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Home My WebLink About8507-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi[icale O[ Occupancy THIS CERTIFIES that the building located at ...~9~.n..Bp.a.d. .............. Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~,P?....] ~.., 19. ?.15. pursuant to which Building Permit No... 8~.0.7.~ dated ............ April...1-9, 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 .. ?.r~..v~,.t.~...o.~?..f..~.~.~:~..y..~? .~.~..¢.~.¢. y..~.t~ ?..~. ~.d..¢.t.¢.~. ................. The certificate is issued to .~.orX.~]~ql..B.~.~LrIRi7 ...... .O.~.n.e?. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... E..,~.~., ........................... UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER ...... 1.2.0 .....Street .... ~9.I~...R. 9.a.d. ..... S. gu..t.h.o.~..d ............. ..... ........ Building Inspecto/ FOB, M NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLE'rlON OF THE WORK AUTHORIZED) N.o 8507 Z Date Aoril 19 19. 76 Permission is hereby granted to: ~e~:.t... ,,u~t ~.... A/.CL .~ion..B~:en~ ......... to .~;~ ~d.. an...~d £t ~o~...~..e x~ ~.~g...d'~l~J~ ............................................................... at premises located at ...~..9.~.:~..~...o.~..~. ................................................................................................... ................................................ ~outh, o;Ld.....l~...~ ................................................................................ pursuant to application dated ......................... ~Lp,?.~,.l~.....1.~ ......... , 19..~.~.., and approved by the Building Inspector. Fee $?. ~.'{."~32.0. ............. FOF,~M NO. 6 TOWN OF $OUTHOLD , Building Department 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: l. 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 all property lines, streets, buildings and unusual noturoJ 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: I. 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 A~tg 2 1976 New BclildJng ................ Addition x~OC Old or Pre-existing Building Vacant Land Location Of Property ..... ~,o..~.~....~..o.~ .......... ,~..,o.~..~.br.o...]z.~. ............................................................................ Owner Or Owners Of Property ...... ~.9..z.~.~..~.~e.~g~..~. ............................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. PermitNo, ,~...~"..0..[....7~T,.,.... Date Of Permit ..i~//~/Z_~..Applicont . .~...C..~ ...................................... N .R · N .R. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ..... ~]..-.f.~.: .......................... Request For Temporary Certificate ........................................ Final Certificate XXZ~KX Fee Submitted $ ....~.:..0...0. ...................... Construction on above described building and permit meets~all opplicable~godes~and regulations. App,icant ............. ................................ Sworn to before me this ............ . ay of Notary Public ~ ....... County FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, H. Y. ...... ....... Approved ................................. ~...~.'.., 19 ........ Permit No ..................................... Disapproved a/c ...........~.;~:.~../.~.~.~?~...~.~.%~..?...~...~·._.j.~~~ /V (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 7.. Application No...~.....g...~....~ ............... 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 oF 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, and regulations, and to admit authorized inspectors on premises' and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ........................................................................................................................ If applicant is a corporate, signature of duly authorized officer. "x (Name and title of corporate officer) Builder's License No ........ -~..;...~.. ............................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed wor.~ will be done. Map No.: ............ ~u ............... . ......... Lot No ......................... Street and Number ...,~...~//~..J'~.....~.~..'.Ct.O.C~'b ..................................... ~,~iO..l~..~.~.~..,~.~J. .................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use end occupancy ......................................................................................................... b. Intended use end occupancy ......~.....~......} ................................................................................... 3 Nature of work (check which applicable): New Building.. ................. Addition ...~..'. .......... Alteration .............. I~epair .................. Removal .................. Demolitior'. ................... Other Work .................................................. ¢ ~¢ ¢ ~ (Description) /:.-¢ ¢ . ............................................................................... 4. Estimated Cost ............................................................ rea (to be paid on filing this application) 5. Jf 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. D,mens,ons of ex,st,ng structures, if any Fror,~ ...... ~ .............. 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 ..,/....d ........................... Depth .~.~.f ................. 10. Date of Purchase ........ Z.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 frame__premises: ( ) Yes ~¢/No~ ~ _ 14. Name of Owner of premises ~..~.~.~.,.~.,...~...:..~ ........... Address ..... Phone No ....... Nome of Architect ............................................................. Address ..................... % ...... Phone N0 ....................... Name of Contractor .~..~.,.~ .......... Address ~~. Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existihg or proposed, and indicate all set-back dimensions from propcrt~ Jines. Give street and block number o~ ,¢escription according to deed, and show street names and indicate wheth~interior or corner lot. Fog ~ro~ f<~ ['~'.~ ~ ' ~ ................ ......................................................... being duly sworn, deposes and says that he is the appliconl (Name of individual signing contract') kle is the ................................................................................................................................................................................. (Co~tractor, agent, corporate officer, etc.) o¢ said owner or owners, and is duly authorized to perform or have performed the said work and to make and file d~is application; d~at ali statements contained in this application ~re true fo the best of his knowleSge and belieF; that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ ............................................ .,, ........ Mot~ry Public, . ................................................... Coun~ ................... : .................................... (Signature of applicant)