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Home My WebLink About7508-zFORM NO. 4 TOWN OF $OUTHOLD BUH,DINC, DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No~099 ....... Date ~pt...~0.. 19.7.~. THIS CERTIFIES that the building located at Ma~.l~..La. & .])~ ....... Street Map No..x~ ....... Block No.. ~xx ..... Lot No... x~ ..... i/~tituak.. ~.~I, .... conforms, sub~stantially ~o. the Application for Building Permit heretofore filed in this office dated': ............ A~4~i .... 29., 19.~. pursuant to which Building Permit No. ~.~..O~.. dated.. ....... Au~.. 2~ ...... , 19 .~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .])r&~t~. &oc~s~. ~to~&g~ ). b~lld~g ........................... The certificate is issued to . .Ch~ataSn .&. ~ttldr,d .ROSsI~.QF~ ..... .0v~r$ ......... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ....N.,~,. ............................ UNDERWRITERS CERTIFICATE No.]~,l~, ........................................ HOUSE NUMBER. 2.~ ........ Street .. Ma.l,l~u$ .l,an~ ......................... Approved .... ~ ................. , Disapproved a/c ........ ~ ........ ../ ...................................... ..... r'~'7~':,~' ..... .~-"'".'.'::"'"': ............................................... · ' - (Building Inspector) 19 ........ Permit No ....................... APPLICATION FOR BUILDING PERMIT ..... INSTRUCTIONS a. This application must be completely filled in by typewr ter oe. in ink and subm tted in triplicate to the Building~ Inspector, with 3 sete 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 adjo n ng p?m ses or publ c streets orl~ areas, and giving a detailed description of layout ofproperty mU~t be drawn on the diagram ~ghicl~ 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 appfication, the Building Inspector will issue a Building Permit to the applicant. Such perml 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 .f, or the issuance of a Bud ng Perm,t pursuant to the~ ~Build!n.g. Zon,e O.r.dinance. of the T,o~v. n.o.f. Southold, Suffolk .Count~, New York, and other applicable Laws, OrdinanCes or ~.~geUSor?.ns, .~or me c.onsrruct!on at. ou~!d,ags, additions or alterations, or for removal' or demolition, as herein described.~l e app~mont agrees to comply with a. applicable laws, ordinances, build ng c..ode, hous ng cac~ ~%regulatlon$, and admit authorized inspectors on promises and in buildings for~essary), Impect,ons. ,~'. ' ....... · --' (S'gnature~6f applicant, or no//~ if a (Address of applicant)/.~,j ~/~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signatur,e of duly author~ed officer· (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~:~r..~ ~~4/J_i~/_~/.J__ ~ wh~h~"°~r~?~'~dz~ill be'd°n~/~' AA-ap- N°"~'~~ ................. Lot No~.~... Street and Numar ,~ · ........ ~..~... ~.~.~ ~...~ ~..~.....~...... ~.. ~ ............................ ~~ ...... 2. State existing use and ~cu~y of promises and int~ded use and_~cu~ncy of n~ed c~mction: a. ~isiting use a~ ~cuponcy ..~..~,.~ ............................................... b. Intended use a~ ~cu~y ....... ~L...~...~ .......... ~....~...~.~ ................. 3. Nature of wore (check which applicable): New Buildi ition .................. Alteration ...~ ........ Repair .................. Re,,~l,,~ ~ .................. Demolition .................... '~ Other Work ..................................................... (Description) 4. ~timoted C~t .... ~C ........ ,~....~ ................... Fee~ /~ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dWelling units on each flor; ........................... If garage, numar of ~m ................. ~:. ...... ~....~'. ........................................................................................................ 6. If busine~, commercial or mixed occupancy, spec~'~ nature and extent of ~ch ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ....................... ~?.. Rear ................................ Depth .................... Height ........................ Nu~r of Stori~ ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................R~r ............................ Depth .............................. ~;~t ....... ~......~ ............ Number of Stories ................................ 8. Dimensions of entire n~ construction: Front'......~: ............ ...~...~. Rear ...... ~.~ ......... Depth ..... ~ ....... -~----Num~°f Stories ........................................... ,~--~'~ .................... ' .................... ~ -~ .................... Height Size of lot: ~t ...~.~.:..~ ............................ -- Rear ....~.~.~ ...............-.... ~epth ..~.....' .......... ....... .................... 10. Date of Purc ~. Nom~ Former ~ner 11. Zone or use d~stnct ~n which premises are s~tuated ......... ~.~ ............................... ~xj~..: ...................................... Does ro osed construct on voate an zonin Iow ordnance or re ulati~ 12. p p y g , g : ....................................... ~ ............... 13. Will lot be regrad~ ............................ Will excess fill be rem~ed fr~ promises: ( ) Y~ ( No 14. Nome of ~ner of premi~s .................................................... A~ ................................ P~ No...~ .................... Name of Architect .............................................................. A~re~ ................................ Ph~e No ....................... Name of Contractor ............................................................ A~re~ ................................ Ph~ No ....................... PLOT DIAG~M L~ote clearly and distinctly all buildings, whether existing or pmp~d, and indicate all ~t~k dimensions from prope~ lines. Give strut and block number or description according to d~, and Show ~r~t na~s and indicate whether interior or corner lot. STATE OF N~ ~ J. ~ / t c c couN .... ; ............. r ........................................................... : .................. b~ing duly ¢~orn, d~os~ ~nd soys t~t h~ is t~ (N~m~ o~ individual siCning cont~c¢ ..... above nom~. : , ~ . He is the ................................................................................................................................................................................. (Contractor, ag~t, corporate officer, etc.) of ~id owner or owners, and is duly aut~rized to perform or have performed the ~id work a~ to ~ke and file this application; that all statements contained in this ~plication are tree to the best of his k~ledge and belief; and that the work will ~ perfo~ in the manner set fo~h in the application fil~ t~re~th. Swam to ~e me this ~ ....... ~oto~ ~ublic~~....~~n~ .... Z ..5.~ .~ ~.2....~~..~ ~ {$'~notur~~ ' o~ JUDITH T. gOBM NO, I TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7508 Z pursuant to application dated Building Inspector. FORM NO. 6 TOWN OF $OUTHOLD Building Deportment 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: l. 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 I /4 I~; 7,7 Date ......... /. ............ ~...~..~. ................ New Building ~/j~14 ii~y .~ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....................... ~ ..................................................... ~....~. ............. t ................................ Owner Or Owners Of Property ~./r~..//.?r.{?..~:~.!?..~.~/~`x/:~4ia~'.~/?~.(~..p.~.~'~..(~..~....i~.~i~.~ ........................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..'.~.:.~.~-.'.~...Z...... Date Of Permit .~.~.~:.7...~/.....Applicant ..~_!..~.~..r!...~.~...~:.:~.~.~..~.k'.~[~.~ ................. Hea'th Dept. Approval ............... /~!..'..~.~... ............. Labor Dept. Approval ...............!'i~.:..!!'.'~.. .................... Underwriters Approval .................. .~..!..:..~.(..: ............. Planning Board Approval ...... .~:!..'...!.~.~n. ................... Request For Temporary Certificate ........................................ Final Certificate ........... ~ ....................... Fee Submitted $ .....~......~ .................. ---~ Construction on above described<j~B~ u,,d~rmi~ meets al~ ap~pebJ~o~and regulations. Sworn to before me this //-" ' ~ ; (stamp or seal) ,'