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Home My WebLink About7429-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate O[ Occupancy No. Z63.06 ...... Date ............ d~... ] ?. ...... , 19. ?~. THIS CERTIFIES that the building located at .. }4®&do~..Lane ............. Street Map No~tt.. ~Sto. Block No ........... Lot No.l+6 ..... 14~tt~ttt~k.. lt.,Y, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ,luly...19, 19~lt.. pursuant to which Building Permit No. dated ........... J. uly.. 49", 19.?1+., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P. riyate, a~cesaory..(.storage .Buildillg~ ........................... The certificate is issued to . Edward 'Rilles' &'-~/ife ..... Owners .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N oR, ............................. UNDERWRITERS CERTIFICATE No. ~,Ro ....................................... HOUSE NUMBER .. ~-~0 ........ Street ... 14eadgw..Lane .......................... BUILDING PEIt~IT (THIS PERM T MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) N? 7 29 Z Permission is hereby granted to: ................. ~$~$.1~.¢k ........................................ at premises located at' ..~..l~.......~.....~lt~.t,~,.~.ll~....~tl.t,&.~l& ................................................... llead~ Lan~ Ratt~tuek pursuant to application dated eTt~.7 'lC) 19~ , and approved by the Building Inspector. Building n~spector ~ TOWN 01~~ BUILDING DIPARTMINT TOWN CLERK'S o~lqcl a. This .a. pplication must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~ Inspector, w,th 3 set~ of plans, accurate plot plan to ~ale. Fee according to schedule. 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 port 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 permitl~ shall be kept on the premises available for inspection throughout the work. ~ e. No building shall be nccupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy ~, shall have been granted by the Building Inspector. r~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm t pursuant to the Bui ding 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 lows, ordinances, bulldi'ng code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necr~smy i~-~oectians. (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 nrem ses ~..P./,4/~ ~ C, .~...//u~r$ ~',~,&~e~e~' IAi,/~.e,~'$ ~', ~e If applicant is o 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 done. Map No.: .....~....~....~....~. ..................... Lot No. Street and Number ...~.~..~...~...~..~....~...~...~...~.~....~..~....~..~.!...~..~..~..~..~....~.~.~..~.~.~.~.~ ........................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............. !~.. ........................................................................................................... b. Intended use and occupancy /o Nature of work (check wh h applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Deecription) 4. Estimated Cost ...../..~...O...'.~*.. ........................................... Fee .......................................................................................... (to be paid on filing this application) 5.' If dwelling, number of dwelling units .....~....o. ................ Number of dwelling units on each floor ............................ If garage, number of cars ........................ ~0 ............................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .....~...G.:..~. f Rear G~. ~- · Depth ..~...~.:.~. .......... Height ../..~..~ ............... Number of Stories ....{~..~.~...,...~.A..~..~ .~. ................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ./..o. ......................... Rear ....~.?. ................... Depth .../..?. ................. Height .'7 ~. ..... Number of Stories .. ................................................................................................. ~' Y&'.'$9': ;~' '~-' ;~i~"" 9. Size of lot: Front ../.~.~..:~.../.: ................................ ~ ........ Rear ..~...°.../. ................................ Depth ..~.~..e.:...~..'?...-~...~C~ ...... 10: Date of Purchase ........................................................ Name of Former Owner .~'..~....~..r.../..~...u..?.?.....E'~.z..,*,~.s.,../..~...¢... .... 11. Zone or use district in which premises are situated .....~....E..'s..'D.~....~...~../~..~. ........................ ; ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .....~....o.. ............................................ 13. Will lot be regraded ..../~..?.. ................ Will excess fill be removed from premises: ( ) Yes ( *~ No 14. Name of Owner of premises~..~..~.~.~..g.:...~.~..~..'.s..?...A~..~.?.~..~.r....~.:. Address ........... Phone Name of Architect .............................................................. Address ............ , ................... Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate Whether interior or corner lot. STATE OF NEW YOBK, I e ¢ COUNTY OF ....... ~.~..'.~...W..~..~......$ ~-~ ................................................................................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing contrac0 above named. He is the ............... ...~.....~....,~...E....~. ............................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .......... ...... doy of ......... ...................... , , ....... ¢ o_ _ _ v,~w^~) t{. m~s (Signature of applicant) No. 52.6906750 FORM NO. 6 TOWN OF SOUTHOLD Building Deportment 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: I. 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 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 /'/ Addition Old or New Building ................................ Pre-existing Building ................ Vacant Land .............. Location Of Property .~. 7- ~/~ -/7/xrr/ro¢/< 45T~f~ -/7/,e~ Subdivision ~T~t vc¢ ................................................................ Lot No...~.... Block No.......~ ..... House No ............. Permit No. ~.~.~. ....... Date Of Permit~......Applicant ~,~.~.~..~/..~.~ ...................... Health Dept. Approval ..... ~P.~.ff~.~.f~.~ ........... Labor Dept. Approval ................................................ Underwriters Approval .............................................. r~annmg Board Approval ........................................ Request For Temporary Ce~ificate ........................................ Final Certificate Fee Submitted $ .~. ........................ Construction on above described building and perm~,eets all ~l~,le codes and regulations. Aoo[ cant .,m.~..~...~.~-~ ~ Sworn to I~efore me-this ~i~/~//~ Notary Public ........ ~~oun~ SHA~ON KIO ~/f ~ ~ / -- ~otart Public, State of N~ Y~ ~ ~ ~ No. 52-2~27085 ~ - - //--~ ~mm~ssion Expires March 30, 1~