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Home My WebLink About7373-zTOWN OF SOUTHOLD BU~DING DEPARTM~T Town Clerk's O~ice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .I/B .l~d~:te. ~ad ........Street Map No.. IIX ........ /Block No.. l ...... Lot No.33X .... ~la%ti~a~k.. ~1~, ........ / conforms substanti~ly to the Application for Building Permit heretofore filed in this office dated ...........Jlz13r'' 2'" 19. ~ pursuant to which Bui]di,~g Permit No. ~J.~.~.. dated .............JuJ. y .... ~19. !'~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is issued is ...l~l~&te. a~eem~l..¢m~)~ ........................... The certificate i~ issued to . ~ee~ll &.,; l~. AIIdel. e~ ..... ~l~®l,a ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County' Department of Health Approval · · t~ ,~, ............................. UNDERWRITERS CERTIFICATE HOUSE NUMBER...~ ~ .... .:. FOB..M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7373 Z Date ......................................... ~... 19 ........ Permission is hereby granted to: · t4A-n- t--cu/c~c ~/. ",-' pursuant to application dated ......................... ;.....~........~....~.......~......, 1~, and approved by the Duilding In~ector. Building Inspector Examined ................... ;..~.....,~ .....~...., 1 ~/.../... / Approved ..................... ;....,..,......,..,.-........IQ ;' '1 Permit No...~...~...~...~,.."~ .......... Di~rov~ o/c ............. ~ ........................;, ........................... ............ .................... APIq.I~ATION Fait ~JILI~Ni PEW~IT INSTRUCTIONS a. This application must be completely filled in by t~AoeWriter o~. in ink and submitted in triplicate to the Buil~ Inspector, with 3 sete of plans, accurate plat plan to ~cal~ Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofprpperty 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 ar, y purpose whatever until a Certificate of Occupancy shall have bee~granted by the Building Inspector ' B .A,P,.PLI ~CATIO~N .!S HEREB, Y MA_DE to the Building Department for the issuance of a Building Permit pursuant to the _una~r~.. :on,e v.mlnance or me i..oym of Sauthold, Suffolk Cou.n.~, New York, and other applicable Laws, .Ordinances or .~.l~Ulatl.o. ns, Tar the construction ~ buildings, additions or a!teratlonS, or for removal or demolition, as herein described. · app.cont agrees to comply with all applicable laws, ordinances, 'building code, hauslng code, and regulations, and to admit authorized inspectors on premises and In buildings for necessary ir~,e:mctions. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee; agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ,'~..~. ~..~.. . ~ , ~ ~. d.~;..~. ~ ...~... ............................................................... 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 ............................................... 1. Location of land on which proposed work will be do~e. Map No.: ......................... Lot No .....,.~::~ ...... Street and Number ~/~"~" ~,~c.,~)/.~....~.. ,,,f"/l~ . ..~...'.~...T...~.../.Tw~4~ /'~ y //y] '" ~'~ ......... . .......... .~ ....................... ~ ................................ ~ ......... ~ ................................... Municipality 2.State existing use and occupancy of premises and intended use and occupgocy of proposed construction: o. aisi.ng use and occupo" ....... ....... ........ Nature of work (check which applicable): New Building....*~... ............ v- /" (/ v "'*'-Addition .................. AJteration .......... ~.,'.....e Repair Removal Demolition .................... Other Work ~ ' ...-~..../.~..~.. ~ ~1~ .__ ~.~._ (DescriptiOn) 4. Estimated Cost ...................................... Fee ...... ~.../...G......./...~... ............................................................... (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 occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ....... ear................................'"-' Deptl~ .................... 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, ........ ./...o.:. ........... Depth ...... ./...o.. ............ Height ......~....~ ....... Number of Stories ......... ./. ............................................ ~ ................................... 7;~;;:...~..~ ........ 9. Size of lot: Front ................/...~....o.. ................................ Rear ............ ./...~...?... ............ .~... pepth ..... Z.~..~:..~.~.~....'. ........ 10. Date of Purchase .,....!~'..../.~.....~'.....~... ......... ~Nam,e, of Fo~.r nor .~...~... 11. Zone or use district in--sos are situated ...... ~. ............. ~'~ ...................................................... 12. Does 'proposed construction violate any zoning .law, ordinance or regulation: ....... ; ................................................ 13. Will lot be regraded ................ '--~..~ ......... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...,~ .............................................. Address ................................ Phone No. ...................... 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-back dimensions fram to deed, and show street names and indicate property lines. Give street and block number or description ac~erding whether interior or corner lot. ~J~/~ dj.Bt STATE OF NEW YORK, ~ ¢ S COUNTY OF ....................~ ........ '...~' ~' .................. ~':'t.-~"~"~'-~ ............... .~.~i~.~....,..~...;.~ ............. being duly sworn, deposes and soys that he is the applicam '(Nome-of individual 4igning contracf) above named. ' He is the .......................... .',J.,...,'L:.~,...:~. ............................................................................................................................... (C~ntractor, 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 best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ' day of Notary Public, ....................................... ,~...~...._~unty .............................. ............................. JUDITH T. BOK~N Notary Public, State of New York I~o. 52-0344963 Su[folt~ County C~mmie~ion Ex~,iree March 30~ 19__ FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Sou~hold, 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 Dote c~..~ ~ /%'4'/~'New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~ / ~J'-- d'_;'~ ~J ,× 7~ ~ /~7~ ~.. ~/~ ~4z7~7~ 7--u ~ ~ ~ /~/~ Owner Or ~ners Of Property ..~..'.?~.~ ......... ;~...,~,~ ........ .~..~..~..~.~..~ .................... Subdivision ............................................. :..L ............... Lot No ............. ~l~k No ........~.. House No ............. '~Z~ ~OateOfPerm- ~/7~ -- ' ' ~ ~.,/o~ Permit No ................... r ......... ; .......... ~pp tcant ..... ...................................... : ...................... Health ~pt. Approval .............................. Z ........... Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval . '~. ........................... Request For Temporory Certificote Final Certfficote .......................................... Fee Submitted $ ..... ~.2.5~. .................. on a.~l able codes and regulations. Construction above described building a.n~ 'rmit meets all i~ ~ ~...d_ ~Z--~ . App cant ,.~...~. ~~ ~ .~,~...c. ....... Sworn to before me this (stamp or seal)