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Home My WebLink About8694-zNO, e TO~N OF $OUTHOLD BU1LDI~{~ DEPARTMENT To~rn Clerk'~ $outhokl, lq. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .8.1;.$.1.1..~a..t.e.~..A.v~.. ......... Street Map No.. ~ ........ Block No..X~. ....... Lot No, . .x~....C,u.t.c..h.o.~.. ................. conforms substantially to the Application for Building Permit heretofore filed in this office ,dated ............. .J..une...1.~., 19.7.6. pursuant to which Building Permit No..8..~..Z.. dated ............ .J.u~..y.....1.., 197.6.., 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 ...~?.~.~?..?.~? .~..~..~Y...~".~....~L~... ?..~,~.h .~..~.~. ~..o.~..~...~.Z.~.e..r.~.o..~ .... The certificate is issued to .Ed.¥.a.r.d. ~.a.~..b~l...c~.s.k. ~ ................................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No. p.e..n.d.t~..~. .................................... HOUSE NUMBER ..... ?.~.~. ..... Street ...S.t;.~.1..1.~.a.t.q.r. ATe. ...... .C.~q]~g~ ...... ............ B~l'~ing ~pectorI FORI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby g ................................................................... L. J,~;:~.~.,.:~;i.,~..,.:.::;::~;: ............................................. pursuant to application dated ........... :.~.J......./'-..-~- ............ , lC).Z~;;~and approved by the Building Inspector ~ ' .............. .............. Building In~ector TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOK 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 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 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 ................................................ New B~ilding ................ AdditioD .....~ ......Old or Pre-ex~sting Building ................ Vocant Land .............. · ocato of property ../.~ ....... ~ ........... ~:.~ ....................... ~....~......q.~.~ ................................. Owner Or Owners Of Property ~.~:;..~.~.....:.:.:.~.~.:~.~?.~. ......................................................... Subdlvision ................................................................ Lot No ............. Block No ............. House No ............ Permit No..2L~ ..... Date Of Perm't.ZY:.Te...App"cant ..~.~!.~ ................................................. Health Dept. Approval ......... ~_.-ZC...;.'Z~..-.'.L.J ................ Labor Dept. Approval ..... ~.'. ................................ Underwriters Approval .............................................. P anmng Board Approval .:TZT£L] ............................. Request For Temporary Certificate ........... .~.;;:.:..:..: ............. Final Certificate ...ZTZ. L: .............................. Fee Submitted ~ '~' r;'~(/ Construction on above described building an~l~ermit meets alJ)/,/,7//j ~ //~'a~licable codes a~ndz4r~gulatlons. ..... .......................... ! Sworn to before me this t' Notary Publ'e ~,.~CT,,.,,-t~.,~, County APPLICATION FOR BUILDING PERMIT ......................... , INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 pu.blic str. eet.s or areas, and giving a detailed description of Ic~/out ofproperty must be drawn on the diagram which is part of thts apphcat~on. c. The work covered by this application may nat 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. (Name and title of corporate officer) Builder's License No .......... /~....~../**.~ .................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... Location of land on whi_ch~proja.o.se, d.work will be done. Mag, No.'.......: .......... ~ ................ Lot No ....... ~ ............. Street and Number'~..~..~~.~..f.,A~y"~ ~-e~ ~~ ....... ~~ ............................... '~(~i~Ji~,~ ........ State existing use and occupancy of, pTemises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ,~:~,...~.~....~,~:tLr....~ .................................. ; ....... b. Intended use and occupancy ~...~...;.~-~..~ ...... 3. Nature of work (check which applicable): New Building.. ................. Addition.........J~- ...... ... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................. .... /. !Z....~... (Description) 4. Estimated Cost ...................................... 2 .................. 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 ........... ~ ....................................... Dimen~,i~nS;.o, same structure with alterations or additions: Front ....... ..~...Z ....... Rear gepth.:.'.;....~:~..~.. ................ Height ............................ Number of Stories ................................ 8. D,mens,pn~ 0~!entire new construction: Front ....... )...~.. ....................... Rear ...../....~.. ................. Depth ~ ................ Height ........... ; ........ Number of Stories ........... ~ .............................................................................................. ~ ..... ~ ~ ~ 9.: Size of lot: Front ........... ~ ...... ~/.l.....~. ........................... Rear ......... ../..~....~.. ....................... Depth .....~....~.../. ................. pre~mises 1 1. Zone or use district in 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 ( ) No ]4. Name of Owner of premises .................................................... Address ................................Phone No ....................... Name of Architect .............................. .; ......................... Address ................................Phone No ...................... Name of Contract Address .... ...................... . ....... mane mo ....................... 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. ,/ STATE OF NEW~'OR~K= COUNTY OF ..,,~..?....P~.....~.!..~::. ...... ................................................................................................. be~n~ duly sworn, d~oses and says that he is the applicam (Name of individual signing contrac~ above name. .e ,h. .......... .................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are t~e to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the app~ion filed therewith. Sworn to before me this ' ..... ~ot~ ~ublic, ..~..~~ ......... C~n~ ..... ~.3~ ....... ~.4.~.~......~.w.~....Lx ........................ (Signature o{ opplic~nt)