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Home My WebLink About7330-zTO~N OF $OUTHOLD Bu~.nlNG DEPARTMENT Town Clezk'~ O~ie~ $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the bugatng located at ~l~l~l~m- Blv~ ............ Street Map No. Latlghimg. · Block No..m~ ...... Lot No...~m .... Booth®lA · .1~,~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...........Jmm.. 1.7.., 19. ~ pursuant to which Building Permit Nc~3~... dated ...........JU~...ly..., 19. ~, was issued, and conforms to all of the require- me,ts of the applicable provisions of the law. The occupancy for which ~ht= certificate is issued is . Pr&vats. ona .fa~t~y. ~ll~ng .... W~.t~. additioa ................... The certificate is issued to .~ermal~. ~a ..... ¥~ ........................... of the aforesaid buflalng. Suffolk County Department of Health Approval (owner, levee or tenant) .N.~o .............................. UNDERWRITERS CERTIFICATE No..~i.1.?.$86~ ................................... HOUSE NUMBER... 1 ~ ~) ...... Street ....)i~e~m. ~lv~ ....................... TOWN OF SOUTHOLD BUILDING DEPAITMENT TOWN CLERK~ OFFICE SOUTHOLD, N~ Y. BUILDING PEIMIT (THIS PERMIT MUST BE K:EPT ON THE PI~,EM!SES UNTIL FULL COMPLETION OF THE WORK: AUTHORIZED) N? 7330 Z Permission is hereby granted to: ..... ~i3,4e~eae-.ll~ ........................... ; ............... ............... · ~--~maet ............................................. to~l~..a~..~L ~Lo~..m~.. ea~l~t4~..a~m~ .................................................................. at premises located at l~L~eh&l~.....~/~ .......................................................................................... ..................................................... ~o~J~h~....~ ~'¥~ ................................................ ~ ........... .............. pursuant to application dated .............................. ~TtiI~.-...J.~ ....... , 19.r~,.., and approved by the Building Inspector. Fee $,-1.F,.~0' .......... Examined ...... !...-] ........ , 19..~...~.. Approved ...~.. .......... c...~ ................... , Ig..~..~ Permit No....~....~.....~.....~.....~ Disapproved a/~ ........................................... ~ ..... ..,...~ ~ _ '~APPLICATION B"ILD1/NG F'EILMIT .............. ...................... , a. T~ a~licmi~ mu~ ~ c~pletely fill~ in ~ ~e~ter ~ ink a~ ~mi~ in triplicate ~ ~e Bui~di In~, with 3 ~ of p~, ~cumte ~ pl~ ~ ~le. F~ a~i~ to ~u~. b. Plot plan shying I~ation of lot a~ of buildings ~ premis~, m ationsh p to ~joininp. premiss or public str~ o~ ar~s, and givi~ a detail~ d~ripti~ of I~ ofp~ mu~ be drown on the di~mm which is ~ of this a~licah~. c. The work c~er~ ~ ~is a~lieati~ ~ nm ~ comme~ ~fore i~uance of Bui~ing Permit. d. Upon a~mval of ~is a~licati~, ~e Buil~ Ins~tor will issue a Building Permit to the ~licant. Such ~it shall be kept ~ the premis~ ~il~le ~r i~i~ ~h~t ~ ~r~ e. No building shall ~ ~cupi~ or u~ in ~ole or in ~ for any pu~e wh~er until a Ce~ifi~ of ~cu~ncy~ shall have ~en granted ~ ~e Buildi~ Incr. APPLICATION IS HEREBY ~DE to the Building ~pa~ment for the i~uance of a Buildi~ Pe~it pu~nt to the ~~o~t~ ~i~ ~,h~l~. ~,,olk ~ou~, N~ ~ork, and ~.r ,~l~cable ~, O~i,nc, or~ The a--Ii ............ a~f a~j~s or a~mmt~s, or ~or mm~a~ or ~liti~, ~ h~in ~ri~ . ~ ~u.~ ogres m comply w~m a, a~.came ~, o~, building c~, h~sl~ c~, a~ ~l~i~, aamit authoriz~ in~tom ~ premiss a~ in ~J~l~ ~ n~ i~tj~s ........................................................... ........... (Signature of applicant, or ~, if a co~mti~) Store wh~th~r applicont i* ~n~r, I~,, ~O~nI, a~hlt~, ~n~in~r, ~neml c~tmctor, el*ctrician, plumb,r or buil~r.~ Name of ~ner of premiss ........... If ap~ant ~ a co~orat~ignatgre of d~ authoriz~ officer. ...... ............... ,-,-- ~ Builder's ...... Lic~ No .................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ! _ _ j. Location of land on which proposed work w be done. Map No.: ..~.~.~..~.../A')' Street and Number .~./~.~......~.'.~../.~.,~..~...~'~.....~....~...'.~..'..~..~. ............... Municipali~ State existing use and occupancy of premise~s and intended use.and occupancy of proposed construction: __ use end occupancy ...... /...~./.'./...~. ....... J~.~......~<.....~...~....~.i...~.....~. .............. ~ .......................... Exisiting b. Intended use and occupancy ......... ...~...~...~..~......~...,..~..' '-- ..~.......O....C~...~'~ ..... ~.~ ...................... 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 ..... -I ..................... 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 ..~.~Y...~.. ............ Rear ........... ~..~... ............ Depth .................... Height ......... /~ ........ Number of Stories ................. ~. ............................................................................................. Dimensions of same structure with alterations or additions: Front, ......... ~...,~.. ................... Rear ............................ Depth .~....~.. ...................... Height ....,~....~....~ ............ Number of Stories ...../. .................. /.~... 8. Dimensions of entire new construction: Front ........ ..~. ........... : ........ Rear ..... .,c~....~... ............ Depth ...,~.....~... ............ Height ./~....../. ...... Number of Stories ....... ~. .................................................................................................. .......... 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ..... ~.....~. ........ : .............................. 13. Will lot be regraded .~J.~ ................. Will exces.s fill be removed from premises: ( ) Yes ( ) No Nome of ............................................................. ,-,uuress ................................ Phone mo .................. 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 lot. /6' STATE OF NEW YO~K,~./'. ..................... ~.; ......................................................................... being duly sworn, d~oses and says t~t he is the applicant (Name of i~ividual signing c~tm~ a~ve name. He is the ................................................................................................................................................................................. (Contractor, ag~t, co~rate officer, ~c.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t ~ statements contain~ in this a~lication ore tree to the ~st of his knowledge and belief; and tha~ the work will ~ performed in the manner ~t fo~h in the application filed the~ith. Swam to ~e me this 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 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 th~ 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 ~nd condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent 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 ................ ¥ocont kond .............. Location Of Property ......... :...r...' ..~..J~. 1 .................. '~ ............................ I ...... , ...................................... Subdivision ................................................................ Lot No ............. Block No ............. House No....ff..~..e Permit Date Of Per, t .... ~ealth C~pt. Approval ...~...:..Z..~......'. ................... ~bor ~t. Approva~ ~ Underwriters Approval ..~/'.~J~/....::~C.J....'.~..J..~'.~,.~,,,....planning Bo~rd Appraval .~...:../...-~.. ........................... Request For Temporory Certificote ........................................ Final Certifi¢ote .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ................. ~ .... r ........................................ Sworn to before me this of Notary Public ....... ~'~~ ~ '~ ~' County · , ~ (stamp or .lon Commission Expires March 30, 19~