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Home My WebLink About8543-zNO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . gX, it. ~$n. La .............. Street Map No. Xx .......... Block No .... X~ .... Lot No, . .X.X.....~..OAt..t.h.o,~..d ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Ap~... 28, 19.76. pursuant to which Building Per~it No..~ .~.3.Z.. dated .............. Apr.. 28, 1976.., was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr.$.vat~ .o~le..$~n$.~-y. ~[we~3.~l~g. ,~$th. ~dd~L~;.:kol~ .................. · · · The certificate is issued to ... Ed.~¢iIl. ~:~ .F~,cke~.ss$n. &. ~,~)w~et*. .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ·..~I~t~, ............................ UNDERWRITERS CERTIFICATE No..p.~l.d~g ................................... HOUSE NUMBER ..... ] 0~0 .... Street ... g~.$tte~ .La ..... ~ttho~l ............ lrOBM NO. ~ TOWN OF SOUTHOLD . BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8543 Z Permission is hereby granted to: ~c~- ~w~E~c~els~e~ ......................................... ................... ,~.~,t;h.c.].d. ......................................... to ..!~...~...~....a..~.~..4~...o.m..o.m.~,.~..~...dw~,3,J,~ .............................................................. at premises located at ....N./.~;..~:F.~.~-t,e~..~e~zie ................................................................................. .................................................... ~u.tJu3~ ~L ....~ ,.~;., ........................................................................... pursuant to application dated ............. ~.....A...~..~,....~ ............ , 19...~.6., and approved by the Building Inspector. Fee $.1.~.,,.~0 ............ I~OP~.~ NO. 6 TOWN OF $OUTHOLD , Building Depbftment Town C~lerks Office Southold, H. Y. 11971 APPLIGATION FOR GERTIFICATE OF OGGUPANCY 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. Fina~ 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 disposol--(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 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 Date .................... 7 ....................... New Building ................ Addition ....~..~. ........ Old or Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ...:,,~.~ ......... ........................ ........ ~ ....... ~"~'"'~'~'~'~'"'"~'"'7' ....................... Owner Or O~ners Of Prope,y .............. .......... ~....~.d...,.~ ......... ........... ; .......................... Subdivision ................................................................ Lot Iqo ............. Block ~qo ............. House lqo. .~. Health Dept. Approval ............................................ I~bor Dapf. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ....... .-....~ .................... Request For Temporary Certificate ........................................ Fin~ Certificate .......................................... / Fee Submitted $ .~....~... ............... Construction on above described building and perm? meets all applicable ~es and regHlations. Sworn to before me /.. day of ...~..../..?....~...~.. ...... (stamp or seol) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all build!ngs, 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 installa- tions, 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use XX 3. Copy of certificate of occupancv $1.00 $5.00 Date .... .O.c..~.o.b.e.~...~.,..1. ?.~.0 .... New Building ............. Old or Pre-existing Building ...... .~ .....Vacant Land ............. Location of Property ...1.0.7...0 ......... C.~,. ~ .t;.~.e.~. ,~.~.~.e. ............ S..o~,~..o~.~:,..]..~:.~'.o. ........ House No. Street Hamlet Owner or Owners of Property E¢.w,~.z~ F, F~_c~:e:[ssez3 & w'~'. County Tax Map No. 1000 Section ....7.0. ......... Block .... 1. .2 ......... Lot ....... ~. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ................. ' ..... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $..1. :.0.0 ....................... Construction on above described building and per_mit meets all applicable~codes and regulations. Applicant _~,~ .~.'. "-'-- ' ... · Rev. 10-10-78 d.o .7-7 BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .........~......~.....~..., 19Z.?. Approved ~' " 19.Z.~. Permit No. c~....~.. ~/~ ~ TOWN OF SOUTHOLD ~ :/~,c~ ~..~. ~ ~ _ ~, APPLICATION FOR BUILDING PERMIT 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 or areas, and giving a 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 o 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 o 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, orchiteqt, engineer, general contractor, electrician, plumber or builder. .................................... ............................................................................................................................... Name of owner of premises ..~...~...../r~.../..~.......~:--.....~.../...C'...../~....~7.'~..~...-'~...~.....4'.~...~.... ............................................................. if applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............ ~.~...... ....... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... ~ ' V Location of land on which proposed work will be done. Map No.: ......................................../'~ Lot No ........................./~' Street and Number ........... .~...~./...~..~..~.~-.~?......~,/Z~.x~.....~T...~. ...................... ,~.~..~....~..~'.--.-~....~.., .~.......~.........~.......C~., Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Fxisiting use and occupancy ......... ./.......~'..Tzf-.~..../.'~./...~. ..~....~.........~....r,.4~.../~../,~.4,,/.....~....~. ......................... b. Intended use and occupancy ;~ ~:~ ~ ~ 3 Nature of work (check which applicable): New Bui!ding . ................. Addition ....~ .........Alteration .............. Repair .................. Removal .................. Demolitio~ .................... Other Work .................................................. -- o'o (Description) 4. Estimated Cost ............................ ~,...~).'~..'..o....~.. ............ 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. Dimecsions of existing structures, if any: Front ....... ..~...~.~ ............. Rear ....?...~'...~. ................... Depth .~....~. ......... Height ...../..~...~. ........... Number of Stories ...... ./. ........................................................................................................ Dimensions of same structure with alterations or additions: Front ....... ~....z~'....r. ................... 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 ...... ../.~....~...~ ........................ Depth ......./..?.....~ ............... 10. Date of Purchase ........ ~...,~....~...~.. .............................. Name of Former Owner ~.~...E~....~..../~.....,~......~...~..W.../....C.../..~..;... 11. Zone or use district in which premises are situated ....... Z~....~..../..~....~.....//-~....~....~'...~.......~.. ............................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: .~...~. .............................................. [3. Will lot be regraded . ....... ~..~. ............ Will excess fill be removed fram premises: ( ) Yes ( ) No ~f ~remis~- ~.."..~'..¢ .~.~.~ ~ ~-..~.. Address ~ o ~Z'.~..o ~, ~ Phone No. ~.~.~....7...~..~..~ 14. 1'4ame of Owner ~ ~ .......................................................................... Name of Architect .............................................................. Address ................................ Phone No ....................... h!ome of Contractor .......... ~..~t....~........~... .......................... Address ................................ Phone No ....................... PLOT. DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from ~ropcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. S]-A]-E OF NEW~ORI~ ~ L, S S COUNTY OF .~-]T...'~..!../~. ..... ..... ~Z~...~..~Z..~.~.~.~Z..~ ....................... being duly sworn, deposes and soys that he is the applicarn (Name of individual ,signing contract) above named. He is the ....... ~..~..~..~.: .............................................................................................................................................. (Contractor, agent, corporate officer, etc.) of s~id owner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that ~11 statements contained in this appJicction are true to the best of his knowledge and belieF; tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn~m~to before me this ~ / ...... ~... day of ............. ~.~.~ ........................... Cou. ...... .................. (Signature of applicant) ~OTARy PUBLIC, Sta e oJ ~ew No. 52-8~25850, Suffolk ~ou~t Term Ex~ires March 30,