The URL can be used to link to this page

Home My WebLink About7397-zFOB,~ NO. 4 TO~ OF SOUTHOLD i BUILDING DEPARTMENI Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~. ,/~. :~....A?~. ........ : ..... Street Map No...7~. ......... Block No. ~ ....... Lot No...X~......~..~.t..~.t..~k.,..N.,.~. ? ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............~... ?.~! .... , 19.?~.. pursuant to which Building Permit No. ~'~... dated Jlll,y 11 19 7~+ , ....................... , .... was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is The certificate is issued to l~a~k Dox*o~k (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N. :.R., ............................... UNDERWRITERS CERTIFICATE No..N..,.R., ............ : ........................... HOUSE NUMBER ...~?..~ ........ Street ~lom~d A ~ Building I~spector FORM NO. · TOWN OF-SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7397 Z Date ........................... .~.L~......1.1 .......... , 19.~..~... Permission is hereby granted to: A ,..~e .S.~.~ ..&...~ene..&/.C...~'~,ez~...~o~*eek.$. ................ ~ti.tu& .......................................... to b~:l d...r~,~...p r.,t~r~.t;~ ..g,a~aga .................................................................................................. at premises located at ...... ~(3t333d..~e, ................................................................................................ ............................................................. ~.t t.i.t~ek..... ~, .1: ~ ............................................................... pursuant to application dated ............................ .~.u..~r. ....... .1,1. ...... , 19....~..., and approved by the Building Inspector. Fee $...1.0~0~ ......... · I" Building Inspector Approved .................... i TOWN OF SOUTHOLD BUILDING DEPARTMENT TQW~I CLERK'S OFFICE $OUTHOLD, N. Y. ] 9..?...~ 19..'.~...yPermit Application No ................ Z. .......... ~.. No. ~ ..... ..?... ...... APPLICATION FOR BUILDING PEIU~IT Date ....1.0,Z..1.1./.."L4 ......................... , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the BuildingS. Inspector, with 3 sets 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 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, thi~ 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 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 a~terations or for removal or demolition, as herein described. The appliCant agrees to comply with all applicable laws, ordinances, ~uilding code, housing code, and regulations, and to 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. .......................................... ]lt~L~.~e~ ................................................. Name of owner of premises ..................... .Ja~ll;...~,~ .............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of c0r~rate officer) Builder's License No ..................................................... Plumber's License No. i~'. .......................................... 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 ~.~..?~..~....~.~.~.?.?.~!~.~...~....~...~.~..~"..?..~.~*.~.~..~..~.~.~..~~ .................................................. ~C~ '~ ~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisifing use and occupancy ................................................................................................................................ b. Intended use and occupancy ......... .~.~..~.~ ........................................................................................................ 3. Nature of work (check which applicable): New Building ..... ~ ..... Addition .................. Altqration .................. / Repair .................. Removal .................. Demolition .................... Other Work ....................... 't ........................... (Description) (to be paid on filing this application) 5. if dwelling, number of dwelling units ....... ; .................... Number of dwelling units on each floo~ ............................ If garage, number of cars ..... .~. ....................................................................... , ............................................................. 6. If business, commercial or mixed occupancy, specif3/ nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Del~th .................... Height ........................ Number of Stories ................................................................................../.. ............................. Dimensions of same structure with alterations or additions: Front .................................... Rear ................. Depth ................................ Height ............................ Number of Stories ................................ dO 0 do t 2d 8. Dimensions of entire new construction: Front ....... ~. ............................ Rear .~ .......................... DePth ....'%. ................... Height ............ : ...... Number of Stones ....................................................................................... T ............................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth .~ .............................. 10. Date of Purchase ...........: ............................................ Name of Former Owner .........................~ .............................. 1 I. Zone or use district in which premises are situated ...................................................................... I .............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. ' Will lot be regraded~ ............ ~J~.~ ......... Will excess fill be removed from premises: ( ) Yes J ( ) No Name of Architect .............................................................. Address ............................ '... Phor~ No ....................... · PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exitfing or proposed, and ndicate al set-b<x~k d mens OhS from property lines. Give street and block number or description according to deed, and show street rlames and indicate whether interior or corner lot. STATE OF I~l~v' YO~,K./ / .y' ...........''----- --'-- '~ - ' ~..O...~....~...~.g.,/~....:~.,..;.~ .~..Z'....~.,.~..~... ........... ] .......... being duly sWorn, .deposes and says that he is the applicon, (Name of individual s~gning contract0 j above named. I He is the ..................... ~....U.../.../TT....~...~,,d'~ .................................................................................................................................. (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 bel et; and that the work will be performed in the manner set forth in the application filed therewith, l Sworn to before, me this ~ / j .............. · /./...,-'C~_,)y o~.:.:;~..~..,e~,~, ...... :...., 19..~...~. Notary Pub I lc, ~.e~.~.~-4~..L..: 4~,, ,~C. ,~Cou nty .... .~'. ~',~ ..<n<3..~.. ~ .h .............................. JUDITH T. BOKEN (Signoture of opp/m)jj~lq~ Notary Public, Stale of New York No. 52-0344963 Suffolk Coun~/ Cornmi~ion Expires March 30, 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: I. 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 disposaI--(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-ex'st'rig 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 $1.00 Date ...... J~.~/..~..~ ......................... New Building .....~'. .......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~i/~....~..O....~.~.,. ,A,~..~.l....~...,.~,..~.,~..?...0.~...~.e...~.J$..~.,~.....~..T.~,? ............................................. Owner Or Owners Of Property F~.i~]~ ~)OZ'o~lrl Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..i.,~.~.z~. ....... Dote Of Perm (/~/..'J..1.~.~(.4: App contJLt.....l~..e...J-..-J:..~.~'......~...~....~..O...~..~..F....~.~..~ ............ Health Dept. Approval ............... l~..~ ..................... Labor Dept. Approval .............. .~....'.....~... .................... Underwriters Approval ..................~..t..~..t .................... Planning Board Approval ....... .~...:.!...~... ................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..... $..~,0.0 ................... Construction on above described building and perrnit meets all applicable codes and regulations. Sworn to before me th s /