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Home My WebLink About7392-z~'0~ NO. 4 TOWN OF $OUTHOLD BUII.llING DEPARTM'RNT Town Clerk'~ Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. ~/8. l[o~tl~ .l~a{t .to. l~3~l~let Map No..~ ........ Block No...~ ...... Lot No, . ~ ....So~l~O~.d...11 ~.~ ....... co~o~ subst~ti~y to ~e AppHca~on for B~ng Pe~it heretofore ffl~ ~ ~ office dated ............. J~. ~ ~., 19.~. p~u~t to w~ch B~ding Pe~it No..~9~ · dated ..........~...~..., 19.~., was ~sued, ~d co~o~ to ~ of ~e ~ ments of the applicable pro~sio~ of ~e law. The occup~ for w~ ~ ce~ica~ ~ ~u~ is ... ~r~w~. ~..~e~. ~e~ .~$~ .e~$~ .................... ~e certificate is ~sued ~ .~. PSe~l~ ...... ~ .......................... (o~, lessee or ten~t) of the ~ores&d b~d~g. S~olk Co~ty Dep~ment of He,th Approv~ . .. ].,~, ............................ ~ER~I~RS CERTIFICA~ No. ~e~ .................................... HOUSE ~ER ..... ~ .... S~et ... ~T~ .~95~ .~. ~ ............. lrO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7392 Z Date ........................... ~lr],~ .......... ~10'"', 19~1~.. Permission is hereby granted to: O e~.d.~.$.~l~..I/-].4e-~...C~a~t ,..-.. k/~ -... #~eha~d P~l. er sea .............. ~o~tho.:].~ ............................................... to. bu.t3~...a~u..a~ldA ~:~Loz~..oa..ex~,s t~t.r~ .. d~e .~.l$~g ............................................................... at premises located at .~,/(k~..li~l~..i~el&..~eo..Zla~l,v~.elt, ............................................................... ............................................................... ~e~ztho~d'-'"l~,~/', ................................................................ pursuClnf to oppiication doted ......................... ~llz-/~.....1.~. .......... , ]~'~.~...., or, d o~proved by the Building Inspector. Fee $$ ~.eA~) ............ Budding Inspecto/ TOWN OF SOUTHOLi) BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, No ¥o Examined . ......~...,~ ........ 19..~. Approved i ....... ii , 19..2./Permit No..?..~....~...~....~ .... Disapproved a/c ........................... ......................... - APPLICATION FOR/~UILDING PERMIT L~ ............................ ....... INSTRUCTIONS .~ a. This application must be completely filled in by typeWriter oe in ink and submitted in triplicate to the Buildln~ Inspector, with 3 sete 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 adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproparty must be drown 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 permi~ 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 Occupanc' shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the 'ssuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord nonces o~ 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 code, and regulations, and tc admit authorized inspectors on premises and in buildings for necessary inspections. (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 ...... /~7,~..~__.....~;:~./~ ......... .X~.~'d?,,~. ................................................................... If applicant is a corporate, signature of duly authorized officer. ~ ~ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. z~".~.~,( .~,.. .............................. Electrician's License No ................ ..~..~...~..~..~ ....... Other Trade's License No .............................................. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .,4~...~.~...~:......~./.~7~... ...... ~.~ ....... ,~,e~'~.......Z~../~.~,/~'~ .......... .~..~..~'/~:~.~.~... ....... Munidpality State existing use and occupancy of premises and intended use and occupancy of. prppased construction: a. Exisiting use and occupancy ~ .......... ~..~..~..~./..'.~..~----------------~..~....~.... i ......................... b. Intended use and occupancy (,.~,~.~ ................. Nature of work (check which applicable): New Building.. ................. Addition ..~. ......... Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost .................~¢Z:Z~..:..?... .............. ........ Fee ....... .~...-.~...~....'E~... .............................................. --~'-'----(to be paid on fil'in~' ~'l~is 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 .....~;~...~. .............. Rear ....... ~.~..[. ................ Depth .,~.~.../. ........ Height ...... ~,~..~. ......... Number of Stories ...... ~..~ ................................................................................................. Dimensions of same structure with alterations or additions: Front ..... ~ .......................... Rear .. '.~......"~i ............. Depth ............. ~.~IC~... .......... Height ....... ~..~'.. ............. Number of Stories ....,~...Az,,~... ............... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........ a~..~. ........................................ Rear ............. ~.d~...~. .................. Depth ...... /.~ ............... 10~ Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ....~.~.~...Z~'.~.'...~. ................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~..~...~...-~... ................................... 13. Will lot be regraded ....... ~.~....';T... ...... Will excess fill be removed from premises: ( ) Yes (~ No 14. 'Name of Owner of premises ...~..~.~g~'~ ....... .~z~..~. ..... Address .~.I~.~.~...~.'~ ......... Phone No ....................... Name of Architect ......................... ~ .......... ~ ......................... Address ................................ Phone No ....................... Name of Contractor ..~...~..~...~..S....~J. 4~......~...L....~......~...~C~.....s~..~. Address .~'.~,~.~"~?~f~.. ....... Phone No. ~..~.*..~...~....~.~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oll 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 Y(~,I~J. COUNTY OF ..~.)"~'"' .::...,~.~.~..~l~...~.~.~.~..~.~/~dl.J~..~ ............................ being duly~ sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ......... .~..O./~...:........~./...~..~ ........................................................................................................................ (Contractor, 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 tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to herons, me this .... of ......... . -. · ..... . ...... ........ ~ (Signature of applicant) N*tary Public, State of New York N~ ~2-0344963 Suff<~l'~ Cou?jy~'~ FORM NO. 6 TOWN OF SOUTHOLD , B.ilding 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 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 D~te ........... ~. ~?..~. ~/~. · ~. ~ .~.. ............. New Building ................ Addition ....~ ........... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....,,,7'~C~.5.....,~,~V~-.-T...~ ........ ,/~.~,/~....C.~/~-~2....,~),4!~--~ ..................................... Owner Or Owners Of Property ..~.,2z~..~f:....,,~.~: ...... ~l~a_~x~t~/_~.....~.../.~,~,.~:-o,~./. .......................... Subdivision .... ~ ....................................................... Lot No....-. ........ Block No ............. House No ............. Permit No ..................... Dote Of Permit .................... Applicant ~-~ ~,;-'~...~..~.'.~...~.f~,~ .~..: .......... Health Dept. Approval .../,~..~.~:~-~.. ...... .~.~T-2~ ........ Labor Dept. Approval ................................................ Underwriters Approval ..... Z~.r2.~.CF. ........ ~.~ ........ Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate ....~.. .................................... Fee Submitted $ .......~...'.....~..,.~.. ............... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~.~...~,.~.~x~ /~'~X~/~- ~'~'~"~ c~- Sworn to before me this day of .....0. 2/ t amp or seau Notary Public ............ L.~.4Z-~F~./.~... County