. Nature of work (check which applicable): New BUilding.· ................. Addition ....... Al eration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... )ascription) 4. Estimated Cost .............. .(~...~..~.~...~........."..i ...... "."i".Fee .~ ...................................... (to be paid on filing this apl ,lication) 5. If dwelling, number of dwelling units ......... ./ ................ Number of dwelling units on each fie .J ....................... If garage, number of cars ............................. ~ ............................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of u!; ............................ 7. Dimensions of existing structures, if any: Front ....~.~.~ ............. Rear .....~.~..~.~ .................. D~ :~th ..... ~.~ ....... Height ....~.~ ...........Number of Stories ............./. ................................................................................................ Dimensions of same structure with alterations or additions: Front ....... ~.~. ..................... Rec ..4~...~. ................. Depth ..... .~.~..~. ............ Height ~ ........... Number of Stories .,~r~.~;..~>~ ........... 8. Dimensions of entire new construction: Front ..... ~.!~..~ ........ ............. Rear ..... ~,~:i.Z ............. :~th .,~...~. ............. Height .................... NUmber of Stories .................. ~ .............................................................................. 9. Size of lot: Front ................ ,~-- __~"~' ................................ Rear .,..~..~.~....~.~. ............... ~-o,Depth' ...../...~.~....~...--. ........... 10L Date of Purchase .~,~'.~..~,./~...~..~'~ ..................... Name of Former Owner C~/'.,~..../~f~ ~ ..................... 11. Zone or use district in which premises are situated .................................................................................................... !2. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~:. .............. ~ ............. 13~ Will lot be regraded ........ ~ ......... Will excess fill be removed from premix-s: (,) Y,es, ~ ~' PLOT DIAGRAM LoCate clearly and distinctly all buildings, whether existing or proposed, and indicate all set4x :k dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior orcorner lot. STATE OF NEW S.S being duly sworn, deposes and says that he is the applicant (Name of individual signing contractO above named. He is the ...L~ ...... "..~ ................................................................. ~ ................................................................... (Contractor, agent, corporate officer, etc.) of said owner at owners, and is duly authorized to perform or have performed the said work an, I to make and file this application; that all statements contained in this application are true to the best of his knowl~dge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ........... of ......... , Notary Public, ....................... County ..................................................................... (Signoture of opp,cort, ANFO,'~ STRAUSS NOTARY PUBLIC, S~a~e of New No. Quel~ed in I(/n~s CountF Commi~io~ Expires Ma~eh $0,