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Home My WebLink About8788-zFOI[I~ NO. 4 TOWN OF SOUTHOLD BUll,flING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy No ............. Date ......................... , 19*} Map No ........... Block No ......... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .............~ ,~ ., 19~-~?,~.~ pursuant to which Building, Pemit ......... dated .................. , 19 ...., was issued, and conforms to all of the req~_~i~re- ments of t~e.,applicable, g_provisions_gf the law. Th_e occupancy for 2rhich this certificate is issued is The certificate is issued to /~..~ .~..~ ~..~/. ...... .Z'. ~.. ~..~/.~: ?..,..~ ........ .~..c~/...~.t.'..~. (owner, lessee or tenant) o£ the aforesaid building. /~/' Suffolk County Department of Health Approval ........... i .................... UNDERWRZTm~S CERTIFICATE No....~/...~'/.. .................................. B~ilding Inspector FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8788 Z Date ............. JJ,ttS:g,S.t..9 ........................ 19...~6 Permission is hereby granted to: lz'ene Tsavaz'is 22-J+6 7~th Street ........... ..¢..~..~,.o.~..~.?.~..~.L.~.:...~.... ............... pursuont to opplic~tion doted .... A~t,S.~...~. ................................ , ]0..~., end opproYed by the Building Inspector. Fee $...].~'.e..O..O.. ......... , ', Bu~ ~mg Inspector FOI~M NO. $ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, bi. ¥. 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 d~spgsal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and s~milor 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 oll property lines, streets, buddings 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: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occul::~ncy $1 00 ..................... ......... [New B~ilding ................ Addition f Old or Pre-existing Building [ Vacant Land Lo at on Of Property ...... .... .................................................... ', ........................................... Owner Or Owners Of Property ...... .~.~.....~....~..,/~...~..~,'~.LZ/-~.,~-~..~' .........' ............................................... / Subdivision .~....~..,.,1~....~.[..~....~....~...~_. ..... ~.~..: ................ Lot No....~. ...... Block No ............. House No..~...~..~'~/ Permit No .~..?....~..~...~... Date Of Perm,t .~..-..?."./...~.?.~.Applicant .~....~.....~....~......~....~....~..../~..../...~...~ Health Dept. Approval .... ~.....~... ............................ L~bor Dept. Appraval .m ..~......~.:: ............................... Underwriters Approval ....... ~. ..... :::: ........................ Planning Board Approval .../~..-/'~- ....................... Request For Temporary Certificate ........................................ Find Certificate ~ Fee Submitted $ .~..~ ...................... Construction on above described budding an~;L.t~rmit meets all applicable ~odes and regulations. Applicont ....... ~;..r ........................ before ; ~ 0~/:~-/?~' .... "2'" Notary Publ'c ~ Examined ,..,~,l~:l,lS.~, ..~ ................. , Approved ...~,Bg~lS.t..~ ................. , 19..~. Permit No ..... ~8~7, ................... Disapproved a/c ......... ~ ................. ~.~ ............................................... ~i- · ('~'uilding Insl~ctor) APPLICATION FOR BUILDING PERMIT ~) Date ....... A~t~U.a:~..9 ...................... , 19 ...... 76. ~1 INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sate of plu~s, accurate plot plan to scale. Fee according to schedule. b Plot p an 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 part of this app iCat on. c. The work covered by this application may not be commenced before issuance of Building Permit. the Building Inspector will issue a Building Permit to the applicant. Such permit d. Upon approval of this application, shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY /V~DE 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 authorized inspectors on premises and in buildings for nece,¥ary inspections. // (Signature of applicant, or name, if a corporation) (Address o? applicant/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~,~,c].re.'ez...~a.~za-l~'L~..~..l~.;i.~. ........................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~.~.~,¥Jd~'..~L]~;].e~'.s~ ........ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ...,S.t~<~,t;;;oz'x~..F,s.t.e,.~f,~t No. ~ ...................... Street and Number ...~...~.~..~Dz'~...[~,,~.cl.s...~/~a.s-~.-~'~z'~.~.....~.~-.¥o ..................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....~.~'.~y~te...0z~e..F. am'~2~..~:)~el.l.~.rdt .......................................................... b. Intended use and occupancy .-..-,~a~,e...~,t,h...ad~..t.[.e~..o£...pa.t~.oX'""Fea-f~sed ..................................... raised 3. Nature of work (check which applicable): New Building.. ................. Addition p~.t,'iQ ......Alteration *~'~ ' ,' . Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost ........... $.~.0...O.e.0.g. ................................ Fee ...$.1~.10.(] ......................................................................... (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, s~ecify nature and extent of each type of use ............................ 2' 2' ' 7. Dimensions of existing structures, if any: Front ....~ .................... Rear .....~. .......................... Depth ........~..8..~ ....... ' one Height ......1.~ .............. Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ..... ~2.! ......................... Rear ..~'~.~. .................... Depth ~..8..~....~.....,,J~,..I. ............ Height ...... ~...~..! ................ Number of Stories ....... .~.~.~ .................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ....... .1..Q~. .......................................... Rear ........ lj~.~' ........................... Depth ..... '].~.~ .................... 10. Date of Purchase .~.~..6..~. ............................................... Name of Former Owner ....... 11. Zone or use district in which premises are situated "A" 12. Does proposed construction violate any zoning law, ordinance or regulation: ~.q...i ................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..~.:...~.~.¥.~.~..~.S. ........................ Addres~-~..-.~.~...~..IJ:.~..~...~.,. Phone No ....................... Name of Architect .............................................................. Address Jack~o~ !~.e:J. jJl~h~o~e No. Name of Contractor ............................................................ 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 corner lot. 6 STATE OF NEW ",~ORK/ COUNTY OF ................................................................................................. being duly sworn, deposes ond soys thor he is the applicant (Nome of individual signing contraef) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to .b~pre me this .......... ..7..- ......... day Notary Pub~'~.~~..~(/~ ..;....~ ........... ~.~ ...................... ~' (Signature of applicant) ~ 1344963. Suffolk County