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Home My WebLink About8729-zNO. 4 TOWN OF $OUTHOLD BUr[,]~I~ DEPARTMENT Town Clerk% Office $outhold, N. Y. Certificate Of Occupancy No.. Z72.~2 .... Date ................. 8elal;..2.., 19.7J6 THIS CERTIFIES that the building located at .. Tl'&ek .AVe ............... Street Map No. Peq~lamk Ae Block No ........... Lot No, ~ ..... C,atcho~ue.. K,Y, ......... conforms substantially to the Application for Building Permit heretofore fried in thi.~ office dated ............ J..u~. y....~ 3., 19.7.6. pursuant to which Building Permit No....~..'~.. dated ............ ~..n.l~....~.3., 19..7.6., 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 ...A.o.e.e..,.~p..~..(.~.e.~..e.e.d..h..~..~.q }. b..~..1.d..~. ~ ............................... The ce~fficate is issued to . .Jal~e~. %. AlI0~ .8la,elF .... .O.w~erj. .................. (owner, lessee or tenant ) of the aforesaid buUding. Su~olk County Depaz~ment of Hee/th Approve/ .N,~.. ............................... UNDF_~WRITE~S CERTIFICATE No..1],~.o ....................................... HOUSE NUMBER ...... &~O .... Street .. T~'~¢k. ~.ve ............................. ........... Building lnspoc~ BUILDING PEBMIT CT'HIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) 8729 Z Permission is hereby grontacl to: ....... JiL&.~aa.,~r. ........................ .............. _~te~lmlmlUe ....... X.~'. ........................... pmsuant to eppllcaflon dated ........................ .~'...~.~' ....... !~, ......... , 19..~.6., and approved by the Building Inspector. .~ SOU*THOU), iq. Y. ~'~'~ "/ ~. / ~* .om,n., ..... Disapproved a/c ....................... ._~.~ INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building Inspector, with 3 ~ of plato, 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 areas, and giving a detailed description of layout ofpraperty 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 Zorm Ordinance of the Town of Southold, Suffolk County, New York, and other applicable laws, Ordinanc..es or Regulatlem, f~r the construction of buildings, additions or alterations, or for removal or demo/ition, as herein descr:bed. 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. _ .......... ................................ /l~ignature of opplicont, or ~me, if a corporation) .... ........ ................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ½ ............ ..................................................... ~-r' ...... i .......................................... : ......................................................... Name of owner of premises ....... J..~...~...~.~ ...... ...~.........~.......~.//.~.~.......~...:.....~./~...~....~.. ........................................................... 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 ............................................... Location of land on which proposed work will be done. ~ap No.: ~...~...~..~..~..~§~.~.q.~..~./~.¢.~,~ Lot N~. ......~'... .............. um r ~.~ .T.~.~,~ Av~u£ ~T~H-e~'~- Street and N be ........................................................................................................................................... Municipality State existing use and occupancy of premises and in:ended use and occupancy of proposed construction: a. Exisiting use and occupancy ...... ..~.~.~.h~F..~.,,<:.,.<'. .................................................................................................~.._... . 3. Nature of work (check which applicable): New Building....~.. ............. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ' . .... .~ /~) (Description) 4. Estimated Cost .... .~..~...O..:...O....O.. ................... . ................. 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. D~sions of entire new construction: Front .......... ./.~ ..................... Rear ......... ./..~. ............. Depth ..... ../...~. ............. ~ ...../...~..../. ...... Number of Stories ..............~..~..~. .............................................................................................. 9. Size ~f lot: Front ........... ~.~..C).,....O.. ............................ Rear ...... ~.~..~i..../.~ ................... Depth ........ ../.~..~..:~ ........... 10. Date of Purchase .....~.~...~.....~,......./..~.Z.~.. .................... 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. ....... .A./~ ............. Will excess fill be removed from premises: ( ) Yes (~<) No 14. Name of Owner of premises ..~.j).~.~....~.~:...~..~....~....t. ........ Address~...~...~....-[.~.a...c.L~......A...~..~.. Phone No..~.,~..~.~...5~.....2..(. 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*b~ck 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. t STATE OF NE~/_ ~,j~jx.~ ~ S S COUNTY OF ..I~I~[IIM~ ............... ~ ' ........................... ..~..~....~....~ ................................. being duly sworn, deposes and says that he is the applicanl (Name of individual signing contracf) above named. He is the ............................................... ~ ...................................................................................................................... (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 fife this application; that all statements contained in this application are tr~,'Tto the best of his knowl~ge and belief; and thor the work will be performed in the manner set forth in the applicatig~ ~ed therewith. // , ~ Swam to before me th s / / /// / .......... ......................... ,,,, ......... ., Ng~ary Public, ...................... ~ .......... County ............ ~.,~:.:..~... · ~..... 6-~~ ............................ ~ 9~' ' ~ ~ ,~ /',,~ *'~' "~ ~, /2 // (Signature or applicant) J -" ! I \ ! z I ! / / / I / I / I / \ ! , o/ FOI~I NO. 6 TOWN OF SOUTHOLD , Building Depa~tmen~ 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 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 os 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 s'o~,z~,/~,s*~'~ Date ...~..~7.?.~.?.~.~.=.....! ...... !~.. New Building ~?fr.~-~.~P.~./,~ddition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ......... .~.~.°......L..~..~.~.J.c:.......~..\~(~ ........... ..~.f/..!.~.~.~..~.£Z..~Z ........ ../~.:..~... ........................... Owner ~r ~rs Of Property .............. ~.~.~ ...... ~...,~C~.~ ................. ,~ ................................................... Subdivision ..........~['X.~.~-....~.~.~:~ ....................... Lot No.....~.... Bilk No ............. House No..~.~O... Permit No. ~.~.~ ..... Date Of Permit ~,~¢~Applicant ... ~f.(~:...~.~ .......................... Health Dept. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinoJ Certificate .................................... Fee Submitted $ ....o~.~.~.c.~.described ..................... O~ ~/D g~ Construction on above building and p/ /_.~ meets all appli ulations. Applicant ~ ......... ~~~ ........................ // Sworn to before me this / / ...... o, ......... NOTARY No 52-8125850, SuHolk County