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Home My WebLink About7437-zTOWN OF $OUTHOLD BUH.T~ING DEPAHTME, NT Town Clerk's Office $outhold, N. Y. Certificete Of Occupency No...Z .~. 1..~. ~ Date ~ /~CT 19..~.~/ THIS CERTIFIES ~at the b~g locat~ at MapN B1 kN ~tN o ........ ~ .... oc o ..... ~ .... o .................................. co~o~ subst~a~ly to ~e App~ca~on for B~g Pe~t heretofore f~ ~ ~ o~ce dat~ .............. ~ ~.~?.~19.~ p~u~t to which B~g Pemit No. 7 dated .............. ~.~.~.~]~ 19.~, was i~u~, ~d co,ores to ~ of the r~ men~ of ~e app~cable prov~ions of The certifica~ ~ ~sued to L (owner, lessee or ten,t) of ~e ~ores&d b~ding. S~o~ Co~ty Dep~ent of He~ Approv~ AC ~ , U~ER~ITERS CERT~ICATE No. ~f' HOUSE~BER ~ ~D S~t ~7 ~g ~ee~o~ FORM NO. 2 ~TOWN OF SOUTHOLD BUILDING DEPARTME~4T TOWN CLERK'S OFFICE SOUTHOLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7437 Z Permission is hereby granted to: ............ ,L .,to. ~:o.:~ £.,~ Z.'~ ......................................... at premises located at .....~.~q~G..~..~.",,z~..~ .................... i ......................................................... Lattrel ; pursuant to application dated .........................J.1J3.y ........ 2~.....~...., 19-.~..~., and approved by the Building Inspector. Fee $. ] .~..,...0.,0. ........... APPLICATION FORM NO. 6 TOWN OF SOUTHOLD. Building Department Town Clerks Office Southold, N. Y. 11971 ~ 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 6se: 1. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sew~erage 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 ar 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 oil property lines, istreets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, 0ccuponcy and condition of buildMgs. 3. Dote of any housing code ar safety inspection of buildings or premises, or other pertinent in- formation required to prepare o certificate, C. Fees: 1. Certificate of occupancy $5.00 2. Certlficote of occupancy on pre-existing dwelling or land use $5.00 2. Copy of certificate of occupancy $1.00 New Building ................ Addition .]~..~¢~./;%. Old or Pre-existing B~ilding ................ Vacant Land .............. Subdivision ..................................... ~ .......................... Lot No ............. B~ock No......'-~. ...... House N~...q..~.> .... Request For Temp~xorary Certificate ........................................ Finah Certificate Construction on above described building andr~it meet~g~ ~pp~lica~le codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) ~_~ Z_ ~/,5~ Notary Public .................................... County ~~ Iult.mN~ UI~*~TMI~T ~ TOWN CLIRK'S OFFIGI ~ ~D, N. Y. ................... , ....... ~l~r~ ~/c ......_~ ,,~ ........ ;'"': ...... ~ .................. ......................................................................... ................................ ....................... , o. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Buildingo~ Inspector, with 3 sm of plans, acourat~ plot plan to scale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drown on the diagram which is part of this application. 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 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. ~ ,..?. -- .. ,,,,,-~, u i..w ,~wn or ooumola, ~U~OIK ~oumy, ~low Yom, ona omer applicable Laws, Ordinances or admit authorized i-----t Y . ~pp! ...... , o,rat ances, bu~l.cling code, housing code, and regulations, and to~ n.~ec ors on premises ana Jn DUII~I~$1'or necessary (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premise~ ....... ~ ............... iiiii .............. ~f applicant isa corporate~', ~1~nat~r~ of duly authorized officer. ~' '~' i~-~ ................................... ........................................................................................ r"- (Name and title of corporate officer) Builder's License No ..................................................... ~.\ Plumber's License No .......................... ....~... ................ Electrician's License No .............. ...~......~ ......... Other Trade's License No ............................................... Location of land on which~oposed work will be done. Map No: ................... Lot No...~:... Street and Number ...... ~.~....~...~..~ ~_~.~.' ~ ~ ~ ................... 2. State existing use and occupancy of ~ises and in, tended use and occupancy of proposed construction: o. Exisiting use and occupancy .~"-- ........... o .......... r'~ I , ^'"'"--'"'~'-~ ......... ~ ...... ;~"~'", .... ~,' ........... b. Intended use and occupancy .............. ~....~.....~~......~..~,~:...~.,~. ........... 3. Nature of work (check which applicable): New Building..... .............. Az~dition .................. 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 ............................ Rear ................................ Depth ................... '. Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Sto~ies ................................ 8. Dimensions of entire new construction: Front ......... .~...~ ....... ~ ........... Rear .............. .~ ............ Depth ..[..../'~.. ............... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10~ Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..~........~..~..,....! ............................................................................. 12. Does proposed construction v?la/te any zoning Iow, ordinance or regulation: ........................................................ ~3. ~/~J~l lot be regraded ............................ &/ Will excess fill be removed from.premises: ( ) Yes ( ) No 14. Nome of Owner of premises ...... .~ ........................................... :. /- '~ Address ........................ :-.' ...... Phone .No ................... Nome 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-beck dimensions from property lines. Give street and block number or description accordin0 to deed, and sh°w street names and indicate whether interior or corner lot. STATE OF NEW"YOI~, / I,.SS COUNTY OF .~., .......... ~ ............... } ' · ................................................................................................. being duly sworn, deposes and soys that he is the applicanl (Nome of individua] signing contracf) above named. He is the .................. '.~.....~ .................... ' ................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge end belief; end thor the work Will be performed in the manner set forth in the application filed therewith. Swam to before me this ........................ ay of ........................................... , ...... Notary Public, .................................................... County ..... ~ .............................................................. :.~ .......................... (Signature of applicant)