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Home My WebLink About8346-zFO~t.~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy No..Z79.1.2 ... Date ................ Se.~t ..... 26, 19.7.7.. THIS CERTIFIES that the building located at ~a.~ s~.u.. P~nt. P~ad ....... Street Map No~a~.s. . ~ ... Block ~o ...........Lot No, . 4~7 · .. duteho~ue ........... conEorms substantially to the Application for Building Permit heretofore ~Hed in this office dated ............... Dec...1.9 19.7E. pursuant to which Building Pe~it No. ~6Z.. dated ............Dec.. ~", 19~.~., was issued, ~d conforms to ~ o~ the requ~ ments oE the applicable provisions oE the law. The occupancy for which ~s ce~ificate is issued is . P~iV~. on~ .f~mt. ly. d~elrling..~ith~ ~an. ~itlon .................. The certificate is issued to .Geo. rge. ~..Vi~ian. B.e. hrm~ ..... Owners ................ (owner, lessee or ~n~t) of the aforesaid building. Suffolk' County Dep~tment of Heal~ Approval ~, ~., ................................ UNDERWRITERS CERTIFICATE No. p~d.~2g .................................... HOUSE NUMBER ..... 6~,8~ .... Street.. Sa s sa~. Po.i. nt · Road ...... Cu. toheg~e ·. BuILDiNG'DEPARTMENT TOWN CLERK'S rOFFICE SOUTH'OLI~ N,.Y. BUILDIN~ pERMIT (THIS PERMIT MUST BE KEPT ON THE~ PREMISES UNTIL FULL COMPLETION oF THE WORK AUTHORIZED) N°. 8346 Z · Date ..... :L:....:L...:}i.~...:.D.~.':.~ Permission is hereby granted to: ,, ,,,,' ~, ' ~ ,~ · .... ..,, , ., ..... at premises located at .,;,L~; k~ ..... ~.~a~ .... ap .... .~........,.,~ ......... f.. ................ ~ ................ ...:,.: ............. ,.'.....L ........ l~.8.,Jl~i.~a~.~i:..=c~d....:..:.~ai~o~a~,.: ....... :.i ........ L:...:i:i ....... pa'rsuant to oppffcatJon doted ~ :~' i :! i,'19~, end approved By the Building' Inspector. ~ Dui~oing inspector.· ~Ol~ NO. $ TOWN OF SOUTHOLD , Betiding Deportment 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 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 fram 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 ....~.~...~.....~.Z.? .~... ...................... LN~ t ,Bo~i Id iorfg ;;~;: ;;';' ' ii...A~iii ~..P. ~.~.~.~ .~'., d ' r.~V.i~c.~.n.~.t. ;.~ .~...iiiiiiiiiiiii i Owner Or Owners Of Property ...~..~..~...;..../....~..~;...../'.~ ........... Permit No...ii~.'.~i~.'i ~2 ~; ~'2~'ii i iii iiii ................................................ Applicant ~J~ ~..~.~.. ~...~' '''' Health Dept. Approval ......... ~./..,~ ......................... Labor Dept. Approval ...~.:...~. ..................................... Underwriters Approval .......... ~....,~. ......................... Planmng Board Approval ........................................ Request For Temporary Certificate ...~..'..~.., ........................... Final Certificate .......................................... Fee Submitted $ ...... ~.:...~....o. .................. Construction on above described building and. permit ,~ts all applicable codes and regulations. Applicant .... ~ .......... :...Z~ ............. Sworn to before me this ~~;~: ..~../...J'.,..~.. day of .."~"..~...P...~...~...~'.~.~ .............. (stamp or seol)~//~u~-[~ Notary Public ..,~,,.,~,../~,, ,~.,.~,,~,. ...... County AUSTIN B. TUTHILL NOTARY PUBLIC, State of Sew Yo~k No, 52-4040975 / Qualified Jn Suffolk Counfy/ Comnljssion Expire~.~Marc_h~/~O~ i9'79 NASSAU I POINq' TOWN O~ SOUT~OL~ BUILDING DEPARTMENT~o. TOWN CLERK'S ~UTHOLD, N. Disapproved o/c ............................... APPLICATION FOR BUILDING PEP, MIT INSTRUCTIONS a This application must be completely filled in by typewriter aC ~ ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee acco['~li..,g 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 ofproperty must be drawn on the diagram which is port of this application. C. The work covered by th s app cat on 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 ~;hole or in part for any purpose whatever until 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 ir~ buildings for necessary inspections. (S~'gn~t~,m o~plica~t, or name, if a corporation) ~Address of applicant) /~'~_~__ State whethej~appiicant is owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or budder. /~,,,/~,., . .. ................ ....................... ........... .................. Name of owner of premises ~-~~...~...'.;~..../--~..~:~.~,~...~-e~. ...... ,~.~..~...~..r~.. ....................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................. ;~..../..; .......................... Plumber's,License No..d:.~...'.~.*~..~-~ Electricians License NO./fi~f-~,~...~%.~<~...~....2..~'~' ~ Other lrod* ~ Lmenso No ........................................... · · · 1. Locat,on of land on w~gropased work w.l' ~one. Mop ~ ........ ~ ...... ~ .............. ~... Lot No. Street and Number .~~...~ ........ /~Z.,....~/~~.i;i..;ii .......... ~ Mu~" 'p 2. State existing use and occupancy of p~m~ an~ed--~ ~ use and~~~sed~~~_~ construction: a. Exisiting use and occupancy ..... ..~..................... ......... ~~-~...-.~ ............................... b. Intended use ond eccup~ncy ...................................................................................... ~ 3. Nature of work (check which applicable): New Building'. ................. Addition ..... ~... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ...................................................,. ~/,/ ('~ ~- ~/~ (Description) 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 ~pe 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 ~ntire new construction: Front ........ ~ ........................ Rear ..... ~ ................... Depth ...~ ................ Height ...... /~..~ ..... Number of Stories .......... /....,' ..................................................................................................... . . /~/}~.....~., ~. s~ of ~o~: F~o~ ............ ~..~.~,..~ ........................ ~ ...... ~..=,.....~ ................ _,~D~p'h .............. ~0. ~,e o~ ,~ch~ .............. hZ~..~ ........................... ~ o~>~r ....... ~¢.., .................................. I 1. Zone or use district in which premises are situated ............ ~.~ ................................................ 12, Do&s proposed construction violate any zoning law, ordinance or regulation: ........................................................ I3. Will lot be regraded . ....... ~. ........... Will~c~s fill be removed from premises~ ( ) Yes ( ) No Nan~ e or- ~~A rch.t act ........ ~....,~ .............. ~ ,.~....~ ............... Add tess ..,.~ ............/7~ ............ ~ Phonen No ............ Locate cteaH7 and distinctly all buildings, whether existing or proposed, and indicate all set-~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. .......... ~...~.;.....~.~[~.....being duly sworn, deposes and says that he is the applicam ~ ~me of i~Ni~al signing contract) above named. He is the .................... ~.~,~. .......................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 fo~h in the application filed therewith. Sworn~to.b~ me this .... ~.'....'..:~ ~ ~ ~ ~d~ o~ ...... Nota~ PubJi~,.,~Z~,~ ...... Co, n~ ......... ~..,..~.~.~ ....... ........................... / ~ ~ ~ ' - (Signature of applicant) [ 'X ~ J~YNE M~c~ONAL~ X, ) ~[i~ur~k Couety //