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Home My WebLink About7298-zNO, 4 TOWN OF SOUTHOLD BUH.~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~ .60.8.0 ....... Date .............. Aug .... 28 .... , 19. THIS CERTIFIES that the building located at .. Px~. I~ .~Jl~. ]B~,Z~.*.a .l~ym..l~treet Map No..~X ......... Block No.. ~ ...... Lot No. Z:~....0~.~.e.~.t;.t .1~..,.Y... ........... conforms substantially to the Application for Building Permit heretofore filed in this office ·_,~ / dated .......... ~..m~.... ,~ ..., 19..~.. pursuant to which Building Pemit No. ,, ' dated .......... J.lme ..... 3.-, 1~br.., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P. rlY.~t~e..o.n.q..f..lmm..ly..dw..e.l.l.~..~g...v.$..t~., a.d.d..i.t.~.qn. ..................... The certificate is issued to .R.~.q .ha.l'.d...8.~.~.~k ...... . .c~..e..1, ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 1[o.8, ................................ UNDERWRITERS CERTIFICATE No. 1~.,..R.e ........................................ HOUSE NUMBER ...¶.200 ....... Street . ]J~J~..R. ge~i..~. ~...B. $.~.d.~.e. y~....1~. ........... FORM NO. ,2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFIflGE SOUTHOLD, N~ Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7298 Z Date ..................... ~:lii~e.....~ .................. 19~... ."" ) Permission is hereby granted to: O~.ient, Private Road N S RT.2.~. . . at premises located at ......................................... /. ............................................................................ pursuant to application dated ...................... ~ll~e'""~ ................. , 19.~1,.., and approved by the Building Inspector. BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. £xomin,d ........ ..~...~-~ .~.....~'~. ...... , 1~..~.~ ........................................ . ........................ ............. INSTRU~I~S a. This application must be completely fill~ in by ~pewriter o~ in ink and s~mitted in triplicate to the Building,~ Inspector, with 3 sere of pl~s, aocumte pl~ plan to ~ale. F~ according to sch~ule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and givi~ a detail~ description of layout ofpr~e~ must be drawn on the diagram which is ~ 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 insp~tion throughout the work. e. No building shall be ~cupied or used in whole or in part for any pu~ose whatever until a Ce~ificate of ~cupancy shall have been granted by the Building Insp~tor. APPLICATION IS HEREBY ~DE to the Building Department for the issuance of a Building Permit pu~uant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable ~ws, Ordinances or~ Regulations, for the constru~ion of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building c~, housing c~e, and r~ulations, and to,~ admit authorized insp~tors on premises ~d in buildings ~r n~es~ in~ections. , ................... .................... .................................................. (Addm*s of ~pplic*nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. applicant is a corporate, signature of duly authorized officer. (Name ond title of corporate officer) Builder's License No ..................................................... PJumber's License No .... ~...,2,-~.....~... ....................... mectricion's License No. ~ ~ ? ~- Other Tmde's License No ............................................... Location of land on whic~b, proposed work. will be done, Map No.: ........................................ Lot ,No ......................... Street and Number, ,.~...~,..~ ....... .,,4~../~..5......~...~....~. ............... ...~,.~ .................... Municipality State existing use and occuponcy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~'~1;~ · b. Intended use and occupancy ............................:.~....~. .......................................................................................... 3. Nature of work (check which applicable): New BuiliJing .................. Addition ...... Repair .................. Removal .................. Demolition .................... Other Work ~...~.......~.~ ......... ' (Descripti~) 4. Estimated Cost ....Z.~ ........................................ Fee ............J. ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each flc~or ............................ 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 ....~.....~....r. ............... Depth ..... .~,...~....r..~..../.:. ......... Height ...... ./....~..~. ............. Number of Stories ...... ./.. ....................... 8. Dimensions of entire new construction: Front ..... ..~....~/...! ................... Rear ...~'....~...~ ............... Depth ..../.../~...../. ........... Height ../.~..~ .......... Number of Stories ....... ./.. ........................................................................................... 9. Size of lot: Front .......... ~:.....~....~...../. ............................. Rear .....~.....~'7....J~...~. ..................... De~h .?.....~..../..:...?....~T. 10. Date of Purchase ........................................................ Nome of Former Owner .~.....~.........~. 11. Zone or use district in which premises are situated ...~.x. ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~ .......................................... 13. Will lot be regraded ....~;;7 ,,~, ~' ~Z', ~_Will excess, fill be removed from~/~ ,-. ~',premises: ( ), Yes (-iQ No~ No.~,,,./~,-,. ~:... ,~, ~...~,~' 14, Name of Owner of premises ...,~...,..,,w¢,.¢..~~ ............. Address ,,,~,,,~.~Phone Name of Architect ......................................... ~.,...~ ...........Address ................................ Phone No ....................... -~-'- /'/~.r/,,..~,.~ ......... Address, ,~,,,~ ......... Phone No,~,,,,'~,,,~.,T. ,~,,~ Name of Contractor x/~ 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 Jot. STATE OF NEW Y_ORK. ' '- [SS {~ ~! COUNTY OF ....-,,~...,~..~T'..~....~...~....~....~ ' P ' ............................ .7....~.../~'...~.....4~....~...'~..~./m~..~..~... .................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. He is the ................................. ..(~..:.~...6(.....~....A~....'~.....~./.~-.~....../~.. .................................................................................................... (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. Sworn to before me this .... ....... of ...................... , Nota ...... Coun ....... ............................. ~' ~/ (Signature o applicant) MARY O. KLOS NOTARY PUBLIC, STAT[ OF NEW YORK ~52-7306925 SUFFOLK COUNTY . Commission1 ~pire~ March 30, ~.~ FORM NO. 6 TOWN OF SOUTHOLD 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 fo[lowing; for new buildir~gs 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-existing dwelling or land use $.5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ....../~... ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....~..~......~ ......... ...,~......~....~........~_r:~...~......~..~ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...'~'. ~,Z:.....~....?..~.. Date Of Permit ...~...--.Z~../...*~...~./.Applicant .~~.....~..~ 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 oil applicable ,code~ and regulations. Sworn to before me this Applicant ~........~...~...?'~../......~....~....~X~-- ............................... ......... ~...~ day of .~...~..~...~...Z...~....~,~ ~ /./ (stamp or seal)