The URL can be used to link to this page

Home My WebLink About8600-zFO~,~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No..Z. 799.~. ..... Date ............... }~o~ ....9 ....., 19 ~.~.. THIS CERTIFIES that the building located at Bmr. th..Dr. ~.ou~h ........... Street Map No~oose .~e~. Block No ........... Lot No.. ~T&~. .... ~outk~.~d ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. Apr.. 2~ 19.76 pursuant to which Building Permit No..86003 · dated ............. ~a'y'' ~'%', 1976' ', was issued, ~d confoms to ~ of the req~e- ments of the applicable provisions of the law. The occupancy for which ~is certificate ~ issued is , private..one. ~amil.~ .dwe.lling. w~th. add~.t$on. (~pgr~ved- b~ .~1..Appeals ) The certificate is issued to . .Hob.err. }~mi~on .................................... (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval .~,~., ............................... UNDERWRITERS CERTIFICATE No..~5~ ..... ~k~..30.. AgT~. .............. HOUSE NUMBER ..... ~ 2.~ .... Street. 3~h. D~ivc. ~eu'~h .... ~eut~.Id ...... Building Inspect~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~, Y. BUILDING PERMtT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE wORK AUTHORIZED) N? 8600 Z Permission is hereby granted,to; ' Bui,lding Inspector, · ' '~ ~ B~Hdih"g Inspector FOI1DI NO, 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y.. 11971 APPLICATION FOR CERTIFICATE OF OCCUPAFICY 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 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), Nomconforming 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 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: 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 .............. Location Of Property Owner Or Owners Of Property ..4~.~.f~.~./.~?.~......~:~.,......//.-.~..~...~..~/..(.,~....7-~...~,../. ............................................... Subdivision ................................................................ Lot No. '~.7./~.~Block No .............House N~.~.~..~};~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building an~ p~rmit meets all applicable ~odes and regulations. App,,cant ................................. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) yORK BOARD OF HE,NEW': FIRE UNDERWRITERS 'Roberg:;B; 'H~iltoh,'"Smiths'Rd;; SOuth' 1/~ 0f Mile East. of Bay view '~Rd.,~Southold, L.I~. ~ ' l~h~°tt°~hg~~*~ ~ ~r~.~m ~'~a rt. Outside s~t}o~ RANGES COOKING DECKS OVENS EXHAUST FANS NO, O5 CC COND klexander O. Hubbord Box 222'-', Aqueb0gue,:'NiY.. 11931.' :' i Lie.#30~E must not be altered in any manner;, return to fh~ office of the Board if incorrect. Inspectors may be identified by~ credentials. Approved . ............................ Disapproved ~,~Li~.~,.;,~,,~:~.L..~.,._~.,.:~.~~.~~ ..... ~'~ ............................................................................ .............. ........................ - ~ tBUllOmg nspector// ,/ ~ ~: ~ ~ . ~ N BUILDING PERMIT ..... .... ........ ................ , TOWN OF SOUTHOLD ,-,-/,,u~///~' ~-~ "~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE /,77/-,,7_ SOUTHOLD, N.Y. ~ ~ / Application No. ~..~.~.. .............. INSTRUCTIONS a. 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~ and giving a detailed description of layout of property 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 wilt issue a Building Permit tq 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 CQunty, New ~ork, and o~her 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, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~ (Signature o~ applicant/or name, if a corporation) (Address of applicant) (Name and title of corporate officer) Builderq License No ......... ~~ ........ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ,Z~.~...~..~,,-(.~,'~/.../.-'~.~-.~ .~-./.,~, .r~..~....'~'.~,....~.'~....~'<~.~.~'~:~~q .................. If applicant is a corporate, signature of duly authorized officer. X~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ( h Location of land on which proposed work will be done. Mop No.: ........................................ Lot No .......... ~ ............. Street and Nu ......................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy .~..G~...~...~...~..~..~--~. .......... r..~..~..'~...~.~ .................. - ................................. b. Intended use and occupancy ......................................................... ~,~ ............. /, ........................................ 3. Nature of work (check which applicable): New Building'. ................. ition .................. Alteration Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... (Description) ......................................................................... 4.Estimated Cost ............................................................ Fee (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 ~ 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 .... ~ .......................................................................................................... Dime~]ions of same structure with alterations or additions: Front ................................... Rear .Z.~.~.~.~L .......... ~ ~ ~ s ................................ 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~.~.f. Tf....~..~.~, 10. Date of Purchase .~.~.~[.[.~r.Z.~.'~ .............. 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 premise2: ( ) Yes ( ) No 14. Name of Owner of premises ~.~.~4.~.~ ............ Address ..~.~ ............ Phone No]~.~.~.~... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ..~,~ ...........................................Address ..~.~.~.~ ...............Phone No. ~.~ ........ PLOT DIAGRAM 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 NEW YORI(, I c ¢ -- -- COUNTY OF .... ~t££O3.~ ........... fY'~ - ........................ ~Q.~.'~..,-I~.~...~QZ;[,],.'I;D,I'~ ............................ being duly sworn, deposes:and says that he is the applicam (Name of individual signing contracf) above named. He is the .................................................... D~.~.~ ................................................................................................................. (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; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ............... ~day of ......... ~,~.~.~ ....................... , 19~ .... ~ , -- (Signature of applicant) ~rm ~X~res ' ~?POI~ Cn~ ~" [ I -~c~ ~,:T I o~ ~OBo~RT' .~A MiLTOq l~oo