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Home My WebLink About7512-zTOWN OF ~UTHOLD BU~.r~ING DEPARTM'k'~ Town Clerk's OEiee $outhold, N. Y. Certificate Of Occupancy ~o. Date ................. O.~ .-['.. l.~, 19'J~,,~.'"' THIS CERTIFIES that the building located at'l.l.~0..N~.I~.If..[=~8~..~... ~.~¥YJli ~reet Map No..,~.. ~. ~.... Block No... ~ ..... Lot No..~o~,.'~...~-. [ [..~....'~v~...*~. J.F._ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........~E~'[... ,~., 19 .'~ .~/pursuant to which Building Permit No.'~l$1.~ dated .........~E.~.~ .... .'~.., 19.7.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi., certificate is issued is. ~A.. · .t~t V,~ .-rE... ~. ~.E... F.~ ~ I .~,.% .... ~.W. ~. t,J, ~ ~. ~ ............... The certificate is issued to E.LLEE. H...~.. ~.~H.~.....S.T.~I ~..L/..$~.. ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... /9....~ ......................... UNDERWRITERS CERTIFICATE No ............ ~...~ ............................ HOUSE NUMBER...'7.. !. ~, t).... Street. N0l~'~t~....~.~]~...'~..'~ky.V.I.E. t~. ............................................... ~ ~ .-?.,..o...~..~. ................ Buildin~ In-,pector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. N°. BUILDIHG PERMIT PERMIT MUST BE KEPI' ON TH.E PI~EMISES UNTIL FULL C~LETION OF THE WORK AUTHORIZED) 7512 Z ~t, ...................... ~.~.,.~.e.~....~...., ~9.~.. Permission is hereby granted to: .... .Y.~'~Lemn..~..,l'.cd~,. ~m ......................... ........... .~........~ ..x~....~..~ ..................................... .............. ~.~.9.~.. .............................................. ~o ..~.-~..~..s.~.s.:~...~...*.~.e....~.*..~.e....~..~.~.~.*..~..~.*.?.~.). ........................ at premises located at ...... ~.t...~,~K..~&~ ................................................................................. ..... ~ ............................................................. t~,t~.3,~....~.AT~ .......... : ................................................. pursuant to application dated ..........................R~.~)~ ...... .~ .......... , 19...~t., Ond approved bythe Building Inspector. SOIrrIIOLD, N.Y..( ~ c:,d).9..-.~.. /~.., v-'"' a. This application must be completely filled in by typewriter oe n nk and submitted in trip icate to the Building Inspector, with 3 set~ of plans, accurat~plat~ pian to scale. Fee according to ~hedule. x b. PI? .l~.n sho~v, i.ng. I ,c~, ion?=, qbra, .n~O~ buildings on premi.ses,?eldtia~hip t~ bcl~%ining I~remises or public streets areas, aha g~vlag a acta.ca aescnptJon at layout otproperty must be clrawn on the diagram which is par~ of this applicotlon. c. The work covered by this application may nat 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. ~ .A,P,.PLIC~^TIO~N .!S HEREB, Y.,MA~DE to .t~e B.uil.d!ng. D,e,p.a, rt~ent for. the issuance of a Building Permit pur~lont to the o~u~,a~r~.. ~on.e ~Jra,nance at .?e/own or ~oumola, ~.~g_u_la_?,..an_s_~ tar the c.onstruct?n o..f, bu!!ding.s: ,ac~d. it ons or a,!te..rat~i?s., o.,r,.for rem, av?l or d~molition, as herein de~ribed. ~e .u?p~!,cam. ag.r.ees to comply wnn .al, app?.coo, le ~ ,a?s, ~amances,..ou.a,rlg coae, housing{ code, and regulatlom~ aamlt aurnonzea inspectors on premises anti ~$'~ure o,~ opplicm!, ~.1' ~me, i{ oco. rpor~ian) , ............ ' / {^ddmss of oppli¢ont) Stole wJl~h~r_opplic~t i~w~,~..les e, agent, on:hitect, engineer, general contractor, electrlcion, plumber or buiM~r. ....... Name of owner of premises ................... [~.... ~.~, ................................................................................. / If applicant is a carporate, signature ~0f duly auth_orhed afficer. . Builder's License No ..................................................... Plumber's License No ................................................. £,ectr,c,on's Ucense No ............................................. Other Trade's License No ...............................................~ I I ~ ~, 1. Location of Iond on which prppo~ed work will be done. ~ap No.: ........................................ Lot No ......................... Stree and ........... ....................... .......................................... Mu~iclpplity 2. State existing use ond oocuponcy of I~emises and intended use and occuponc¥ of proposed construction: o. F. xisiting use and occuponcy .............. ~ ...................................................................... } ...... b. Intended use ond occupancy .~.~. ....... ..~...~.....~.....~...~ ... ' Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work . ~../..~'.~. .... Estimated Cost .~..~..O~.i.~...D.. .......................................... F~e /*~"-~) ..... ..(l~.escription) ~_ (to be paid on filing this applic, ation) If dwelling, number of dwelling units ................. ?../'.J~..~T'... 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 b/pe 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 Stories ................................ Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Nuttier of Stories .......................................... .~, ......................................................................... 9. S ze of at Front.~. :~jl~,~ ............. Rear ........ ./..~...~. .......................... r___ _ __ ~')-- __ ''Depth ...... ..~..../..~. ............... I0~. Date of Purchase ........ :.~('~11~. ......................... '. ......... Name of Former Owner .~',~..~..~/...~'./~.~......~....~../...~...../..A~....~'......'.'. 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regrade~ ............. : .............. Will excess fill be removed from pr~mJses: ( ) Yes ( ) No 14. Name of Owner of~pr/'e~im~ ..~..O...~...~ .~.(.~' ................... Address ~../..~.~..~..~....F..~'~.....~...'~J Phone No.~JL.~....../~.~.~.. Name 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 setJoack 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. h J /t '," t ,r tha~ the work will be performed ~ the manner set forth in the application,~ed therewith, j~ Sworn to.s~e/~me this /_- -~- -- .~.~..... ~ · ............................................... ; ~/ - // (Signature of applicant) COUNTY Of~".f*'~ · ................................................... ¥,."....r~ ....................... .~.~abe~~r~ d~es a~ soys t~t he is the applicanl (Nome of i~ividual signing contrec~ above nam~. He is the .................................................................................................................................................................................. (Contractor, agent, co~orate officer, ~c.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t all statements contained in this application are true to the best of his knowledge and belief; and FORM NO. $ TOWN OF $OUTHOLD , Building Department 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 / New Bqilding ................ Addition ../-~..~...~...~...... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~'/.~.........~.~.........~...'~fX.~.../.~?.~..~.......'~..~.; ......... ..~.~...~.../.~.~....~...~...~.. ......................... Owner Or Owners Of Property ~. './~..~."~F:"~.....~.......~..~..//../.(........~....'~'...~,..~.~..~...~ ....................................... Subdivision ~..~.'..~...~......~........~..~..A~.~..~. .................. Lot No. 7./....,~. Block No ............. House N .~.../..~..~... Permit No .~..../..~.....~... Date Of Permit ......~..~.>~...Applicant .... ...~.~..../~.~........~...~'.,~4. L~..~..J.: ................. Health Dept. Approval ..................... ../~.....(.~. ........... Labor Dept. Approval ......................... ./..L/..x.....hh.....: ..... Request For Temporary Certificate ........................................ Final Certificate ....~.... ................................ Fee Submitted $ ~..'.~....~... ....................... Construction on above described building and permi s all ap s and regulations. .... x ~ppl~canr ......~ ............ ~A ........................................... ~..:...~ .............................. Sworn to before me this // ~ ,- // ' · ./~-u~..-~. day of ......~.~,,,~ .............. v (stamp or'seal) Notory Public ........... Count~ Y -.. ~ EtlZABETH ANN NEVILLE /,., NO 52-8125850. Suffolk County Term Expires March 30,