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HomeMy WebLinkAbout8088-zFOl~g NO, ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's O~Eice Southold, N. Y. Certificate Of Occupnncy No..Z73.1.3 ..... Date .............. Oct .... 19 ..... , lg..~.6 THIS CERTIFIES that the building located at . ..Lair. el. A.v.e · &. Long. Ck. ~reet Map No. ~Y~CO~%. ~ock No ........... Lot No.. J.~ ..... So~holt..N,Y.. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Jnly.. 2] 19.7~. pursuant to which Building Permit No. dated ........... Jul~.. 2~..., 19.7.~, was issued, and conforms to ~1 of the requ~e- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is . P~.~V~P..0~..~l.Y .~w~.l~ Ir~g. ~.ith. addi~Aon ...................... The certificate is issued to . .Clifford .~tz ........ ~er ........................... (owner, lessee or ten.t) of the aforesaid building. Suffolk County Department of Health Approval .N ~t.. ............................... UNDERWRITERS CERTIFICATE No. ~.~(.~ ........................................ HOUSE NUMBER ...~8.~ ....... Street.,. L~re~ .A~e. 1~90 Long Cre~k Dr ...... ..... Building Inspector FOENI NO. 2 TO~N OF SOfT,OLD 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? 8088 Z Permission is hereby granted to: ....~ ~i: ~:'~...'i3.t,~ ................................................ ........ /~.ghc~-]:d ..................................................... to .~,~.t~ ~2~.. an...ad~ ~.t ~ ~.. ~.n.. ~ x.i.s.~, .~ ~ ~.. c~.v~ e .t.t -i-~ g. ............................................................... ot premises located at ..... L.c~.t...~..~......~er~e.a~.tt..~k ....................................................................... ................................................ · ~or:g..~.~:~...9 r-..e~...:~,a.u~re Lb"~'~e ............ ~'o'cc~c~_~ ......................... pursuant to application doted .............................. .~.~.~..~.~. ....... .~..1.:,.,., 19.~.~..., and approved by the Building Inspector. Fee $. J..;~ ~.v.O ........... Building InsPector FORM NO. $ TOWN OF SOUTHOLD , I~uilding Depmtment Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOP, CERTIFICATE OF OCCUPANCY Instructlons 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 disposol--(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: ]. 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. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. CertificQte 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 // Rte .......... .~~:/..?.:'.~ ~4 ................... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locot~o. of Property ......... ~.~. '~ .................................. ~,Z~ ....... -.Ye ........... , ............................... Owner Or Owners Of Property .......... ~..~..//.~.~..~.?.~.....~..~..~/.Z~....... ............................................................. Sub,~iv, s,on ........... .7..'~r~:?.'.d.~. ........................... Lo, No...~.~.. B,oek ~o ............. House No ............. Permit Na ...... °ate Of Permit .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ................ ii ............................ Planning Board Approval .............. ,~.,,. .................. Request For Temporaryoe~ificate ........................................ FinaJ Certificate ................ 7-~.~ ............... Fee Submitted $ ~ Construction on above described building and ~e_/al//~/?/i/C~ .W~)/~ulations, Sworn to before me this BUILDING DE.P,A. RTMENT TOWN CLERKS OFFICE ~ ...~.'~! SOUTHOLD, N.Y. ~'f'~a~ ~~-~ ~)~ (~ ~:~'-- Examined 19..)..~ Application No....~.. ....................... ~' {l~ui~ding Insl:~:tor) APPLICATION FOR BUILDING PERMIT ...... .......... a. This application must be completely fill~ in by ~pewriter oe in ink ond s~mi~ in triplicate to ~e Buildi~ Insp~tor, with 3 ~ of plons, occumte pl~ plQn ~ ~le, F~ accusing to sch~ule. b. Plot plan showing I~ation of Eat and of buildings on premises, relationship to odjoining premises or public streets oreos, and giving o detoil~ description of I~out ofpr~e~ must be drawn on the diagram which is ~K of this opplication~ c. The wark covered by this o~licotion moy n~ be commenc~ before issuance d. U~n QpprovQI of this opplication, ~e Building Inspectar will issue o Building Permit to the oppllcont. Such permit~ shall be kept on the premises ovoiloble for insp~tion throughout the work. e. No building shall be ~cupied or used in whole or in pa~ for any pu~ose whoever until o Ce~ificote of ~cuponcy~ sholl have been gronted by the Building In~ector. APPLICATION 15 HEREBY MADE to the Building Department for the issuance of o Building Permit pu~uont to the Building Z~e Ordinonce of the T~n of ~uthold, Suffalk Caunty, New York, ond other opplicobleosL~S'he~inO~i~nC~de~ribed. Regulations, for the constru~ion of buildings, additions or alterations, or for mmovol or demo~, The opplicont ogrees to camply with oil opplicoble laws, ordinances, b~ing c~e, h~ ~ o~d r~ulati~s, ond edmit authorized insp~to~ on prem,ses and in buildings for n~~./~ ffff / ............................. (Addm~ of oppllcont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .....//!111.~"~....~ ...... t...#"'"~..... ................................................................................. £1.~ . If applicant is a corporate, signature o~dl~ly authorized office. (Nome and title of corporate officer) Builder's License No ........ ~....'. ............ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location o. ,on o. w i. wor w,,, Street and Number ..... ~"~'""~"""~'/~~~" ' ~'u~~'""~'"' '~~i~i~Ji~ ........ State existing use and occupancy of p~ed use and occupancy of proposed construction: a. Exisiting use and occupanCYand .................... ~-~, ......... , ............ '~~'~'"'"~"~i~ ......... i .................. b. Intended use occupancy .................. i ........................ "~?'" ................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition ...~ Alteration~, Repair .................. Removal .................. Demolitior .................... Other Work ................ ~ .......................... (Description) (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 type 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 ....., , u _ .~"~' ............... 8. Dimensions of entire new construction: Front ......... ..~......% ................ Rear ~ ...... Depth ......'~...~.. ........... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ...................................................... N~me~ Fo/~er Owner ..................................................... 11. Zone or use district m which premises are s~tuated ...~I....~.: ......................................................................... 12. Does proposed construction violat~,ony zoning law, ordinance or regulation: ...... ~...~.~. ...................................... 13. Will lot be regraded ............. ,~. ~Vill e~ce~s~fill be removed from pre~l~e'~ ) Yes ( ) No 14. Name of Owner of premises ~~...~.. ............... Address~. PhoneNo ....................... Name of Architect ............... /~ ...................................... Address ................................ Phone No ....................... Name of Contractor ........... /..~ ...................... Address ................................ Phone No ....................... PLOT DIAGRAM Locote clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock 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 NL~O.~,/¢' IS 5 / COUNTY of · rz-;r. x / ............................ ~/..~.?..~........~ ..................... being duly sworn, deposes and says that he is the applicam (Nam~'6f-indj//,crual signing co'l~jbf) above named. ~' ¢ He is the .................................................. ~ ...................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authori2ed to perform or hove performed the said work and to make and file this opplication~the willth°t oil statements contained in this application are true to~d thetherewith.best of his~knowledge/ond belief; and that work be perform~C~in the manner set forth in the application fj Sworn to be]f4~re me thisNotary Public,.'~"' of / /J ~'/~ ', .~ · ~s~ County19'~""~-- ~ ,~/'~ ~~ .............. ...... ...... ...............................