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Home My WebLink About7514-zl~OmW NO. 4 TOWN OF $OUTHOLD BUH.])ING DEPARTMENT Town Clerk's Ot[ice $outhold, N. Y. Certificate Of Occup;,ncy THIS CERTIFIES that the building located at .~..0.~.~.,, ..~...~. ?..~. .... .~.0..~.~. Street Map No. -- Block No Lot No conforms substantially to the Application for Building Permit heretofore filed in this office -. dated ~ 5/: ~'T 197/ pursuant to which Building Permit z~o ......... dated ~ $~P7 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 .... ~... ~..~..~' ..... f~ .~./.~..~: .... ~. N ~ .~.~..~..! £- ........................... The certificate is issued to C ~l J~ ~ L £ ~ ~. ~:E ~ ( owner, of the aforesaid building. Suffolk County Department of Health Approval ...... ~.¢.?~.: ................. UNDERWRITERS CERTIFICATE No ................ .~! HOUSE ~UZC, BER H ~ ~0 Street ~-r~ s .-~.. ~ ....................................... ~_~-r~.~ ........ .... Building Impe~r FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING IXERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 751~t Z Date ...................... apt .......... ~ ........... , 19...~'.~ Permission is hereby granted to: ..~l~e~...~at.~ .......................................... i. ............... .~.~:l~e~;L~ ............................................ ~ob~] d...n ..ad~L~..on..ez~&t~n&..d~al~u~ ................................................................. at premises located at ........ ~.~...~.tdLl'Jl..~{13~.(~ .............................................. .................................... ............................................................. ~.~.~..~'~,~i...~ ........................................................ pursuant to application dated ..................... ~§~.~.....3, .................. , 19..~..bf.., and approved by the Building Inspector. Fee $...1.~,~.(~0 .......... .............. r-v ...... .:...:; ............ ; ......... ~,~, ..................... Budding Inspector TOWN O~ SOUTHOLD BUILDING DEPARTMEHT TOWH CLERK'S OFFICE SOUTHOLD, N. Y. Approved ......................... .~.... ......... , ¢ ! 19 ........ Permit No ..................................... Disoppraved o/c .............................. ,,oR ,u,u),.G INSTRUCTIONS o. This opplicotion must I~ completely filled in by typewriter o~ in ink and submitted in tripli¢ote to the Inspector, with 3 ~ of plans, occurot~ plot plon to scole. FN occording Po schedule. b. Plot plon showing Iocotion of lot ond of buildings on premises, relot onsh p to odio ning premises or public street~ oreos, ond giving o detoiled description of Ioyout ofproperty must be drown on the dlogrom which is I~rt of this oppllcotion. ¢. The work covered by this opplicotion moy not be commenced before issuonce of Building Permit. d. Upon opprovol of this opplicotion, the Building Insl~ctor will issue o Building Detroit to the opplicont. Such permit shall be k~pt on the premises ovailoble for inspectlon throughout the work. e. No building sholl be occupied or used in whole or in port for on,/purpose whoteYer until o Certifi¢ote of sholl hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the ~ildi_n~ Zon~e O.,mlinonce. of .t. he T,o.wn ,of. Southo. l.d, Suffolk .County, New York, and other app icable Laws, Ordinances or r~ gu,croons, Tar rne construct, ion o~ Duimings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary~...~..~~inspections. (S,~n,a~re o,f_gpplicont, ,O~ name, if a corporation) .......... .......... ....... ............ ~aaress of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... ..(~Z..~..t~.....]..~..~.......~...... ~.t~......-~..~.....2~..... if opplicont is a corporate, signoture of duly outhorized officer. Builder's license No ..................................................... Plumber's License No ................................................. Electri¢ion'~ License No ............................................. Other Trode's License No ............................................... 1. Location of land on wh ch-,/~ ,-~ ,-. 2'1 p .r.oposed work w be done ~x p No ' ~'i~ ' 'L 't Street and Number ........ .~....?...~....o.......~......~.~l~...~..../~...o..~,~ ............................................................................... Municipality 2. State existing use and occupancy of premises~/and intended use and occupancy of prOposed construction: a. Exisiting use and occupancy ~ ...~...~. b. Intended use and occupancy ....... .z~.~ .~...l~t~...~. ............................ 3. N ure of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ..........~..?....o. .0. ..................... 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 Stories ................................ 8. Dimensions of entire new construction: Front ...... /....~... ....................... Rear ........ /...'~...~ ........... Depth .....~...J. ............... Height .................... Number of Stories ........... ~.~.~ ................................................................................................ 9. Size of lot: Front ........... ~.~..?. .................................... Rear .......... ~..~...~. ...................... Depth ...,/~...o. ..................... 10~ Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. zone or use district in which premises are situated .......... .~..~t.........~...¢~ ............... '.~ ........................................ 12. Does proposed construch,~,~ violate any zomng law, ordinance or regulaho: .......... /.Y.~ ........................................ t3. Will lot be regraded ..... ~.J...O. ................ Will excess fill .be removed froj~..p~['nis~_~..).Y/~s~. ( ), No Add ress~'j;~'..~4;,~'~' ~...~one No..~..~.~.:.~.~ .~ ."). 14. Na me of Owner of p remises(,'~/'2/T~..l~-.~- - .Jj'-. · './' '~. ~;~- -~F-- · .~. · · -/u-- · ...... Name of Architect ..... ~. .................................................... Address,,;~j~.~.~..,~ ............ 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. COUNTY OF .~..~-~..... S.S .................................................................................................~' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract~ above named. He is the ................................................................................................... ............................................ (Contractor, agent, corporote officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work ond to make and file this application; that all statements contained in this applicotion are true to the best of his knowledge and belief; ond that the work will be performesI in the manner set forth in the application filed therewith. Notary Publi~tY ............... t3~gnaTure oT app~caml ........ JUDITH T. I~OKEN NOtary Public, Sfm~. of New York No, 52.0344963 Sufalk Coun Cornmiss on Expires March 30, FORM NO. 6 TOWN OF SOUTHOLD 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-ex'st'ng' 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 $§.00 3. Copy of certificate of occupancy $1.00 Date ....... /.~..~/.~ .~.?.,~... ............... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ¥.~)~...0.......~....,~,~.~..~.......~....~....~..~ ........ ..~.../~.~.T......../Y.~.Z/t.~...../~...~.~..: ...... Owner Or Owners Of Property ......... ...~..~..~.,,~./~.~.......~.........~....C~.:.~..-~...~....~... ....................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~ .......... ~ Date Of Permit ...~./.~.~....Applicant ....~....~..,~....~..Z~°..~.......~...~.~.~.. Health Dept. Approval ............... ..~......~ ................. Labor Dept. Approval ................................................ Underwriters Approval ............................. : ............... Planning Board Approval ........ ,~......./..~. .................. Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $~.~. ..................... Construction on above described building and per, it,meets all applic,,al~le ~:c~es and regulations. Applicant ......... :.., ~.c,~.~...~.-- ....................... Sworn to before me this ................ day of ............................................ Nota~ Public .................................... County (stamp or seal)~¢ 9~ I ~D