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Home My WebLink About8751-zNO. 4 TOWN OF SOUTHOLD BU1LDI~G DEPARTMRNT Town Clerk's Office Southold, N. Y. Cerlificnte Of Occupancy No..Z?.2..~7 ...... Date ............... ~.e.p..~...~..0 .... , 19. ?.6. THIS CERTIFIES that the building located at . .P.~.e. ?.?~..~.?~..v? ............ Street Map No. ~uge~e. H.t.~ Block No ........... Lot No... ~...~.9.....~.u.t,.ekqg~.. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~:~ly.. ~619.. 76 pursuant to which Building Permit No.. dated ......... ~.ul~f .... 26..., 19.76., 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 ...~.r.i.v..a.t.e..a.? .c.e.~. ~ .o.r~.. ! .s.t.o.r.a. Se. !..b.u. ~..1~i.2.n. g ........................... The certificate is issued to ... ~e~.tr~l.~ .~a.c~l~r~. .... .~.r. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....~...~: ............................ UNDERWRITERS CERTIFICATE No..l~ o~ ....................................... HOUSE NUMBER ....... .2~... Street .. I'ierce..~ri.v.e ......................... ....... .... ......... FOBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'~EMISES UNTIL. FULL. COMPLETION OF THE WORK AUTHORIZED) 8751 Z Permission is hereby granted to: 6ertr~le Backl~n ............... 2R~[...2Le r.c.e..P.r. ....... ~t~g~.e.. to build new accessory (storage) building pursuant to app!ication dated .........................J.~l~ ...... ~ ........ , 19..~.~., and approved by the Building Inspector. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted 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, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperb/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 pan 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 g~lding 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. (Signature of applicant, or nome, if a corporabon) (Address of applicant) ~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .0.. ................. ' Nome of owner of premises ....,~...~..~.~,..,~..P.~....~..~....~...~....Lz..!...~.. ................ ..~...~:.~...~...~...~,..~.~..~ ................................. 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. Locat on of and on wh ch d work w,II be done Mop No ~ ..~..~o Lot No .~. ~- .~..~.. . propose '. . ~.: .......................................................... M~ici~li~ 2. State existing use and ~cu~ncy of promises and intended use and ~cu~ncy of p~d c~t~tion: a. ~isiting use a~ ~cupancy ........................................................................................................................ b. Intend~ u~ and ~cu~ncy .................................... 3. Nature of work (check which applicable): New Building.. .......... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~; /~f) ~ (DeScription) 4. ~timated Cost ...... .~....~...~.. ............................................ Fee /~ ~) ~ (to be paid on filing this application) 5. If dwelling, numar of dwelling units ............................ Number of dwelling units on each flor ............................ If garage, number of ~m ............................................................................................................................................. 6. If business, com~rcial or mixed ~cupancy, speci~ nature and extent of each ~e of use ............................ 7. Dimensions of existing structure, if any: Front ............................ Rear ........................... : ....Depth .................... Height ........................ Nu~er of Stori~ ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ ,-~Number of Stories ................................ 8. DimenSions of entire new construction: Front .J~.~ ........ Rear ...I.U.~ ...... Depth ...~..~.. Height ..../...~Num~r~~ of Stories .......... ~ ............................................................................................ 9. Size of lot: Front ...............~.0..~E~ ..................... Rear ....,.~..~.~. ........... Depth ,..~..~.~..~ .... 10. Date of Purchase ...~..~.~...~.....I.~.~.~--"--~ -- '-~ .....................Name of Former ~ner ~...~...~.~ .................. 11. Z~; ~;o~e;iSj~i~t ,2c~ho2~ ~[~'~ a~ situated ....... .e..~..r.~.~.o..~.~..~ ~ .~. 13. Will lot be regraded ......~.~ .............. Wil~exce~ fill be rem~ed from premises: ( ) Yes ( ) No 14. Name of ~ner of Premises .~.~.~..~.~.~.{.0....."~ ~~¢~. Name of Architect .............................................................. A~re~ ................................ Phone No ....................... Name of Contractor ............................................................ A~ress ................................ Pho~ No ....................... PLOT DIAG~M L<ate clearly and distinctly all buildings, whether existing or pr~osed, and indicate all ~t~k dimensions from prope~ lines. Give street and bl~ number or description according to de~, and show street names and indicate ~hether interior or corner lot. ~ ~ STATE OF N~ YORK, . [c c ' - ~ COUN~ OF ~..~ ....... ~'~ ~ ............ ~.~~...~.J.~....~ ............... being duly sworn, d~oses and says t~t he is the applicam (Name of individual signing cmtrac~ above name. He is the L .......... J.~.~ .............................................................................................................................................. (Contractor~ agent, co,orate 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 cont~ned in this a~lication are true to the best of his knowledge and belief; and that th~ work will ~ performed in the manner set fo~h in the application filed therewith. Sworn to ~fore me this ........... , .-- ... ....... ....... ................. (Signature of applicant) FOI~M NO. 6 TOWN OF $OUTltOLD , Building Department Town Clerks Office Southold, N. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation 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 hnes, 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 end "pre-existing" land uses' l. 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 Rte ...... New Building ....~'.... ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .l ..... '. ............ I ....... .~. ....................................................... Owner Or Owners Of Property ....~....~...~...-~.~...?...D...~.....~....~...~...'.~....~.i!..M.. ................................................................ Subdivision ................................................................ Lot No. 1..9.r.~.!. Block No ............. House No..~..~..~.. Perm,t No. Date of Permit~..U..~..Y....~.~:!~.Applicant ~....~.~..-~...I~.?..~.E......~...~.~..~.,./....(..~.. .................. Health Dept. Approval ........ .~......~:.. .......................... Labor Dept. Approval .L .............. .~....'..(.~.. ..................... Underwriters Approval .......... ..~...l...~.... ........................ Planning Board Approval .......... ..~..;...(~... ................... Request For Temporary Certificate ........................................ Final Certificate ~ Fee Submitted $ ....~........~....~.. ................... Construction on above described building andpermit meets all applicable ~odes and regulations. Applicant ...... ~..J~ .......................... (stamp or seal) WALTER ~. 8,LLECK ~oJi~ P~hc m the State of New York No ~2L89~350 Remdmg m Sulfolk County Commission Exp,~es March 30,