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Home My WebLink About8077-zNO. & TOWN OF SOUTHOLD BUILi~INC. DEPARTltfE.~IT Town Clerk's Office Southold, BT. Y. Certificate Of Occupency No.Z.7.~.9. ? ....... Date ............ &.l~ .... .~t~ ..... , 19.7.6. THIS CERTIFIES that the building located at ... ~/8..Third .1~. ~ .IM~r... Street Map No... ~ ...... Block No.....X/~. ..... Lot No, . ~g....~.e.w....~f..f.o..~. ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .J..u.].y... ~. ~., 19.7.~. pursuant to which Building Permit No.. dated ............ J.~Y...~.., 19.?~.~ was issued, and conforms to all of the require- ments of the applicable provisions of the law. Theoccupancy for which this certificate is issued is ...N?...~...B~..S.~.l~.e..s.~..B.~t..~.~.d..~[~. g...(.F~..~.~..~.e. 8.t.a.~. $.o~..). ...................... The certificate is issued to . .Nev.~Qn. F~hbi~.s ..... 0a~nel, ........................... (owner, lessee or tenant ) of the aforesaid building. SuffoLk County Department of Health Approval ...N,~e ............................ UNDERWBITEBS CEBTIFICATE No..N.~t~ ....................................... HOUSE NUMBER ..... ~.0 ....... Street .. ~,~. ~.~ ...... ]~e~..81~ff.o~k ........... FOEM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 8077 Z Permissign is hereby granted to: . .~t.~w.~.or~... A~ o~.~b ~_~ s .......................................... ........... · ];,~e~ .. ~u~£ ~.~k .......................................... Fo ~.b.~.u..i...~.~..a..n.~.a.~:~.i.~.t..i...q.n..~..~..~.~.e...x..i..s.~.t.~:~..s.~g~`.~.~$~.~.~ ............................................. at premises located at ...... ~.~z..~,b.~,:~.Cl,..~,~...~..,~ ~. .......................................................................... ................................................................ ~.~...~i.~'~.~k ....... ~:^~.,. ..................................................... pursuant to application dated ..................... J.~.~.y ........ t..~' ............. , 19...~.~., and approved by the Building Inspector. FORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLiCATiON FOR CERTIFICATE OF OCCUPANCY Instructions A. This appllcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building inspector with the fallowing; for new build!rigs 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--iS-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: ]. 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: l. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existir~j dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ................... ....... Location Of Property ........... --~...~ ........... ~' ~~' ~..~..::..~..:~..~..~.....%~ ~.J..~..~ ~ ~' ...... Owner Or ~ners Of Property .......... ./.~...~~~. ............................................................... Subdivision ................ Z: ............................................. Lot No ....... Z;:.. Block,No..~.~ ..... Hous~ No.~.~.,., Permit No. ~[.~...~.... Date Of Permit ....~. ........ ~plicant ........ ~ ...... .~ ~.....6.~.I: :~ ...... ............ ................... ........... ........................ U~d~r~rit~r~ A~r~r~l ...... ~ ....................... Pl~..i~ B~rd A~r~r~l ....... ~ .................. R~I F~r T~m~m~ ~ifi~t~ ........................................ ~i~ ~rtifi~t~ .......................................... Foe Submitted $ ............. ~..~ ................. or~t m~s oll opp~ble~ond regulations. Construction on above described building on~~ Applicant ................................. Sworn to before me~/this// ~ w~ ................ day of ~...'~;~..... .......................... (stomp or seal)~-- //~ .o.~ .u~,,~ ....... ~x ......... ~.<:... ..... Cou.~ TOWN OF SO~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........... Examined .. Approved APPLICATION FOR BUILDING PERMIT Date ..................... .~...~ ................ , INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 lecation 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 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 insj~ections. ........ ........ ~ ', - (A~Jdre§~ 6f applicant)'// State whethe~he,~rr applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... .......... ............... ............................................................................... Name of owner of premises ...~~i..~.~ .../f~.-~ ....................................................................... 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 pr~l~osed/) /~., ~work ~1~ be done. Mc~p,~qo.:.,. ............. ~ ................... ~. Lot, No. ~ ..................... Street and Number ~.~~...~.~..~"~'""~~~ ........ I / ~ State existing use and occupancy of pr~es o~dfin~ded use p~ occu~ ~f~roposed con~n: a ExJsiting use and occupancy ~~-~. ~~¢'""~)":~" ............ b. Intended use ond occupancy .............................. ~:'.~ ~"'~7'" :~' ........ .~ 3. Nature of work (check which applicable): New Building.. ................. Addition ............. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................. ~ ~'r~l/~e--~ (Description) 4. Estimated Cost ............... .~?~.~.. ....... {': ................ Fee ........................... ~..S_.~..:~.~. ........................................... (to be paid art' 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 n~ature and extent of each type of use ................. 7. Dimensions qf ex)ftmg structures, if any: Front ...... ~1~1 ............. Rear ......... 2~. ..............Depth .......'..~.~..' ..... Height ..... /.~.. ........... Number of Stories .............t .................................................................................................. Dimensions of same structure with alterotio--or additions: Front ......... ~?~.~ ............ Rear .....,s~.....~).. ........... / ' ~/ umber f torles Z Depth ......... ~ ........... Hmght ........ ~ .................. N -- o S ' · ................ ~:.....~ ..... 8. Dimensions of entire new construction: Front ................ ~ ............. Rear ............ ~ ......... Depth ...... ...~......~.. ....... Height ..... ~.~...~ ...... Number of Stories. ........... /. ................................ .~w ........................................... ~ ..................... 9. Size of Iot:~Front ...................... ~...~....? ................... Rear .............. ..~..~....~ ............. Dep;k~ ...... ./ff..,~...~.~.Z...,~ ..... 10. Date of P.,_u.~rchase .................................. /..~.~.~e ~f~orm~ Ow~~.~.~.~t'~ 1 1. Zone or Ua,; district in which premises ore situated ....~ .............. ~1~. ................... 12. Does proposed construction violate any zoning law, ordindhce or regulation: ............. .k~r../~c~,. ........................... 13. Will lot be regraded . ......~_..~.~.. ........ W411 exce,~t~ilJ~;~eremoved frj:m~:pi:emisesh( ,} Y,.es 14. Nome of Owner of premise~ .~.~,~...~¢-~Address ~~(~hone Name of Architect ~.~......:...~...~,,1~ Address/' . .~.~'. Phon~ No ..~.......~.. ~L_ .......................................................... ?~..~.. ....... P ............ Nome of Contractor .................... ~....~.~L.D~ ................. Address ............. ~.e. ............... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing 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 corner lot. STA3E OF NEW~,ORJ,~,.,, ,, ~ S S ' cou NT.Y,, .~,OF ,.~z~i.~. ~. ~,---...f ', , ......... ........ ......................... (Name of indivi~Zai signing contract) obow~ named. He is the ........................................... D.~.~.~ .................................................................................................................. (ContractSr, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make ~nd file this application; that oll statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this~ ...... o, ...................... , Notory Public,. ......................... :~,.J.J~... Coun~ ...~ ...... J/~,~"Y'"/'I'~"~ ......... TARY PUBLIC, State of New York No. 52-8125850, Suffo]k County T~rm Expires March 30, ]9~ ~