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Home My WebLink About7126-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMI~,N'T Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z60~3~ ...... Date .............At,t&'~t.. ,~..., 19 .~t. THIS CERTIFIES that the building located al~. lbl .~...{~el. ~y). S~t Map No. ~... ['. ....Block N~ ........ Lot No.~... co~o~ subs ~y~ ~e ippH~on for B~g Pe~a ~ore ~ ~ ~ o~ce dated .........~...~1 ....., 19~.. p~t to w~ B~g P~t ~o. 71~.. dat~ ..........~.. ~ .... , ~9~., was ~sued, ~d co~o~ ~ ~ o~ ~e r~e merits of the ap~ble pro~io~ o~ the law. The occup~ ~o~ issu~ ~. ~.rtw~, ~ .f~. ~~ .v$~ .~. ~$~.~q~ .................. The ce~icate g ~u~ to .~.~ .... V~$~ ;~.... ~er ............. <o~er~essee fr of ~e ~ores~d / S~o~ Co~ty DeP~ent of He~ Approv~ .. ~i~../. ........ ................. UNDERWRITE~ C~T~ICATE No~ HOUSE NUmB~ .~.~ ..... S~,t..~.~. ~. ~;~.. ~_~ .~Sll .... FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORI7ED) No. 7126 Z Permission is hereby granted to: ..~.~..£.~L~. ........... .~..~..aL.~...LL.~ ................ ..~....U..Z.C.~ .~..~...u..,.~: ......................... .... ~......~.~.~.,..~ ........... .~..C....~.C.o...C~/~ z~ ~ ~r ro ...Z~..~.~ .......... ~..T...o..., .......... .A.. ........ .~Z.V..~:.....~:......F...~.Z~!..U,.:~: ......... .C).~.~:.U.,.~..~.(..~....~... at premises located ............................................................................................................................ / pursuant to application dated "~ I /~"/~t~ 1~..~...., and approved by the Building Inspector. F. ~..'~ ................... ~ ........................................ Building Inspector ./ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ , 19~ ....... Disopproved o/c ............................................................................................ ......................... ........... Z ......... ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or' 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 adjoining premises or public streets or areas, and giving a detailed description of layout ofprpperty must be drawn on the diagram which is part of this application?J c. The wark~ .covered by this application may not be commenced before issuance of Building Permit. d. Upon dpproval 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. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy e. shall have been granted by the Building Inspector. APPLIC^TION IS 'HEREBY /~DE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, blew York, and other applicable I~w~, Ordinances or Regulations, for the construction of buildings, additions or alterations, or.for removal or demolition, as herein descrlbed. 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 necessary inspections (S ration) (Address of applicant) State Whether applicant is owner, lessee, agent, architect, engineer, general Contractor, electrician, plumber or builder. o T-re 7-0 Name of owner of nrem ses .L. L='~..~......,~(-.. ~. ~)0.-~ j,,/'j~J/~/' O~l~L~ ~,J/ 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. Mep No.:. ....... ~ .................... Lot bio...'~ ..................... Street and Number ...................... ~i..l~j.~:: ...... ~.~;.~t.~...~.l~ .......................................... ........ 2. State existing use and occupancy of premises and intended u.se and occupancy of prgposed construction: a Exstn useandoccu anc / ~-~H,t~~ .. g P Y ........................ ,.*'w ................ , ............................ ;....;...:.~.~..~ ............................... ~/.,I r~ ~,.. ~ ~J ½. '~ ~ ..~4. I J' ~' ' b. Intended use and occupancy .................. ~ .............................. · ....................................................... 3. Nature of work (check which applicable): New Bqilding ~'..; .............. Addition .................. Alte ati°n .................. Repair .................. Removal .................. Demolition .................... Other Work ......................... I ............................. 4. Estimated Cost ................ L....~'.....~....~....~........~... ........ i.....Fee / ,~ ~ (Description) ........... .................. 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each flood ............................ If garage, number of ~rs ...................................... ......................................................................... ; ............................. 6. If business, commercial or mJx~ ~cupancy, ~eci~ nature and extent of each ~pe of usff ............................ 7. Dimensions of existing structures, if any: Front ..... , ...................... Rear ................................ De~th .................... Height ........................ Nu~er of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rea~ ............................ Depth ................................ Height ..................... ~ ...... Number of Stories ................................ I 8. Dimensions of entire new construction: Front ..~~~ Rear ............................ D~th ........................ Height ....~..~... Nu~er of Stories ............. ~i ........ ; ................................................................ ~"~ ....... ~';;;" ........... ..... '. ~ ~ ~ n--- 3 7~ De-th 11. Zone or use district in which premises are situate/ ---- ~ --..Z,..>..,.~ .............................. L .............................. 12. Does proposed construction violate any zoning laW, ordi~nce or regulation: ......................... ~ ....... ~ ............ 13. Will lot be regraded' ......~ ................ Will ex~eSs fill be rem~ from premiss: (_) Yes l / ( .......... ....... Name of Contractor ......... ~.~~ .......... A~re~ ............... ~: ............... Pho~ No ........... L~ ......... PLOT DIAG~M ~ate clearly and distinctly all buildings, whethe~ existing or proposed, a~ indicate all set~k dimensions from prope~ lines. Give street and block number or description according to d~, and show street ~ames and indicate whether interior or corner lot. STATE OF NEW. YORKr, , ~-, I c c COUNT~ OF ................................ .......... ~. ....................................................................... ~ ..........g duly sworn, deposes ond seys that he is the epplic~m - >' (Name of individ~signing contrac~ I abo~~ named. ~ ... , - He (Contrac~;?::~; co.orate officer, etc.) I of ~ajd ~?owne~end~g'~uly authorized to ~erform or have performed the sGad work a~d to ~ke and file ~t~iS'~pl~cati~; that ~11 stateS, ts contoined in this application are tree to t~e best of his knowledge and belief; and · "that the.w~Ck~wilr be pe~f?~ed in the manner set forth in the application fil~ therewith. Swo~'f~ ~ore mq t~i~*:: ~.. . ~'7 I ................ ............... ........ ........ , ......... ' :. ' ' ~'~ ?' ~ ': t i ,.: -- .. Notam, Pa~fic,; ........... ~,,,.~.,., ................. ~ .......... -C~n~ .................. q ................. ~ ................. ~ ... : ~j~ ~ ~ ?'~ y~of~'~PubiJc, State of New ' , ~r~'''t ' NO. 52~0344963 SUffolkCount~ . ~pmmission ~pires March 30, FOl~I NO. $ 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-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 3. Copy of certificate of occupancy $1.00 New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~...~....~..../~...~..L.....~.....~...~.../?..?.........~....~..~..... ~..~_7r-~ 7'~x~,/~' ...~.~/ Owner Or Owners Of P p y ................................................... ..~..~..~ ............ ~ ......... ;./~...~..~......../~.. .......... Subdivision ..... ~ ......... ~~...~...~:....: .......... Lot No...~. glpck No..~..,/ ...... House No..~..~..--~ Underwriters Approvu~... ........................................... Planning Board Approval Request For Temp_.~ary Certificate ........................................ Final Certificate ..,~,,. ................................... Fee Submitted $ ~ .......... ~ ................ Construction on above described building and permit meets all~'~licab~ codes and regulations. App cant~X~. '~.f' I ~4?..' .. Sworn to before me this · ..~ day of ~(~...~..........~...~.~....~. (stamp or seal) Notary Public .................................... County