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Home My WebLink About7348-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z..6.0.77-? ...... Date ............. THIS CERTIFIES that the building located at . S~;-1-1.1wa.~e~'. l~.v.e .......... Street Map No.:~.,,~ .......... Block No. z:z, ....... Lot No..xx...Cu~aho~,-,:~.~.. ~.~X o ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ : ~,5~c,...].G.., 19..7.~ pursuant to which Building Permit No. dated .............. June.. 25 19-7-1+., 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 i~.*zivate, ry. (.a ,: r ge)..blzl.lAilal ............................ The certificate is issued to ~2~/~,,c¢....~¢~;~o.~$g~, .... v.w~..e.r. ...................... (owner, lessee or tenant) of the aforesaid building. ~'~. ~. ].~ .* ............................... Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. ~].o. ~ ........................................ HOUSE NUMBER .. ?.~ ........ Street .. ~.t~..~.V~.t.e.r...A.v.e. ....................... ....... .... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT 'TOWN CLERK'S OFFICE $OUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7348 Z Permission is hereby granted to: '~,~L~.~.. ~e.e.~nc~.~J. ......................................... at premises located at' ..!?.~ ....... ~.~$,~.Z.~e~e.~..,.~ve ................... : ...................................................... ' Cutchggue N,~, .. pursuant to applicatior~ Building Inspector. dated FORM NO. 6 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: I. 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 compleled 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 '~1 r'~ I Date..~.~....../..i~...~..~...?..~.'.~... New Building .............. /'~i~]1~/~..~_~%~. Id or Pre~existing Building ..... ~;.i'... ' ~c'~nt Land .............. Locaton Of Property l~. ~.,~..{~.,~...~..~,~[~r..~.~...~... ~.~. ..~..~...~..~,0(~,~ ......... .................................. ............... ............... Owner Or Owners Of Property ....Ic~.......~,~.~.lL~....~.~.~t.~.~i .~......~....~./..¢~..,-~ ................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No..J.?..~.. Permit No...~...~.~. ....... Date Of Permit .~..../..~,.'.....L/...Applicant ~..~..~.....~/J..~.~.~..~..' ....... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....~..¢...0..-...~.. ................ Construction on above described buildin~ ~p.er~.~ ti ~et~ll app~o~b~leZo~,~? regulations. Sworn to before me this (~ (~0~(~ ',~ (..~. ~::~ day of(~ ~ ' ~ j_C~. ~-) ~ .............. at .~:':~.~, ......... , (stamp or seal) ~?/0 Z(gO ~ ~' No. 52-4518967 /y./. ~,/. ~ NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ..... ........ Approved ........................................ , 19.~...C/Permit No.~...~.....~....~....~ ..... Disapproved a/c ..~ ................ APPLICATION FOR BUILDING PERMIT Date .................. , 19 ............ INSTRUCTIONS g~, a. This application must be completely filled in by typewriter or in ink end submitted in triplicate to the Buildin Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo ning premises or public streets or areas, and giving o 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 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. APPLICATION IS HEREBY MADE to the Build ng 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, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ............... (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general c~l~ftractor, electricia~r~, plumber or builder. _ . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which grgpose~/w~ork*~l~ be done~ Mop h~' ~,~ J,,~ k~,, Street and Number .~./~.5:~..~,......~~' ........................................................... .. ~/' (.,/ Muni~:ipalit~ State existing use and occupancy of pT?rs:fda, in?nded use and occupancy of proposed construction: a. Exisiting use and occupancy..~~[..~ ........ ~:~.....~ .................................................................. ~ll~ ,. Nature of work (check which applicable): New Building .................. Addition ........... ~x~ Alte,ggtion -~ Repair .................. Removal .................. Demolition .................... Other Work ....~ ........................ t,~s,//y.~ /t.~/~ ~'/,~ .~--~ // (Description) " 4. Estimated Cost .......... C:.....(....~-~...~,,.~/...~.. ....................... Fee ..........." ~/...~....'~....~.....,~...... ..................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each flo~.r ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, speci.f,/ nature and extent of egch type of use ............................ 7. D,mens,ons of ex,st,ng, structures, ,f any. Front~ .............. Rear ..... ..,~.(.. ................... Depth ........... Height ..../~.~.../.. ......... Number of Stories .......... .~..../...(,~.... ........................................................... i ........................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ........................~-"t~'N~umber of Stories ........... ..(~):;, ............. r~! 8. Dimensions of egtire new construction: Front ........ /_./ ......................... Rear .........~.. ................. Depth ........................ Height ....~..~. ......... Number__._ ,of Stories ........... ~ .................................................................. s.~ '~""~'~' ............. 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 any zoning law, ordinance or regulation: ~~ ................................. proposed violate 13. Will lot be regraded. ......... ~ ............~-,Will ex?ss fill b,e{removed from premises: ( ) Yes ( ) No 14. Name of Owner of premis~.~.~~.. Address 2~.~.~..~.~q~; Phone No.~..'.Z.~...... Name of Architect .............................................................. Address ................................Phor~ No ....................... Name of Contractor ............................................................ Address ................................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 whether interior or corner lot. , ~i'"' ' _~ J~-'J) J"~-~' STATEOF N~%,~ [SS COUNTY OF .~.~.~Z~..: ...... ~ ' ~ ........... ~~.....~.~.~.~.~.J .......... being duly sworn, d~oses and soys t~t he is the applicom (No,-of individudl signing controc~ above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have per~ormed the said work and to make and file this application; that oil statements contained in this ~pplicotion are t~e to t~e best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the appli~ion filed t~erewith. Swam to b~ore me this ~ ~ J :~ ~OBE~ ~ DI~ ~ (Signature of applicant) No. 52-4518967 Qualified in Suffolk Coun~