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Home My WebLink About8798-z~ORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy Z 7/7~ ]~To .......... Date ........... .~..V..f~....'.?., 197...~. THI~t~S that the building located at ........................ Street Map No ............ Block No ......... Lot No ................................ conforms substanti~l~v~o tl~e~Aptfl~e~tion for Building Permit heretofore filed in this office dated ........ '/~V'& ,";/'" 1~ ~. pursuant to which Building Permit N .o~7..?.~...7- dated ................... , 19 ..., was issued, and conforms to all of the require- ments of ghe~apvlicablevrovisions of the law. The occupancy for wkich this certificate is The certificate is issued to .................................................... O~ the a~ore~aid building. I N~. Suffolk County Department of Health Approval ................................... No. HOUSE NUMBER ............. Street ........................................... ~ A-T~ Building Inspector FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT . (THIS PEP, MIT MUST BE KEPT ON THE P~,EMISE$ UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N? 8798 Z P~rmission is hereby granted to: ...,q..q.~.:Y.. ....... .E~,~....S'...7...~...~.~,~ ................ Building Inspector FOEM NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 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 w~th 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 d~sposal--(S-9 form or equal). 3. Approval of electrical ~nstallation from Board of Fire Underwriters 4. Commercial buildings, Industrial buildings, Mulhple Residences and simdor buildings and mstallatlons, 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 ex~sting buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1 Accurate survey of property showing all property hnes, streets, buildings 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 premises, or other pertinent in- formation required to prepare a cerhficate 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 Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locot,on Of Property 7 /.~-~,~....~.~...~7..: ....... ~.f.~.~.. ................................ Owner Or Owners Of Property "fO~'~°/ ~'/~ A ~ -/~q ~t _~ Subdivision .......I ........................................................ ~-o~ No ............. Block No ............. House ........... Permit No ~'7 a)r~.~ Date Of Permit ............. : ...... ~pp,canr ................................................................. Health Dept. Approval ............... .¥....?. .................... Labor Dept. Approval ................................................ Underwriters Approval Planning Board Approval AZ. ./....~ Request For Temporary Certificate ........................................ Fined Certificqte ......................................... Fee Submitted $ _~ 0 o Construction on above described building and perr~it/]meets ,all. applicable codes and regulations. ~:~plioant ............ , ....................................... Sworn to before me this ................ day of~~.~ .......................................... Notary Public ...~., ......... County (stamp or seal) ~//7/7 7_ 7/7.9 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. D .wroved a/c ............................ ........................................... Application No....~....~.. (Building Inspector) APPLICATION FOR BUILDING PERMIT ......... .................... ...... INSTRUCTIONS o. This application must be completely filled in by typewriter or 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 o~ areas, and giving a detailed description of layout ofproperty 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 part 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os 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, (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . .......... Name of owner of premises ...... J..~..~.../~.. ....... .~,.~,.....~,.~...'~.....~......~.....~...,,~ ...................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... ~....C~......../~.....~.~......~. ............. Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Z'~ ~. ~ ~ ~ . 1. Location of land on which proposed work will be done. Map No.: .~...-~..~...........' ~ i.....~:..., ....... I~t No ...... ~..l ........... Street and Number ~:t~..~..~...~......~.....~.~..~.. ...... ~:~.;... ~..~[.~/~.~".~.~......:;.?';...~, ............... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ExJsiting use and occupancy ...................................... ~ ......................... b. intended use andoocupancy ..,~)..~. ~. ,.~..,.~..,,~. ' ......................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitio~ .................... Other Wa r k O......~. · ....~.~ ..~....~........~...~ (Description) (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, 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 same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 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 ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........... ., .............. Will excess fill be removed from premises: ( ) Yes 14. Name of Owner of premises .~.?..../J(..~........~'.~..../~...f.~....~.¢4.~ Address ).~.~.~...,/~.?...~..~...~one°C/Nr-~o. Name of Architect .............................................................. Addre~ ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~ck dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWj~Og4/-,/,,/~ j [ ¢ c COUNTY OF Fy' b.. d. y d poses h. is (Name of i~ividual signing contracG above named. He is the ........................ e~.~..5...:~ ................................................................................................................................ (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 contained in this application are tree to the best of his knowledge and belief; and thor the work will be performed Jn the manner set fo~h in the application filed therewith. Sworn to before~.~.~ay of .~me this ~.~,~19 0~ .~ ................... ............................. ........ ......... ........................... (~0 i~la:8~i0n Expires Marc,, 30,