The URL can be used to link to this page

Home My WebLink About8968-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificete Of Occupency No..Z78,95 ..... Date ............... Sept..~..., 19. '77 THIS CERTIFIES that the building located at ...0rehard..St ............. Street Map No.. x~ ........ Block Bro... x~. ..... Lot No...xx .... Orietat. · ~Y, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. l~ov. · .~.7 19,7f,. pursuant to which Building Permit No..896~Y,. dated ........ B, OV,..t,7. ...... , 19.7.6., 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 . Pre, vats..one..£a~lily .dw. elling. ~.lth. addi~;~Lon ...................... The certificate is issued to .. The. odor.e .Bohloi'f ....... .~aaer ...................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval .l~,Ro. .............................. UNDERWRITERS CERTIFICATE No.., ]perad~.ng .................................. HOUSE NUMBER .... 28.7.0 ..... Street .. ~.ch~.d. St ........ Orient ............. Building Inspector FORI~ NO. ~ TOWN OI; SOUTHOLD BUILDING DEPART/v~.ENT TOWH CLERK'S OFFICE SOUTH'OLD, Iq.. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P'REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8968 Z Dote ...... ~o.v.e~nbe=...1.~.., ..................... , 19..2.6.. Permission is hereby granted to: TOB~ ~O~'kl~ ............ a.../.~...%~.o.~?...~.o.~.~?.~ .................... ............ O~.ient. t ..~...,...~.,~ .................................. to .. ~.oz~st~.us~t .. a~.~ aa.. ~o...~ ~'iv~e... on~...t'~.. ~.we.tli.~g. ................................... at premises located at ....l~.ll...0~e~..~e~ ............................................................................. .......................................... ~)~'~en~i'"~'~,'"¥'¥ ...................................................................................... pursuant to application doted ..~.~.~.~'...~L~.~ ......................... , 19~.6...., and approved by the Building Inspector. Fee $.~.~.Q0 ............ FORM NO. 6 TO~N OF $OUTNOL~ , 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 dlsposalm(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, o 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 all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildlngs. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent i~ 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 Date ..................... Z...~...~.~..~...~.." ............ .. New Build ng ................ Addition ................ Old or Pre-e×~shng Budding ................ ¥o¢ont Lond .............. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~.,.~.'...~,..~,.,',~... Date Of Permit/.,//./,?/.~.,,~,,Applicont., ,,~...,.42~.,,,~..,,~.,~.,c:T;TL,., ........ H Ith D t A I L '' eo ep. pprova ............................................ obor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tempo,~ary~C~rtificate ........................................ Fino, I Certificate ~ Fee Submitted $ .................................... Construction on above described building and permit meets oil applicabl~codf~s~ and regulations. Annlicant ~;~';~ .?~ ~?-~-~-'~ Sworn ,o before met~ / ~/~ Notar~ Public ...... ...~.4~:~W/~... County EL~ABETtt ANN NEVILLE NOTARY PUBLIC, State of NeW No 52-BI25B50, Suffo,k ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Approved ....... ~...~*.~*......, 192~. Permit No. ~(***~,.,..~..- ....... Disapproved o/c ............................................................................................ /(Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ 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 or areas, and giving o 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 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 code, end regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ................................. (Sight, re of applicant, or nome, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ~ .............. ~ ............... ~ ...................... z: ................ : ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ..~..~...~.Z ................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... kocat on of land on which proposed work will<be done.~Mep. No.: ........................................ Lot No ......................... Street and Number ....~..~'..~...~..'....~~'~..~'.....~.....~... ............................. .~..,..'~..,,~..';.~,'..~5..~.-~. ........................ Municipality State existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: o. Exisiting use and occupancy ....-~' ~ b. Intended use and occupancy ........................... ~.-...v .......................................................................... Nature at work (check which applicable): New Building'. ................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolitior. ................... Other Work .................................................. Estimated C__t ............................................................ Fee ....................................................................................... property lines. Give street and block number or description pccording whether interior or corner Iai, (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Numbcr of dwelling units on each floor ........................... If garage, number of ears ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ....... ; ................... 7. Dimensions of existing structures, if any: Fron~ ...... ~.,.L ................ Rear .....-~..:.~. ..................... Depth ..%../. ............. Dimensions~,of~same~ stmcture~ with alterations~, or additions; Front ................ ~ .................. Rear ........................... Depth Height ....... .:. .................. Number of Stories ................................ & Dimensions of entire new construction: Front / ''~ / Rear ..../...~.~ ................ Depth Height ..... /...~...~ ........ Number of Stories ........ ./ ........................................................................................................... 10. Dote of Purchase ........................................................Na_~eof Former Owner ........................................................ 11. Zone or use district in which premises are situated ......4~:.~.:. ................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: -:':/"~f~' ~ 14. i',arrle of Owner of premises .l...:...'.v...~r:.:/~.~.. .................. Address ................. :: ............. Phone No ........ ............. Name of Architect ............................ i~ ....... :.....y ................ Address ................ ~: .............. Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from to deed, and show street names and indicate I*1 ' ?TATE OF NEW_ 'Y..C)RI<., COUN'i'Y OF ..?,Q. Zi.f.~/~. ............. f~"~ .............. ?.~.../?..~. ........ .~...¢.../~..,/~,.,~.~....//~.. .................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, eta.) of said owncr 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; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... ./.Z..7../].:.... day of ................ ./~:(....~.,~.'. ................. , 19.:.7..~... ........................... 6/ (Signature of applicant) Notary Public, . ................................................... County Note~ Public State of New York No. 52-7267800 Suffolk County Term Expbos M~rch