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Home My WebLink About8960-z~ · · FO~ NO. ¢ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. T~MPOI~Y Certificate Occupancy No..Z'27,O.~ ..... Date ............... J.~UO...~ ..... , 19..~.~. THIS CERTIFIES that the building located at ........... Parkway. ........ Street Map NoSouthwood.. Block No ........... Lot No, 38 .... /~outhold.. ,N,Y,. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. ~OV.. J.] 19.76. pursuant to which Building Permit No..8960Z. dated ............ No.v...12..., 19.7~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pr$,vate..one. £amil~ .dwe.llin~ ...................................... The certificate is issued to .Edwa~.cl. L~tahht~t ..... 0w~el, .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .pe~ding .......................... UNDERWRITERS CERTIFICATE No..pendJJag ................................... HOUSE NUMBER ...93[ ........ Street .. Pa:~kwa~. ......... aouthoJ, d ............ FOI~M NO, 6 TOWN OF SOUTHOLD , Building Depmtmenf Town Clerks Office Southold, N. ¥. 11971 APPLIGATION 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 oil buildings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disp0sal--(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, ,~Aultlple Residences and similar building.,s 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 alt 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 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 ~, / / De,e ......... ~./..,~.~...~ ................... / New B~ilding ..... .~......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. ' ~i~ ~ ~ ..N..~ ~ ~ u ~ ~ ~.o.. .......... Location Of Prope,y ....,,,, ................. ~9 ............ '~ .................. ~ ................ ~ ..................... property ~.~.~,'Zi:(~.Z~ ~ ........... Owner Or Owners Of ........................ ~. .................................................................... Subdivision ..... ~..~.~.//.~..~.~!S. ................................ Lot No.............3~ Bioc~ No. ............ House No ............. Permit No...~...~...~..~....~.. Date Of Permit ..Z///,~.~l../..~pplicon, ..~.~ ..... :..~. ............ .~....;c~ ........ / Health Dept. Approval .../.~..~-~..~ ................... Labor Dept. Approval Underwriters Approval ...... ~- ~~.~...~. .................. ~./ Planning Board Approval ........................................ Eequest For Temporary Certificate ........... .~; .................... Final Certificate .......................................... ~ee S.bmitted $ ..~.......~. ..................... Construction on above descr,bed bu,ld,ng and pe~/'~a,l/a/Jo I,cable S~:~es o~regulations. A I Sworn to before m~t~ois ...... ......... , ~, ,'/.,~ ;-~' THE[, NEW YORK BOARD OF FIRE :;UNDERWRITERS ~ ~: ~; ' ~; i!- ',; :~ 85 J0hn STREET NEW YORK NE.W YORK 10038 only tke electrical equipme.t ~ ~scribed below a~d i~troduced by the applicant ~med o~ the above apphcat~on number ~n tt~ premtsea of :~ :'~Windsway-Building, Pa~rkway~. between Pineneck an~:Woodway i~thefollownglocadon; ~:~ B~e~e~t ,: ~ ls['Fl[ ,~ 2ttd FL ~ _ :_~ ~. :~:j [.: ;' :~;$ection Block ~ Lot [~s ce~ificate must no~ ~e altered ~n ~y mcnner; re~urn ~o the off~ce o~ t~e Board if incorrecL'lnspectors ma~ ~~eir~credenti~ls, ,--------~'~ ,J TOWN OF SOUTHOLD .... A .fl~- %~3~/~ ~ ~'~.-', BUILDING DEPARTMENT '°/'-"'r/c /,~-gr / ~ - TOWN CLERK'S OFFICE ~/7 ~ /~ / ~ ~-~ ""-- '> o ~ro~b ......................................... ~ ........ wrm,~ ~o ................................... APPLICATION FOR BUILDING P~MIT / /~ ..................... ///~. .......... , ~9 INSTRUCTIONS ~ a. This application must be completely filled in by ~pewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan s~owing location of Jot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproper~ must be drawn on the diagram which is pa~ 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 wor~. e. No building s~aJl be occupied or used in whole or n part for any purpose whatever until a Ce~ificate of ~cupancy 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 Laws, Ordinances or Regulations, for the constru~ion of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building c~e, housing code, and regulations, and to admit authorized inspectors on premises and i~ buildings for n~essary in~ections. (Signature of appelant, or name, i~a corporation) .... ....... ..... (Address of applicont) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eJectrician, plumber or builder. .......................................... ~.g..; ~ .~.~ %..~.. ..................................................................................................................... .:.... Name of owner of premises .. J~ .~....~...r.. >.. . .%./ ...................................................................................... If applicant ~ corporate, signature/of d~authorize/ffiicer. ~ ....... :"'i~]~-~"~i(l~' of'"-'~'~'rporote off""""-'~'-'~'~ ......... Builder's License No ..................................................... ,~ ..... Electrician's License No. q.~.g.~..~.~.....~~ Other Trade's License No ............................................... ~ ~ 1. Location of land on which Rroposed work will be done. Map No.: .~.~....?~,.9.~ .......... Lot No...~..~ ....... ". ....... Street and Number ........ ~C~.~.~ ...................................................................... ~.~~.~j~ ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ O~oL~ "~f~.,.,41t~ . . . b. intended use and occupancy ............................................ ...Ii. ............................................................................ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) ?, 4. Estimated Cost ..... y.~..?....~,...~..~.o.% ....... ~ ...................... Fee (to be paid on filing this application) 0 F) ~' *'umb ............................ 5. It' dwelling, number of dwelling units ............................ ~'4 er 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 ..... ..~j...O.. ...................... ReQr ...... ..~...O..t. ............. Depth .~....~....~. ......... Height ...... I..~.~. ........ Number of Stories ......... ~.~.~ .................................................................................. ; ................ 9. Size of lot Front ........... L..~...O. .................................... Rear .......... [.~...~ ......................... Depth ...... ..~... ...................... 10. [)ate of Purchase .............. ..~.....e~...L..,J...Ct.'.~....E'....~. ............ Name of Former Owner ..~ ............................................. 11. Zone or use district in which premises ore situated ......................................................... 12, Does proposed construction violate any zoning Iow, ~';~i'r~' ~)' 13. Will lot be regraded ........~. ................... Wdl excess fill be removed from premises: ( ) Yes ( I~o 14. Name of Owner of premises .~..~...~...~......~...L~'..~.f~..~J..~.. Address .~.~?¢...~.~..~.....~...~?r~fi'o~r~ N~o~?,.7.,.~..~..~,~. ..... Name of Architect ..... ~ ................................................. Address ................................ Phone No ....................... Nome of Contractor .~x~.~.~......~.r.,,.~r..~..kl.,......~..u¢..~,~ ........ Address ,P...~......., ................. 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. COUNTY 0 F/~--~/,~,.,~.~- ...............' . ......... ...~.. ,~.~,,~,z.~ ...... : .................................................... g duly deposes and says that he is the applicam (Nome of individual signing contract) above nomed./~,~,. '~ ~ ~ He is the ...... ~ .......~ .................................................................................................................................................... (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 end fife this application; that all statements contained Jn this application are true to the best of his knowledge and belie~; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to b~re me this ........ _ (~ ~ ~ ~ ~ (Signature of applicant)