The URL can be used to link to this page

Home My WebLink About8560-zFOF~I NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z?~!'0. ..... Date ........... D. ee...8 ......... , 19.~.6. THIS CERTIFIES that the building located at .~/./8. Alber.~;son..t,~r~e ...... Street Map No. ~ ......... Block No... X.X ..... Lot No .... XX... Gl'.~ellp.o~.t.. I~.,Y, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ l~Iay....!~. ., 19. ?~ pursuant to which Building Permit No..~)~5.0.~. dated ........... ~aiz..1~ ..... , 197.~., 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~.iva.t~e. one. A~am;kly. d.w. e3 ~[:[ug ....................................... Thecertificate is issued to .. ~amual..&. l~e.tty. (~ptrr .... 0~r~e~.s .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. O~.e....8...~ ~?.6... biZ .l~,YlJ, la ..... UNDERWRITERS CERTIFICATE No...~.1.~.1~? .... l~o.v., .~.~...~. ............... HOUSE NUMBER .... 22.6.~ ..... Street ....~$.~.e.~.t.~..I,~ ..... ~r.e.~.rlp~.~;, ....... Building Inspector FOBM NO. :~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE/vIISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8560 Z Date .......................... ~a~. ....... .~ ............. , 19..~. Permission is hereby granted to: Sa~u,~..~..2e ~t~...Co~ ~$% .................. : ................. ................. G.z, een~,e ~ ......................................... to ...~.%~ k<[..ae.~... ~...£ ~ily....d~ ~l~iag ............ £ ~1~ ~,..b~...~ ..A~e~,~ ~.). ............. at premises located at ..~;;~.~...A,~b~;.aOP,...][,~,Le ............................................................................... ............................................... ,Az'.s~mc~m~a. me ......... G~e e.~e~.t, .................................................... pursuant to application dated ........................ .i;[.~.......l!. ................. , 19...7..6.., and approved by the Building Inspector. Fee $...~.~,~0 ......... FOP~I 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: 1. Final survey of property with accurate location of oll buildings, property lines, streets, and unusuo} 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, o certificate of Code compllonce from the Architect or Engineer responsible for the building. 5. Submit Planning EIoord 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 ~te ..... Z.~...~.~...=Z.~ ............ Bqilding ....... ¥./.......~//// -- / /~ ,/- / / ~/'~/Additi°n ..: ............. 0Id or Pre-existi, ng 13uil?ding ................ Vacant Land .............. New L o,,on of -- ------ .................................... Owner Or Owners Of Subdivision ................................................................ Lot No ............. Block No ............. House No ............. .ea,tb Dept. Approvo, /.~Z.~. ...................... ~bor ~t. Approva, ................ ~:..~"' .'~ ................. Undorwriters Approval ..~..~t.~.~.~......*~....Plonnin0 B~rd Approvo~ ........ ~.Y.~ .................... Roquost For Temporo~ Ce~ificote ........................................ Final Certificate ............ .~ ......................... lee Submi~ea $ ....~.~. ................. Construction on above described building and permit meets oil applicable codes and regulations. Applicant .....J4~*~.~z.~,~...~'~'. .................................................... Sworn to before me this ........ ~doyof ..... ~:~,...~.f,.~.,~,. Notary Public .....(~~-~. County FIRE UNDERWRITERS Town Harbor -Lane ' Southold, L.i..11971 This certificate must not be aJtered in any man,er; return to the offke of the ~rd ;f incorrect, inspectors may be ~dentified by their credentials. Approved ................................... TOWN OF SOUTHOLD/~/~/?~ BUILDING DEPARTMENT TOWN CLERK's OFFICE ~ ~UTHOLD, N. Y. ...... .......... No. ........................ Disapproved a/c ..~~ ............................. ~ APPLICATION FOR BUILDING PERMIT Date ............ .~......~........., INSTRUCTIONS o. This application must be completely fined in by typewriter or, in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat 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~ 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 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 Regulotions, for the construction of bu Idings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with alt applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. nature of applicar~, or name, if (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~...¢,~1~...~..'. ,.. .......................... .,.,,.., ................................... .~.~ ........................................................ ................. (~.. '~/'?~'/~,,7/~, //~ Name of owner of premises ..,~ .~..~..'~'/.-.~.Z...~?....~:.:~'~-v. ~..:~.~.~..,~'~...~: ............ '~ ~/'~/~r./.~ ............................................. If applicant is o corporate, signature of duly authorized officer. (Nome ~nd titJe of corporate officer) Builder's License No ..................................................... ~-~,.~ ~ ~t/) Plumber's License No ...... ~..,...~'...~....~..~...~...~...~..~. Electrician's License No .... ..~..~...~ ............... Location of land on which proposed work will J~e done. Map N9,: ........................................ Lot No ......................... Street end Number/.~..;r~.:%J~'.c~..~,.....',~(//-~.v~.'~~'~/'~''''~'''~X'/~'''~ ....................................................................... Municipality State existing use and occupancy of premises and in.~ended use and occupancy of proposed construction: a. Exisitin~ use and occupancy .......... ~..,~ .................................................................................................... b. Intended use and occupancy .... ~;~ ................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration Repair .................. Removal .................. Demolitioc .................... Other Work .................................................... ~,~ ~ (Description) '- 4. Estimated Cost ........ ~.¢?.~2.¢...q.~. ............................ 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 .............. Rear .. ...~. ............. Depth ..z...~7 Height ...... ./'.~,'./.q~ ..... Number of Stories .......... ~ ....................................................................................................... 9. Size of lot: Front ...... ~.C.*./.-...~.. ..................................... Rear ..,2/~.:..:~'..."~'.. ....................... Depth ~.~....~...': .................. 10. Date of Purchase ........................................................ 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' . ......... ~:¢~Z..~ ......... Will excess~i, ll be removed from premises: (), Yes ( ff No 14. Name of Owner of premise ,e..~..~; ./..... /./.... Address ¢-..~'..~Z,/.~.....~... Phone INa ........ ,? ............. Name of Architect ................. ~.~.. '.~...'. ............................ Address ................................ Phone No ....................... Name of Contractor ................. ~ ......................................... Address ................................ Phone No ........ ; .............. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from 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 .......... ~ ~'~'.0.~ ..... f "'" ............................ 8i3.Q'ttzel...C~D.!~i~ ....................................... being duly sworn, deposes and soys that he is the applicam (Name of individual signing contract) above named. He is the ............................................. .CtlC~f~ ....................................................................................................................... (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 thor the work will be performed in the manner set foffh in the application filed therewith. Sworn to before me this .............. ~,., day of ........................ ~ ............, 19...~. ~ ~ ~/ Notary Public,. ................. :..S~Z~ .............. Coun~ .... ~~~....C ~ .................................... Term Expires March 30. 19~ ......... ~ ~FOLE OOUNTY ~EAL~H DEPAR~MEN~ Th~ sewage disp f&¢illtiosfo{1 thi~ location have been to be satisfac'bogyo Chie~ of O~ner~l Engineeri Sorvicos F c~q r lid F L. o01~ o~ ,13 , I ~'T F LOO-~'x APPROVED AS NOTED DATE: FEET~ :1 x,.t~ E W Iff "i~ GH'm V