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Home My WebLink About7186-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~?~.1 ..... Date .............. Ma~.~ .... ~1.., 19..~/ THIS CERTIFIES that the building located at .. ~p.t;.~. pi;. R~ ......... Street Map No. ~ ......... Block No. ~ ........ Lot No. ~ ...~~ .............. conforms substantially to the Application ~or Building Permit heretofore Efled in this office dated . ~/]?~.~. ~/~0 .... , 197~.. pursuant to which Building Pemit No. dated ~1~ .&. ~0~ .~., 19 .... , was issued, ~d conforms to ~ of ~e req~ ments of the applicable pro~sions of the law. The occup~cy for which issu~ is . ~$~.~. d~ll~g .~h .~.1~ The certificate is issued to . P~$P..~.~V .... ~ ........................... (owner, lessee or te~~t) of the aforesaid b~lding. S~olk County Department of Health Approv~ .. ~.*~* ............................. UNDERWRITERS CERTIFICATE No. [.*.R~ ....................................... HOUSE NUMBER .... ~0 ...... Street .. ~. P~. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7186 Z Permission is hereby granted to: ...~'t 314~....~.lx~ ............................................. ........ Z,~to~..l~.t..~l ........................................... l~att ~,tuek t Build nov accessory (storage) bui~d:~ng ct premises located at ..... ~{~....LuI~tO~..Y~Ut..~Roa~L..¢pX;Lv~ .......................................... ............................... ~a.tt;£tu~ ...... ~,3~, .......................................................................................... pursuant to application dated .................... .~p~'J.~. ......... .~.~. ......... , lC~.~.., arld approved by the Building Inspector. Fee ~:.0.......0~.. ............. Bull ng FORM NO, 6 TOWN OF SOUTHOLD 0 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 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 end 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 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 Dote J..0..,....1.9.22. ..... New Building .~,CC,~.,... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ......... T,~:D.t~.Q:F~...~..O.:J.~,.,~&~,.~...~v~.~.t;.~..1;:.9,~.~.~...~,.~...~.... ....................................... Owner Or Owners Of Property ....~.~,~,:L~D...~9.~..~.~.s ............................................................................ SubcJJvision ........ ~.~.~.(;:..*. ............................................ lot No. ............ Block No ............. House No...~..~..0.... Permit No..~.~.~. ....... Date Of Permit ....bc/.J.~./.~..~.Applicant ..~..~.~,~;~...~.~.9..e.~...~.~.... .......... Health Dept. Approval .......... :~./,,'~ ........................... Labor Dept. Approval ...............~!./..~.. .......................... Underwriters Approval ............ ~{,,/~ .......................... Planning Board Approval ...... ~.~ .......................... Request For Temporary Certificate ........................................ Fined Certificate .....~ ............................... Fee Submitted $ ...~.~.0.Q ........................ Construction on above described building and ~t:s all~/e'odes ~/~e/~'r/el~ulotions. App, cant ... ..... .................... .... 7y"z/ ..c~/~."L day of .......... ~'..¢'~L .., ...~ .q .~7 (stomp or seol) ~ , ota~ry Public ............. ~"14~,~'j/..~'C o u nt y ._ NOTARY PUBLIC, S~Ie ~f New No. $2-812§850, Suf)olkCou Term Expires ~arch 30, 19 FORM NO. S TOWN OF $OUTHOLD , 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-ex'sting" 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 New Bqilding ................ Addition .....,~, .'.....--- Old or Pre-existing Building ................ Vacant Land .............. Owner Or Ownem Of Property .................................................................................... Subdivision ............................................................. ~..kot No ............. Block No ............. House No....~..d~... .ca,th pt. Ap,rova, ....... ...................... Labor Approva, ......... /Y/...Z..: ........................ Underwriters Request For Temporary Certificate ........................................ Final Certificate ............. ~ ................. Construction on above described building and perm_j_t il opplicaJCe- es /e 'd Term TOWN OF SOUTHOLD BUILDIN{3 DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~'~/' ~ ~ Approved ~ ~ q ../..~.. ........................................ , '9. Permit No. "~ ~/Z....-~ Disapproved a/c~....~ (Building Inspector) . - Date ................ , ............. , 19. INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 ~ or,plans, accurate ,plot plan to scale. Fee qccording t.o schedule. 7~ b. Plot plan' {h0wing location of lot and of buildings ~)n premises, relationsh~p I;0 a'djoining premises or public streets areas, end giving <3 det~il~ descr pt on of ayout ofproperty must be drawn on the d]agram which is part of this application. c. The work.covered by this application may not be commenced before issuance of Building Permit. d. Upon apprb~ctl 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 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .......... ...... ~ ~ ~ ,_ ~ (Addre~,of applicant) , State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................... ..................................................................................................................................... If applicant is a 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 ............................................... 2...~...~....~..~.' 1. Location of land on whic. c._hh p_rapo work will be done~ Map No.: -:w~ ......... o. Lot No ~ Street and Number ...~.O ......... ~.¢.~.....~.~ ...... t;,~.~t~.~. I ' ~ ' Mdmcl~ 2. State existing use and ~cu~ncy of premises and intended use and ~cupancy of pr~osed construction: Exisiting use and occupancy ................................................................................................................................ Intended use ond occupancy .............................. Repair .................. Removal ................. ~ Demolition ............ i ...... ~ Othe'r Work ....................... ,L.../;-- ........................ · 4. Oo /o. (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 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 ............................ Depth ................................ Height ............................ 8. Dimensions of egtire new construction: Front ..... /.~,.~¢~..... .............. Rear ....~ .~:..~..... Depth ../...~..~.......:... Height ...1~.~.... Number of S~ries ...... ~.. ........................ ...,-~....., ...................................................... 9. Size of lot' ..............L/~:~,/~ ...................... Rear ~l~..~ ................ ~.~. Depth ....~¢~.~..?.~/?~ '~.~ .... i0. Date of Purchase ....~..~r~4'.~.. ..................................... Name of Former Owner ..... ....... ~.~.~/.m~... 11. Zone or use district in which premises are situated ....................................................... .~ ........................................ D r o construction v,olate an zon~n law ordinance or re ulahon . · · .~'.-.O. · · 12. oespop sad ' ' y ' g , ' g ' : ............................................. 13. ~Niill lot be regraded ............................ ,Will excess fill bq removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ....P.~.~..J~.....PJ~.'..~....~.....~...~. Address:...~..~i~.i...~....C:....~.. . ........... Phone No..~...~..~..~ Name of Architect ......................... J .................................... 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 fram 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 NEWY~RK// ,J I,~ COUNTY OF .~-~~;"~ ' ................. ....... .......................... .,.....~ .......... ~.~ ........ ~ ................... b~ing duly sworn, deposes.and says that he is the applicanl · (Name of Jndividual signing Cdntracf) . above named. He is the ................................................................................................................................................................................. (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 applicqtion are true to the best of his knowledge and belief; and that' the work will be performed in the manner set forth in the application filed therewith. ..... ........ JUDITH T. BOK~N // (Signature o a No/ory Public, State of New ¥¢~ No. 52.0344963 Suffolk CounLV-7~' Commission Expires March 30, 19-~