The URL can be used to link to this page

Home My WebLink About7316-z1"O~ NO. 4 TOWN OF SOUTHOLD BU~.nlNG DEPART~mNT Town Clerk's Office $outhold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the builalng located at $~[...~.~.., ..R~... ............ Street Map No...~ ....... Block No...~ ...... Lot No ...... .~. .......................... conforms substantially to the Application for ~uilding Permit heretofore ~ed in th~ office dated ...J~ .1 ............ , 19..~ pursuant to which Bui]dingPermit No. ~..... dated...~f~ .~D., ..........,19..~.,liwas l{SSued' and conforms to all of the require. ments of the applicable provisions of the lawt~he occupancy for which th;, certtt~cate is issued is l~al~ .~ ........ ~... ?~-..... ~ .. The certificate is issued to .... ~.e~l. ~.t~tl~l~ ........................... (owne~, of the aforesaid building. " Suffolk County Department of Health Approval ~ ................................ UNDERWRITERS CERTIFICATE No. .... ~..~. · ...................... ." ............. IPORM NO. ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Hi Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7316 z D~te ~TllZMI 10 19 ~ Permission is hereby granted to: oo~.~..~.....~j ..... Southold. t.o ~..m~..md~.t~on..~ .m~a~LGa .~mzm..m.t~G4 ............................................................ at premises located at ....Jj/.J~.....~...~.tJ~. ........................................................................................ Clttehofum N,¥, pursuant to application dated ........................ ~T~II~I.....~. ............... , 19~..., and approved by the Building Inspector. Fee $ ............ .. ........... BUILDING DEPARTMEHT -~ C..,~,~,~ ~ K ~ L~ TOWN'CJARK'S OFFICE /' ~ . ~ r% SOVI'HOLD, N.Y. /~ ~ - ~ '~'~,~' ~ ~ ~omi,.d ! 0 ~ ·· "2.~ / ..... ................... _ ,o. ................ r,. ............. APPLTCXTION FOR BUILDING PERMIT '- INSTRUCTK)N$ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, 3 sets of plans, accurate plot plan to scale. Fee according to ~chedule. ~,: b. I~lot ptan showing location of lot and of buildings ~on J~remise~,:relationshjp to ~ ,o~ning ~remises or public streets or areas, giving a detailed description of layout of property must be drawn on ding'ara which' is I~rt Of th~s apl~lication. 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 the premises available for inspection throughout the work. e. No building shall be oCCUpied or used in whole or in part for anv: purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departmen.t for the issuanns of a Building Permit pursuant to the Building Zofle .' Ordinance of the Town of Southold, Suffl)lk County, New York, andj~{he~ applicable Laws. Ordinances or Regulations, for the constructlen e~ buildings, additions or alterations, or for removal or demolition, as herein described. 'J~e'al~oliCant agrees to comply with all applicable lawl, ~ ordinances, building code, housing code, and regulations, and to admit authorized inspect~s on premises and in buildings for necassarv inr4~ectiont. ~ig~ature of applicant, or name, if a corporation) · (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....~,~,,~.~..~,~c~T=.K~ ................................................... ~ ............................................................................................... Name of owner of premises .'.....,.~l~,,......l~.:L~,~.~.l,......[:..:.~.~.~l~Oga'lKr[.'. ........................................................ If applicant is a corporate, signature of duly authorized officer: Name and t~tle of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ............. LocationOther of Trade'Sland License which No ........... :::::::::::::::::::::::::::::::::::::::: work will //~ ,, ?l~ ~~',.I 1. on proposed be done. Map No .................. ~...,~..~,, ....... ~.: ....... Lot No, ~...~.¥..,.~,..L:. ", Street and Number .~.,f~....~'X~q. ........ ~1~-.-~...~ ...... ~-.~Z.~ ..'~...~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and OCCupancy ...... .,/~.~.~ ....... ~'~/.~, .............................................................................. b. Intended useandoccupancy ........ ~.~.~lf.4.~ .......... ~.......~ ...... ..~.~ ........................................................ Nature of work (check which applicable): New Building ....................... Addition ...L ......... Alteratiol~.....'....;.,..:' Repair .....................Removal ....... Demolition ........................ Other Work ............................. ...................... I D~¢riptionl ......... 1,~'=o ,~o .......... Fee Io ,~o .............................................. 4. cs~lmama ~o~ ........................................... i~'~'l~i*~l'~"~i'l~':t*l~i~'app~ication) "' 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 occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..... ~,.~ .......... Rear ............ ~,,,.'f .......... Depth ......JLa.'. ...................... Height ............ [.et. .......................................... Number of Stories ............................................................................. Dimensions of same structure w~th alterat ohs or add tons: Front ..... ~.~ ............... Rear ........ ~..%1. .......................... Depth ............. .Ji~. ........................... Height ...... ,...J.~. ................ ,...:.... Number of Stories ....1..'::. .............................. 8. Dimens~ons of entire new construction. Front ......................... Rear ............. Depth Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ....... I.IJ~.,- .................... Rear .....~ ............................ ~ ...... Depth ...J5'6.'...+:- ................................... 10. Date of Purchase .~tlRILi~gt~ ............... Name of Former Owner .....--:.. ..................................................................... 1 I. Zone or use district in which premises are situated ..................................................................................................... 12, Does proposed construction v olate any zon ng law, ordnance or regular on ................................................. .... 13. Williotberegraded .................................. Will excess fill be removed fr°m premises: [ ] Yes [ ] No ~ 14. Name of Owner of premises ..... ]D/]r.,...--)~'!.~'.~. ~-L.....-~,.ct~..l~tl~.. J;, "* ............................... .'~3..~,..'...~fL~ ............. (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) {Phone No.) Name of ContraCtor .~__,TaJ,,.12gt~l~j~......~LlJJ.~......~l(J~t, ....................; ........................ ~.~.~....~..~.~J'~' ........ (Address) {Phone No.) PLOT DIAG RAM 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 show street names and indicate wheth- er Interior or corner lot. STATE OF NEW, ~)/,R K//./~/~ COUNTY OF '~'"'*'i ........ ) ,SS ...x~.~....F..AI~/,,,~O .........~..~.gdg:).g~....~....t:.~. ......................... ~ing duly s~rn, ~ and ~ys that ~ is the appii~nt abo~ na~. ~ , {~ oyin~.i~ ~n~O .... . He is the ......~ .......... ~.~..~..~ ..................................................... ~ .................................................................................. (~n~tor, a~t, comte offi~r, etc.) of said owner or owners, and is duly authorized to ~dorm or have ~rfor~ t~ ~id work and to ~ke and file this appli~tion; ~ all statements ~ntained in this appli~tion are true to t~ ~t of h~*kn~ed~ ~,~l~f; ~ that ~ work will ~ ~or~ in the ~n~r mt forth in the ap~i~tion fil~ t~mwith. Jum7"~ ~ ~ ~ ~ ~ NotaWuo. 52-034~ff°~guj''4¢ Stole ~. ,ew~nW~Yo~: ~ ...................... ~......~ay~ of -- ................ ~~ ~ch- 30, 19~ ...... ....... ............ ~ (~ of ~t} FOI~M 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 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: I. 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 ........... .,~../~..~-,~/~.~)....'~... ........ New Building ................ Addition ....~.. ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ,~TZ~ZX~ ~T/..~ .... ~.~..~'~.f~.~'d,,,~r.'~.. .............................................. Owner Or Owners Of Property ~..~.,~..-~.'..4~.~ ....... ~./..~.'~-.-.~..4[I&E~., ~.~..~./~/~ .......... Subdivision .............. ~ ............................................. Lot No. -- Block No ........... -~.. House No.........-~.... Permit No...~.3].~,...'~:. Date Of Permit .//.J0/~.~....Applicant Health Dept. Approval ..,~.O ...... -~4~O~f/4.'4~....Labor Dept. Approval ................................................ Underwriters Approval ..~.....,4~O. 6~.c~.-~. ................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ...¢~ .................................... Fee Submitted $ ........~.......6~ ................. Construction on above described building and permit meets all applicable code~ and regulations. Sworn to before me this ~/' ~~ /~/d~-~o ~9' ................ day of ............................................ (stamp or seal) Notary Public .................................... County