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Home My WebLink About7093-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z..~.~.~.? ..... Date ........... l~.y......3 ......... , 19..~.. THIS CERTIFIES that the building located at Ma.in.. Rga. d .......... Street Map No...xX.X ........ Block No. ~ ...... Lot No. ~ .... .l~t..~t!~;.~.e.k.. ~'.Y.: ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .F. eb.' .2.6..., 19 F.~.. pursuant to which Building Permit No. ?.0.9.3.2.. dated .......... F.eb.. I~6 .... , 19..~.., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...~l~;e.d. 0.e. cUp.~.c.y..-..dW.e.l.l.i.r$~....FAro., e.ra.!. H.om.e. ..................... The certificate is issued to D.e.F.r.i~.st...F~..e..r.a.1..H9~e*. I..nc ....... .0~...e.r ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N.R, UNDERWRITERS CERTIFICATE No .... p~.ml..~n.$ ................................. HOUSE NUMBER 1380~ Street Pain 1t4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH.E PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 7093 Z Permission is hereby granted to: ,~ ~..~.~.',:......~.....~£~.2. ................. pursuant to application dated ~/~ '~ 19.Z..,~., and approved by the Building Insp~-'tor. Fee $....~...~.. .............. Building Inspector FOF,~I NO, 6 TOWN OF SOUTHOLD Building Deportment 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, o 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 $§.00 3. Copy of certificate of occupancy $1.00 ~' Date .................... ..7...~.. .................. New Building ................ Addition ................ I'/ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..................... ./. .......................... ~ ................. ~.~.~'.. ........ ..'~...../..: ........... Owner Or Owners Of Property ~.~.../'T...~..?..~..~...~'~... ...... ~...~.~....'~....~....~...~.....~........~...~...~'~...¢.~. ....... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Date Of Permit .~/;~.~/.).~..Applicant .~...:~..~...4'..~...~../...'~.......-~...m....~....S. ....... Permit No. Health Dept. Approval ...... ..~..'./~.: .......................... Labor Dept. Approval ................................................ Underwriters Approval ...... ~...:...~.. ............................ Planning Board Approval ......... .._...~ ...... Request For Temporary Certificate ........................................ Final Certificate .......................................... ,.~o Fee Submitted $ .....~...' .......................... Construction on above described building and permit meets all appl~_e .c~.~/~ and regulations. Sworn to before me this Y/~//a~ ~ 7~// e '/ .......... a day of .................. ~ .........../...~. (stamp or seal)~ Z ~ Notary Public .................................... County ~. 8~ f ,/ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN a. EItK'S OFFICE $OUTHOLD, N. Y. Disapproved a/c .............~ .................................... APPLICATION FOR BUILDING PERMIT ate ................................................ , INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjo n ng prem ses or pub ic streets or 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 not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the app cant Such perm shall be kept on the premises available for inspect on 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 cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. '[Signature or applicant, o~'name, if a/ll6rporation) ' ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... .])~....~.h~.J.,C.~.TI ........... ~.L:~,.I~..I~.,~.~ ......... t;!.C.~:;.l~..~ ...... ~..~.JC ................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No .................... At.:.L;~...: ................ Electrician's License No. ~> Other Trnde's License No ............................................... Location of land on which proposed work will be done. Map No.: .. ....................................... Lot No ......................... Street and Number ............. ~.~.~.~.,~:....~,st~.~.~l ......... ~:,a..~ ........................ z~..~.....~..../...?...~,~.!...~ ................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................... .F.~,;A(.C.A..~./. ......... /.'~A~.(L./~ ......... ..~.. ...... ~.......A....~.~. .......................... b. Intended use and occupancy ................................ ~.A.~J.~. ......... /t,~.l..T.~ ............. .~.....D.~.../..~.!.~..AJ. .................. · 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. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................. 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 ................ ~.~. .................................. ~..~,~ ............................ ,.~..? ............... Dimensionslo~,s~me structure with alterations c~r additions: Front ....................................Rear ............................ Depth Height Number of Star es 8. Dimensions of entire new construchon: Front ....................................Rear ............................ Depth ..................... :.. 9. Size of lot: Front ........................................................ Rear ..;...~, ..................... .~. ......... Dep~ .............................. 10. Date of Purchase ........................................................ Nome o~ ~brmer Owner i~ ............................. 7 ........... ~ .... ~ 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction/bjol~['a~,~ zor~n~l'd~,~Shslincll~ce or regul~ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (~ ) No Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... Locate clearly and distinctly all buildings, w~ether existing or proposed[ and indicate all set-back dimensions from proper~ lines. Give street and block number ~r description according to,deed, and show street names and indicate wheth~ interior or corner lot. I STATE OF NEW YORK, COUNTY OF ................................ (Name of individual signing contrect'~ ~, above named. that he is the appliconl He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, otc.) of said owner or owners, and is duly authorizec[ to p__erf(~rlp/or have performed the said work and to make and file this applicatiow{~hat all statements c~ntoi~,ed ~ ~ al:/pl~etion, are tru.e.to, t,he best.o_f his kno~.[,edge and.,~pelief; and that the work'~L[/be perfg~me~hF'~qpr~ er Set.f~'hvila~the ~PP~ilat~n fi~ea merew~.. ~/~/ /'~./~./ Swomtobefor~T~~ ~~ ~/~~ ~' ~/ ..................... ~day of ............................................ , 19 ........ ~ Nota~ Public, . .................................................. ;~ .............................. ;;. ................ 7 ....... ; .........../~ ......................... ~ [3igneture o~ epp~ic~nt) JUDITH T. ~OKEN ~ - Noto~ Public, State of New York No. 52-0344963 Suffolk County Commission ~xpims M~mh 30. ]9~ ~ DATE,__ ,~:h~ 7Y - , . ' ~., ;, ~ 76~;2660 9AM '~O 4PM FO3, REQOIR- ; - p ,, , 'd A PROVED-AS NOTED ' , , ?, DATE: ,,~,~ /7 ~" ' ' ~',' FEE .~.~' .BY~ , NOTIFY BUILDING D, EPARTMENT AT , 765-2660 9AM TO 4pM FOR REQUIR- ED INSPECTIONS; 1, BEFORE BACKFILLING F~'UNDA. TION OR START FRAMING 2. BEFORE COVERING PiP~LINE 3. FINAL WHEN JOB CQMFLETED