The URL can be used to link to this page

Home My WebLink About8574-zTOWN OF $OUTIIOLD B1m.nING DEPARTMENT Town Clerk', O~ee Southold, N. Y. Certificate Of Occupancy No.. ZTB12 ..... THIS CERTIFIES that the buildin~ ~ocated at -l~/B..l~:l.n .Rea~ ........... Street Map No. xx ......... Block No.. xx. ' ...Lot No..xx .... Ct~t. chog~... ~[.o.Y. ,. ........ conforms substantially to the Application for Building Permit heretofore ~ed in thin office dated ..............Nay.... 1l)19~ pursuant to which Building Permit No... 8~'~Z dated ..........!~Y... J.~. .... , ., was issued, and conforms to all of the require- ments of the applicable provisio~:'~f the law. The occupancy for which this certificate is issued Is ~.rivate one la, il .~ell~')g v~th addit.io,~ (deck) The certificate is issued to . P,o~er~. T~th~L~ ........ O~mt3~. / (owner, lessee or tenant) of the aforesaid building. Suffolk County Department ~ Health Approval · ~,R, .............................. I~C ~E No.l~oR. ........................................ UNDERWRITERS CERT A .... ....... ....... Building Inspector TOWH OF SOUTHOLD BUIM)IHG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P~.~IT 8574 Z Date .......................... lCa~,. ......... '1.~ ........ , 19,~76. Permission is hereby granted to: Rab~=.t,..:Zut~L~, .............................................. ................. ~.~,~ ......................................... to ~.~;L~,~...~.rL..~L¢~.t _~___n__n_ ,.a~..ez~t J4~&.A~e~.~ ................................................................... at premises located at ..~/..~ ....... ~,;Li2..~,~a~l. ........................................................................................ ............................................... .9.~&ue..... Z~ ~]( ~ ............................................................................. pursuant to application dated ..........................~:L~.IL ....... ~.:t.1 ........ , 19.~..., and approved by the Building Inspector. Building IR"spector ( FOR~ NO. 6 TOWN OF $OUTHOLD , Building Deparfmenf Town Clerks Office $outhold, 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: ]. 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-g farm 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 Beard 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 New Building ................ Addition ......z~'....... Old or Pre-existing Building ...... ~Vacont Land .............. Location Of Property ............ I ..................................................................... Owner Or Owners Of Property .... ~ ....... .~......~.... .................................. Subdivision ................................................................ Lot No ............. Block No ............. House 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 $ ...Z.?/......~. · ................. Construction on above described building and permit meets all appli~ codes and regulations. Sworn to before me tl~s ........... ~.. ~ay of .....~/'~~...../..~...?.'.~.. ........ (stamp or l~OltM NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLIGATIOH FOR Bu/LD/NGfPt:RMIT INSTRUCTIONS ~. This application must be completely filled in by typewriter o~ in in~ end submitted in triplicate to the Bui~ing Inspector, with 3 sets of pl'ans, accurate plot plan to ~ale. Fee according to schedule. b. Plot p~an showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets oJ areas, ~nd giving ~ detaiJ~ description of layout ofproperty must be drawn on the diagram which is port 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 ~cupancy 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 bu!ldings for necessary inspections. (S~gna ure of ~pphca , or name, ~f aqcorporah~)~ .................... 2"; ........ ............................................................................................................. Blame of owe of p m' es .................... ~.6~.../~:~.~....~ ....... ~~-'~:~.:z~ .............................. If applicant is a 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 Trade's License No ............................................... ~/z' 1. Location of land on which pr, r,r,r,r,r,r,r,r,~o~ed_~work will be done. Mop No.: ............ /.~, ......... >,~.....~.... ~pt No.~F ....................... Street and Number ......... J..,G,/,...,.~'~. ...... .~....~ ...................................................... ~'~...~..',,,.~.,.~-. ......... 2. State existing use and occupancy of premises~.~_2~,_~ded~ use and occupanc__ 'y of proposed c~onstrMuUc~iloC~P:allty o. Exisiting use and occupancy ................. ,...¥...~....r..:....'::,..~ ...........,...,./..,,,.,.,,~.,... ........................................ b. Intended use and occupancy ..................... /~...-=~-,,-,...v..~/.,,,~.,,Z~i/~J//' ~/~/~ ~ ..................................... / 3. Notate of work (check which applicable): New Building'. ................. Addition .................. Alteralian ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) ' (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. I~ business, commercial or mixed occupancy, specffy nature and extent or,ach type of use ................ ¢ ........... 7. Dimensions~ -- of ~sting structures, if any: Front ...... ~.,f. .......... Rear .~.~..[... ................. Depth ~..~. ....... H,,¢,...~O....m... N,m~,, of S,o,~.s ....... ~~ ........... ~ .......... · . Dimensions ofsame structure with alterations or additions: Front ..... ~ .................... Rear ...~ ................ ~./ .~/ ~_ l Depth ,.~.~......~ ....... Height .~.~....~ ......... Number of Stories ......... ;..,;..~ .............. 8. Dimensions of entire new construction: Front .................................... Rear ...~ ................. Depth ..~. .................. Height ...~ ....... Number__ /°f Stories .......... ~ ............. ; .........................................................................................../~f ~. ~i.~ of ,o,: ~o., ......... ~~_~~..:. ........................... ,. ~e~r ........ ~.Z...- .................... ~ ~,,,,~e"'"'~¢'"~' ............. ~0. D~,~ o, ,,,~"a~, ........ /~.Z~'.~....,~m~ o, ,o~me~ Ow,e, .... ~.~.'.':.(....~.~~ .... 1 1. Zone or u~ district in which~remises are situated ......................................................... :..) ....................................... 12. Does proposed construction violate any zoning Jaw, ordinance or regulation: ......... ~ ................................... 13. Will lot be regraded ...... ~ ............ .Will e~ess~iJJ be removed from p~e~ses: ( ) Yes ( ) No ~m~o~Ow~,of,r~m~s,, ~~,~.~ ............... ~~ ~ome o{ Architect .............................................................. ~ddro~s ................................ Phon~ ~o ....................... ~me o{ Controctor ............................................................ Addross ................................ ~hono No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indica}e all set-back dimensions from proporty 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, / c S COUNT~(~[ ~~ ~OF ..~ ............................. [o~ ~ .......... /.[~.~.~Z~..~¢,..~.~.~ .................. being duly sworn, deposes and says that he is the applicon, (Name Cf, individual signing contract) above named. He is the ................................ ~~ ............................................................................................................ (Contractor, agent, corporate officer, etc,) of said owner or owners, and is duly authorized to perform or hove 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 fo~h in the application filed therewith. .............. ~,... ~,~ o, ... ~OtO~ Public, . ............... ~~_.. ...... Coun~ ..... (Sion*ture o* opplicont) ......... 13 ,/zm. ~i, k z.