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Home My WebLink About7139-zTOWN OF $OUTHOLD BI~.DIN~ DEPARTM~T Town Clerk'e O~ice Southold, N. Y. Certificete Of Occupancy No. ~63.8.1 ....... Date ..............~..~..h....~.6. .... , 19 THIS CERTIFIES ~at ~e b~dlng l~a~ at . .8/S .~o~. Map Ho. ~ ......... Block Ho... ~ .... ~t Ho...~... ~~S. ~ ...... co,om subst~fi~y W ~e Application for B~g P~t he~tofore ~ ~ this office dated....... ~' ....... 2'~a,-- · 2~, 19~' p~, ~ w~ dat~ .......... Ma~...26 ..... , lg~., was issue, ~d co~o~ to men~ of ~e appUcable pro~io~ of ~e law. The occup~ for w~ this ~u~ ~. A~cesl~..(~l~l~l)..b~l .~. !e~l ................... ~e ce~fficate ~ ~u~ ~ . ~ene. ~aV~ ..... ~ ......................... (o~er, lessee or ~t) of ~e ~or~&d b~ding. S~o~ Co~ Dep~ent of He~ Approv~ . ~.~ t .............................. ~~I~RS C~T~ICA~ No. ~.*~t ....................................... HOUSE ~ER... ~0 ...... S~t ..... ~a~d. Ave .......................... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7139 Z Permission is hereby granted to: ..... ~t..~.v.~.~.~ ........................................ ................. .~..o..~. ~... ~..v..e. ......................................... .......... ~.t,t,£t~,,k ................................................ ~ .~.~..~.~.~..~n.4,..~...~ ~,~Ar~....~..~.e. ~.~.~....{,~ ~.~ .~.~;~.t~.~ ~.)...~.~.~g ........................... _...~ _, S/S Sound Ave - E. main ba~q~ at premises [~.u.~u u, ............................................................................................................................ ......................................... A~.~.t~.~.~s:~ .....~.,.~.., ................................................................................... pursuant to application dated .............................. ~'. ....... ~3. ........... , 19.~'..~..., and approved by the Building Inspector. Building Inspector / 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, an6 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 ]957), 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: I. 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 ..... ..~/~........~...o...~....~...?~....~.....~.. ...~...~../.~'..1.?..?...~.../~' ............................................. Owner Or Owners Of Property .~.U G .¢...'~...-. Permit No. '7'v.~e.'~... Date Of Permit .'~..~..~./.'~..¢X...Applicant ..~...u...(~...q..."~. ~....'~...~....~..1: ?....o....v~.. ............ Health Dept. Approval .......... ~ .............................. Labor Dept. Approval ......~ ......................................... Underwriters Approval ...... ..-. ..................................... Planning Board Approval ...-'. .................................... Request For Temporary Certificate .....'~.. ................................. Final Certificate ............ ~ ...................... Fee Submitted $ S Construction on above described building and permit meets all applicable codes and regulations. Applicant ....... ~,~._..~ ................................... Sworn to before me~rf ................ day of ....... Notary Public ....... (~ County (stamp or seal) ~,~ ~3 c~',/_ TOWN OF SOUTHOLD BUILDIN~ DEPARTMENT TOWN CLERK'S OFFI~,E SOUTHOLD, N. Y. praved ................ ....... '*-7-.TPerm't Di.~ppraved a/c .......................................................... ................................................ ii'i'"'i'ii ..................................... APPLI~.~TI~I FOW BUILDING PE~IT INSTRUCTIONS Appl~ ................ a. This application must be completely filled in by typewriter ~ in ink and submitted in triplicate to the Building Inspector, with 3 sete 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 o~ 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 permi 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. ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem ses .,~......~....~....,~..,..~......~...~.~..~....~.....~,. ............................................................................. 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 Trnde's License No ............................................... 1. Location of land on which.~./~ ~ ~-,~,-._ ,e.~,~., ,,, ~---_, ~pr°p°sed work will be done. Map ~No.: ........................................ Lot No ......................... Street and Number ..~../..~.....~..C~.U..~..~...~.I~.......-~...~.~..~....~.~.t~..~..~.~...C..~.~.~.~.~.~.. -- ~Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. ~xisiting use and occupancy ................................................................................................................................ b. Intended useandoccupanc , ........ ........ .......... ............................................ '3. ~ture'of work (check which applicable): New Building ~'~ f'J · ................. Addition .................. Alteration .....~...;... ..... Repair .................. Removal .................. Demolition ................. ,. Other Work ................................................ . ..... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floo~ ............................ 6. If business, commercial or mixed occupancy, sp~ify nature a~c~ extent ~of each type of use ............ ~ ............... 7. Dimensionslof existing structures, if any: Front .....I.{3 .................. Rear ..~.~ ....................... Depth .~....~..~ ........... Height ..~ ................... Number of Stories ..... J ........................................................................................................... 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 ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .......... .~.......~... ................................... 13( Will lot be regroded ....... J~..; ............... Will excess fill be removed from premises: ( ) Yes : o Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phonei No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, <3nd indicate all set-back dimensions from property lines. Give street and block number or description accon:ling t° deed, and show street names and indicate whether interior or corner lot. STATE OF NEW)~'OI~. ~ Y ),~ ~ ................... ~. ........ ;..; ............................................................... being duly.sworn, deposes and says that he is the applicam (Name of indK'idual signing C(~ntract) above named. He is the ................................................................................................................................................................................. (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 oil 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. Sw~o~ e~r,e me this ~ ~) (Signature of applicant) JUDITH T. BOKEN Commio~ion ~pires March 30, )9~~