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Home My WebLink About7354-zNO. ,I TOWN OF $OUTHOLD BUILDING DEPARTM~,NT Town Clerk's Office Southold, lq. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at 8/8 I~d~a l~eal La .'//' Street conforms substantially to the Application for Building Permit heretofore fil~ in tl~ office dated Jgl~o ~t~ 19 , was issued, and conforms to the require- ment~ of the applicgtble provisions of the law. The occupane7 for which thi~ certificst~ issued is P~ivate aoaeleoz'7 (storafe) bu~ldins i\. ..~ ..... The certificate is issued to D~ 8a~lol 80 goholl Owl~X* (owner, lessee or of the aforesaid building. .. Suffolk Coartt¥ Department of Health Approval ~ ,Re '.' UNDEaWaI aS CmTIFICAam ........................................ HOUSE NUMBER 6010 Street InSiau Heok Lane Buildin~ Insp~r FO~,M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT -(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7354 Z Permission is hereby grunted to: iitch.te~...C.enst:r, ue.tton.....A/C.....f~a.~:,el ¢ohll~ ....... ~.e~....6.2.6 ...................................................... .............. ~z~een~o~.~ ............................................ to ..~,ld...a~..a~csss~.y..l~ld~ .................................................................................................. at premises located at ....~a.O.~.~'.~......~/.~..~Xtd.~-~l~,.~e~...~.~ ......................................................... .................................................. P.,~ec,n/g ............................................................................................. pursuant to application doted ................... ~....,,T~:~..-..2~F ............ , 19.'~..., and approved by the Building Inspector. Fee $.~J.~..*..~. ........... Building Inspector 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: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural ar topographic features.~ 2.Final approval of Health Dept. of water supply and sewerage disposal--(SO form.'or e~lual). 3. Approval of electrical instaUation from Board of Fire Underwriters. .. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar but.fdings and installations, a certificate of Code compliance from the Architect or Engineer responsible far the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to Apri~ 19,57), 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 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 Oa e . 3. ............ New Building .,.h~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...E..,..,0..,..~.". .......... ~/.S....~'}~...,.Ol..L/t~I¢,~ ....... Owner Or Owners Of Property ...... .~..j~.~......~r..~L~.~.~..[........~,..,......(.~:..O...~..~.:~ .......................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. Of Permit. pp icant .... Health Dept. Approval ............................................ Labor Dept, Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tem~frary Certificate ........................................ Final Certificate .....~ .................................. Fee Submitted $~..~.~-~.0..0,. .................... Construction on above described building and pern~t meets all applic91?l~ cgfle~? and regulations. Applicant Swor to before / Examined ........ ~/. ........... ........... .......... ........ . IUILMN~ le)AIWM~IT t, · ~ (~ Permit No. ''~ 3 )'" ~/',~.._~ > Ai)piicatian No. .. ~.. ................ '~ Disapproved a/c ................................................................. (Building Inspector)' APPLIGATION FOR BUILDIN~ PERMIT INSTRUCTIONS a. This application must be cor~pletely filled in by typewriter ac in ink and submitted in trjl:dicate to the Building~ nspector, with 3 sm of plans, accurate plot plan to Kale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoin ng premises or public streets o~ areas, and g v ng a detailed description of layout ofproparty 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. beUl~tapproval of this application, ~ Building Inspector will issue a Building Permit to the applicant. Such permit shall__ ___,__on the I~'ernlses available for inspection throughout the work. e..l~llldj~uilding shall be occupied.or used in whole or in pert for any purpose whatever until a Certificate of Occupansy.~ shall illaC~l~en glqnted by the Bulldmg Inspector. B iAIdP~LI ~CATIO~N .tS HEREB. Y~MA_DE to ,the ,.,uil.d!ng..De.p,a,,,rt..mont for the issuance of a Building Permit pursuant to the u ,alng /.one uralnonce o? trle lawn at :N~l~ota, buttOIK ~.ounty, New York, and other applicable Laws, Oedlnancee or R~egulati..ons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. , ne apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on promises and In buildings for necessary inspections. (Signature ~q:)lica~t,';r ~'~'; if'~;'~ti~j ........ .................. (Address of applicant) State whether applicant is ownm:, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ......... ..................................................................................................................... Name of owner of premises ..... .~.~.. ...... ~.~.U.~:..~ ......... ~...:......~..~..h.I/~.l~ ............................................................... 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 Trode's License No ............................................... Location of land on which pmpoeCKI work will be done. Map No.: ....................... _. ................ Lot No ......................... Street and Number .....~..I~.~.L~r..K~.. ...... ..~J..l~..c..~......~,~-.~T......t.~.J~..~ .o...~..L.~. .................. , ...................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a..Exisiting use and occupancy ......... g..~..~.~...i.~.:~L,,. ............................................. ............. i ............................. . . . ..i. .... b. Intended use and occupancy .. .,.~ ..................................................................... Nature of work (check which applicable): New Bui]ding~ ......~.... ...... Addition .................. AIter0ti0n '~ ...~...~. ~ (Description) ' ..O....o...:....6...O.. /0 4. Estimated Cost .......... .............................. Fee ....(..r. ................................................................................. (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. tf 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 ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............. ~.. ................... Rear ........... ~.. ............. Depth ........ J..?m.. .......... Height .................Number of Stories ......... I ........................................................................................................... ~0' 0 ~ 9. Size of lot: Front ........................................................ Rear ....... L.0. .............................. Depth ...~..~..o..~.,~_.,..~,/.,q,.',,,, 10. Date of Purchase ........................................................ Name of ~:ormer Owner ........................................................ 11. Zone or use district n wh ch prem ses are s tuated ~T 5. ~ a h~ /~r..L,.. ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ..~.....O._.i ..................................... 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No ]4. Nome of Owner of prem,ses~.~.~..~A.~ ........... ~ ......... .¢'. ............ Address ................................ Phan~ No ....................... Name of Architect ............... : .............................................. Address ................................ Phone No ....................... Name of Contractor -.~.'.lC....)..~......l].:...~.~-.I.'.~.~..-['.~6 ~ ~ ' ....... Address .C~..~.~.~...~.~).~.v~. ...... Phone No..~.l.-/.~..q.l.~.~7.~-~" PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or cnrne, r.J~,-.-~___ -~ t OF NEW / s cou,T¥ ' ................................................................................................ being duly sworn, deposes end soys thor he is the applicom (Name of individual signing contraclO above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, end 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 best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before, j~ne this ..... ,,,,. · Notary Pub lic, . ....'~~.... ~..... ~:~t~ ......... , ....... ~...~.... ............................................................ ~ '//(Signature of applicant) JUDITff 'r, BoKEN hlel~ty Public, Stale of flew Ng.~:q~4963 Suffolk Counly.~,x C~ornmJssion Expires March 30,