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Home My WebLink About8001-zFORM NO. · TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certi icale Occupancy' No..Z?0~.7 ..... Date ............... I~y .... I~6 .... , 19.~.6.. THIS CERTIFIES that the building located at . .Del3aar. D~,ive ............ Street Map No..La..~1.,..~.i;y. t~sl~lock No ........... Lot No..lt~ ..... La~ll... H,Y, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .,Itme...](z 19.7.~. pursuant to which Building Permit No..~00]Z.. dated ............. ~[tlrlo...16, 19.7-)'., 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 ...PI'l.v.~t;e. a,~ce~sn~y, l(~t:oI, age ). .blllld~ng ........................... The certificate is issued to . Chas .&. tt~.enda .l~izlao .... awn~l,s ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~N,R., ............................... UNDERWRITERS CERTIFICATE No..N.:.R; ....................................... HOUSE NUMBER ...2~0. ...... Street ... Do,al'. [)ltive ......................... Building Inspector ~ FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8001 Z Permission is hereby granted to: chft~.:l,~.~...,X...~.a..~.......~.~..o. ............................. ........ I~.~..L.....:~... ~. ....... :. ~q~:~ .................... ~ ..... Matt. ) to ...Bu~d..4ne.~..acceaso~...sto~aga..buildir~ .................................................................. at premises located at ...~.Qt....~.....L.~,.q,V.O~...g~.O. qlP,.t~ZY...~.a.t;'~l.~.~ ................................................. .................................................. .~..t.~.o......~...~...~ ..~r..t.~.~ .......... .~.~_~ ~1 .......................................... pursuant to application dated ..........................~..~.~.......1..~.. ........... , 19.~/~..., and approved by the Building Inspector. FORM NO. $ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Saul'hold, 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 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 formation required to prepare a certificate. C. Fees: ]. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $,5.00 3. Copy of certificate of occupancy $].00 ..-Ii D~te ..... .~.~... ~....*..Z:....~..~..?....(D., .............. mew ~ilaing .:- .............. Addition ................ Old or Pre-existing Building ................ Vacant Lend .............. ...... ..................................... Location Of rroperty Ow e Or ~ ers O~ ~ro~e~v ..~ .......... ~.....~ .......... :...~. .......................................................... ~.~.~ Pormit ~o ..................... Dot* O{ ~ormit .................... Applicant ...~r.~.~[n~.~.h.....~..:...~.~.:~.~:~. ......... Heolth Dept. ~pprovol ............................................ kabor ~pt. Approwl ................................................ 0ndorwriters Approval .............................................. ~lonninfl B~rd Approval ....... ~ .......................... R~quest For T~mporo~ Co~ificote ........................................ Fin~ Cerfific~t~ Foe Submitted $ ....... ~)..~ ............. Construction on obove described building ~nd pormlt moets oll 0ppficable c~s ond ro~ulotions. Sworn to ~fore ~ thi~ ...... ........... ........... No~ Public, State o~ New York ~7 co~ion expires Mar. 30,19 ~ ~ TOWN OF $OUTHOLD ,,~o~ -'¥ ~ ~.~ ,~,?,~.,~ ~, ~ BUILDING DE~RTMENT ~ ~ /~ TOW S OmC ' ~ ~UTHOLD, N.Y. ~ c~ ............... .......... , ~proved ~..,d/ ............ /.~. ........ , 19..'~. Permit No.~.~ ~.~....~/~ ~ ~. ~'~ ~ ~ Disapproved o/c ....... ~ ............. ~ ...... ~*-..: .......... ~ ....... I~STRHCTIO~$ 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, relationship to adjoining premises or public streets or 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 a Building Permit to the applicant· Such permit/Z) shall be kept on the premises available far 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 Southald, 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 app ica t,'~rfr , ' p ' ............... ............................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ..~...~.....Om......~...~....~...S:.,....~.........~..~.~.~...!~..[7..,~..?..?...~.....Jm...."...*.!'N..!*.''2T..'.'~...~ ............................ If applicant is a corporate, signature of duly authorized officer. ....... (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electricians License No ............................................. Other Zrode's License No ............................................... ko-ctrtJ (Zou, vbtr¥ I. Location of land on which proposed work will be done. Mop No.: ................ .~,.~..~.0~.~.e~.,%... Lot No. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .......... ..~.....~ ......................................... 9 ........ ~"~ ............................................. 3. Nature of work (check which opplical~le): New Building'. ............. 7' 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 ..... ,.J'.'. ................. If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specffy nature and extent of each type of use ............................ Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 10. Dote of Purchase ..... ..~...~..'..'1 .................. ...... Name of Former Owner ...... ........... 12, Does proposed construction violate any zoning law, ordinance or regulation: ............... /,,~.....~.. ................................ Will lot be regraded , ........ I.~....~ ........... Will excess fill be removed fromm premises: ( ) Yes (~ 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 according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW Y~q~[~, #~ lc c COUNTY OF...~~.....c f~'~ ................... ~:~,...~ ................................... being duly sworn, deposes and says that he is the applicon, (Name of individual ~ing contract) abow~ 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 ali statements contained in this application are true to the best of his knowledge and belief; and thQ~ the work will be performed in the manner set foffh in the application filed therewith. Sworn to before me this '. ........... ...... ......... , o 0 ~ 'Public, State of ~ew York ~0. ~2~41175 Suffoll Cotm~ ~y c~{ssion expi~s Mar. 30, ~9 '/~