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Home My WebLink About7146-zFOP-,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .~..~.~...~!.~.~..~..~.~......~.0..A.~., . Street Map No ............. Block No ........... Lot No .................................. conforms substanti~ly to the Application for Building Permit heretofore filed ~ ~is office dated ........ ~.~.... ~ ~.., 19 ~ ~ p~su~t to which B~l~g Pe~it No.~.~ dated .......... ~.~... ~.., 197~., was issued, ~d confoms to ~ of the r~ ments of the applicable provisions of the law. The occup~cy for which ~is certificate issued is .. ~ .... ~V~.~ ..... P~. .... ~ ~'.~)'.. ~.g~.~ ~(CW ................. The certificate is issued to A ~ ~ ~ ~ 0 ~ 0 (owner ~ of the ~ores~d building. S~olk County Dep~tment of He~ Approval M · ~ ' UNDERWRITERS CE~TIFICA~ No. N O N k- HOUSE NU~EB ... ~ ~ ~ ..... Street...~ ~ ~.~. ~.~ ..... .~.~ ~ ........... .. .... .......... Building Inspector ~UTHOLD, I~ Y. (THIS PERMIT MUST BE KEPT ON THE PREAA1SF. S UNTIL FULL C~ION 01: THE WORK NJTHORiZED) N? 7146 Z Bulk{{ng Inw~"tor FORM NO. 6 TOWN OF SOUTHOLD Building Depa, b~ent Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m m to the Building Inspec- tor 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 installa- tions, 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 p:operty 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 %2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5.Updated C.O. $15.00 $15.00 3-13 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~..~..~...'.~./~..~..~..~?.~. .......... ~.~..~..~..~?./..Z~. .................... House No. Street Ham/et Owner or Owners of Property .~..~...~..~..~..... ~...5~. ~.~... ~//. ~.~...~_~.~f~.~..~../~..~?..X~..~.,3 ......... County Tax Map No. 1000 Section .../..~'.~. ........ Block..../. .......... Lot..~.'. ............ Subdivision j~,,~/'~. ,7-?, ~;/~,,, .~, ,~,~, ,~,~. ?. ~....Piled Map No ........... Lot No.. ~ ......... Permit No..~./,~,~'...~,. Date of Permit ~,, ','.27,'. ,7,~..Applicant ~,. ,Z~,/fZ~.../~.¢,/,~. ,&~, ,~, ............. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporal/Certificate ..................... Final Certificate ....................... Fee Submitted $..~ ........................... Construction on above described building a~d perm t meets all applicable codes and regulations Applicant ...~... . ..-~. ....... Rev. 10-10-78 .~' FO~M NO, 6 TOWN OF SOUTHOLD , Building Depmtment Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFICATE OF OGGUPANGY Instructions A. q'his al~piicati0n 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 disposol--(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. Swam 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 Date ...J.~.n...u.~.~.7...~..0..,....~ ~..~..~. ........ New B~ilding ................ Addition ...... .x. ........ Old ar Pre-existing Building ................ Vacant Land .............. Subdivision ................................................................ Lot No ............. Block No ............. House No..../~.~...0.... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate .......................................... Fee Submitted $ ~..;..0..0. ........................... Construction on above described building and~~s and regulations. Swot. ta faro mo /? I~OTARY PUBLIC;, S~a~e of New BUILDING DEFARTMEHT ~WH CL~I('$ OFFICE Examined J'; ~'~ )'j< '" '/ ',/~ /~., Approved ....................... '...~......~'.:..::, '19 ...... :. Permit No. Disapproved a/c .......... :,.. .............. '; "~.~ ~!: '-"-::~L~'_'_' '. ......... . (Building Inspector) SOU"THOLD, N. Y. Application No...: ............................. APPLICATION FOR BUILDING PERMIT '///.... Date .................... INSTRUCTIONS a. This application must be completely filled in by typewriter at Jn ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. PI0t piton 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. 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. 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. 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 lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (S~gnoture of opphcont, or nome, efa corporahon] (Addre~ of applicant] /, Stare whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. /~,,<-/ ~,,, c,~ ~ Nome of owner of premises /1 ~' ~ ~ ( ~ ~" ( ~ 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 TrOde's License No ...................................... ; ........ 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... '~ , '~ . . j ~l i· ~ t Street and Number ................................................................................ ~ ............. ~ .................................................... Municipality 2. State existing use and occupancy of premises and in?ended use and occupancy of proposed construction: o. Exisiting use and occupancy / ~t( ~ ~' / ~ r ' b. Intended use and occupancy ................................................................................................................................ 3. Nqture of work (check which applicable): New Buil~li~g~ ................. Addition................../ Alteration .................. Repair .................. Removal .................. DemoJition .................... 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, specify,n/g, ture and extent of each type of use ............................ 7. D mens ons of ex st nn structures, f any: Front .-~ .~ : ...... Rear . n~n~h ~ '/ ' Height ........... L.~....-~... Number of Stories ...................... /. .......................... Dimensions of same stFH, cture with olterations 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 ........................................................ 1 1. Zone or use district in which premises are situated 4 _/' '- / 'v 'x, 12. Does proposed construction violate any zoning law, ordinan6e or regulation: / 13. V~ill lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( 14. Name of Owner of premises .,~ .............. ~ ~ :.~.(...f.....~' ~' ................... ~ ~ddress .~- ....... '~: ....... ' ' ....... ' :' ....... '" Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~' ~, ; ! ~ r, ~ ', or~. ,, ....................................... ,~ ................... Address .../~.~'.~..-7.'-.~.~..L;¢.~,~... Ph ' . ................. .... P. LOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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 YORK, ~ c ¢ COUNTY OF ................................ [~'~ ................. ~l...j.~ ....... /.. ................. g..(~../~..~.....~.. ........................... being duly sworn, d~es and says t~* he is the applicanl (Name of i~ividual signing c~tr~ above name. He isthe / ~ /' ~ -, ,' '~ ~ ~x L ~ T (Contractor, agent, co,rate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contoined in this application are true to the best of his knowledge and belief; and that the work will ~ performed in the manner ~t fo~h in the application filed ther~ith. Swom to ~fom me this ..................... ~. day of /) ~ ~" 19.~.)./ '~ Nota~ Public,~ ....... ~ ,. ~,1 , ' ............ ' , / "' ' - ~'- ~ ~'(Signa~r~f applicant) ~D~ T. BO~ Notaw Public. Sta~. of N~ No, ~2'0344963 Suf/oJ~