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Home My WebLink About7140-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 .......................... lrOK~ NO. ~ TOWN OF SOUTHOLD IUILDIN~ Dr:PAI~TMEN'r ~N CLERK'S OFFICE ~OIJTHOLD, I~. Y. BUILDING I)F. RMrT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNT L FULL CON~PLETION OF THE WORK AUTHORIZED) N? ?1~0 Z Date Karch 26 19.~... Permission is hereby granted to: E ene Daviso ........... ~.~.v~...~.7.~. ............................................... .................... ~tt~tu~ ............ J ....................... erect and maintain a corral fence - post & rail a~ ,o ................................................................................................................................ ~...~ba..3Z~/9~ pursuant to application dated ........................... ~ .......... 2~ ...... , 1f1~...., and approved by the Building Inspector. 'TOWN OF SOUTHOLO BUILJNNG DEPARTMENT TOWN CLERK'S OFFICE SOUTIlOLD, N, Y. Approved ........................................ , 1 ....... No. ~' Disapproved a/c . ...................... ~__ ~ APPLICATION FOR BUILDING FERMIT ................... . INSTRUCTIONS a. This application must be completely filled in by typewriter 'or in ink and submitted in tript!mte to the Building Inspector, with 3 sm of plans, accurate plot plan to scale. Fee according to schedule. b. Plat plan shOWing location Of lot and of buildings on premises, relationship to adjoining prembes or public str. ee.~. of areas, and giving a detailed descripti°n of layout ofpraperty must be drawn on the diagram which is part of this apphcation. 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 regulatiom, and to admit authorized inspectors on premises and in buildlng~ for necessary Inspections. (Si~,~ature of applicant, Or name, if a corporation) ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber o~ builder. Name of owner of premises ....... i ........ ~..i ............................................................................................... ::i.i ................. 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 willie.done. Map, No.:~ ....................................... Lot No ......................... Street and Number .... V~. ....... .~........~.......~...~........~.(~D...~...I~. ............. ~. ...... ~¢~.. ............... Municlpollty 2. State existing use and occupancy of premises and intended use and occupancy of proposed co~4truction: a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ................................................................................................................................ Nature of work (check which applicable): New Buil~ling ,~:: .............. Addition .................. Alteration ........... Repair .................. Removal ............... ~. DemOlition ........... [..~,.;.. Other Work .....~...~.i..M....C...~'.'. ............................... c"Jt c~o/' . .' . ~: ~ (Description) Estimated Cost ...........I.~.....z4....O...~ ............. .............. Fee ..../- ...... : ............................................................................. 4. (to be paid on filing this application) 5. If dwelling, num~ber .of dwelling units ............................ Number of dwelli~ng units on each floor .......................... .~ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature bn~ e~tent of each type of use 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. 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 are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ~...c~...~,.~ .~....U.~.~..~..~. ........ ,. Address ..~....: ................ ; ........ Phone No.~...~...~..~....~..~..;.. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil 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 corner lot. STATE OF NEW Y~l~J~/./.// t S S COUNTY OF ,~..J ' .................. : .............................................................................. / ~'~ being duly sworn, deposes and says that he is the applicant (Name of individuai signing contract0 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 all statements contained in this application ore true to the best of his knowledge and belief; and thru the work will be performed in the manner set forth in the application filed therewith. Swam to befo~ me this ...... of ...... ....... , ' C'x ' O (Signature ot appficant) JUD~T'.'i T. BoKEN Nolary pub',it, Stale of New York No. 52.0344963 Su~oJk COUc~ Commi~ion Expires Marr. h TOWN OF $OUTHOLD' Building Department Town Clerks Office Sou~hold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF:~ OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and st~bmitted in DUPLICATE to the Building Inspector with the following; for new buildings or new u,~e: 1. Final survey of property with accurate location of all ibuildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sew{~rage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire U~derwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from th~ 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, istreets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, 9ccupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent 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 Date New Building ................ Addition ................ Old or Pre~existing Bulding ................ Vacant Land .............. Location Of Property ...... .~/~.......~..q.~...~....~....~/.....u~..........~....~.../.~..!.~.?_.~.../..~. ................................................ Owner Or Owners Of Property .... .~.u G.¢~ ..~..~.. ~J Subdivision ................................. .~ ...................... Lot No.....~..'"-~.. Block No..-~.... House No ............. Permit No..~.,~.~e.~_~.. Date Of Permit .~.J..~..~./..'?...~..,Applicant .~.?...~...c....'~. ~....~...~....~.L.5'...O....~.. ................ Health Dept. Approval ~'- ............................................ Labor Dept. ~pproval ................................................ Underwriters Approval ...... Z ..................................... Planning Bodrd Approval Request For Temporary Certificate .....'~.. ................................. Final Certificate .................................. Fee Submitted $ ..s..~...~ ............ Construction on above described building and permit meets all dppliceble Applicant ........ ~¢_....~.. Sworn to before me/,hh. ..... o, codes and regulations.