HomeMy WebLinkAbout7333-zTOWN OF $OUTHOLD
BUIi~BING DEPARTI~.NT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z6102 ..... Date ...............~ep.t..12..., 19.
THIS CERTIFIES that the building located at . t/est,..La~e. Street
Map No. ~ ......... Block No.:~x .......Lot No.. x~.. East, ~,a~.. ]~,Y, .....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............June.. 17., 19.7~. pursuant to which Building Permit No.
dated .........Ju~-. 'l? ...., 19?tr.., was issued, and conforms to an of the require-
ments of the applicable provisions of the law. The occupancy for which thi.~ certificate is
issued is ... ~ra. te. one · fmmLly. 4well~ul .~Xth .adder:ton ...................
The certificate is issued to 'Thow '8~,malJ~to .... er, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval 'N,R, ..............................
UNDERWRITERS CERTIFICATE No..pmaldda~ ...................................
HOUSE NUMBER .... 3~ ...... Street .. ~/mst. J, am~ ........ : ....................
Bufld~,~g., Inspector
IN)BM NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'~ OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7333 Z
Permission is hereby granted to:
F...~e~.C~.....~..~..~.~..~..e~l~g .............
Orient
ro ..i~u~.l~..~ ..&~l.~.t~en.. e~..e..~t.~ug.. ¢l.~Z.;l&n{t ..............................................................
at premises located at ..1~e~.-[~ ........... ~);t4..~q~ ..............................................................
............................................... ;E~t..Ear.;t..Jm ..... I~.~ ......................................................................
pursuant to application dated ............................... .~l,lD, e......'J.~......, 19,.~...~., and approved by the
Building Inspector.
Fee $.$.~0~ ...........
INSTRUCTIONS
a. This application must be completely filled in by t~ewriter or in ink and submitted in triplicate to the Butldlng~
Inspector, with 3 sete of plans, accurate I~ 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 st.reets or
areas, and giving a detailed deSCription of layout ofpraperty must be drown on the diagram which is part of this apphcation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Uppn approval of this application, th.e Building InspeCtor Will issue a Building Permit to the applicant. Such permit
shall be kept on the premises Qvailable for ,nspection 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
~Build!ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, O. rdinances or
.~l~umati,o. ns, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto described
· apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in buildings for nece~a., ry Impecfions.
? c ...... : ..........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises Tho~8 ~.oul~.m~O ~
If applicant is a corporate, signature of duly authorized 9fficer.
(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No .........................
Street and Number Womt, L~I~o
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy
b. Intended use a~d occupancy ..... ~.~m,®z~ed...po~.o~ .........................................................................................
· ' 3. NO,ire of wor~: (~eck wh ch app ~cab e). New Bud ng ................ ~ t on ^lterat o .
Repai~ ......... ;..~ ..... Removal .................. Demolition.., ................. Other Work ..~.~....~...~...~....~.~.
(Description)
4. Estimated Cost ....... ~t~...~ .............................. tee ..........................................................................................
(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 t~l~e of use ............................
7. Dimensions of existing structures, if any: Front .........,~. ............. Rear ............. .~ ............. Depth ......... ...~.. .....
Height ............. ;.: ........ Number of Stories .................. ~ .......................................................................................
Dimensions of same structure with alterations or adc~itions: Front ....... ~ ........................ Rear ....~. ...................
Depth .....;..~L.~...?~ ................. Height ............. ...~., ........ Number of Stories ........ ~ .................
8. Dimensions Of entire new construction: Front; ....... ..,...~ ..................... Rear ............................ Depth ......~.~.. ..............
4J~lJl'.. "u "r of
Height .;. ............... . m ~ ! Stories .......... ~1~.~1 ................................................ ~ ...................................................
9. Siz~ of lot: Front ........................................................ ~ear ...... ~..I ................. .~ ......... Depth '...~.l... ..................
10. Date of Purc;ha~ ~1~..~-~1~ .................... ~ame of Fo~mer Owner .~lllllall~. .......... ~ ............................
1 I. Zone or use district in whi~% premmes are situat~ed .I....,~..-: ....................................... ;;;;. ............................................
12. Does proposed construct on v olate any zomng law, ordinance or regular on .................... ~ ................................... '
13." V~il!~ tot~:l~,r~gmded:,;.~;.,...;:..~.,~'...~ ....... Wilt excess fill be removed from premises: ( ) yes (
uaie llt ta e :..' ..,. 'll ir
14. Name of Owner of premises ............................................. ....... ^aaress ~llll~..~j~l[~..... rnofl~ mo .......................
Name of Architect ............................................................... Address .......................... ........ Phone No .......... ; ............ -
Name of Contractor ~ ~&l~ee~l; ~1 ~ Address L.II~ ]ql~,,~, kb, ,t~...~.....
............................................................ ~r~am~ll. ~ .a~l~a~ ..............................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setdxlck dimensions from
property lines. Give street and block number or description according to deed, and shaw s~reet names and indicate
whether interior or comer lot. ... ...... ~,Lp~t ~_.~
.!
,. , ,,-o.
OF NEW_YORK,/ ,
'Y OF ..~:/~.,/~',.~'.~.~-~..."~:.. ....... ~'~'"'
.~~..~.~.~..~ .......................... being duly sworn,
. (Name of J~dividua[ signing' c~trac~
He is th~ ~ .........................
es and says that he is the!applicant
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this app ication; that a statements contained in this application are true to the best of his knowledge and belie~f end
that the work will be performed in the manner set forth in {he appli'cation fi ed therewith. '
MARY O. KLOS
NOtaRY PUBLIC, STATE OF NL~/YORK
~52-7306925 SUFFOLK COUN~f~
· Gommission Expires March 30, 1,~
FORM NO. 6
TOWN OF $OUTHOLD
Building Depaffmeot
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: 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
O te ..........
New Building ................ Addition .....X. ........ Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property ...... .~...e.~.~...~..n~....~.~....~...~.~.~....~.~...~...o..~..,...~...~. .............................................................
Owner Or Owners Of Property ....... ..T~...9..m...a..s.....~..i..g..u. 1..i....a~....o.. .........................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
I ~ ~ -- ti ]~ Contractor
Health Dept. Approval ........................................... Labor Dept. Approval ................................................
Underwriters Approval ....... ,.~..~.~.,..d.~ .................. Planning Board Approval ......... .~....:.]..~.. .................
Request For Temporary Certificate ........................................ Final Certificate ...x.. .....................................
Fee Submitted $ ......~... ...........................
Construction on above described building~nd permitl~meet~xall~Q~plic, able codes and regulations.
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