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Home My WebLink About7241-zFORM NO. 4 TOWN OF SOUTHOLD BUff.BING DEPARTMENT Town Clerk's Office Southold, N.' Y. Certificate Of Occupnncy No...Z~...~. ...... Date ............ .~..Y. ·...~ ........ , 19..7?. THIS CERTIFIES that the building located at Centex'. S. tree.t ............ Street Map No...XX ........ Block No.. ;l~ ...... Lot No.. XX ..... .~.~;.t~t. Bgk...~ ;.Y.; ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. l~.i.ay...6.., 19...~. pursuant to which Building Permit No. ?~]Z.. dated .............. ~..y.....8., 19..7..~, was issued, and conforms to all of the requh-e- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .P..r.i.v.a.t.e...(.a.q .c.e.s.s..o.ry.)..g.a.~.a. ge. ....................................... l~ichard & 2arbra Owners The certificate is issued to ......................... ~~ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~,H., .............................. UNDERWRITERS CERTIFICATE No. X,R, ....................................... HOUSE EMBER.. 2.Q0 ........ Street ... ~er..S.~ ............................ .... ........... Building Inspe7 FO~M 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? 7 41 Z Permisslo~ is hereby granted to: .... .B.,-L ~l:u~ct.. ~:..,1~ m~b z,& .. Ym.t,t l:u~w.~ ............... ........... Cei~te~..4~t,~eet ..................................... ..................... ~a*.t ~.t,u~k ..................................... ~o ..~.u~..~e~..~£v.~.~...£~.e.~.o~. ~ ...~.~r'e' ................................................................... at premises located at .~I~,~.. -~:~'.e~,t .......................................................................................... ................................................. ~{~{;.~.~IY~ ........ }{.,~., ...................................................................... pursuant to application doted ............................. J~J&~,. ...... .J~ .......... , ]~J+......, and approved by the Bu{ld{ng {nspector. Budding Inspector Examined Approved ........................................ -- [ !~.....~... permit No..2~.......~....~...~ ...... Disapproved ~....~......~~ ............... TOWN OF SOUTHOLD BUILDING DIFARTMINT TOWN CLERK'S OFFICE INSTRUCTIONS a. This application must be completely filled in by typewriter or~ 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 adjoining premises or public streets or areas, and giving o detailed description of layout ofproperty 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 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 (~f 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 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 ~pplicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ............................................................................................................................ ................................... Name of owner of premises ~...~..~.:~.?.~.~..~..~.~...~...~..~..~.~?...~..~....~..~.~..~`..~...~....~..~ .~.......~........., ................ ,,.~ If a~licant is a co~orate, signature of duly authoriz~ 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 which prappsed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ..~.~).~.......~...~.../'.C~,~.. ............................................................................ I~,/~.~/.~/.... 4'~ ~ CD Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ...~.~',',~..~.......~.~..~...~....,/....74-~Z~.~.~.......~..~...~.....~. ....................................... b. Intended use and occupancy ....~..~.~......C~/,~.C....-.....f../..~........~..~..~.....~. .............................................. T 3. Nat~'re of work (check which applicable): New Building ;:......~.. ....... Addition .................. A terohon ............ ? ..... Repair .................. Removal .................. DemOlition.; ......... ;; ....... Other Work ...................................................... (Description) 4. Estimated Cost ..~. ........ 7..~..; ........................................ tee (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... J~. ............. 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 ~.:f... ....... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .............. ~ ..... Height ........................ Number of Stories .................................................. : .............................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~..~1~ ........ ~ ...... Rear .....~.~....~ ........... Depth~.~ ................. Height .................... Number of Stories ......... ~ ........................................................................................ Dote of Purchase ........................................................ Nome of Former Owner ........................................................ Zone or use district in which premises ore situated ~..!.L.~./..~....~.,~ .............................................................................. Does proposed construction violate any zoning Iow,/' --ordinance or regulation: ...... ./~....~ Will lot be regroded' . ............ .~..~. ...... Will excess fill be removed from premises: ( ) Yes ( ) No Nome of Owner of premises .................................................... Address ................................ Phone N° ....................... NOme of Architect ................................... ; .......................... 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 from property lines. Give street and block number or description according to deed, and shaw street names and indicate whether interior or comer lot. 10. 11. 12. ~13. ........................... /~¢/. ................................................................. being duly sworn, deposes and says that he is the applicant (Nan,/of individual signing contracf) above named. /4~r, ~t..u.~ 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 applicat on; that a I statements contained in this application are true to the best of his knowledge and belief; and that the work w~ll be performed m the manner set forth n the appl cat,on fded therewith. Swam to befoz~ me this ~_ ................... of ...... .,., _., _.. ,--- _..., .. , ~' -' ~ ,"'~ (Signature of applicant) JUDITH T. BOKEN Notary Public, State of New York ' No. 52-0344963 Suffolk County..~ f- 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: 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), Nomconforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing ail property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os 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 ...... .~..~.~....../.,.. _/. ~.I.6.Z. ......... New Building / Addition ................ Old or Pre-existing Building ................ Vacant Land Location Of Property ...... .~'Z~ ........... : /' .C:../~. * ~ Property ...~...( Owner Or Owners Of C~..~.~.. ~' ~/-~/.~...~/ :"t"~TM~''~''~''~' .(~..~:; Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. 7...~...~..L..~..... Date Of Permit .~...~..~.~.'..~.~....Applicant' ..~...~..~....~..~....~..~..~.~.~ .~.....~. ................... Health Dept. Approval ......... /f~..:..r~. .................... Labor Dept. Approval ............ ...~...r..i~ ..................... Underwriters Approval ............ ................... Planning Board Approval ........... ...~...:.../~. ............. Request For Temporary Cer.~ti f_icate ........................................ Final Certificate ......~. ........................... Fee Submitted $ ....~... ........................ Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ........... - .~, day of ~..~....~...../..~...~..~ Notary Public ..~-,~-..~_..C County