HomeMy WebLinkAbout7318-zNO. 4
TOWN OF SOUTHOLD
BU-H~nI~G DEPARTMENT
Town Clerk's Office
flouthold, N. Y.
Certificate Of Occupancy
No. 7'.6.~. 3 ....... Date ............. .A~g ....9 ...... , 19 7.~..
THIS CERTIFIES that the building located at . D. qt~g;L.&s. ~..o~4 ............ Street
Map No... ~ ....... Block No .... ~ .... Lot No .... ~ .... .0~..~.e.n..t...~. :.Y., .........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........... J...tl_X~....1.0.., 19..~.. pursuant to which Building Permit No..7.39 ~E~.
dated ......... .J..l~..e .... !.1..., 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
issued is .. pT.:[~r~.t.e..o.~..f..a~. ;I.~,y. ~i.~.e. 1. ~. g..~,th..&d..~;I..t.~e~t .....................
The certificate is issued to . .~.~.~.a..~.. ~o.I..b~L.e.q~ ...... . .(~..e, ........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .N....R.,. ..............................
UNDERWRITERS CERTIFICATE No. N..,.R.o ........................................
HOUSE NUMBER . .2.~..~ ......... Street ...D.o.~.$.i.a.I...R.o.a.5. .........................
~NO.~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
COMPLETION OF THE WORK AUTHORIZED)
7318 Z
Permission is hereby granted to:
· .~r ~"~-"f~:~ta.' 'Ma~.e~. ...........................
to BIL~l..a~.&d~l ~.t~.. en.. e~..~t J~g.. ~al~ .....................................................................
ct premises located ~t ...... ~)01Y~.2~j..~l~..~..~.~[..~ ...................................................................
......................................................... 0~.J~ut. ........................................................................................
pursuant to application dated ........................ ~%IZ~' .......~1 ........... , 19~...., and approved by the
Building Inspector.
Fee $.1.Q, ~ ............
Bullding'"~spector [
leORM NO. !
TOWN OF EOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
~×om~nedl I ........ , ,~ ~/
..... i'"i" ..... ,.,m,t.o. 7
Disapproved a/c ..~........~.~-'~
Application No ................................. .~
APPLICATION FOR BUILDING PERMIT ~
Dote ................................. , 19.?..~...., }
INSTRUCTIONS ~
a. This application must be completely filled in by typewriter of in ink and submitted in triplicate to the Building ~,'
Inspector, with 3 set~ 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 o~.
areas, and givinga detailed description of layout ofproperty must be drawn on the diagram which is part of this application.r,,J
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 o 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 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 alteratiens, or for removal or demolition, as herein described.
The applicant agrees to comply with all a~l)lieeble laws, ordinances, building ~derhousin~-codel ar~ regul0~tions, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
.... ...............................
(Signatu of app ,cant, or name, if a corporation)
./..~_/~... _Z.~.. ~.4...... ~q.Z.. ~//~......~../.~ ..f..~
(Address of applicant) //,.7,.j'~,~'"'7'''
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
O~E~ ........
Name of owner of premises ...Z~....~...~.~......~..~.~.~,~..ff.~....~.. .................... V/...~_./-T....~....... ~..~...~.~'...d:...~...~...~.. ...................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .................................................
I~]ectrician's License No .............................................
Other Trade's License No ...............................................
Location of land on which proposed work will be done. Map No.: ........................................ Lot No .........................
Street and Number ..... ~..~..~.......~.~...~...~.~..~.,]....J/~. .................................................................. /~.Z'~...~.~...
Municipality
State existing use and OCCupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy .~...~..'~......~.
....... ~.~/.../--Z..,E...~ ........... ~ ...............................................................
use and occupancy .......... (.~ ................ ./..: .................. ~.1/~,,,~., ,~,, .~..,~,.~ .........................'..
b.
Intended
3. Nature of work (check which applicable): New Building .................. Addition .~ ...... Alteration ..................
Repair .................. Removal .................. Demolition .................... Other Work ......................................................
(Description)
4. Estimated Cost .~.. ......~.~..~... ........................................ 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 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 ........~...7.. ............ Rear ........ .~...~.. ............... Depth ....~.~... ......
Height ...~.~.../'. ............. Number of Stories ....... ~.. ................................................................................................. i ....
Dimensions of same structure with alterations or additions: Front ........ .~....~.... .................. Rear .....~.....~.. ...... ; .....
Depth ~..~.../..~..~.~..~)~. Height ...... ~.~..../. ............ Number of Stories ...~.. ..........................
/
8. Dimensions of entire new construction: Front ......... .~...~...~ .~... ............. Rear ....... ,/~...~.. ......... Depth ....~...~.. ..............
Height .~..~..~..../.~.../.... Number of Stories ......... .~. .................................... .; ........................................ .~..~.,~.~ ...............
9. Size of lot: Front ............ .,~...~...../. ................................. Rear ........ .~..~... .......................... Depth ....Z..../~. ....................
10. Date of Purchase ...... ?./~/.~..,..Z~.~. ...................... Name of Former Owner ...... ,.~..~...~...J....~...~...~. ..........................
11. Zone or use district in which premises are situated ..... , ...............................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ....... .~...g ..........................................
13. Will lot be regraded. ...... ,~....O. ............. Will excess fill be removed from premises: ( ) Yes (~o
14, Nome of Owner of premises..~..~,.,~,.~,, ...... ~.~,~,~.,~.,~,~,..~...... Address ¢.~.~/~.~,,~,~,,~,,.~;,..,.. Phone
Name of Architect .............................................................. Address ..,~..~,(,/,'~,~,,.,,,~',,C ........ 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
properb/ lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
.5'} F'r
STATE OF NEV~ ~)Jf~',,//,,I,/~'~ Lc c
COUNTY OF~~'~
...................... ~ ........................................................... being duly sworn, deposes ond says that he is the applicom
(Nome of individual signing contract)
above nomad.
He is the ...................................................................................................................................
.............................................. (Contractor, agent, corporate officer, etc.)
of sold owner or owners, ond is duly authorized to perform or have performed the said work and to make ond file
this application; that all stotements contoined in this application ore true to the best of his knowledge ond belief; ond
that the work will be performed in the manner set forth in the application filed therewith.
p/~ . of . , , 19.~....~...
· ... ¢' ...... . ........... .... . .......................
JUDITH T. BOKEN
Nola~ Public, State of New Yor~
No. 52-0344963 Suffolk Count~ /
FORM NO. 6
TOWN OF SOUTHOLD
Building Deportment
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 pbn requirements where applicable.
B. For existing buildings (prior to April 1957), Nomconforming uses, or buildings and "pre-existing"
land uses:
I. 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 $$.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 ..............
Owner Or Owners Of Property ~ ~ ~ ~(~L~
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Ce~ificate ........................................ Final Certificate
Fee Submitted $ ........~..~ ......................
Construction on above described building and,~rmit meets all ~olicable codes and regulations.
Applicant ......~"~/'. ~.. ~..~--..~..~......~., .~..~" ..............................
Notary Public, State of New York
No. 52-4518967
Qualified in Suffolk County
Commission Expire~ M~rch 30, 197~