The URL can be used to link to this page

Home My WebLink About7344-zFOB,M NO, & TOWN OF $OUTHOLD BI. III.flING DF_~ARTMF31T Town Clerk's Office Southold, N. Y. Certific2te Of Occupancy No. Z ~ / ~7 Date ............................ , 19~.~ THIS CERT~S ~at ~e b~g loeat~ ............................ SMut Map No. /~& Blo~ No. .~t No. eo~oms subst~ti~y to ~e Application for B~dlng Pemit heretofore ~ ~ thi~ office dat~ ~0 dO~l~ 19~. was ~su~, ~d confoms men~ of the applicable pro.iota of ~e law. ~e ce~icate ~ ~su~ to ~tOe~ ~ ~4 (omer, of ~e ~ores~d b~g. S~o~ Co~ty Dep~ent of He~ Approv~ Al. ~ · ~0~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 734 Z Date .......................... Permission is hereby granted to: ..;,...~o~s......~/.~.....~h~..~akar~ ................ .......... ~.e.~...~iif.£.alk ........................................... ~uild an addition on ex~ s~Izig d~ce~.li~g at premises located ~t ~.~..~ ......... .~P.~..~.~..~t~.~ .............................................................. pursuant to application dated ................. ~...20 ...................... , 19~.~..., and apprav~ by the Building Inspector. Fee ~.~..~ .C2Q .............. Building Inspector FaIL'TI NO. 6 TOWN OF SOUTNOLD 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: l. 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 disposa[--(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-ex'sting" 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 Date ....· .~,. ~..:.....¥~ ../../,.~ .?...~., ..... New Building ................ Addition ....... ~ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....~/'.'.9..~.:..~......../~..!.'...~..,./~... ....... ~...O.t:.~.../......../~....~...'~.~.:_~.~.~..~.~ ...... ..~..:.,..~..,,.....~..:....~.:. Owner Or Owners Of Property ....; .:2Z'...~..~..~..'~.....~,..{ ......... ../~.....~...~....~...~...: ............................................................ Subdivision ................................................Lot No ............. Block No ............. House No. .~... Permit No..~.~.....~.~.T....~-.. Date Of Permit .~..~...~.~...~.~.~..Applicant .... .~...,~. i?..~......~.'~'...~..~..~..~....,L". .................... Health Dept. Approval ....................~.,...-..~...~..~..r....Lobor Dept. Approval .............. ...~....?..~. ...................... Underwriters Approval .............................................. Planning Board Approval ....... ...~.: .'/? ...... Request For Temporary Certificate ........................................ Final Certificate ......~ ........................... Fee Submitted $ ff.,,~...:K~..~ ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .,./~*..'~...?..........~.~.~..: ...................................................... Sworn to before me this ...... ~.. day of ....... ~~... /~7/ (stamp or seal)~''"D' Z /~t 5 '7 t/ t~ Approved ........................................ , FORM ~TO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, 19...~....YPemit No....~...~...~/.,.~....~. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building inspector, with,~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, ar/d~ giving a detailed description of layout of property must be drawn on 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. ¢1 e. No building shall be occupied or used in whole or in part for any purpose whatever until a Cer, tificate of Occupancy shall have bee 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 Southoid, Buffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant 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. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .................................................................................................................................................................. Name of owner of premises .~.~.'~,.-~......~.4:~,.~.~..~.~. ....................................................................................... If applicant is a corporate, signature of duly authorized officer. ..................... i ..................... Builder's License No .......................................................... Plumber's ~icense No .......................................................... Electricians License No ..................................................... Other Trade's License No ...................................... 1. Location of land on which proposed work will ,be done. Map No....:..~:~.: ..............................,.LotNo ......................... Street and Number ....~.-...C~...~.~);....~...~.~.~....~..~..:.~ ............................................ ~...~...(~.~....~...L...[..,....~...~. ..... Municipality 2.State existing use and occupancy of~remi.ses and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~;'.~..t.i.~..~ .................... .~ ...................................................................... b. Intended use and occupancy ..... .~k,. ~..~...L~..c,,~t~-.....~.~.~&4~ ........................................................ 3. Nature of work (check which applicable): New Building ....................... Addition .....~ ......... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4.Estimated Cost .,,?....~..~..C~,..~.....,.-'. ............. Faa ....................................................................................... (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 occuoancy, 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 .......... ./...~.. ......... 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 ..................................... 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 ............ ..~..~ ............... Will exce. ss fill be removed fro[n.prenli~s: [ ] Yes. ,,[ ] N~_ ..... Name of Owner of premises ......... (Address) (Phone No.) Name of Arch tect ............. Name of Contractor ,.~.,...~..~ ............ ..~.(~z;;C~...~.~.....~--d~..~.~.~.~/~ ........... ~.,;:~....~...~..~.~" (Address) ~/~t (Phone NO.) PLOT DIAGRAM Locate clearly and distinctly 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 wheth- er interior or corner lot. NEW ~ORK~ , ~ ) SS ~-g~'l' ~'~ 1'\~ &_~It I~,.J ~"t ~p"¢~.. ~N _~ STATE OF COUNTY OF ~.¢~... ............... .......) ~> ~ ~ ......... ~ ~ ;.~.~.~:~-~:) ....................being duly sworn, deposes and says that he is the applicant above named. (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 b~.~.t, o~l~l!~r~o~t~t~ an,,d belief; and that the work will be performed in the manner set forth in the application filed therewith. ' · '" ';" Notary P u b, i ~~..~....~.....~~V ............ ~....~........~ ........ 2 ....................... ~1 (Signat~/re of applicant) tab THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC [-- 0otobe~ 23j 1-9'~5 JOHN STREET, NEW YORK NEW YORK~IO038 THIS CE~IFIES THAT Tho~e ~. ~on, 190 Captain ~dd Rd., ~ttttuck, in thefoll~ing tocat~n; ~ B~ement ~ lst FI. ~ ~ n. OutnSde ~tio. S~ ~t .~ ~..~.d o. O0tobe~ 22. 197 ~ .~/o.~ ~ ~ in comptiafl~e with t~ r~ui~ments of th~ ~rd. RXTURE LECEPTACLES[ SW T HEI RXTURES OUT,.TS I [ MOTORS FUTURE AI~tlANCE FEEDERS SERVICE DISCONNECT OTHER APPARATUS: RANGES ~T. :<. w. SPECIAL REC'PT, R EXHAUST FANS DIMMERS Anthony J. Harris Twomey Ave. Calve~ton, L.I.11933 ~-~.~ ~COPY --~FOR BUILDING__ DEPARTMENT. THIS COPY OF CERTIFICATE' MU~T: NOt. ~'ALTERED IN ANT ~ ,