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Home My WebLink About8051-zPO~M NO. & TOWN OF SOUTHOLD BUII.I~ING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupency No. Z~3.~ ...... Date .............A. gg...!~. ....... , 19.7.~. THIS CERTIFIES that the building located at . .~ :.0.:~ :..P.a.r.k...A.v.e. ........ Street Map No... ~ ...... Block No..xxx ..... Lot No...L'C~... ~a/;/; ~.~;uak. lt..X o ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........J~l~.o...27..., 19. ?~. pursuant to which Building Permit No....8.0.~.1~. dated ........... Ju3,y.. ~..., 19..7-5, was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... Ac¢Z.~OrY..~V.;[~.~.~,~l~ .($.t.o.r~g~.. q.t.c.). .............................. The certificate is issued to .. p.e.~. ~.a..n~9.~ ....... ~e.r. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~.,.R.: .............................. UNDERWRITERS CERTIFICATE No...~.*.'q.: ...................................... HOUSE NUMBER... 27.Q ....... Street...~rlc..J/V~ .............................. Building Inspector FO~M NO, 2 TOWN OF $~UTH~LD 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) N? 8051 Z Permission is hereby granted to: ~,..~e~i.....A/fL.i:2~;e.~..~an~n ............. ..................... Ma~.~i.t.~k ....... E.~.~.. ..................... to...b.~.z.~...~.e..v....a.~.e...q~..s..s...~.~....~.~.~.:.c.~..~:..~...z..~...~..~ .................................................................... ( to be in rear yard area) at premises located at ....~.?..0..,.~.~..,.......~../~....?.~.~.~....~..y.~. ........................................................................ ............................................................. ~;L .~ .~.¢~,.... ~..., X ,. ............................................................... pursuant to application dated .......................... .~....~..~. ....... ~ ........... , 19..~..~.., and approved by the Building Inspector. Fee $...1.o......o.9 .......... .............. ~ ~ Building Inspector / FOF~I NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office So.thold, 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 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 ................ ~..I.. ................... . ..... New Building ...... ..~ Addition ....~.. Old az Pre-existing Building ................ Vacant Land ............. Location Of Property "'~""~'"'~'"'~'~"(~'~]~F ~/~. ~'~""~'"C~z'""~ .......... ~'~:~ Permit No. Date Of Permit .~.~l.~.Applicant ..... ~.....~~..:: - ......................... ......... ..................... .............. ............... Underwriters Approval ....... ~ ~ Planning B~rd Approval ~' ~ R~uest For Zemporary Ce~fficate ........................................ Fin~ Certificate ....~ .............................. Fee Submitted $ ~' ~ Construction on above Sworn to before me t? ......... dw of ....... Notary!Public ...~ / t~.../..~.~-~ (stamp or seal) County ~0~ NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE (~ SOUTHOLD, N. Y. Exom ned ............ Approved ..... .~../......::..! ....... ~..~......, 19...2.~ ~erm,t No. ~?.~.~.i.~....~ ....... Disapproved o/c ....................... APPLICATION FOR BUILDING PEI~MIT Application No...~..~(~}~.~/. .............. 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 Eot 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 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 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 inspections. (Signature of applicant, or name, if a corporation) ........... .... (Address of applicant) t State whether applicant is owner, lessee, agentr/,6rchitect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and ti1 of corporate officer) Builder's License Plumber's Electrician's Other Trade's 1. Location of ap wh!r,~ proposed work will be done. Map No.: ...~ .......................... Lot No. ~ ......... Street and Number .~~., ........................ ~~'_~ .................... i ........................ Municipality State existing use and occupancy of premises and intended use andoccupancy of proposed construction: a. Exisiting use and occupancy ...~ .......... .....~:...-.....~.: .......................................................... b. Intended use and occupancy .....,~ L__ , z',/.~f~,iT,~~~,~-,~....~.~.. .............. . .............................................. 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demoiitior ............ ~ ........ Other Work ................................................ .... ~*' (Description) 4. Estimated Cost .............. .~. ....................................... r..~ee .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelting units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent o~,each type of use .............. .t ............ 7. Dimensions of existing structures, if any: Front ..... ..~...~.. ............... Rear ...?...../.. ..................... Depth ....~..~.. .......... Height ..L.~.....' .......... Number of Stories ..................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories . 8. Dimensions of entire new construction: Front ....~...~). ........................ Rea . . .... Height..~. 'c~.;....~.~.. ,.fNumber of Stories ...... ~ ..................................... ~,: .................................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: .... ~ ................................ 13. Will lot be regraded ..~ ....... Will excess fill be remqved ~;~mi~es: ( ~ees ( ) I~o Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ........................................ ' .................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex]sting or proposed, and indicate all set-back dimensions' frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corne,~ 0 L ........ ~....being duly sworn, deposes and says that he is the applicam (~~l signing contract) above named. ~-'~ ~ ~ ................................. .......... ............................. ~ (Contr*ctor~ aoont, corpo~o officer~tc.) of said owner or owners, ond is duly ~uthorized to pot{otto or h~v~ per~6rmed the s~id work ~nd to moke ond file this oppHcotionj thor oll statements contoined in this ~pplicotion oro truo to the best of his knowledOo ond belief; end tho~ tho work will be perfor¢~ the m~nner set fo~h in the opolic~tion filed thorowith. .................. .......... ,, ................ .. ..... Coun ....................................... Noto~ Public, (Signature of applicant)