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Home My WebLink About8671-zFOB, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy Map No....~. ......... Block No...X: ....... Lot No, ~ ...... conforms substantially to the Application for Building Permit heretofore filed in ~his office dated .... ~f~-,. ~! ........ , 19.-/~. pursuant to which Building Permit No~.~./~ dated '~ '~ ~ 1~ was issued, and conforms to ~1 of the req~e- ments of the applicable provisions of the law. The occupancy for whi~ this ce~ificate is issued is . ~:~.. O_~ . ~ ?. U,~ .... The certificate is issued to ./~f~ (~. ~. ~ ......... ~ ......... (owner, lessee or ten~t) of the aforesaid building. Suffolk County Department of Health Approval ~ ~ ............................... U~D~W~S C~Z~CA~ ~o. ~.~I fi i:~. ~ .......~.~.~.,~)..l~'~ ~ ........ HOUSE NUMBER. ~ (.~ .~ ...... Street .C...~~..~_~ .... ~.~~ FORM NO. 2 TOWN OF SOUTHOLD BUILDIHG DI~PARTMENT' TOWN CLERK'S OFFICE SOUTHOLD, Nm. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8671 Z Date ~JO/~/L~- ZZ 19Z~, Permission is hereby granted to: at premises located at ............................................................................................................................ .................................................................................. .................................... pursuant to application dated alL) N/:~ ~'l 107....~.. and approved by the Building Inspector. Building Inspector TOWN OF $OUTHOLD , Building Depmtment 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: I. Final survey of property with accurate location of oll 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. [3. 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. 9. 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~...~.. ~/...!~.../...~...~.,.TZ ........................ New Building ................ Addition/~... Did or Pre-existing Building ................ Vacant Land .............. Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ..~..~.. .~...'~.. .........~'~ ...................... Subdivision ................................................................ Lot No./.~3...~./~L~.. Block NO ............. House No ............. Permit No~.,~..'.~../...~.... Date Of Permit ..~./..?././~....Applicant ..~~.......~..~.~...~ ........ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ . Underwriters Approval ~ ................ Panmng B~rd Approval ........................................ Request For Tempora~_C~ificate ........................................ Fin~ Ce~ificate .... ~ .................... lee Submitted $ .:: ................................. Construction on above described building and permit meets~,~/~o~o~es and regulations. Applicant .~ ........................... ~. ......................................... Sworn to before me this ........ of (staml~>r seol) ':m ~,7/ 2001 3,scr.~ ' M.~T'7'! TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE UT.OLD, Y. Examined' ....... ~ ........... [~'~ 19 ........ ~ ,,- ........... ;Ap~,caho' 'n Nor~.~.~-~ ~ ................ n ~proved ................ ~.....~.., 1~ ...... Permit No .......~ .............. ...................................................... : ........... .......... (~il~in~ i~ector) APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS o. This ~pplicotion must be completely filled in by typewriter o~ in ink and submitt*d in triplicate to the ~uildlnfl Inspector, with 3 set* of plans, accurate plot plan to ~olo. Fee ~ccordinfl to schedule. b. Plo~ plan showin~ Ioco~ion o~ lot and of buildinos on premises, relationship to *djoinin~ promises or public ~troet~ areas, and ~ivino o detailed description of lo,out ofproperty must be drown on the di~rom which is po~ o{ this ~pplic~tion. c. Tho work covered by this application may not be commenced before issuance d. Upon approval o{ this ~pplicotion, tho Buildinfl Inspector will issue o Buildin~ shall be kept on the premises available for inspection throughout the work. e. ~o buildin~ shall be occuplod or used in whole or in port {or any purpose whatever until shall have been ~rontod by tho Buildin~ Inspector. APPklCATIO~ IS HER[BY ~AD[ to tine Buildin~ Deportment {or the issuance of o Buildin~ P~rmit pursuant Buildin~ Zone Ordinance o{ tho Town of Southold, Suffolk Count~ ~ew York and other ~ppl c~ble ~e~u}~tions, for ~he constru~ on o{ buildings, additions or *Iterations, or {or removal or demolition, The applicant ~roes to comply with *11 applicable I~ws~ ordinances, buildlno codo~ housin0 coda, ~nd ro~ul~tlons, admit authorized inspectors on premises ~nd in, buildings for n~esso~ in~ect[ons. / OI/'-/~ :>' (Signature of applicant, or nome, if a corporation) (Address o{ applicant) State whether applicant is owner, lessee, agentt architect, engineer, ~enerol contractor, electrician, plumber or OUllaer. Nome of owner of premises ....... ~. ....... ~ ................................................................................................ 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 bicense No ............................................. Other Trade's License No ............................................... Location o{ land on which proposed work will be done. Mop No.: ........................................ Lot N6 ......................... Street and Number ~ '~' ' : ' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building.. ................. Addition ~c Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... f (Description) 4. Estimated Cost ............. ~ .......................................................................................................................................... (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 ........... ~.,. ........ ~ ............ ,.?.~;L~...' ....... '.:~.,.. ................................................................................... 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 ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front Rear .......................................... Depth ....... ; ........................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ ] 1. .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 from premises: !~ .) Yes (v) No 14. Name of Owner of premises ....... ; ............................................ Address ~ Phone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Nanne of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all 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. $TA1-L: OF NEW YORK, I ¢ c COUNTY OF ........ S~£~.olk ....... ~ ~'~ ............................... .~rg, l't~;..~a~'.tg~.az:~o ............................. being duly sworn, deposes an~ says that he is the applicon (Name of individual signing contract) above named. He is the ................................................... a~e~t..~oE..om~t~.ac.to~ ............................................................................. (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 tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this -, ......... ..... .................... .............. . Nota~ Public ~a~ Coun~ ' .~.~..~ ~~", ~ '. ~~,,'~ ............ ~"~-~ ~'~'~ure of a~'~' ............................ ~L~ZA~H ,~N N NEVILL~ N~ARY PU~I~, State of New York Term Exp*ies M~rch 30. 19. ~ -ii LI I' A ~'VF,.OVED AS JqOTED FEE: / ~ "BY' "~:~f,' NOTIFY BUILDING I~EP~RTMENT ,~ 765-26~0 9AM TO 4~ FO~ ~EQUIK- ED INSPECTIONS: 1. ~FORE BACKFILLING FOUNDA- TION OR START FRAMING ~ ,BEDE COVERING PIPELINE ~. 3.,FINAL WHEN )OB COMPLETED ~T RE~NSIBLE FOR DESIGN OR CON- STRUCTI~ ERRORS ~