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Home My WebLink About7150-ZFORI~! NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. Z7.1..~Q ...... Date .............. July.... 28..., 19.7.6. THIS CERTIFIES that the building located at . .King .&. Second .St ....... Street Map No.. Y,Y~X ....... Block No. xxx ...... Lot No..xx .... New..~uff.o. lk ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~Dr .... 1., 19...~. pursuant to which Building Permit No.. 7~1.~0Z. dated ........... Apr...1 ..... , 19..7.4-, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Pri.v. ate. acces, s. Qry...g~-.~ge ........................................ The certificate is issued to ...J.o..h,u..C.a. $.e ..... . .0kn2..e..r ................................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ,N. ~I~., .............................. UNDERWRITERS CERTIFICATE No. N.67~70.1 .................................... HOUSE NUMBER .. 6.7.5. -. ~Cil~g S$~et .......................................... 106~ Second St New Suffolk Building Inspector lrOK~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7150 Z Date ........................ t, p~'~l,~ ....... e~ ........... 19...~.1~. Permission is hereby granted to: .~ g~.~:...~..,....q.~, ~.~. .................................................. ...~.~.n.~t..~...~.~..q.o.~...~ ...................................... ....... .tie.~..~u~'.£o,~l~ ............................................. to ~.~.~,~,~...c~.i.~ ~'.i.va.t~..~:age. ................................................................................................. at premises located at ..~./.."......~:~,ag...~..~.e.~.~l~k..~.eat ........................................................... .................................................. ~le~,..~.u££o~k ......... ~..Y.~ ................................................................ pursuant to application dated ................. .~.~.~ ....... .1. ................. , 19.~..., and approved by the Building Inspector. Fee $.1 ~. ~.~. ........... t It Buildlng rn~ector / FORM NO. 6 TOWN OF $0UTHOLD ~ Building Deportment 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 formation required to prepare a certificate. C. Fees: 1. Certificate of occuponcy $5.00 2. Certificate of occuponcy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ......... NewB ildin ~/' A'd~h n ^1' ~' n ~ I'n / ~ ' ' ~ g .............. a ' 'o u a or ~'r~e-~x st g Du a g ...... 4,....,... ,vacant Lane ............ ...... x.¢. · ............... Owner Or Owners Of Property .......... Subdivis on ................................................................ Lot No ........... ~.. B~3ck No~/~/. ........ House No ............. ermi,DateOf ...... ................. Health Dept. Approval .......... ~./...~ ....................... Labor Dept?Approval .......... ~....l~ ............................ Underwriters Approval .~..~.~?./.~'f./~..T..E...~....~...Z.~...Z..~.~/..Planning Board Approval ...~./..l~.~ ............................ Request For Temporary Certificate ........................................ Fin(~l Certificate .... /~.::~ ............................... Fee Submitted $ ..~.~.4~;..~. ......................... Construction on above described building 9pd pa/fruit meets all applicable codes and regulations. Sworn to before me '~ // ~ ~z~'/~:~f'~ ~' ....... ~. ~ o~ ~...~....~..~...~.. .......... ~ o~ ~oa~ ~, BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT ~ ............... ....... ........... .... INSTRUCTIONS a. This application mus~ be completely filled in by ~pewriter o~ in ink and s~mitted in t~iplica~e to the Building Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is pa~ of this application. I c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be ~cupied or used in whole or in part for any pu~ose whatever until a Certificate of Occupancy, shall have been granted by the Building Inspector. ~.~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to th~ Building Zone Ordinance of the Town of 5outhold, Suffolk County, New York, and other applicable Lows, Ordinances or~ Regulatlons, for the construmion of buildings, additions or alterations, or for removal or demolition, os herein describe~ The applicant agrees to comply with oil applicable lows, ordinances, building c~e, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for n~esso~ inspections. .... .................................................... ~noture of opplic~nt, or nome, if o corporot[on) New S~folk State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~..o.~.....g.~.$.~. .......................................................................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License Nol~° ............. ~...~,~ ............ Electrician's License ............................................. Other Zrade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ................. ~ ................ Lot No..)r.~ .................. Street and Number .... ~[~...q~..~.~g.Q~t...~.~ ......... ~D.~..~.!P~P,].k ................................................................... Municipality 2. State existing use and occupancy of premises and in;ended use and occupancy of proposed construction: o. Exisiting use and occupancy ....d~e~.i].-i.~ ....................................................................................................... b. Intended use and occupancy ........... ~....~..m...e.....~..~..~...JR....:P..e..~'....~.~.~.~.~...~.~..r..~.§.e. .................................................. 3. Nature of work (check which applicable): New Building ..... ~ ..... Addition .................. ,,~lt, J~ration .................. Repair .................. Removal .................. Demolition .................... Other Work ..................... ~ ............................. (Description) 4. Estimated Cost ............................... ..~.. ......................... Fee 1.!.07..0.0. .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ..0. ......................... Number of dwelling 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 ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ~.~ ....................... Rear ...........~.lf. ........... Depth ......... ~.~.. .......... Height .................... Number of Stories .......... O~e ...................................................................................................... 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 ......... U,A!!...d£s.~ ......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... Xqf? ............................................... 13; Will lot be regraded ..,.,~.~ ................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ,...J. Ob, Z),..,Q~,~.~t .......................... Address ..,N.e..~...~.l~..~.g.~... Phone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Name of Contractor ............ ..s.~.m.,e. ...................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oll 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 YQRK. I-- COUNTY OF ....... .~...'~...~...o...3~... ....... f ~-~ John Case ................................................................................................. being duly sworn, deposes and says that he is the appJican! (Name of individual signing controcfl above named. He is the owner (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 conta,ined in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................... J!.. of ..., ......... ............... , b. __; Notary Publi,~'~ ..~.'..~6'/~.~;~.. County .... ..'~....~,~1~..~...~.~ ............................................ BoKEN ,~/ ' JUDITH T. - ~ // (Signature of applicant) FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLIGATION FOR CERTIFIGATE 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: l. 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 and installations, o 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: ]. 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: h 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 BLdlding ................ Addition ................ Old or Pre-existi. ng Buildin. g .....~.......... ~'acant £and.. ............. Subdivision ........... ........~..~..'. ............... ~.. .................... Lot No.....-.'~'.-.n BIo<;k No........"-~..... House No ............. Health Dept. Approval .................. ~...:..~.,: ............ Labor Dept'~'Approvo, .......... ~.....~ ........................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ '~' ~ Construction on above described building ~d p,~rmit meets all applicable codes and regulations. Applicant ~,~ ......... ~ ................................................................ Sworn to before me this /.// / /~/'~ 4 ........ ~.~. aay or .~....>..~..x....:.~ ..... (stamp or seal).:: ~ , Nota~ Public .....~:~.,.~/Coun~ v ,~ " / It'/'