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Home My WebLink About7326-zNO. 4 TOWN OF $0UTHOLD BU~.BING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at //-~ Y~t/~f~ $ ~ V~' Street Map No ............. Block No ...........Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated /i~ ,.]///~'lQ7~/ pursuant to which Building Permit No. 75-~, dated ....................... 19 ., was issued, and conforms to an of the require. ments of the applicable provisions of the law. The occupancy for which ~.hls c~_'f~cate is The certificate is issued to.././.~..~. ~. ?'....~...~..~..~.~..~..~. ~. ?. .... . ."~....'~..>! ./.~..~. ....... (owner, of the aforesaid building. Suffolk County Department of Health Approval /w -~ , UNDERWRITERS CERTIFICATE No. /~/' ]~ HOUSE NUMBER / / -~ Street ¥'6/Y~1~ ~ ,~ Building In.~-ctor lrOB~ NO. :g TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7326 Z Permission is hereby granted to: · ~ar.~.~...~=g&ret...~,th&~.~. .................... ........... Y'o'uzzl~'g ";q.~'~ ............................................. ............. ~a~ct l~c~k- ............................................ to .~l~..~..~ ~o~..~...e~..~..pe~m~t..e~et~uo.b ~en.)...~..ex~.~ .......................................................................................................................................... ~g.. at premiss I~at~ at .~...~ee...kve ....... ~.~ ........................................................................ ....................................................................... ~~ ....... ~;.~; ................................................... pursuant to a~lication dat~ .............................. ~e......l~ ...... , 19..~., and a~rov~ by the Building In~tor. INSTRUCTIOI~ ~ a. This application must be completely filled in by typewriter ac in ink and submitted in triplicate to the Building~ Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee ~c_c_-~ding to schedule. ~P b. Plot plan showing location of lot ond of buildings on premises, relationship to ocljoining premises or public streets of oreos, 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 Permff. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permi~ shall be kept on the premises available for ir-~oection 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 Th ' the construction of buildinj~/additions or alterations, or for removal' or demo ition, as herei.n described. · applicant agrees to comply with aU~licable laws, ordinances, building code, housing code, ond/m~lulattons, and to (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (Name and title of corporate officer) Builder's Lic~se No ..................................................... Plumber's License No ........................ Electrician's License No ............................................. If applicant is a corporate, signature of duly authorized officer. Other Trade'~ Li¢onse No ............................................... 1. Location of land on which pr~gosed work will be Ckm,. Map No.: ............... ~......, ...... ~Lot No ..... ~ .............. Street and Number ...t~./....~... ...~.~......~. .~......j~. ................ ~~~ .............................. Municipality 2. State existing use and occupancy of ~?_i~se~ a.a_,nd;mtended use and occupancy of proposed construction: a. Exisiting use and occupancy ..../...~ c"~....'-'"~T-.. ......... .... :'i iiii ii ................ i ...... b. Intended use and occupancy ............................................................ ' '~.. '-~oture of work (check which applicable): New Building.. ................. Addition~,.~ ............. Alteration ...~.. ......... Repair .................. RemOVal .................. Demolition ...... ; ............. Other Wor~k .~...~.~...~..., .....~...O...~.. ............. :. ......... (Description) 4. Estimated Cost/~--~.!~-~....~)... .................................... Fee ........... ..c~/../....~...~.~.."..~.... ....................................................... (ira be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of ~lwehing uni~ on each fl~lor......~...t .................. If garage, number of cars ...................................................................... ' ...................................................................... 6. If business, commercial or mixed occupancy, sp~ci'fy nature and 'extent of each type of use ............................ 7. Dimensions of existing stru~;tures, if any: Front ............................ Rear ................................ Depth ....... ............. Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of ~tories ................................ 8. Dimensions of entire new construction: Front ............................... ' ..... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ..... :~ ...................... ; .......................... Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............. ;. ............. Will excess fill bej:~rnoved from premises: ~ ) Yes ( ) No 14. Name of Owner of premises ~..~..~..~...~....~.~..~.;....~..~..~.....~..... Address ~..~....~..~...~....~..~.. Phone Na~c~'.~.C..o~....o)...~..~ Name 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 show street names and indicate whether interior or corner irJ'ot. (Contractor, agent, corporate office~', etc.) ~ owner or owners, and is duly authorized to perform or have per'formed the said work and to make and file this application; that all staten~nts contait~ed in this appliCation are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner' set forth in the application filed therewith. Swam to I~foce me this ~ ~ .... of ...... .... , -- - ............ ".... ............ :::::::::::::::::::::::: " ............................. /~~ y (Signature o oppl,cant, NOTARY PUBLIC, State of New York No. 52-5658570 Qualified in Suffolk 'Ceunly Commi~i~ Expim~ Mama 30, ]976. STATE OF (;QUNTY. OF ...~l~.~e~)./. [,~,.....~"~ be n,~ '"~'"""(~' (Name of indiV~d~ s~ning contrac~f) duly sworn, deposes and says that he is the applicant above named. 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 compleled site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming 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 $1.00 ../..~../y/ ' Date /...~. ~ ....................... New Building ................ Addition ................ Old or Pre-.~existing Buildi.?g ................ Vac.%nt Lond .............. Location Of Property ....~.../~.~.. ~.~//.~.~.~ .../.~/..~.~- -J~././.$ ' ~.'.~.~.. ......... ??? . ................................................................. ......... ...... Owner Or Owners Of Property .~..~, .~..~.~.....~.. :~.'~.~...~./~..~..~....~...~.... ~.~../Z.~.. .................. Subdivision ................................................................ Lot No ............. Block No ............. House No...~.-./../... Permit No.~...~...~.....~.......~Date Of Perm~it ~.././.~.-/.~.../,~Applicant ')/~ .~.J~.~.......~...~..~..~'..~....~..~...~...~1 Health Dept. Approval ............................................ Labor Dept. Approval Underwriters Approval .............................................. Planning Board Approval ...... ......_j;~ ................... Request For Temporary Certificate ~ Final Certificate .......................................... Fee Submitted $ .. ~.~..~i~f~. .................... Construction on above described building an~ permit rpe~all applicable codes and regulations. App ' ica nt ~L,~ ~ ' ~~.. ~...~..~,' ................................ Sworn to before me this / / I~//~'D~ ~ /~' , -- ...~T ....... day of ...~.....~.,..~.~ (stamp or seal) ~,,~ ~.1 N~a~y Public ............................ ~ETE~ ~AN ~ ~ -- ~mmi~i~ Expires Ma~ch 30, Jg~