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Home My WebLink About7136-zTOWN OF $OUTHOLD Buu.r~ING DEPARTMENT Town Clerk's O~iee Southold, N. Y. Certificate Of Occupancy No. ~63,¥~ ..... Date ..............Feb .... ~ .... , 19.~. THIS CERT~'IES that ~e b~dln~ 1~ at ~Sat.~ ............... S~ co~o~ su~y ~ ~e AppBc~on for B~dtng P~t h~fo~ ffl~ ~ ,h~, ~ menM of ~e appUcable ~io~ of ~e hw. ~e ~p~ for wM~ iht, ~ifica~ ~ of ~e ~or~d b~d~. UNDERWRITERS C~RTIFICATE No. NEB,, ........................................ HOUSE NIJMBER ....~O ........ Street .. l~$e.t~ .~/&y. ........................... I~O~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN (:LERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7136 Z Date ..................... L,:~.~....26 ............. , 19~ .... Permission is hereby granted to: .............. .~,u.t.~ ~,~o~e ............................................ to ~ .~...~.~...~.~ ~,.~ ;,.~.~,...~.~...~ ;~. ~.~ :,~,~:. ,.~.~.~.L ~ J~ ~, ................................................................ at premises located at .Z..q.¥....~.~;~. ......... .~?.~,£j:....~,~i~...~.~ ........................................................... ........................................ ~l~,~e.t,.. ,J~y... ~ ~V~, .. ,~.) ........ ~eU~ho~l~ ....... ~.:.~. ............................... pursuant to application dated ................... .1~.2.~/.~..~. ................... , 19 ........ , and approved by the Building In~oector. Building- Inspectc~J TOWN OFSOUTHOLI~ ' f'~/'-~' ' BUILDING DEPARTMIN'I~,,~ ,~pproved, · ....................................... , 19. TO~VN CLEItK'S OFFIGE SOUTHOLD, N. Y. Application No. ,.L,.../.,~.....~,.. ............. [~isopproved ale ........... ~ ......... , ... .............. APPLICATION FOR BUILDII~G PEItMIT INSTRUCTIONS ............................. ]9 ............ a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building.~. Inspector, with 3 set~ 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 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 applicant. Such permit shall be kept on the premises 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 necessary inspections. ,,/, ................... i ................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ame owner premises .. .: .............................................................................. If applicant is a corporate, signature of duly authorized officer. (N me and ti e o corporae o icer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... · Location of land on which propose~l work will bq done. MOP No '~-;.'.;-- -- ...... ._...~ ......... Lot No..L. .................... Street and Number '....~....~.~..,~~.~.,~....~'' ............................................... / Municipality 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 .................................................................................................. 3. Nature of wa (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 cars ............ ~. ........................................................................................................................... 6. If business, Commercial or mixed occupancy, spac£fy nature and extent of each type of use ............... , ............ 7. Dimensions of existing structures, if any: Front ....~.'....~.... ............... Rear ..~.. ..................... Depth ...~....~... ........ Height ......... i.~...I ....... Number of Stories ..../. ........................................................................................................... ~ Dimensions o~ same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ Rear .....~.~.. ................ Depth .....~....~.. ............ 8. Dimensions of entire new construction: Front ...~..~.../. ....................... / Height .......~..~ ........ Number of Stories ../. .................................................................................................................. 9. Size of lot: Front ..... ~'.w~.. ........................................ Rear ..... ./..~ ........................... Depth ..../~...~.../. ................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~....~.. .............................................. 13. Will lot be regraded ...~--~. ......... ? Will ex~e,ss fill be removed from premises: ( ) Yes (~No 14. Name of Ownei of premises .~,/~.0.D~~Address ................................ Phone No ....................... Name of Ardhitect ....................................................... ~~ ,~/~,~- ~.... Address ................................, ~'~/~ Phone No ..........~.~..' Name of Contractor~.~....~.~ ................ Address ..~.~m~....... Phone No. ............... 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 4orner lot. 14.1 STATE OF NE'~V ¥ORI~ COUNTY OF ...... .............................. j .................................................................. being duly sworn, deposes and says that he is the applicant (Nome of individual signing contract~ above named. He is the ............. i...,~,......, ...... .~..', ....... ;;....?Z'.', ........................ L .............................................................................................. ~ (Contrc~tor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; ti~at all statements contained Jn this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ........................ Nora Pub ic ~ ......... County ..'~...~....~..~---. ~...'~ ................... FOR~ NO. $ TOWN OF $OUTHOLD , Building Depu~tment 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 $!.00 ..... New B ,I ',n ,I--~ ,hon~' ,~/~4-~1 x, tin Buddin ocont n q' d' g ~1.~., ........ Add'fTon .~' ............ Ola~or Pre-e's ' g ' ' g ....~. .......... V La d .............. Location Of Plroper~ ..~..~..0...~...~.~.....~......~...~4.....~ ............. Owner Or Owners Of Property ..~...C~.......~..~..~(~. ................................................................... Subdivision .~..~...~.{L,~'.....'~...~-~, ................ Lot No.l.¢~,..."0 Block No ............. House No..L~..~....~.. Permit No..~.L~/..~.~ Dote Of Permit~..-.J.~.:.'~.~..Applicant//~'~V '~'"'~'"'"('~'{~'/~'"'~' '"~'J~"~"! ...................... . Health Dept. Approval .......... (;...t.~.. ......................... Labor Dept. Approval ..... /.~.'..I.~ ................................. Underwriters Approval ............... ~ .......................... Planning Board Approval .... .~'.../..~. ............................ Request For Temporary Certificate ........................................ Fincd Certificate ......... .~... ........................... Fee Submitted $ . ..~...~ .................. Con st ruction on above de sc rib~dpp ibl~itng and pe~.~m ee..~.., a~e~c~..oc~s..~...nd...r..~ .~ .~..~t.i..~;1~.~ Sworn to before me th, ' /";'"~~'~ ....................... ::i:'~or" ea~/:~ ........ ....... ...... ....... Nota~ Public ......... ~~.. Coun~ ~ ~