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Home My WebLink About8937-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ottice Southold, N. Y. Cerlificale Of Occupancy THIS CERTIFIES that the building located at . Rope. Lam ................ Street Map No. XX ......... Block No .... ~:X .....Lot N~...Bou~,,hO~[d...lq,¥., ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. OCt...2~., 19 .~.~. pursuant to which Building Permit dated ......... )c.t;.. 2.~. ..... , 19 fyi., 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 P. ri,~a~ce, o~e. family. ~l~,~l~ir~B ....................................... The certificate is issued to . Ar~ge~lo. · Tl~g]..to ...... oWrt$1' ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval l~la~.. 214. ~ .~,~.~. ~19y .R,. ~ill& ....... UNDERWRITERS CERTIFICATE No. ~329~[~. .... ~al'...1.6....lr.~..~ HOUSE NUMBER .... 38~ ...... Street . .ltop~ .Lam... ~ot~gh~d ................ Build~'~g I~r FORM NO. ~ TOW. o~~ S~U~"O'~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8937 Z Permission is hereby granted to: at premises located at ............................................................................................................................ pursuant to application dated ~7 2g "~ ........................................................ , 19 ........ , and approved by the Building Inspector. Fee ,.....!..~..~....~.D'~.... Building Inspector FOItM NO. 6 TOWN OF $OUTHOLD , 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 oil 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 peffinent 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 Building ..... xx×........... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property }~oDe Lane So~thold Owner Or Owners Of Property ~.~.g.~.~..O. .~...r..u.~.l..i.o. Subdivision ..;iX ......................................................... Lot No. ~.~ ....... Block No....x...X. ..... House No ....... ~..8.~ Health Dept. Approval Ma~ 2LF .....1.~).~..~.. .......... Labor Dept. Approval Underwriters Approval ~..,~.~.~.~..~. ....... ~../.J..6../'..~/.~. ...... Planning Board Approval ....... .~.:.~..: ....................... Request For Temporary Certificate FinoJ Certificate XXX Fee Submitted $ ~..0.,0, ........................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~'-'-~..,. ~....~ ...................................................... Sworn to before me this ....... day of ....... J..9.7. Z ............... Notary Public .......... ~,.u. ~[~,o...Z..~. .......... County -,BOARD 'OF FIRE: UNDERWRITERS 'BUREAU al=' ELECTR cITY t; : ' ~ /",' , J': Soundview.Ave.-~,'SOuthold, L.I.. ' ....... - NI~HEATERS MULTI-OUTLET DIMMERS~ SER¥ CE. I:,ISCONNE~T This ceflificate mu~t'~ot be altered in any manner, return ia the, office o( the Board l{ incorrec{.': ~s~ec(ors may be identified APPLICATION FOR BUILDiN6 PERMIT NST UCTIONS a. This application must be completely filled in by ~pewriter o¢ in ink and submitted in triplicate to the Buildi~ Inspector, with 3 sets of plans, accurate plot plan to ~ele. Fee according to schedule. b. P~ot plan showing location of lot ~nd of b~ildings on premises, relet onsh p areas, ~nd giving e detailed description of layout ofproper~ must be dr~wn 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 approwl of this application, the Building Inspector will issue ~ Building Permit to the applicant. Such permit~ sh~ll be kept on the premises available for inspection throughout the Work. e. No building shell be occupied or used in whole or in pert for any purpose whatever until e Ce~ific~te of ~cupency~ shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of ~ Building Permit pursuant to the BuHd~ng 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 remowl or demolition, as herein described. The applicant agrees to comply with ~11 applicable I~ws, ordinances, building code, housing code, end regulations, end to admit ~uthorized inspectors on premises end i~ buildings for n~esse~ in~ections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general con~'d~r, electrician, plumber or builder. Name of owner of r ' If applicant is ~ corporate, signature of duly authorized officer. (Name and tiHe of co,orate officer) Plumber's License No ................................................. Electrician's License No ............................................. Street and Number ....................... ~ ........... ~ ......... ~ ........ ~ ........ ~/ ......................... Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ .... 4. Estimated Cost ............................................................ Fee .................................................................... (to be paid an filing this application) 5. If dwelling, number of dwelling units ............... ; ............ Number of dwelling units on each floor ............................ If garage, number af 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; ............................... I0. Date af 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. WHI lot be regraded ....;,~ ...................... Will excess fill be removed from premises: ( } Yes ( ) No 14. Name of Owner af premises ..~..' ...... ;. ........................................ Address ................................ Phone No ....................... Name of Architect'.....'~.... .................................................... Address ....JJ .......................... Phone No ....................... Name af Contractor ...... ; ............................ ; ........................ Addre~ ................................ Phone No; ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ar proposed, and indicate all set-~ck dimensions fram prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or c:orner lot. STATE' OF NEW YORK, ~'~ c c C~LJNTY OF ..... 8~JO~ .......... ,../... ..................... ,j~.t,..l~'O~OJp:Ll~ ....................................... being duly sworn, deposes and says that he is the applicam ,/ (Name of individual signing controc~J) ~gbove named. Fie is the ........................................ ~O,~,~&~.t.O~: ................................................................................................................ (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 true to the best of his knowledge and belief; ant] that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... · ~?~h'" day of ....... Notary Pub c, . ............................ SLi~E£X~11C.... County ..... .':~.;~,.',,.~ .......... :~,~ .......................................................... ' -"" ~' %/- " ~(S'ig~ture of applicant) ~llll~y PUBLIC, St~te Ilf New York ~dV I '% z r- 3'90H J..~3.L 3¥'D IdX.L 99~M e ,00'()0~ ON 1993M(3 O0 9 I '9 ~,~- .LNVS .J. NVDW