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Home My WebLink About7046-zNO. 4 TOWN OF SOUTHOLD BU[[.nlNG DEPARTMENT Town Clerk's Office Southold, N. Y. CertifiCete Of Occupency THIS CERTIFIES that the building located at .~..q...~..~.~..N....~?..~.m.~..?.. i.. Street Map No. ~ ~o ~ Block No. .Lot No. . ~... conforms substantially to the Application for Building Permit heretofore filed in th~s office dated .......... .~. ,~. N.....~.., 19..~.~ pursuant to which Building Permit No..7.0..~..~..7--- ments of the applicable provisions of the law. The occupancy for which th~s ~eertfficate Js o~ t~e a~oresaid building. Suffolk County Department of Health Approval /~ '~ ' ' UNDERWRITERS CERTIFICATE No. Building Inspector FOF, M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y, BUILDING I~ERMIT (THIS PERMIT MUST BE KEPT ON THE PD, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~ ~Tt4{'N'I' ~ ]~iN IZ! 0 at premiss I~at~ at ...................... M.~.~ ........... ~..[~ ................. ~.~..~......~.~ ............................. ................. : ............................................. ~E~.~L~,~ T. ......... ~.~,~.~,~.C.....~e..~.,L~ .............. ............................................... ~E~.~f..~ .......... ~,~.~..~ ............. ~.~g..~.m~.~.~Z ....... pu~uant ~ a~lication ~t~ ................................ .~....~.~' I~..., and app~ by the Building Inspector. Fee $../....~....~. ........ ...~..~:<~..... ,,,~,,../...~.~,.~,,, ..................... Building Inspector FOItM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions ^. 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 ./.~:?/,. ~ ,~ Date .................... New Building ................ Addition ................ Old or Pre-existing Building .............................. location Of Property ..~.//......~,,u'J:~...~.~. ........... ,.~'&-/~ , ~ · J2.~j~,.~.......~. .............. ~.~.~..~..~.. ...................... Owner Or Owners Of Property ....~...~...~.....~.~.....~..~ Subdivision ................................................................ ,4~/~ ~ .,,~Lot No...~..-.~... Block,~lo. -.-w ...... House No..~ ,Permit N~).~...?.:,..~...~..... Date Of Permit .///../....~,).FApplicant ....~.~....~.'..~.....~,,,~u~/ '~J- ~,,Dept.~' Approval ~-'~ '/~' ~ -- --Labor Approval c/ (/ ~alth .... ...~...~.. ................... Dept. ................................................ Approval ............ ./~.. ............................ Planning Board Approval ........................................ Underwriters Request For Temporary Certificate ........................................ Final Certificate ....... ~..i ................. Fee Submitted $ .................................... Construction on above described building and pecrmiJ[z/meets all/'jlq~abJ~_e~ and regulations. Applicant ..... ~.~~ .................................. Sworn to before me this ...... doy Nota~Public` %~ Coun~ /0/~(~9~p or seal) SOUTHOLD, N. Y. Examined .................. ..~....~, ...... , . Application No. ra ...................... · / ....... Z._ ........... App ved ~....~.~...~.~ 19..Z.~ Permit No....:..., D~sapproved a/c ................. -: ........................................................... ...................... .~-:~,~.'x d~'...... ~. :~.~...,~i,~.t.~t_.,~.. ........... / ' (Building Ins~'for) APPLICATION FOR BUILDING PERMIT Date ..~ .............................. , INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building Inspector, with 3 sets 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 areas, and giving a detailed description of layout ofpraperty must be drawn On the diagram v/nJch 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit purgd..ant 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable Iaws, ordinances, building code, housing code, and regul~, and to admit authorized inspectors on premises and in buildings for necessary inspections. ........ .................... (Address of dl>plicant) ~State wh~ther al~licant is owner, lessee, agent, architect, engineer, general c~tractor, electrician, plumber or builder. ............ ........................................................................................... ...................................... ......................... Name of owner of premises ..... ~:~_,/,e~t,....rD~..~.~ ............................................................................................ If a licant is a co~ orate n ' ~f d~ . . . /r,,. ~ pp rp , sig ature o? at~iy authorizea orricer. (Name and title of corporate officer) Builder'S License No ...................................... ,~ ............. Plumber's License No ...................................... ~ ......... /'~ -- ~/7/~- ~ -- ~ '~F~trician's License No ............................................. Other Trade(s License No ............................ : .................. I. Location of land on which proposed work will be done. Map No.: ........ ..~..~..~ .................. Lot No...~.~.~. .............. Street and Number ........ ~ ........ : . ...... ~.~m. ................................................... :.. . . ~. ~'~ ~-. .. ......................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ~Tt~.~ ....~....~ ............................................................................. b. Intended use and occupancy ~~. ~':~.~ 13. ~14. 3. Natur~ of work (check which applicable): New Building .;., ............. Addition .................. Alteration .................. Repair .............. ;... Removal_,~..== ........... Demolition .................... Other Work ...-----------------~...,~-~..~.~ ................ · ; ~' ~-~, ~- / '(O&s~iption) 4. Estimated C°s~t ...L...~..-..~.~. .......................................... Fee ......... /.~,.a., ................................................. i .................... (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 c~rs .................................................................................... J ........................................................ 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 ................................................................................................................. Dimensigns of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire, ela~ constructibn: Front ..... .j..~./. .......... ~ .......... Rear ."...:/.~..'.~ ............. D~th ....~;L: ........ -~:..~. Height ..,~...~. .......... Number of Stories ....... 1. ........................ - ................. ~ .................................................................. 9. Size of lot: Front ........... ..~..~..~ ................................... Rear ........... .~.~ .................. Depth ......~.~ ............... 10. Date of Purchase ..'.il~.l:~..~.....J..~.£..~ ............... Name of Former Owner .~,~.~;;.....;~.~.,~..~ .......................... 11. Zone or use district in ~vhich premises are situated ....... 2,.~;.~ ,.....'~.,..~ ..................................................................... 12. D~es proPOsed construction violate any zoning law, ordinance or regulation: ....... ~ ........................................... Will Iotbe regraded ...... J~J~ ................ Will excess fill be removed from premises: ( ) Yes ( ) No Name of Owner of prem,ses.~?~,~..~...L..~,..~t~,.~,~ Address.. ,.,.....,.~. ~.......... Name of Architect .......... ~..~.E,2~..~. ................ ]~. ................ 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 comer lot. STATE OF NEW YORK, ~ c S cou NTY OF .... ~./f~.:~.....~...:~ ~' ................. :f..~.~..~..J...~..~.'~....: ............ i ............... being duly sworn, d~mes and soys tMt he is the applicam ob~'~~_._ -_...-- ~,vidual ,,~,ng contrac~ ' · .... ? He is the ....... ~.v....~.,~. ................................................................................................................................................... (Contractor, ag~t, co~orate officer, etc.) of said ~ner or owners, and is duly authorized to perform or ha~e p~formed the said work and to ~ke and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and tha~ the work ~lt ~ performed in the manner ~ fo~h in the appli~ti~ fil~ ther~ith. S~m to ~ ~ t~s ......... ............. , , , .............. ............................ ..... .............................. ~(Signa~re of a~licant) / / WILLIAM G ALB WNOTA~Y PU~L~ ' ERTSON C, St~te o No. 52-003.~Rn~ Hew