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Home My WebLink About7227-zNO. · TOWN OF SOUTHOLD BUn'.DING DEPARTMENT Town Clerk',, O~ice Southold, N. Y. Certificate Of Occupancy Map No... ax ...... '. Block No... xX ..... Lot No.~ .... 0r~ent. I~.,.Y', ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Hay .... '3" 19.7t~ pursuant to which Building Permit No. ?~.. dated ..........I(~ ....... 3', 19..7~+, was issued, and conforms to 5il of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pr~va~ce. one .£am~ly. d~eLl~n~ ~with .add.~tic~ .(Ga~,a~.) ........... The certificate is issued to .. R~eha~d · Pa. ssan~nt ...... ~m~, ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk ~ounty Department of Health Approval .. ~/oR, ............................. CERTIFICATE No.. N ,I{, .............. ........ i .............. HOUSE~ NUMBER .. ~ ......... Street ......~u~la. ss. Rd ....................... Building Inspector FORM 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) N? 7227 Z Permission is hereby granted to: Orient to Build an addition on existing d~elling at premises located at Douglass Road & King St Orient , May 3 1971+ pursuont to opplicotion doted ........................................................ ,. . ....... , and approved by the Building Inspector. Fee $.!. ?.......07.. ........... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, No 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 complmed 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 New Building ................ Addition// ............ O d or Pre-ex st ng Bu ~ding ................ Vacant Land, ...... . . ...... Locat on Of Pro err f//~ ~ ~ ~ Owner Or Owners Of Property ~.~J~..../~ ~...: ......................... ~.~..~~ ............................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~....~'....~...~.......~'Dote Of PermiT...~..~.~....:..',~..,.~pplicant .~:..-~..~ ............. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .....~ ............................. Fee Submitted $ .................................... Construction on above described building and permit meets all appl~able codes and regulations. Applicant ...~...~.~(~ ....... .~..~....~..'.~...~.Z~ Sworn to before me this ........... ~'7~x .~../. ,~.7, day of .......~.,~..~...../. ........................ Notary Public ..... ..~...~...~..~.,~..(..~. ............ C°H-r~D F. KING, Term ~xpiros M~zrch 30, 197~ ~0~ NO. ! TOWN OF SO~JTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. .... .................... 'i;7 ................................. Application No ............................... '~1~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~ 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 adioining 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 this application, the Building Inspector will issue a Building Permit to the applicant. Such permit gq shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used Jn whole or in pa rt for any purpose whatever until a Certificate of Occupant?''q 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, Ordnances or, Regulations, for the construction of buildings, additions or alterations, or far removal or demolit on, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ,,~ (S'gnotv of applicant, or nome, if o corpor;'ii;; i ........ ~ (Address 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 ............................................... Location of land on whic~ proposed work will be done. Map No.: ................. Lot No ........ Street and Number..~...~.....~.~..~......~......./.~...~.....~.... ................. ..~...~ ................. 5' 7 o ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy ....~.". 3. Nature of work (check which applicable): New Building..................J Addition .......... ...... .. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work '"~"~;i~l]i~'~')'~(Desc 4. Estimated Cost /~' ~'-~ ~' O ~ 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 ~rs 6. If business, commercial or mix~ ~cuponcy, speci~ nature and extent of each ~pe of use ............................ / ...... ~ .................. Depth 7. Dimensions of existing structures, if any: Front ....... ~ ..............Rear z / ~.~...~. ..... Height ....~.~..( ........... Nu~er of Stori~ / Dimensions of same structure with alterations or additions: Front ........ ~ ...................... Rear .... ~.~...( .............. / / Depth .......~.~.~ ................. Height ....... ~..~ .............. Number of Stories ................................ 8. Dimensions of entire n~ construction: Front ...... [. ............................ Rear .....~.~..~ ............. D~th ...~.~/..~ ........... Height ...Z.~..~ ...... Number of Stories ...Z ............................................................................................................... Size of lot: Front .Z~.~.¢..~ ........................................ Rear ....~.~.:.~ ...................... Depth ../~.~¢.~ .............. 9. Date of Purchase ........................................................ Name of Former ~ner~' ' ~..~....~~ ........ 10. 11. Zone or use district in which premises are situated ...~a ..................................................................................~ ~ 12. Does proposed construction violate any zoning law, ordinance or regulation: .~ ........................................... 13. Will lot be regraded "'"~"~-- ~~~ill excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of ~ner of premises~...~~.. Address ..... ~~ ......... Phone No. Name of Architect ........................... ~..~j~ ..................Address .................. : ............ Phone No ....................... Name of Contractor ~..~.~.~ ............... Address ...~.~.... Phone No. PLOT DIAG~M Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-~k dimensions from prope~ lines. Give street and bilk number or description according to deed, and show street names and indicate whethe[ interior or corner lot. % STATE OF NEW YORK, t c c COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) 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 application are 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. Sworn to before me this .......... .............................. M~RY O. KLOS NOTARY PUBLfC, STATE OF NEW YORK ~52-7306925 SUFFOLK COUNTY . Commission Expires March 30,