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Home My WebLink About7384-zNO. · TOWN OF SOUTHOLD BUI~.DINC DEPART~k~'T Town Clerk'e O~iee $outbolcl, N. Y. Certificete Of Occupancy No. ~6~13 ...... Date .............Ilsa~r... 26 ..... , lg~. THIS CERTIFIES that the building located ali~rov. ZLtve~. ~o&d ......... Street Map No. ~c ......... Block No. XIC ....... Lot No..XXX....0~lell,~ ................. conforms sub~tantiaily to the Application for Bui]dl,g Permit heretofore ~ed in this office dated .......... ,T~l,y ....8.., 1~... pursuant to which Building Permit No. dated ........JulOr... 8 ..... , 19.~t~., was issued, and conforms to nll o! the requLre- ments of the applicable provisions of the law. The occupancy for which thi.~ certLfi~te is i~eued is .~lvat,. one. fma~,l~. 4ve13~t~l .v~2i.a~ &dd~tion ................... The cert/ficate is issued to A~ber.t .~alu~nba~ ...... 0Ule~. ....................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department o! Health Approval II.o.R ~ ................................ UNDERWRITERS CERTIFICATE No. ~q]~, ....................................... HOUSE NUMBER ...... 43~/ ....Street ... lla~.=ov. 3~.vee..Bead .................. Building ~ ....... FOUM' NO. ~ TOWN OF $OUTSOLD 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? 7384 Z Date ........................... ,T~LI~:....~ ............. 19.~J+... Permission is hereby granted to: .Alb~...~r&r~ez~au~ ...................................... ........ .....~..~.~...~.v..e.r..,~ .......................... .................. O~.~.e~;. ............................................... Build new fron.~ at premises located at ..... N~P:z~..~.~'...R~d .............................................................................. pursuant to application dated ........................... ~;1.t.t~' ....... ~ ......... , 1~...., and approved by the Building Inspector. ~v Building Inspector Examined ......... ~., 19 ..... proved .... ....... , .... Disapproved a/c .......................................... i .... ~. ......................... ........................... INSTRUCTIONS a. This application mast be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a 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 progress of the work. e. No building shall be occupied or used Jn 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 Building 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 taws, ordinances, building cede, housing code, and regulations. ......... .... ...................... ~nature ot/app ' , , ' rporation) (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of prem ses ~. ~~ ....................................................... If applicant JS a corporate, signature~bf duly authorized officer ......................................................................................... .................. ......... 1. kocationoflandor~whichprol~sedworkwillbed~one. Map No.: ......................... Lot No ... Street and Number ...................................................... ~'~t~- ~__,,,~.--.,...~ ................. Municipality / ....... 2. State existing use and occupancy of premises a~.,,intended.-/,'/~-~ '~-/'- use and occupancy of proposed construction: a Ex s tng use and occupancy b. Intended use and occupancy .............. · ................... ... ........ . ..................... 3. Nature of work (check which applicable): New Building .................. Addition ................ Alteration .................. Repair .................. Re~.mmgval,, .................. Demolition. ............ j..~_~er Work (Describe) ........................................ 4. Estimated Cost ............... ..~....~-...~. ............................. Fee ...... ~.. ................................................................................. (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 t~pe of use ............................ 7. Dimensions of existing structures, if any: Front ...... ..~....~ ........... Rear .......... ./..~.. .............. Depth ...~..47.....~. ..... Height ...... /..~...~ ....... Number of Stories ............Z. ................................................................................................. Dimensions of same structure with alterations or additions: Front ,~ 2~ ! .................................... Rear ...../..~. ............... Depth ..."...~..~. ............... Height ......... ./..~ ........ Number of Stories ....... ~.. ..................... 8. Dimensions of entire new construction: Front .,....i.../...~..../.. .............. Rear ...... ~../....~....~ ........ Depth ....~....~ ............. Height .....; .............. Number of Stories ........ .../.. ............................................................................... i ........................ 9. Size of lot: Front ....... . .~...~'.....~. ......... Rear ............. .~..~....'. ............. Depth ..~..~....~....i ............. 10. Date of Purchase ......... ~....~.'. ........ ./..?...~...."~.. .............. Nome of F~rmer Owner ............ ~..4~....../~.....~..?.....~....~ ............ 11. Zone or use district in which premises are situated .......... ~-f,-~u... ............................................................ 12. Does proposed construction violate any zoning law, ordinance o~r reauJation? ....~.~. .................................................. 13. Name of Owner of premises ..~.~.~..Address ......~..~........~.. ........ Phone No?R)...~..~...~..?..?.. Name of Architect ....... ~....._....~7_.~_;_.i.~i .......... Address ...~,~_ ..................................... Phone No ..................... Name of Contractor ....~.....~.....C:.~ ........ 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 aocording to deed, and show street names and indicate whether interior or comer lot. STATE OF Nl~r~{~/-~j~ ~S S COUNTY orj~.~/~[....~.] · ................ ~;-.~.~ ............................. be,ng auly ~m, dm~es and says t~ he is t~ applicant ~ of indivi~ual~igning ~n~ above name~. ..... ~e is the .....,...' . ........... ~ ....................................................... ~ (~tmctor, ~t, co~orot, officer~ e~;[~ ....... of said owner or ~ne~, and is duly authorized to perform or h~e parroted the ~id work and to ~ks end file this applicati~; that all ~atem~ts cont~in~ in this applic~im am t~ to ~e ~st of his knowl~ge and belief; and tha~ the ~rk will be ~ffor~ in th~ manner ~t fo~h in the wlIc~J~, fll~ ~e~ith. Swam to ~fore me this ~ ~ .................... o, ................... o' '/ ........................ ....................... .......................... Notaw ~bl c,~.~~Coun~ (SignOre of applicant) N~,52-O344963 Suffolk FORM NO. 6 TOWN OF $OUTHOLD 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 a~l buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water suppl~ 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), Nomconforming 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: I. Certificate of occupancy $§.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 ......... ~.~..../~...~.~/eJ ..~..J. ~ e,~, .~.t~...~..~(.__ ................................................... Owner Or Owners Of Property ...... . ............................................. Subdivision ................................................................ lot No ............. BIoq:k No ............. House No ............. Hea th Dept. Approva .......................................... / / Labor Dept.'"'Ap'pr'Ovcl .../...'"'.'"'"'"'"'"'""..'"'"""'""----'--""'"'Y'"" '"'"'"'"'"'"" '"'"""'""~V Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ '~- '~ Construction on above described building and pe~t~_~eets all ~i~cab,~ codes and regulations. Apphcont ........... ~..~'.....~... .......... ~ ............................................. Sworn to before me this ...... Notary Public ............... (stamp or seot ' 13