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Home My WebLink About7543-zFOR~ NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate O~ Occupnncy No.~3.1 ...... Date ........... D~¢ .~0. .. , 19.~c. THIS CERTIFIES that the building located at .E/.~ .~..b.o..D~?~,v~. ..... S~reet Map No.. conforms subs~tially to the Application ~or Building Permit heretofore ~ed in this office dated ....... ~¢p~.. t8 , 19.7~. pursuant to which Building Permit No..7~. dated ........ ~e~.. ~., 197~., was issued, and conforms to all o~ the req~e merits o~ the applicable provisions of ~e law. ~e occupancy ~or which this certificate is issued ~ Pr~. ~9. f~ .q~.".%~.g. ~. ~ .~9~ ................... The certificate is issued ~o Y?F~.. 9'~.~J-].~ggF ..... ~ ................. (owner, lessee or ten.t) of the afores~d building. Suffolk County Dep~tment of He~ Approv~ UNDER~ITERS CERT~ICATE No. ~ 2~.~ ........................................ HOUSE NU~ .. ~ ...... Street .. ~9. ~Y~. ........................... B~dmg Inspector FORM NO. 2 TOWN OF SOUTHOLD 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? 7543 Z Permission is hereby granted to: A. i~& %Z~..~...~ ~...].r:.~.. ~.~,...~c.~n..,,~.rme l~r ........ l~a.t.~ ~tac]~ ....................................... to .~4:]~..,an:..ad~iozm..on..e~i~tzr~. c,::~...l.irqb ............................................................. at premises located at ..... .~%.~..b...o...~..3'.7..e.. .............................................................................................. ................................................................. /~ur~t ............................................................................... pursuant to application dated ............................ ~ ,.,, ~ ,' ri · ,l~b ...z~ ........ , 19,.;..;.., and approved by the Building Inspector. Fee $..1~.~..0-.~. .......... FO'lt~,l 2',10. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th,s application must be filled ,n typewriter OR ink, and submitted in DUPLICATE to the Budding Inspector with the following; for new build,ngs or new use: 1. F,nal survey of property w,th accurate location of all build,ngs, 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 s,milar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B For existing buildings (prior to ApriJ 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buddings 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 ................ AddJt. ion .... .~.. ..... Old or Pre-existing Building ................ Vacant Land .............. Subdiv,sion .......... /~ ................................................. Lot No......~... .... Block No. ~.. ......... House No..~..~...~... Permit No..~.,~'....~.~.....-~.. Date Of Permit .....~"~....[..~"/..7~.pplicant Health Dept. Approval ..... .~.J...!~ ......................... Labor Dept. Approval ........ ..~...:.,!..Cr. ......................... Underwriters Approval .............................................. Planning Board Approval .... .~..,J..!..(~.. ....................... Request For Temporary Certificate ........................................ Final Certificate ............. .~[h~ ...................... Fee Submitted $ ..~........~....'J. .................... Construction on above described building and permit meets all applicable codes and regulations. ...... ............................... Sworn to before me this /-//~ /'/////,~/'///~/ (stamp or seal) Examined ....... ~.....~.. ......... , 19..~....[.{ Approved ............. !..c. ....... /.....~. ........ , 19.Z.~. Permit No. ~...~.....~....~.....;:..;.. ...... Disal~proved a/c TOW# O~ SOUTHOLD ~ BUILDING I~FAITMINT r~ TOWN a.llK~ OI~ICE . ~. SOUTHOLD, N.Y. ~. ,Application No.....~.....~....~.~.. ~ INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildingt~ Inspector, with 3 sets of plans, accurate plat plan to acale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to (~djo ning premises or pabli¢ st.ree.~. areas, and giving a detailed description of layout ofpraparty must be drawn on the diagram which is pert of this appl,cation. c. The work covered by this application may not be commenced before issuonc~e of I~tlding Permit. d. Upon approval of this application, the Build!ng Inspector will issue a Building Permit to the applicant. Such permit ~.. shall be kept on the premises available for inspectmn 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. B .A.P..PLIC~ATION !S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the u.mng Lone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lav~, Ordinances or RTpe~eUlati.o. ns, for the construction of buildings, additions or a!terations, or for removal or demolition, aa herein described. applicant agrees to comply with all applicable laws, ordinances, building code, housing cacle, and regulatlom, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) Na~tl~mok, ~.Z. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises · J. ....................... u.ez ................................................................. If applicant is a corporate, signature..~f duly authorized officer. Builder's License No ..................................................... Plumber's License No. ........... .~..*...~..e. ........................... ]I.~. Electrician's License No ............................................. Other Trade's License No.' .............................................. 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No. ................... ..... Street and Number ....... ,,l~/..I..~ll.l...~l~,l~l.~..JIi&l~'~...Zae. Z ............... i ...... : .................................................... Municipality 2. ~ ~ Ult e~l eeeupancy of premises and intended use and occupancy of proposed construction: o. ~ um emham,Jpancy .................................................................................................................................. b: ' nt ,ded use and occupancy .......... ........................................................ 3. Nature of work (check which applicable): New Bulling'. ................. Addffion .....1' .......... Alteration ...i.;.~ .... Repair .................. Removal .................. DemOlition .................... Other Work ..., .................................. ~ ............. (Description) 4. Estimated Cost ?.O00eO0 ~ / ~'~' ~ (to be paid on filing this application) 5. If dwellirig, number of dwelling ~unJts ......................... *...Number of dwelling units -on each floor ............................ If garage, number of cars ..... '.....~ ............................... ~ ................. ~ ............. ~ ................................................................. 6. If business, commercial or mixed occupancy, spec?y nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ~..! ................. Rear ................................ Depth ....... ............. Height .....J.~.i ............. Number of Stories ..... .~. ......... i .......................................... i ..................................................... Dimensions of same structure with a terationS 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 Jn which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation: . ....................................................... 13. Will lot be regraded .........JJIJ .............. Will excess fill be removed from premises: ( ) Yes f~ No 14. Name of Owner of premises .~'~...JJrlJ~JJJJ~lli~lJZ ............... i. 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 from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, I ¢ S (~ / e .......... ....... ........ · ./'.//?~Lq~u.~,~..~....~ ............................ being duly sworn, deposes and says that he is the applicant '' (Name of individ~a~ si,~gning/ontmct~ · above named. /~ //~.~, ............................... He is the ............... .~/~,~,(,ew~.~ ................................................................................ , .................. (Contractor, agent, corporate officer, etc.) of said owner or OWners, and is duly authorized to perform or have performed the said ~ ~ I~ ~ emi file this application; that all statements contained in th. is appl cation ore true to the best ~)f bio Jlnmeil~ emll IlJllef; thor the work will be performed in the manner set forth in the app ication filed therewith. Swam to before me this ............... ....... ................. , ................. Notary Public, .................................................... County ~' ' (Signature of applicant)