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Home My WebLink About7270-zFOKM NO. · TOWN OF SOUTHOLD BUll,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z728.2. ...... Date ............ 0.O.t....? ....... , 19..~.~. THIS CERTIFIES that the building located at .. y..~.X.l.a.g..e..L~...~. ........... Street Map No.. ~ ........ Block No ..... . .xX.. Lot No ..... . .x~x.....0.r.~.e.n..t ................ conforms substantially to the Application for Building Permit heretofore fried in this office dated ............. !,l~,.y....2~, 19 ..~.. pursuant to which Building Permit No. ?.2.?.~... dated ............. .~..Y... 2.2.., 19..~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is i~sued is. Pr~'"..~.*. .O~. ~ .~. ~!~ .d. :.e~.~..~. :~t.~.. ,d.d~..~.~.o.,' ...................... The certificate is issued to . .8~?..ah...~.i.i~g .s ..... . .0~n..e.l'. .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N.,R.o ............................... UNDERWRITERS CERTIFICATE No. l~,R.° ........................................ HOUSE NUMBER ...~62.O. ...... Street ....V.~.i..I-age...L..a~.. ........................ FOB~ 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? 7270 Z t Permission is hereby gronted to: ~ra~...~,~=lr~un.....a/C, Sa~dL..li.~,g~.S .......... ..................... Orient ............................................ at premises located at ....~.~:~-~..~r~l~..~ ................................................................................... ....................................................................... ~.~e~t ........................................................................... pursuant to application dated .......................]~]~....~ ............... , 1~...., and approved by the Building Inspector. Fee $.~.t..Q..O. ............ ~ v Building In'Si~ector ~OUTHOLD, N. Y. No. Applicot~on ......................... Examined .........· ~-~, ......~'.....'.~..., 19.Z/ Approved ........................................ , ]0,. ermit No ................................... Disapproved o/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Dote f a. This application must be completely filled in by typewriter oe 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 adjo n ng premises or pub c streets or 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 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 Deportment 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 oppl cant agrees to tamp y with (~11 applicable laws, ordinanCes, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (SigniJfure of ppplica~)t, or tame, ,f , corpor~;i~ni ....... ........................... ~;.; ...... ~ ...................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumbeY or builder. Nome of owner of premises .......... ............ ~..:..........,~ ................................................... · '" . " If applicant is a corporate, signature of duly authorized ?.ffi['er. //---/~,r-.- ~ "'/' -~ - ~_~ (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No....,~,?-,,,~.,....,,/~,.. ......................... Electrician's License No. ~ O ~' Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ............... ~ Lot No ..................... Municipality 2. State existing use and ocCUl:X3ncy of premises and intended use qnd occupancy of proposed construction: a. Exisiting use and occupancy ~¢. ................. . ........ b. Intended use and occupancy ~-~ ~ 3. Nature of work (check which applicable): New BUilding .................. Addition..................~ Alteration ................. Repair .................. Removal .................. DemOlition .................... Other Work .................................................... (Description) 4. Estimated Cost ...:7 ............ , ......................................... Fee .../,9.............~---. .................................................................... (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 ~'~ Deth ..'~....~. ' / ' 8. Dimensions of entire new construction: Front /v~/ . Rear ....../..?...'. ............... Depth ..... .~.. ............... Height ....~.....~. ......... Number of Stories ....... /. ....................................... 9. Size of lot: Front ...... ..~...~.. .......................................... Rear ~--~ /* .......................................... Depth .../...~....~..../. ................ 10. Date of Purchase ........................................................ /~,e,,of Former Owner ........................................................ 11. Zone or use district n wh ch prem ses are s tuated .'~.~ t. 12. Does proposed construction violate any zoning law, ordinance or regulation: ~: ......................................... 13. Will lot be regraded .~ ............... Will excess fill be removed from premises: ( ) Yes (-~) No 14. Name of Owner of premises ...~..: ...... Address ........... Phone No..~.....~.~..~...~..~...~.. NameName olaf ContractorArchitect ....................................... ~'"/a-L~ '"'~'"-'"~"~=~'~'~'"'""'~~' .......... Address ..~~,. ............. Phone No ....................... · -~.....~...~... ........... Address ....... ....... Phone N o. ~...~. ~....'..?...~...z-. ,/ PLOT DIAGRAM /--4, STATE OF NEW YORK. . t S S COUNTY OF ' ....................... · .~...~....~....~.....~....~...~...~..-~..~.~... ....................... being duly sworn, deposes and soys that he is the oppJicdn! (Name of individual signing contract~ 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 that the work will be performed in the manner set forth in the ,application filed therewith. Swam to before me this (Signature of applicant) MARY O. KLOS NOTARY PUBLIC, STATE OF NEW YORK =~52-7306925 SUFFOLK COUN'r( Commission Expires March 30, Locate clearly and distinctly all buildings, whether exbting 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 comer lot. FORM NO. 6 TOWN OF $OUTHOLD , Building Depn~tment Town Clerks Office Seuthold, 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: 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-existiog dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date .....~ .......... o ............................... Iqew Bqilding ................ Addition ......./~... ...... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..../..~....~.....~.......~..~~..~.....~ ....................... .~...~ ................... Owner Or Owners Of Property ....~..~.....~~" Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~..~.~....?..~.....~.. Date Of Permit-'-- -- ~../....~....~...~./..Applicant ....~....~....~'..~/~ ~ ........... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all appl~0ble/codes and regulations. App, ic .................................... Sworn to before me this ~_ ~,~t~,~,,~ ...Z....~....... day of ......~.~.~: .............................. (stamp or s~'c-g/~ / J~' 03'7 FLOYD F. K'NO, JR. Notary Public ..... ,~,,~.~...~.fi.~...~.. ............ County Notary PuSIic St~to of New Yo~ Term EXpires fA~rch 30, 197j~