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Home My WebLink About8783-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy ~o..Z:. ~ ~ 7.. ~.. rate J ^ ~/ ~ 0 ~9~ 7 THIS CERTIFIES that the building located at ~D~..~.~.7. ...... ) ........... ~ree~ Map No .......... Block No....- ....... Lot No .... -.. ~.$.q ~.'.-~4 ¢~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~ c ~ .~, 19.~.~. pursuant to which Buildipg Permit No. ~.?.~.$..Z-- dated ......... /~,.c,.&...~., 19~7.~., 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 .. ~x. · .~r~ ~.¢ ~ :~. [. .... O~ ~. · · · C~a ~:.; ~..'~:. · .-D.~. ~ ~ ' 5! ..~. ............. The certificate is issued to . ZU. S A..'~. ~. £J~ .~ .... ~ .... ~f.~.~'.[ .~.g .................. (owner, ~ of the aforesaid building. ] Suffolk County Department of Health Approval .... N. ~.~ .... '[ .................... UNDERWRITERS CERTIFICATE No ........... ~M..~'... ......[ ..................... HOUSE NUMBER ..... ~.~D Street .i~C~A~.E. ~0 ~> ~ ~ .. . - ................ ?~..~.~.?.%%'¥'.; ~.~¥~' .............................................. ;.-'~...~..<q..~. ,(,,. ................. ........ 7..; ./.~,~. , .. .... Building Inspector FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, 14. Y. BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8783 Z Permission is hereby granted to: ................................................. ,r.=..~.v...a.~.e.....(.~..z:~.~.o. ~:..s..)... ~.o..a...a......~../.s.....s.?.~...y.~.e.~..~ ..... reconic _ p,ur~uant to application dated ..................... ~.tJk~ .......... ~ ............... , 19...~.6., and approved by the Buil'ding Inspector. Fee $3.~..?..0..0.. ........... FOF,~ NO. ~ TOWN OF SOUTHOLD , Building Department 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 s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or Ibuildmgs and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, b~uildmgs 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 pre, raises, 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 New Bqilding ................ ~AdditJon ................ Old or Pre-existing Building ..... i .......... Vacant Land ...{ .......... Owner Or Owners Of Property ...... ./.~...(~..x~..~..~;,.~.(P,~ ...... ..d-~~. ........... ¢~.2...! ....... .~. .................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No...~..~../~.:~..r.~ Date Of Permit ,~..~..~.'.~.~.,~oplicant ...... Health Dept. Approval ............................................ Labor Dept. Approval I ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certific6te ......................................... Fee Submitted $ .......... :..~.../..,~.....,~. ....... Construction on above described building and ~mit meets ail applicablei codes~.a?d regulations. Sworn to before me this J ........ day of ( <stamp or sea,) BUILDING DEF&ItTMINT TOW CLERIC'S SOUI'HOLD, N. Y. INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in' ink. and submitted in triplicate to the Building Inspector, with 3 ~ ~f I:~ms, aa:urate plot plan to scale. Fee aceerc~ng to schedule. . relationshi b. Plot plan showing location of lot and of buildings on premises, ip to adjoining premises or public streets m areas, and giving a detailed deecripfian of layout ofpmparty 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 applicati°n, the Building Inspector will issue a Building Permit to the pppllcant~ Such permit shall be kept on the premises available for inspection thronghout the work. e. No building shell be occupied or used in whole or in part for any puq>ose whatever until a,Certificate of Occupancy shall have bem~ granted by tfm 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 clemolitiae, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulaticns, and to admit authorized inspectors on premises and in buildings for necessary inspections. Peeonic N.Y. $Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .o...'~....e..~. Name of owner of premises .~.~.~,~.~,~.~...~,...~.~,I:~.Q .............................. ~ ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 0 mer Builder's License No ............................. Plumber's License No ................................................. Electrician's License No ............................................. Other Tmde's License No ........................................... 4.. ~..'~ ...~:~.....~....: 1. Location of land on which proposed work will be done. Map No.:~ .......... i. Lot No... Street and Number ..... T.a..~.~:)./1..]~i.,...O~'/~...*qOG.D,~...~.~*G.W..~A~'G ......... ~.e~,~T~.o .......................... ~ ................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .........~,.w..,e.,l.,,],.,l.,ll.,g ....................................................................... ~ .............................. b. Intended use and occupancy ............... .'.' .......... ................. , ............................. 3. Nature of work (check which applicable): New Building.. ................. Addition ......~ .... Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ................... ..~..s...~. ....... .b,...0~..._,+ ............. Fee ..!.~'..t...0~)... ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .o.b.e. ........... 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 b/pe 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 .......... .1..~ ..................... Rear ....1.~ .................... Depth ........ 1.~. ............ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..... .1.0G ........................................... Rear ......... (:Jr3 ............................ Depth ....!.~.2...+..../....1.;~.br.e.~ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated e.~fl cl.:Lsl; 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ..~..O. .............................................. 13. Will lot be regraded ....... X3~ ................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..~s~b~13.e...~.e~.~.Z2 ............. Address ........ ..~..e..c...o..~..~.e. ....... Phone No. ...................... Name of Architect ....................................................... ., ...... Address ................................ Phone No ....................... Name of Contractor ............. ~..e.?. ................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, ond 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 Y'~z~f Olk ~ S.S COUNTY ................................ ................................. ~.~..e..]...~.~.~....~.~'.~..~.. ......................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract0 above named. He is the .................................................. .o...w~.....~....-....]~.~],~(~r. .......................................................................................... (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 oil statements contained 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. Swam to before me this ....... ~..... day of ............. ~.~1~ ................ , ~9..2~.. C~ . ~ ~ Nota ub,lc,. ............. ....... ......... .......... ....... . .................................... ELIZABETH ANN NEVltLt .. ,( NOTARY PUBLIC, Sta~e bf N~W Yom No. 52.8125850, ~1101~ COu~,,'"~ Te~m £xpires Man:h ,10, t~.~.'~