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Home My WebLink About7138-zNO. ~ TOWN OF SOUTHOLD BUH,BING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. ~.~.6 ..... Date ........... Cc~klim THIS CERTIFIES that the b~d~g located at ... ~. X~' 'View' '~. ~eet Map No.. ~.. ~. ~k No ........... Lot No.. -~9 .... 5~$~o~t .... [~.. · · conforms substanti~y to ~e Application for B~lding Pemit heretofore ffl~ ~ ~s office dated ............. ~.. 26, 19. ~ p~suant to which Bulldog Pemit No... dated ............. Nar.. 2~., 19..~, was issued, ~d confoms to ~ of the r~ ments of the applicable provisio~ of the law. The occup~cy for which t~s ce~icate is issued is . P~va~ .ao~o~o~y .b~ld~g. - .Oarago. & .~t~a~ ................. The ce~ificate is issued ~ .. ~ ,. ~. ~ .... ~F ........................ (owner, lessee or ten~t) of the afores~d building. S~olk Cowry Deponent of He~ Approv& ..... N,K, .......................... UNDERWRITERS CERT~ICA~ No... ],R, ..................................... HOUSE NUMBER ...... ~ ..... Street ..... ~ ~d. V$ev..~ .................. FO~'M NO. '~ TOWN OP SOUT#OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7138 Z Permissio~ is hereby granted to: Nl'8 ~itA I l~nd Vier Lane &. ~.....~.. at' premises located at ......... ~. .......................................................................................... ......................... .i..,o.~....e..t~. ............... ,q ?.?...n.~::.o...r..t. ,....~....~... .................................................................... pursuant to application dated l',~r 26 197.I+ , and approved by the Building Inspector. Fee SL°..'. ~ ............ BUILDING DEPARTMENT ,a%oproved " TOWN CLERK'S OFFIC~E I- SOUTHOLD, N. Y~ ' ~J App,ication No Permit No. 7.../.....~.....~..~ ......../ ~- (,lj--/~' ~/~-;a~- ~/,/~ APPLICATION FOR BUILDING PERMIT Rte ................. INSTRUCTIONS a. This application'must be completely filled in by typewriter o~, in ink and submitted in triplicate to.the Building Inspector, with 3 set~ 0f~,plons, accurate plot plan tO scale. Fee according to schedule.. b. Plot'plar~'sho~'i~ Iocatiot~ of lot and of buildin~g orrpremises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofp~'eperty 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 approv:dl'0f'thls 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 beengranted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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 1Bdmit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) //~,~c¥ 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, 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 ............................................... /~/fie NDED Location of land on which__ -- ~ -- ~,~ ~pr°p°sed work will be done., Map No.: ..... ~(.?.LI..~...~.,....,~ .......... Lot No....~...-~....~.. ............ Street and Number ..~,.~..,~.qA~,N~.J~.'~L-~p~.~'..V. LE.W...~.t~tLF-..~....~..~.N.~'.."" .......... ~ ............................ I"F-coN ~ IDR¥ C~T/~TE.~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exi$iting use and occupancy ..... ! ....... g.B.~ ............ .k,..[.r? ......... ....................................................... b. Intended use and occupancy ..c~.~.If£.[..T....O-oJ~.J.T.k~.N...T.D....~.~tr~j~...D.R.~Q~.~..~[~3 ............... 3. Nature of work (check which applicable): New Building .................. Addition ........ ~lte ion .............. ~.... Repair .................. Removal Demolition .................... Other Work ' (~'t'~"-"ription) 4. Estimated Cost ............/...~..?....Q; .................................... Fee .-~.. .................................................................................... (to be paid on filing this app ication) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each flooi ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commerc, Jal or mixed occupancy, specify nature and extent of each type of us~ .............. 7 ............ 7. Dimensions of existin~l-~ruc~ulres, L'~any: Front ......./....~. ............... Rear ...... /...."~... ................... Depth ....~...~ Height ...... [.J..~. ........... Namber of Stories ......... ~/ ............................................... ~ ......................../. ............................. Dimensions of same structure with alterations or additions: Front ............ .~...O. .................. Rear~ ..... ..'~.....o..t. .............. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ....................................................................................... i ............................... 9. Size of lot: Front ....... , ............ ~..~.:. .......................... Rear ........ .~.....~.....~ ....................... Depth .L....z.):-..~'~..~. ............. 1 ]. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............ ~..~. ...... L .............................. 13; Will lot be regraded ..... ~./~.~. ........ ~. Will ex_tess fill be removed f_r_org_p~rnise~_L(~) Yes i ( ) No Nome of Architect .............................................................. ^ddress ................................ ~ No. ~ ..................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setd~ack dimensions from property lines. Give street and block number or description according to deed, and show street hames and indicate whether interior or corner lot. ~ ST^TE OF NEVi. Y~,~/'~ ~¢ ~ COUN'rV OF ..~,~r:~-(/~.c,~'''''' I ................................................................................................. being duly sworn, deposes and says th°t he is the applicant (Name of individual signing contracf) above named. I He is the ............................................................................................................................................... t ................................. (Contractor, 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; that all statements contained in this application are 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~esrro~l~e this %,~ ~, ........................... ....... 'g F applicant[.) JUDITH T. BOKEN Notary Public, 5tale of New ¥o~ No. 52-0344963 Suffo[k Count~%/ OxnmL~sJon Exp~es March 30, ]9_~~ I FORM NO. 6 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: 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 .....L./. ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .-f..~..~..~6/~.~:.~.~y..~.c~/y.C.~.~/.L~.~.!.~/~/2..`~..~..~....~..~.~L~.~.!~.) ............................................. Owner Or Owners Of Property 4.~L.'~ .:.~...(.T...~....,.~.~.~...~..l:z.~ ........................................................... Subdivision .................. Lot No..~..~...~... Block No ............. House No ............. Permit No F{~..~. ,~ DateOf Perm.t..~/{! ~ ' ................... .~.......Apphcant ...~../l~.~.. .~. .~ /.~.l:.[...~. ..~. ~ &... .~. ...................... Health Dept. Approval ........... ..~...~'. .......................... Labor Dept. Approval ................ ~-~ ............................... Underwriters Approval ...............~.. ............................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~/ Fee Submitted $ ...~.~......~... ....................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me t~is ~..dayof ~)--C~./f~ ~ (stamp or seal) ;'. ..... ............. ~ ubhc ~~ County