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Home My WebLink About7085-zNO. ~ TOWN OF SOUTHOLD BUH.DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at w/.m. Cox .L~u~ ............. Street Map No .... XX ...... Block No...XX ...... Lot No ..... XX ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .2/~9~.?i* ............. , 19 .... pursuant to which Building Permit No.F.08~Z... dated .2/1.~!~ .............. , 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 .Add£t:~ona3.. aces ssol~r, se~en, ur~t ................................. The certificate is issued to .... Jam® s. P~&tt- ...................................... (owner, of the aforesaid building. Suffolk County Department of Health Approval .... N/~ ............................ UNDERWRITERS CERTIFICATE No ........ .N../~. ................................. HOUSE NUMBER . 69.69 ........ Street... C,~x. Lane .... Cutchogu~.~ .N o. ~ o ...... Building ~nspector · O~M NO. ~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) o. 7085 Z Date ....................... .~.eh .......... ~9. .......... , 19..~.. Permission is hereby granted to: ...~.~?.~....~:..~: .a.~..t. ................................................... ....... ~u.~.ch~ ................................................... to ...~p~.t; ~j, ~,...~ ~..~,~j,G.~.~,....ac.~ ea.~.r. ~...acy...e.n:~n ~..ur~.i~; .......................................... at premises located at ....~'.~,~......~.OX..~LT~ ........................................................................................ .................................................... ..c.~..t.~.o.~.~,e. ......... ."/..'. L'. ................................................................... Feb 1 ~. pursuant to application dated ....................................................... , lC)...~..~.., and approved by the Building Inspector. Fee $fl.~.,...og.. ........... Building Inspectc~r 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: ]. 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 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 $1.00 Date ........ .~. ~. ?..~ ~...~..~. :~....~ ~..~. ~ ...... Acc. Sdr~en New BHilding ................ Addition ...1,~.~.... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... .w~.s...Co.~..L~e,e ........(~Ll.~ho~q,te.~,.~A...Y., .................................................. Owner Or Owners Of Property ................ ~Tnm~$..~.r~.~ ............................................................................ Subdivision ~ ]~C No ....... ................................................................ Lot No. ~ ....... Block No ............. House Permit No. ~..Q{~.7~ ........ Date Of Perm t ~.~.~/?..i:{: App cant',T~...~.~ ..~.~..B.~..t. ................... Health Dept. Approval ....... .~./...~. .............................. Labor Dept. Approval ........ .~...~...D: ................................ Underwriters Approval ......... .~./..R. .............................. Planning Board Approval .~...~... ................................ Request For Temporary Certificate ........................................ FinaJ Certificate .....X. .................................. Fee Submitted $ ~.*..Q0. ........................... Construction on above described building and perFit meets a~p~ ~es and regulations. Applicant ................ Sworn to before me this ~/ ................ day of ............................................ (stamp or seal) . Notary Public .................................... County TOWN OF SOUTHOLD .... '"- .,'A.,.,?,~-~- '.,- /'-- _/_Z: ~/ Exa ......... ........ Approved .......... ~.~. .............. .(...~ ........ , 19~..~... Permit No.?..~....~....~..~..~ ............. Di~ppr~ a~ ........ ~.. APPLICAT!~ F~ BUI~ING PE~IT e , , G~ , pet ...................... .~ ....... .1.~. ........... 1~..2~....~ :NS u : s a. This a~lication m~ be c~pl~ely fill~ in by ~ewriter ~ in i~ a~ s~mi~ in tripli~te ~ ~e Buildi~~ In--tar, with 3 ~ of.pl~s, .acute ~ pl~ ~ ~ale. P~ ~co~i~ ~ ~h~le, b. DI~ p~n~ SH~in~ I~atlo~ of lot and of buildings ~ premises, relationship to adjoining premiss or ~lic str~ o~ areas, and givi~ a ~t~ de~r ption of ~ ofp~ must be drown on the diag~m which is ~ ~ ~ls ~licati~. c. ~e work ~over~ by th~ a~licati~ may n~ ~ comme~ before i~uance of Buildi~ Permit. d. U~ appall'of this ~pl'lc~on, ~e Buildi~ I~tor will issue a Building Permit to ~e ~licont. Such pe~it shall be k~t ~ the premis~ ~ilable ~r in~i~ ~h~t ~e wor~ e. No building s~all be ~cupi~ or u~ ' ' · m ~ole or :n ~ for any pu~e ~er untd a ~ific~ shall have ~en gmnt~ ~ the Bulldi~ In,tar. APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Bu Iding Permit pursuant to the ~u~dln~ Zon,, O~,nonc: of..the T, .o?..o~ Sout~o~d, S,ffo~k Co,.,.~, New York, and other .pp,,.~l. U~, O~nanc.s or .~gu m?.ns, .~or me c.onstrucr~.on O.T. ou.~a,ng?., .a~d. It!ons or a!terat,ons, or for removal or. demolition, as herein described. ademi~pp,.c, an.~ ag.r.ees to .comp,y with.a, app!,.ca?e.~?s, o,rdmances, building c..ade, hous,ng ca~. e, and regulatlom, and to aumonzea ,nspec~ors on premises aha in ~u,amgs mr necessary inspections. / (Sign~ure of opplic~ant,~br name, ,f a corporatio~i ..... C~teho&~e (Address o~ app~iccnt) ,State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~TA~el l~ratt If applicant is a corporate, signature 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 ............................................... 1. Location of land on which proposed work will be done. Map No.: ..~ ................................ .Lot NO ....... ~ ............ Street and Number ......... .~/~..~I~x..T~L~. ..........(~tA.~,~]~irj4 ................................................... i ...., .................... 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 ~lll~le ~th &dd~t~onal accessers..eree.e.,~ ,..~..~t.. . 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. ~ Repair .................. Removal .................. Demolition .................... Other Work ...~.q~.ql~...1Lll~ ...................... (Description) 4. Estimated Cost ............................................................ Fee ...~.~..e....0~... ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ..0. ................. 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 ~pe of use ...~L~I~.$.~,,.I::L~, 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 ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. ' Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... ~.C~.-..1.~.....~l~(:J3la:t;,l:::La.~. ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... 3lei ............................................ 13. ~ill lot be regraded ....~l~l ................... Will excess fill be removed from premises: ( ) Ye~ ( ) No 14. Name of Owner of premises ~T~me $ ~Z'&t,l; Addre~< ~ehe~li~ Phone No. Name of Architect .............................................................. Address ................................ Phone No ................. ...... Name of Contractor ..... ~1.~...~. ............................................. 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 comer lot. COUNTY OF ...~.~...O:..J~... ............ f~.~ .............. ~ .................................................................................. being duly sworn, deposes, and says that he is the applicant (Name of individual signing contracf) O~ove named. He is the . . 01~leZ' . (Contractor, agent, corporate officer, etc:) Of said owner or owners, and is duly authorized to perform or have perfOtn-ied the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thru the Work Will'be performdd in the manner set forth in the application filed therewjl~, Swam to before me this / 1 ~ ~ Feb ~/ . ' '"'/~ (Signature of applicant) JUDITH T. BoKEt4 Notary public State of ~qew ¥Ot~ / o 52 0344963 Suffolk Commission Expires March ~0~