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Home My WebLink About8434-zFOi~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z .~.l~? ..... Date ....... Jl~y... 3.0. .... , 19.~.~. THIS CERTIFIES that the building located at . .~/(.~ .R..o.~.k.y...Pp.~.n.g...R.o.a..d.. Street Map No.. X~. ....... Block No. ~ ..... Lot No. ~xx East Marion conforms substantially to the Application for Building Permit heretofore filed in this office dated .~ ........... l~r . 22., 19 ?.~. pursuant to which Building Permit No.. dated . .. 1~..a.r..2.2 ..... , 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 .P.r..iy.a~.e...o.n.e...f.~l.l.y..dp.e..1.~..~.g ..................................... The certificate is issued to . .qeg.~.g.e..~. g.d~..rd..~. .... .C~..e..r ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ;~u.ly..2.?. ).9..7.6..b..y..R?....V.i.~.l..a. UNDERWRITERS CERTIFICATE No...l~e.n..d.i.n.g ................................. HOUSE NUMBER ...1~.1~% .... Street .... .R. qqk. y..P.q.i.n.t...Rg.a.d. .................. Building Inspector FOR~J[ NO. 2 TO~/N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ' i BUILDING PERMIT .(THIS PERMIT MuST BE KEPT ON THE PREMISES UNTIL FULL r~CGMPLETI~DI~i~ OF TRE WORK AUTHORIZED) N°. 8z]3,] Z Date ........................ ~ ......... ~ .......... , 19..~.' FOR~ NO. $ TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled m typewriter OR ink, and submitted in DUPLICATE to the Bu~ldzng Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, aha 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 bu,ldings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect ar Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te 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 hnes, streets, buddings 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 buddings 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 ar land use $5.00 3 Copy of certificate of occupancy $1 00 ..... ....... New Building ...,~ ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. .... ..... ......................................... Location Of Subdivision ............. ~ ......................... t' ................... Lo~ No......'~.. ..... Block No.....~z.. ...... House No ............ Perm:* No~..~....~. ..... Date Of~. n . Perm,t ~..I...)~pl,cant ~...(~.~~ ............. Dept. Approva, ............ bor pt. Approvo, ................... --. ............................ Health Underwriters Approval ............................................. Planning Board Approval ........--Z. ............................... Request For Temporary Certificate .............. ~ ....................... Final Certificate .....~.....-~.. .................. I Fee Submitted $ .~. .............................. Construction on above described building and perm_it meets all opplicgble codes and regulations. INSTRUCTIONS o. This opplicotion must be completely filled in by typewriter or in ir~k ond submitte~ in triplicote to the Bui~ing~ Inspector, with 3 se~ of plans, occumte plot plon to scale. Fee occording to schedule. b. Plot plon showing !ocotion of lot end of buildings on premises, relotionship to edjo n ng prem ses or public streets oreos, ond giving o detoiled description of I~yout ofproparty mUst be drown on the diogram which is part of this applicotion. c. .,~.~ ~ork covered by this applicofion moy not be commenced before issuonce of Building Permit. d. U~J~approvol of t.his opplicotion' the Building Inspector will issue o Building Permit to the opp cont. Such permit~ shall be 4~ll~t on the premises available for insPection throughout the work. e. No building shall be eccupJed 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 i~uild!n.g. Zon,e O~inance of the Town of Southold, Suffolk.County, New York, and other applicable Laws, Ordinances or~3 egu~arions, tar the construction of buildings, additions or alterations, or for remova or demo ition, as here n described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ........ ......... .... - ....... ........ (Actress of applicant) State whether applicant is owner~ !essee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises :~;~~ .................. ~ ....... ~ ""~'""-~' If applicant is a corporate, ~ ........................ .................. ......... -- -- -- Builder's License No ........ ,,~,...~....~.......~-..,~... ......... Plumber's License No ................................................. .2.- Electrician's License No... ..~......~ ......................... Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Mop_No.: ............... ~ .................... Lot No.....'=.. .................. Street and Number ..~,~..~...~..~,v~.~..~..,./~....~. ................... ..~...~.~......~...~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .....~:/..~ b. Intended use and occupancy ...,~ "..~i...C~....~.~~ ................................ 3. Nature of work (check which applicable): New Building......~, ........ Addition .................. Alteration ................ Repair .................. Removal Demolition .................... Other Work ..................................................... ~'.~ ~--~.~ ~'2 c7 z....-~oc~o (Description) ,,ma ed ....... ........................... ....... ................................... (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 ~m ............ ~ ............................................................................................................................. 6. If business, commercial or mixed ~cupancy, spec~ nature and extent of ~ch ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Nu~er 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 ....... L~/... Number of Stories ...... ~: ................................................................................................. 9. Size of lot: Front .......... /..~..,.~. .................' ............. Rear ..... ~..~ ........... ~.~ ..... Depth ..~.~ .................. 10. Date of Purchase ~/.~0 ........ ~ -- Name of Former ~ner~~ ..... 11. Zone or use district in which premises are situated ...l~.~..,..~..~.~......~ ]2. Does proposed construction violate any zoning law, ordinance or reg~ation: ...~ ............................................. 13. Will lot be regraded' .....~ ........... Will excess fill be remov~ ~r~ promises: ( ) Yes (~ No 14. Nome of Architect ......... ~ ................. ~~ ~~ .................. ~ ...........A~re~ ............. ~ ................. phOne No ..... '~..' ............ Name o, Contractor '~"~(PLOm .................. DIAG~A~re~ ~~ .............. "hO~ "0.~.~.~.~ kocote clearly ~nd distinctly oll buildings, whether existin~ or proposed, ond indic~t~ all ~t~k dim~n~ion~ {rom prope~ lines. Give stroet and block number or description occordin~ to d~, ~nd show ~tr~t nam~ on~ indico/, ~hothor intsrior or corner lot. .~/./'~ ............... being duly sworn, deposes and .says that he is the applicanl- "'-(lq'ame of individual signing c_ontracf) 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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before,me this ........ Notary Public, ~ec:~-~..~c....~.~ounty ......... ~ ..~.....'w~.....~.....,~.....~:.-..'~:...;...; .................. (Signature of applicant) JUDITH T. BoKEN Nota~ Public, State of New york No, 52.0344963 Suffolk- Coun.~/~7 Commission Expirel Mamh The se~,age dispcnal and water supply facilities for tl:~s locat_oA h&ve been inspected by this ~epartmozit and foun~ ~L~ %f General Engtneerin~ Se~ices