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Home My WebLink About7511-zTOWN OF $OUTHOLD B~.m.nING DEPAR'I'M~CNT Tow~ Clerk',, OEiee $outho]a, N. Y. Certificate Of Occupancy No. 1~6~.2 ...... Date ..........~.tl~'.. 21 ........ ,192~. THIS CERTIFIES that the building located at .2?0...t~u~h .t/pad. .......... Street Map No~ .......... Block Nc~x .........Lot No..z~c .... l/attttuei~ · .N,~, ........ conforms substantially to the AppUcation for Building Permit heretofore filed in thi~ office dated .........J~u.g...3.0 ..... , 19..~. pursuant to which Building Permit No. 7~.1.1z.. dated .............A.u.~.. 3.0..., 19..~.., was issued, and conforms to all of the require- ments of the appUcable provisions of the law. The occupancy for which iht, certificate is issued is Priva~a .one..£a~tly. d~.elling...~lt~ .an. addi.tlon .................. The certificate is issued to. tte.v.,. ,T.o. hn. AritouPt~oulas ..... .L~ez' ................. (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department o! Health Approval . I~.,~1, .............................. UNDERWRITERS CERTIFICATE No. pending .................................... HOUSE NUMBER .... 27.0 ...... Street...I/utl~ .I/oad ............................ Builrli~g Inspect~ lvO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PER~IT MUST BE KEPT ON THE PREMISES UNTIL FULL CGMPLETION OF THE WORK AUTHORIZED) N? 7511 Z Date . August ]0 19...~.... Permission is hereby granted to: R.e.v....~.o..~..~k~.o.~.~.o...,. ............................... at premises located at 2~..0 l:hi. th Road Mattituek N.Y. ' pursuant to application dated ...................... .i~m~1~ ......... 3.0. ........... , 19.~.., and approved by the Buildln~ In.~:tor. Fee $ ....................... Building Inspector BUll. DINe DEPARTMEHT TOWN aARK~ OFFICE ........ i ....... , 19.. Application No. Approved ........................................ , 19....~.~/l~e No ......... ~......~...../....~...~ ............... i.. ............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or .in ink and submitted in triplicate to the Building Inspector, with 3 set. of plans, accurate plot plan to scale. Fee accord,ng to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining, premises or public streets of areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram whmh is part of this application. c. The work covered by this application may nat be commenced before issuance of Building Permit. d. Upon approval rot this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the promises available for inspection throughout the work. e. No building shall be occupied or used in whole or Jn port for any purpose whatever until a Certificate of Occupancy shall have been gra~ted by the Building Inspector. APPLICATION IS HEREBY N~DE to the Building Department for the issuance of a Building Permit pursu..ant to the B~uild!ng Zor? Ordinance of t. he Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmancos or Kegu~ations, for the construct,on of buildings, additions or alterations, or for removal or demolition, as h~rein described. '~e applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and ir, buildings for necessary Impections. ~Signatuf~' of applicant, or name, if a~corporation) ...... ............................ .............. (Address of applicant) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. j~Ol~ No.: ........................... Lot No ................. Street and Number ............ .~-.~...~ ....... e~.~/.~.....~..~, .................................................... i .................................. Municipality 2. State existing use and occupancy of premises and intended use and occu~poncy of proposed construction: a Ex s t ng use and occupancy ~.-..~..~..~1 ~.~..~...., ............................... b. Intended use and occupancy ....... .---~-~g~-...~--~. ')~~ ...................... Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... 4. Estimated Cost ..................... .~.?...?.......'~. .................. Fee / ~ o~ , (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floo)'. ........................... If garage, number of cor~ ............................................................................................................................................. 7. Dimensions of existing structures, if anY: Front ........ ~..~... .......... Reor ......... ?,i~. .......... ,,.... Depth ~' Height ........................ Number of Stories ......................... : ...................................................................................... D~mens~ons of same st~ctu~ w~th a~terat~ons o~ add~tionsi' Front ............. .L.~.. ............... Rear ..... L.~.... ............. Depth ........ ~,~l .................. Height ............ ~ ............... Number. of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ................................................... .,~ ............................................................... . 9. Size of lot: Front .................... L./'..~C ......................... Rear .......... ,/...(...~. ...................... Del;~th ..... ./....~........~... .......... ~.~..7..3. 10. Date of Purchase .......... ........ ........ Name of Former Owner ...... ~...?...~..~L~[..~.~..,~ .............. 11. Zone or use district in which premises are situated ................... ~l.~.~..I...~.. ............................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................ ./...~......~... .......................... 13. Will lot be regraded . ........... ..~/~.....~.. ..... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .....~....:...~.:......~..~.~l~l~...~dclress .~..~.J~....~..~../I..~rPhone No....~...~,~..~..~...0'...~(~ : 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-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. o~ STATE OF NEW YORK, " COUNTY OF .... '~'~ j )i;~i'~"~/"0" ~o~. o.~ ,. ............... .................................................................................. oelng duly sworn, deposes and soys that he is the applicanl (Name of individual signing contract0 above named. He is the .. .................. ..~....~.....~...~.../.,.~ .................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said c~wner or owners, and is duly authorized to perform or have performed the said work and to make and file th.is app!icqtion; that all statements contained in this application are true to the best of his knowledge and belief; and thru the work will be performed in the manner set forth in the application filed therewith. Sw0m to before me this ~ .~q ..~..... ,~.~ ................... :~...c?~ of,...,...._~..,....~. ...... &.~.~, ~7.~.... N'otary Pubiic,~l~/..~-~' .~..P County . JUDITH T. BOKEN ........... (~";no~l~re of a~Plican~~1~ .......... Notary Public, State of New York Ne, ~i2-0344963 Suffolk Coun~lx~ Cemmi~len Expires March 30, ~ORM NO. 6 TOWN O~ $O~THOLD , Building Deparfment 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 disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, hAultiple 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, r'roperty ..:.....~...~.~.~....~..c~.u~~/J~~i}~ ...................... Owner Or Owners Of Property....~(_~.~.'..~..~.~ .................................. Permit No. Date Health Dept. Approval ........ ..~.....!.~.~ .................. Labor Dept. Approval .......... .~.....~.].~ ......................... Underwriters Approval ..]...~,.,~'.....*~..~ ................... Planning Board Approval ..... /..~ ............................... Request For Temporary C,e~ificate ........................................ Fined Certificate Fee Submitted $ ....../...~ ................. Construction on above described building and ~it me~ets~ll applicable codes and regulations. pp ......... y ......... [....~ ~~.~ ...... Sworn to before me t~ ~ . ~ ~~// .......... .~.~day of ...~ ~......(~..~..~... (stamp or ~1)~~