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Home My WebLink About7151-zFOB, M NO. 4, TOWN OF $OUTHOLD Bu~.nING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the buildl-g located at ~' 1,1~ ~ ~ N ~ ~ ~ i' Street Map No ~ Block No Lot No conforms substantially to the Application for Building Permit heretofore ~ed in thi~ office men~s of t~le app]icable provisions of the ]aw. The oc¢.pallc.2 roi' wkleh thln cez~_'flcat~ ~ Tbeeemifieat~i~i~ue4~o THO~n;%~ ~' 14ELIzN -R~£~V'k-. of the aforesaid buildJag. S~olk Co,,-ty Depez~me~t of emta Appz~val ..... .A.< :..7~... ....................... UNDERWRITERS CERTIFICATE No. /V'. 7-~ , Building Inspector BUILDING DEPARTMEI~I"~Z~;~,'~ ~/'~///~-~, ~ ~, TOWN CLERK'S OFFICL~-~ ----'--- -,"' Approved ........................................ , Permit No ............ · .?. Disapproved a/c ................. ~ ...................................... , ''~ (Buff ,d~ng Inspector) APPLICATION FOR BUILDING PERMIT ~ Dote .................................. ~ ......... .~,, INSTRUCTIONS a. This application must be completely filled in by typewriter o~, in ink and subn~tted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relations~ip to adjoining premises or public streets or areas, and giving a detailed description of layout ofpraperty 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 pa rt 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 cede, and regulations, and to admit authori zed inspectors on premises and in buildings for~~ /7 (Signature of applicant, or name, it a corporatiom (Address of applicant) State whether applicant is owner, I , ._.L, ..... . ~----_ ;. __..;L"_ .-"- Name of owner of premises ..~..~..1~...!~...8 '~ ~ R'.~...]:.?..~. ~ R~..~...?. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...,~.g...~..~....b...~....~.~....b.~.....O....l~...?~... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... I. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... ..... l mL ea ..... Street and Number Municipality 2. 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 work (check which applicable): New Building .. ................ Addition .................. Alteration ............ o ..... ' Repair .................. Removal .................. Demolition ................... , Other Work ........ ..R..~.~...~.~ ..................... ~10Oe00 (Description) '" 4. Estimated Cost ............................................................ Fee ............................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ . ................ Number of d~lling units on each floor ............................ If garage, number of cars ...... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ..........~..~..~'.1~ ....... Pear ....~.~:.~.~.e~ ............. Depth .~...,~.,.~,.q ..... Height .....~..~......-~....~ ...... Number of Stories 2 Dimensions of same structure with alterations or additions: Front ....... .~.~...~'..~.~ .............. Rear ...~...,~e~.~. ........... Depth 6.0.. -~e'b~. Height 2/i~ f~ 2 .................................................... ~',...Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~0..~'~, ............... Rear ........ ~,0..,,~.,~ ..... Depth ..... ~,~...;~.e .... Height ...... .~...O....~...t..? Number of Stories ..~. ............................................... 9. Size of lot: Front ...~.e.C;~...~.I~ ................................. Rear ............. .~,e.C~. ................ Depth ...... .~..6..~....+.. ............. 10. Date of Purchase .~....~.O~..~. ................................... Name of Former Owner .....~..]:....e~...~.....~.:....~.e...e.?..e. .................. 1 I. Zone or use district in which premises are situqted ........ ~t~l~l.~lZ),~,l~ .......................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~...O..e .............................................. 13. Will lot be regraded .....'..N..0.~ ............... Will excess fill be removed from premises: ( ) Yes (Z) No remises?ho~a~l B~, &~te~.en Z,I~e /earth. tuck ~o 2~ 14, Name of Owner of p .................................................. .~]K~dress ................................ Phone ......................... Name of Architect .~.{~...~1....~i....~..1~...g~/..e. ................. Address ................................ Phone No ....................... Name of Contractor ....~l~llt~...~....{I.~g.1~..~. ....................... Address ................................ Phone No ....................... PLOT DIAGRAM 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 comer lot. I~ee atlaSeS, a~ee~, / -- STATE OF NEW~7~,R~,~/,~/~Z', [ ¢ ¢ ................ ;..'...~ ~r..; .'. ~. ~. ~mc.... ~.......~ .~'~w; .,~.....'w-~.. ..................... being (Name of individual sigmng contract0 above named. duly sworn, deposes and says that he is the applicom 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 rrmke 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. Sworn to) before me this _ , ~ , ....... ....... , /-'/ JUDITH T. BOK~N - // (Signature of applicant) ~oto~/ PubJJc, Stale of Now York No. ~-03~3 S~,otk Co,~(~ Commission ~pires March 30, TOWN OF .~4~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFfiCE SOUTHOLD, N~ Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~.~-t z ,~o,~~..,..~.....~. ............... ,~.?.../ at premises located at ~....'~.. ..........................................................................~~...~.., '//'''/~ **.~.,,~/...~....~-.."'~.. ...... ................................................................. .../...'.~..~.~.' ...................................................................... Building Inspector. Fee .~..~.~ .... UIJII lng nsp~:tor FOI~M NOo 6 TOWN OF SOUTHOLD ~ Building Depnr~ment 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, end 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 end 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 Date New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...:.~..~..~.......~....~../..~..,~,~../.~... Subdivision ............... ~ .......................... ~/ ............ Lot No ...... ..~.... Block No ............. House No ............. Permit No..~../'~..../Z...~.... Dote Of Permit~. ~/.'./..~./..~...Applicant ~ .~'./~.~'...../.~....~,~'..~....~.... //~ Hea~th ~pt. Approvo~ ....... ~.~... ...................... Lobar ~t. Approva~ ......... ~//..'.;.. ....................... Underwriters Approval ii~ ~./...~.... ................... P,onning Board Approvo, ....~/../.,,.../~.'..·' ................... ........................................ ............................... Fee bmltt ........ Construction on above described building and permit meets oil oppli~oble_c~;xtes and regulations. .............................. Sworn to b~{or~ m~ thi~ ................ ............................................ Nota~ Public .................................... Coun~ .., :7 u W ~ 0