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Home My WebLink About8466-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icste O[ Occupsncy No. Z7.~.~./~ ...... Date .............. A.~ .... 2~...., 10..~.~ THIS CERTIFIES that the building located at . .No~th. Ba~lt:[~. l~Oad, ex,t Street Map No. , .~ ........ Block No. ~ ....... Lot No, .. :~ .... ~.q~.~.h.o.l.d... ~ ~.~ .~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... 11~ ..... ~1, 19. :/.6 pursuant to which Building Permit No... dated ......... Api~.i~....~ ....., 19..'~.~, 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.~tvata. oae. fa~i-~, a~ell&ut$ ....................................... The certificate is issued to . C~.aude. · Ca.l~l~ol~ ........ o~me.~. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~'~...'L~.. -1.97~ ................... UNDERWRITERS CERTIFICATE No.. ~296~.3 ..... Aug...3...1.97.6 ............... HOUSE NUMBER ..... ~ .~. ..... Street ... N~i4:~. Bayvi~w. Eoad. ~xt ............ £ ..... ~ '~'~ilO~ing'~' '~~ ........ FORM NO. 2 ?ow~ o~ SO~TNOL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT O1',1 THE PREMISES UNTIL F~LL COMPLETION OF THE WORK AUTHORIZED) 8466 Z Permission is hereby gronted fo: ~ uthoJ.~L TOWN OF $OUTHOLD , Building Depmtment Town Clerks Office Southold, N. ¥. 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), Nomconforming uses, or t~uildings 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 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 B~ilding ...~.. ......... Addition ................ Old or Pre~existing Building ................//Vacant Land .............. ocot,on Of Property ........ .................... Owner Or Owners Of Property ...... ~_.~,,-~.c~.~........~.....t~,:~......~..~.~/,.~,2~ .............................. Subdivision ................................................................ Lot No ............. Block No ............. House No..,~.,'./..~' Permit No..~,, .~.~,,,.~,,..., Date Of Permit...~.~ .~./~,..?,,~,.Applicant · -~..~.~,~....~..~...~¢~.~,,~:~:2:T/ .... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fino] Certificate .....~ ............................. Fee Submitted $ ,,'7z,.~,....~..,~ ...................... Construction on above described building and p_,~rm~i.~ meets all appJ. i~ble ,qodes and regulotions. ...................... ................................... le)¢ Notory Public ....... ~ ....... County TOWN OF SOUTHOLD ~/~,~/~* /-~'~n,~,*~ ,~//~? o/~ ~/ ~ BUIkDING DEPARTMENT /. ~ ~ ~ ~/ ~. ~ -~ TOWN CLERK's OFFICE ~ ' ~ '~'~ /~ ~ ........ ....... . ..... ............. ........................... ................................. ~..~r.~ .......... ~.~ , o ~ ~ ~- ,~ . A~LI~ATION FO~ B~ILDIN~ ~T~ ~ INSTRUCTIONS ~ a. This application must be completely filled in by ~pewriter o~ in ink and submitted in triplicate to the Building'~ Inspector, with 3 sets of plans, accurate plot plan to ~ale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to odjoining premises or public streets m areas, and giving a detailed description of layout ofproper~ must be drawn on the diagram which is poll of this application. c The work covered by this application may not be commenced before issuance of Bud ng Perm t d. Upon approval of this application, the Building Inspector will issue a Building Permit to the ~pplicant. 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 whoever until a Ceffificate of ~cupancy shall have been granted by the Building Inspector. ~PPLiC~TiON IS HEEEBY M~DE ~o the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~E, and other applicable Lows, Ordinances or Eegulations, for the constru~ion of buildings, additions or alterations, or ~r removal 0r demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, ~ui~ng c~e, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for n~essa~in~ections. / (Signature of applicant, or name, if a corporation) /( ......... ...................................... {Address o{ opplicont) . Store whether ~pplicont is ownor, lessee, ~ont, orchitect, engineer, ~enerol contractor, electricion, plumber or bu~ldor. ~ ...~.~ .......................................................................................................................................................................... ....... ............................................................................................. If applicant is a corporate, signature of duly authorized officer. ............ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~(Nome and title of corporate officer) Builder's License No ................... Plumber's, License No ........ ...~..........~...~: ...... Electrician s, License No ...... -~.-,;,,,,,,~, .......... Other Trades License No ............................................... 1. Location of land on which proposed work will be done. Mop No.: Municipality' ' Street and Number. x/'~,~...~t2~/4}.('~'~.../~.~.,~ ............................ ~..-%~. ......................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use ond occuponcy ................................................................................................................................ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building.. .......... .~.... Addition ..................Alteration ................ Repair .................. Removal .................. Demolition .................... 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 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~....~ ................ Rear ...... ~ ............. Depth ......~....~ .......... Height .................... Number of Stories ....... .~'.i .......................................................................................................... 9. Size of lot: Front ........ /..~// __ ..................................... Rear ........... ~..~....~.. ................... .~///~x/'~/,,De°th ....... ,.~...~....~. ....... ; ..... 10. Date of Purchase .......... ..~/..//..~..,~.. ........................ Nome of F?rmer~ Owner ..,./.~..~.~F~...,~.4Z.(Z~,~B(..¢q:~.! ...... 11. Zone or use district in which premises are situated ........... ~..z~/.~/...~f. ;~f..~..:.. ............................................................. i2, Does proposed construction violate any zoning Iow, ordinance or regulation: ....... ..~...O.. ........................................ 13. Will lot be regraded . ....... .29.D ............. Will exc,~ss fiji be removed from premises: (), Yes ( ) No 14. Name of Owner of premises ..J~f~...~.....~.4:~/..~:X~/... Address ........ ~..~...~....~,~.... Phone No. '7..~.~..~.?.~ Name of Architect ..... ~r~r~...~.~t.~..~.~~__~_~/ ........................ Address .....-~'z~'~..~,.~.~..... Phone No ....................... Name of Contractor ...... .(~..~4~'c~..,..~'.'~,~..]~, .~...(fff-f~ ......... Address ......... ~'~.~.~...~.... Phone No...~..4~..2~r:~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frora property 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 YORK, COUNTY OF ................................ Suffolk ............................................ ~,~ ...... ,~....~.....,,......~ .................... being duly sworn, depases and says that he is the applicam (Name of above named. He is the ................................................................................................................................................................................. (C~G~li~[l~r, 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 thor the work will be performed in the manner set forth in the application flied therewith. Swam to before me this Notary Yublie, . .............. ~.. ~.a.~.. County , .~...:l.{., ~-, . ....... .~ ........ ~::I:~'~ · " (Sig;';¥ure ;~' ~ ........ ~ _ ~IZABETH, ANN NEViLLwE Yor~ -- - ~[OTAtTY PUBLIC State of Ne "' N~, 52-8125,50, S,3['ol~ Term £xpites M~h 30, N IS, O ,/ '1 .! .25 ~ ,~xeldA .N rxob:[o~O . I,