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Home My WebLink About8101-zFORM NO. i TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Of[ice Southold, N. Y. Certificnte Of Occupnncy NO. m gfi~3 ..... Date ............. .J.u.ly.... 28. .... , 19.7~. THIS CERTIFIES that the building located at .Johns.. Road .............. Street Map No...;K~x ....... Block No... :~x .... Lot No, .xxx..Na.ttitueak.. N.,Xo ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. Jlll.y .. 2~ 19 ~.~. pursuant to which Building Permit No. 8.10~z.. dated ........... ,Y. tl.ly .... 2~., 19.7.5., 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 Pr. Ira.ge. ac.c. essor, y. B~lildl~ag .(storage..e. tc ) ........................ The certificate is issued to . Leslie..&. Ninex'.vm.. Algem ........ wr~ers ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N.~R, ............................... UNDERWRITERS CERTIFICATE No.. N,R, ...................................... HOUSE NUMBER ... ?.25 ....... Street..J. ohaa .Road ............................ FORM NO. ~ TOWN O~ $OUT~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) 8101 Z Dote ~.,/U/-. '/' ~' 19.?.~.T Permission is hereby granted to: .LL~:,L...~..~L.~'..~.~.~ ...... .~.L~-.-.5. ........ ~o ....?.Lf..~ .......... .~. ......... .~...'..~ ............ !~.Cc....z.-....:. £ ~'..:~.:~. .......... :~.~.~..,.:,..,.~ ....................... at premises located'at ............................................................................................................................ ...................................................................................... ~L'.].~.!.Z.~:.~..'..~ ................................. pursuant tO application dated ........................... ...~..~.L..'.::....~Z....., 19.7..~..~ and approved by the Building Inspector. re, .......... Building Inspector FOR~ NO. S TOWN OF SOUTHOLD , Building 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: ]. 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 s;Jpply and sewerage dispos~{--(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: i. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existlr'~3 dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 . _ New Bqilding ................ Addition ................ Old or Pre-existing t~uilding ...~ ........Vacant Land .............. ocation ut ~'roperty ........ : ................ z..:_,.,~, ...... :.,~ .................................................... .~ ................................ Owne Or ~ners Of Prope~y ......................... ~... .......................................................................................... Subdivision ................ ~...:::.::: ............................ Lot No.~: ........Bilk No.......;,.... House N~.. ...S ....... ............................... Health Dept. Approval ........... ~..,,:.3 ..................... Lair ~t. Approval .............. ~,.;,,Z,~ ...................... ., . Underwriters Approvol .............................................. manning B~rd Approval ........................ Request For Tempora~ Ce~ificote ........................................ Find Certificete .......................................... Fee ~bmitted $ ...........~...~ ............ Construction on above described building and Fit meets all applicable codes and regulations. Applicant .......... ~,.,..~...*... · .~......~..~ ......................................... Sworn to before me this ................ day~ ............................... Notary Public ~yc ....... ..~ ............ County (stamp or seal) c TOWN OF SOUTHOLD BUILDING DEPARTMIEHT TOW~ CLERK'S OFFICE SOUTHOLD, N. Y. Examined · · ........................................ , 19 :~ .......................... ...... . ,9Z mlt No. 69'0 Disapproved a/c ....~ ....... ~ ........................ (Building Inspector) ~%oplicotiOfl No. (~/~ / APPMCATION 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. P at P on show ng location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofpraperty 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. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy e. shall have been granted by the Building Inspector. APPL CAT ON S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Bud ng 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. . ........... .............. ................................ ,,...,,, (Address of applicant) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem~s ............ ~ ..................................... ~. ................................. ~. ..................................................... If applicant is a co~orate, signature of duly aut~rized officer. (Name and title of co~orate officer) Other Trade's License No ............................................... '----- ---.,, Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ..................~....'~. ~?..('~....T'....~.......~..--~.-.---.~-.?.. ........ .~...~..-.~'...~...-~-..~"' ....... ~ ..~.'....i ......................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: Z ' ' ,'" - t Ar',"' a. Exisiting use and occupancy ............ ~.....~.....'~..~...~.....~.. ......................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of wore (checE which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Wore ................................................ . .... (Description) 4. .mated Cost .......... ................. tee ........... ............................................................. (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 ~ ,=x- Depth ........ ~...~...~.. ............ Height ......... ,J~l~.: ............. Number of Stories ............~ ............... Rear .......... ~..o. ............. Depth ...../.?.. ............... 8. Dimensions of entire new construction: Front ......... /.o.....?.,.(.: ........... ~'~- ~- Height.......,............0~ ! Number of Stories ......... / ........................................................................................................... ....................................................... / ( /~ ~ 9. Size of lot: Front f~..J'~' Rear ........... ~..~..-. ........................ Depth ................................ 10. Date of Purchase ................. /. ..................................... Name of Former Owner .......... ./..~.~...~.~.,e..¥;.."~. ...................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed cons~ructio(n violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded .........~ ............Will excess fill be removed from premises: ( ) Yes (~"~ No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No; ...................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~k 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 NEV~-"~ ~..~,,~ ~ ¢~Y'ORK'~' ~ ,~ ~S.S COUNTY OF · '- ................................................................................................. oelng duly sworn, deposes and soys that he is the appiicanf (Name of individual signing contractO above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and tl-,a~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this . day ............................. .............. Notary Public, . ................................................... County ............ ff.'~...':..';.......?-_. ............... .~..-...-~.~-..._-.~ ....................... (Signature of apl~licant) NOTARY PUBLIC, State of New York N0. 52-8Z25850, Suffolk Co~lZty, ~'mm Expires Ma~h 30,