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Home My WebLink About8712-zFORM ~O. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlificate Of Occupancy No. Z .~'.~. ...... Date ............. THIS CERTIFIES that the building located at .... l~/.S. 9~;h :S~; ............ Street Map No. ~ ......... Block No .... ..xX .... Lot No, . . .x.:g. .... ~. ~.e.l~.p .o.~.~... ~..)i': ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~T~y...2.~., 19. ?~. pursuant to which Building Permit No..~?.].2.Z.. dated .......... ~.u~y... ? ..... , 19. ?.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~p.a.r..~.n[flr.~;. ;[~-~...B{zT.n... ].r.$.t.b....a.(l~.t.! .ot~. ~. A~L.~¢~.t,.J~Q .n ................. The certificate is issued to .. ~.n..~](.a~.J:.?..~'~]:..sp.l~..(..ch~l.s.t.?b.e.r' .~?.~..~q~>.) .......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N. :.R~: ............................... UN ,RW I RS CERTifICATE .... ...... HOUSE NUMBER ... ~ ~.2.0. ...... Street ....... ~.t.h.. ~.~.... ~.e.e.~)pp.~.~; ............. ·/.¥.-~:,:,..~.~ :~... .... L~:. ~. : ~:1 .......... Building Inspecto~ FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8712 Z Permission is hereby granted to: R ..L.,J~.~..tA3c...;'J.C.....Ch=~.s ~o!.~e r...~elson .................. ~ 0.~ hO ]-Z~ ........................................... to ~3.~.~i~-..~-~..z*d~i.tzLo~..on..~x~,~£n~....a. Pa.~'~mert~"&n--'aeee~e ~r~-'~ ~g'"(' barn) at premises located at ..'~.~...9.th...~f,~....~..*_-..-bay. ......................................................................... .................................................... · Gr~por.$ ...... ~. ,~.r ..................................................................... pursuant to application dated ......................JL%l$~....-.2.~. .............. , 19.~..~..., and approved by the Building Inspector. Fee $.'J...,..,~ ............ FO~M NO. S TOWH OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE oF OCCUPANCY 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 end 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 end unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent 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 NewB dn , A'd,h n '/~'"" r ...... U' ' g ...............a ' 'o..e.....~.. Old o ~'re-exisring ~uilding ................ vacant Lena .............. Location Of Owner Or Owners Of Property ..... ~t~....~....~...'-~C..// ....... .~-.~....~...~...~... ................................ Subd v sion .... '~ ................................... LatoNa .....;~ Block No...~,. House No ../..~..o~...~? Permit No ......~...~.../..~.....~ate~JOf~ Permit(~.~.~plicant ..i,....~.../.;...~..~....X~//~ ...... i ............ Dept. Approval ......~.~..~.....~.~/~/) ...................... Labor Dept. Approval .......... ~..~...'..~'...~/,~? .......................... Health Underwriters Approval ..... ~.~.....~.~..~ ................. Planning Board Approval ..... ./.~./....~.. ....................... Request For Temporary Certificate ........................................ Finctl Certificate Fee Submitted $ Construction on above described building and permit meets all applicable codes and regulations. Applicant ..'~.... ~,~...~.....~......~,.~ ............................. Sworn to before me this ........... .?...d yof ...... ............. .'.7.. ..... Notary Public ........ ~.. County (stamp or seal) FOEM NO. $ TOWN OF SOUTHOLD , 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 all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasol--(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 19,57), 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: l. 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 z. ................... New B din Addition ~'~ Old or Pre ex( tin Bull 'in , ' ac t ' ' u g .................................. ~,/~r', ~J~ d'~/., - s gxx~. ~ _a g ............... v an Lana .............. Owner Or Owners Of Property ...~...~..~_,.~.~¥:...~e~.,.~. ........ [~..~..~....~M..~.~.. ........ Subdivision ...... ~ .................................................... Lot No. ,.,.~".. Block No..k ...... House No.,./...q.....)rP. Permit No....~..?../...~(.~..~.... Date Of Permit .,~./..~./.2.~.....Applicant ....... ..~.~.~.~...~..g:...~.~.....~ .......... Health Dept. Approvol ..... ../~...[...~T...: .......................... Labor Dept. Approval ......... .~.....~ ............................. Underwriters Approval . ..~...~ ................ Planning Board Approval J~/~-~ Request For Temporary Certificate ........................................ Final Certificate /~"~ Fee Submitted $ .~,.....~.,.~.. .................... Construction on above described building and~Rermlt meets all opplic~able codes and regulations. App,,cant .................................. ............ ....... .... Nota~ Public ..,,~ ...... Coun~ 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 plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relatiohship to adjoining premises or public streets oF ~ 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 }-IEREBY 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 !nsPections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate ~offi~er) Builder's License k~ ,~' ~- /'~' ~ ~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which/~,/ ~' ~Pr posed work~,-~ii' be/~ ,~-~,~¢t~l~e' Map No.:,.....~... ............................... Lot No:~. ....................... ..... ....... ....................................................· ........ Street and Number 2. State existing use and occupancy of premises and infended use and occupancy of proposed construction: a, Exisiting use and occupancy .......... ~ .................................................................................................................... b, Intended use ondoccuponcy .......... ..~,~.:.~ ................ ...................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) O 4. Estimated Cost ............................................................ 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 .d ......................... Number of Stories ................................ B. 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 ........................................................ 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 . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... 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 all set-back dimensions from property lines. Give street and block number or description acFo~ng to deed, and show street names and indicate whetherinteri)r°rc°rne ~t' ~Ja /~ ' / /.. ~ 7~ /~o~ · COUMTY OF~...~ ' ................................................................................................. bein0 duly sworn, deposes ond soys thor he is the opplicom (~me o{ individuol si~nino contracf) obove nome& He is the ................................................................................................................................................................................. (Controctor, ~oent, corporoto officor~ etc.) o{ s, id owner or ownors, ond is duly outhorized to por{orm or hovo performed the said work ~nd to moko ond file this opplication; that ~11 stotements cont*ined in this opplicetion ~re true to tho best o{ his knowlod~o tha~ the work will be performed in the m~nnor set {o~h in tho oppHcotion filod thorowith. Nato. Pub'~ ~c:,,,. I'uimc, state o, Ne'~ork ~ -- (Signatu~i;;~ ........................... r~ --4 GTB~-T u_ IViOL~. 0,~6 ~v. .m l?~C01dlC MAP OF LAMb AT ~4 y SC. AL-C: 50'= 1" A~EA = t2.t i ACDE$ 'E