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Home My WebLink About7517-zTO~N OF $OUTHOLD BUU.DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at~.8 00../,~'~./,~..~6d/~. '~0 P~ Street Map No...~..~..~...0... Block No..'~. ........ Lot No,.. ~.~.~. ........................ conforms substantially to the Application for Building Permit heretofore filed in thi~ office dated ...........~..~..F~... ~.., 1~.~.. pursuant to which Building Permit N~5, .FT.. dated ...........~..E?..7....~.-, l~.'lr. ., was issued, and conforms to all of the require. ments of the applicable provisions of the law. The occupancy for which this certificate is % ~.ed ~ ~..~..~...~'. ..... .~. u.*. ~ .~.t~ r~. ....... C ~.-c. ~. ~...~.~ ...... The certificate is issued t~..~.~ ~. ~:..~....~ ]i~'.'[~/~ ~:~....X. fj.l~...l~, .............. of the aforesaid building. (~er, lessee or tenant) Suffolk County Department o! Health Approval ..... ~', .~'., ........................ UNDERWRITERS CERTIFICATE No ........... /~l.. ]~'. .......................... HOUSE NUMBEI~ ~.e..0 ......... Street../, ~ .Tr. t. g .... /~. E ~. k['" '-~ 0 ~- ~ ....... .......................................... .C.U. .T. .~. t-t O . ~ U.~.-. ................ I~OB~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 75i7 Z Permission is hereby granted to: ..~.a~..;~:L ............................................ i ......... ........ ~.£ttZa..~e~..~a4 ................................. gu oho e t^build new ~rivate ~arage at premises located at ..... ~g.t~..~.~ ....... E~J~..~3.~ .............................................................................. ............................................ ,T,~t,~.~la..~.ac)~..~ ......... C~r~o&q~ .............................................. pursuant to application dated .........................-~,a~,....~ ............. , 19..~..)5.., and approved by the Building Inspector. Fee $...L9.~2.0. .......... Building Inspector SOUTHOLD, N. ¥. Application No .... t.. .............. APPLIC, A~ION FOR BUILDING PERMIT ~ Date .............~......~...-.~--'..~.... ....................... ,19 ............ ~" INSTRUCTIONS a. This aPPlication must be completely filled in by typewriter or, in ink and submitted in triplicate to the Building~;~ Inspector, with 3 sete of plans, accurate plat plan to scale. Fee according to schedule. b. Plot pJan showing location of lot and of buildings on premises, relatiOnship to adjoining premises or public Streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 gremises 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 pursuant 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 laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for ........ ~~l'~'a"~ ............. or name, i~"~'~q~l~i~'~ ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... !...~..~ ..................................................... ~ ......................................................................... If applicant is a corporate, signatu~ of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ....~..::~..-~.. .......... ~...., Lot I~ ...... ~..~. ........... Street and Number ..... .~....~ ....... ~(-~.~G~'....~.~/.~....,~l.:....l~.~...u~.~:.i.i~.,.".;'.~'....~.i .......................... Municipality State existing use and occupancy of premises and intended use and occupancy a~ p~rapL:~sed construction: ,. a. Exisiting use and occupancy ..... L~...,/.',/~',......~....~.~.,.i~ .......................................... ................................... b. ntended use and occupancy ..... ...... ........ .......................................................... 3. Nature of work (check which applicable): New Building.. ....... ../....'.. Addition .................. Alteration ................. Repair .................. Removal ..................Demolition. .................... Other Work ..................................................... ~/''~ _ ~....~... ~. (Description) 4. Estimated Cost ................... **~ .................................... Fee **. (to be ·.paid on filing this application) 5. 13, 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. D'mensions of existing structures, if any. Front ....,~;~.; ................ Rear ....... ~:..~:.: ................ Depth .....~b..' ....... 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 ....~;'.-;~. .............. Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front .~..=~....~./..a,,: ................................... Rear ........ ;..... ............................ Depth ....... ~....;...' ................. · -,' o 7 · ~ , 10: Dote of Purchase .."./......~.. ...... ~ .................................... Nome of Former Owner ..~. ....... /~/.,..,4~6.,~; ................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction, violate any zoning Iow, ordinance or regulation: ............. > ........................................ 13. Will lot be regraded' . ........... ~ ............... Will excess fill be removed from premises: ( ) Yes ( ) No ....................... .,~..f.;....~**~.~.~. 14. Name 0f Owner of premises .~,~l-.. ~....,~_~, Address ..., ~,.;,,.,~ ................. PhormNo.:' '* Name of Architect .............................................................. Address ................................ Phone No ....................... Nome 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. ................... ~.~:..~.,,<...~,,~e~ng ~tsh/~rn, ~ ~d says t~t ha is the applicant (N~ i~vidual ~ng c~tra~ above nom~. He is the ................... ~ ......................... ~ ........... ~ ........ v ............. ~ ................. , ...................................................... . (Contract~t~ ~ e~r,~tc.) of ~id owner 0r owners, and is duy gut~ ~ perfprm.or~bve pesf~rmed the ~id ~ork and to ~ke ?d file this application; t~t oil statements c~ In this a~tiob are ~ the b~ of h~s ~owledge and behef; and tha~ the work will be performed in the manner ~t fo~h in the application fjl~ ther~ith. Swam to ~ me this / ~ . / / / JUDITH T. BOK~ Hof~ Pu~[ic, State o~ N~ FO~M NO. $ TOWN OF $OUTHOLD , Beilding Deper~ment 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 oil 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, JV~ultiple 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: t. 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 ........ New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~ kc~ ~ "'~0~.~ Owner Or Owners Of Property ..... .~.......~. ....... ~ ........ ...~..?...T~....~ ............................................................ Subdivision ....~...,~...~..C ........... ~.~!?../~..-. ................... Lot No.'~....Z~,. ...... Block No ............. House N~..~..O...°. Permit No. ~ .~...(..~.....~... Date Of Permit~...E.~..7....V/.!?...7.~pplicant ....~f~_..~.......'~.......~_...U....~_..~ ..................... Health Dept. Approval ................ .,./~....-~......- .............. Labor Dept. Approval /k/. ~r~ . Unde..r,ters Approva' .................. ............. P'ann,ng Boord Approvo' ......... ............ Request For Temporary~Ce~r~ificate ........................................ FinoJ Certificate .......... Fee Submitted $ ...... ~..~r/_,~ .......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .....~.~...d~...~ ........ ...~.:.....~.....~ ........................................ Sworn to before me this ~/_.) Z. ~ ¥ ~ ~ ................ day of ..................................... (stamp or's~e~17 ~?~__~ Notary Public ....~oun~ =_.), l'Z g5 O0 L.I ¥1-L.E~ hi L=CV, Z AONV,:inO00 -10 31¥:D1:111~130 lfiOHllM II"I:IMV"INI'I $1 3Sl"l ~0 AONV,:lnO00