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Home My WebLink About8113-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupency No. I~6~.9.i ...... Date ................ l~.el~$...1.?..., 19.. ?~ THIS CERTIFIES that the building located at .. ~e~ .R~ ........... Street Map No~. ~. :Block No ........... Lot No, .t~ .... ~~ ............... conforms substantially to the Application for Building Permit heretofore filed ~ this office dated .......... ~., ~.., 19, F.~ p~suant to which BuildMg Permit No..'8.1.1~. dated .......... ~.. 3~ ..., 19..~, was issued, ~d conforms to ~1 of the requk~ ments of the applicable provisions of the law. The occup~cy for which this ce~ificate is issued is . R~tvate. ~e. f~ily. ~well~g .wi~h, adlltlon. (de~) ............. The certificate is issued to . Jack. Yaq~ys~ ....... ?~r... ..................... (owner, lessee or ten,t) of the aforesaid building. S~olk County Department of Health Approval . N.,.~, .............................. UNDERWRITERS CERTIFICATE No. N,R. HOUSE NUMBER .. ..... ~0.... Strut .... ~e~ .~ ....................... BUilding Inspector / / 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) N.o 8113 Z Permission is hereby granted to: ~.a~k..Y.~ _~ ............................................... ............. .~.~.$~.~ ............................................ to Build ne~ poreh (deck) o~ ex~st~ng d~ell~ at premises located at ......L~....~..~. ................... .~'...~.~O...~..~,ll~.b.~....~tl~ ........................................... ................................................... l~tea~au..~-ead .............. ~tttt~ ........................................... pursuant to application dated .................. ~. ......... ~0 ............. , 19..~'.~., and approved by the Building Inspector. ~- Fee $...t ~..t...00... ......... FOI~I NO. 6 TOWN OF $OUTHOLD , Building Department 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: 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 ]957), 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 $1.00 pete ......... New Bqilding ................ Addition .J,~ ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... .'.~.$Z~.~.~'}..C&.y.X...~...~ ....... .~'..~,...~...~...~.,'!.T.~.¥.L.(..!..C;.. ...... ..t.~....:.Lt ......................... Owner Or Owners Of Property ...... .:.~...~.~.~....?..:.U..~.X.x~...-..l.~.~U.~.~.~...~...V..:....~......~....t..?..~...: ............... Subdivision ...~,;~.~.'. .............. ,¥.~.~1 ....... ; ....................... Lot No....L.O...... Block No ............. House No ............. Permit No. ~.).!.~...7~,.... Date Of Permit ....q..t.~.0..l.~)...Applicant Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate .......................................... Fee Submitted $ ....~;..~.~; ....................... Construction on above described building an?permit meets all applicabl,~I' codes and,regulations. Applicant ...... Sworn]~ before me 'hb a. This Cll~llc~ion must be campl4~ly fllhcl b. ~ ~~ I~i~ ~ ~ a~ ~ ~i~ ar~s, a~ glvi~t ~ ~d~ ~ ~ ~ mint ~ d~ ~ t~ dl~ ~1~ Is ~ ~ ~ ~1~ c. ~.~ ~ ~ ~ ~1~ ~ d. ~ ~ d ~ ~l~m, ~ ~i~1~ shall ~ ~ ~ ~ ~i~ ~l~b ~ ~ . e. No~~c~or~~ A~LI~TI~ IS HE~Y ~ ~ ~ ~i~i~ ~ul~ ~ ~ ~ ~ ~i~, ~ or ....... ' / ...................... ,...~ ............ ~..,.~.~.:...~:.~, ........ Store whe~er a~licant is ~er, I~e, ~t, a~hi~, engin~ ~1 c~t~tor, el~trici, ........................ ~.,,,.~.~ ................................................... Name of ~r of p~i~ ...~.~ .............. If applicant is a ~e, ~re of duly a~ o (Na~ ~ title of c~m~ ~ic~) Buil~s Li~ ~. ~ /~ Plum~s LI~ No ................................................. El~r~ian's Licm~ No ......................................... ~her T~'s ~ No ............................................... ,. ~,~.~,~, ~,~ p~ ~ ~,,, ~ ~ ~o.:~...~...... ~ ~...~....~, ............ s,~, ~ ~ .... g.~....~.~.&s.~.~..~,.X~B..~.........~. ..................................... : ....... ; ............................. 2. State exi~i~ ~ a~ ~c~ 0 pmmi~ a~ inte~ ~ ~ ~y of p~ c~ti~: a. ~l*lti~ ~ a~ ~n~ ......... ~.~..~ ....................................................................................................... b. In~ ~ a~ ~u~ ..... ~. ,~.~..~....,.~. ~, ~ ........ 4 3., Nature of work (cheCk which applicable): New Building'. ................. Addition ........... Alteration ................. Repair Removal Demolition .................... Other Work ~t.c~ ~c_ (Description) ................................................................... 4. Estimated Cost ...~ ...................... .. ............................. ee (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 e~isting structures, if any: Front ..........~(~. ............. Rear ....~..~.~. .................... Depth ~..~'. ............. Height ......~. ........... Number of Stories ...... '~'"i .................................. ;' .................................. ~.1' ................. Dimensions of same structure w th alterations or ~ad?tigns: Fr013t ........ ~ ...................... Rear ...~... ....................... Depth .....~..~.. ...................... Height b or,es .............................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ............................................... ~ .................................................. ; ................... · ' '9. - .... I .~ .~, ~... '. Rear I ~ . Depth /.~.~.' Dote of Purchase Iq (Jo ...... Name of Former Owner ~......~..~...~..~...~ ...................... 3ize o? ~ot: front ................................................................................................................. '~ 1 1. Zone or use district in which premises are situated ....... .(~.~ .......................................................................................... ~ 12. Does proposed construction violate any zoning law, ordinance or regulation: ...~J...~. ............................................ 13. Will lot be regraded ..... ~d..~. ............... Will excess fill be rerqoved from promises: ( ) Yes (/No · co ., 14. Nome of Owner of prom,sos .~' ..................................... .~.~.....y,~ll'ess ..(1~..~..~.. ............... Phone Nc~.?.~f['.:..~../..O..~'... Nome 'of ^~chitect .............................................................. Address ................................ Phone No. ...................... · ~ Nome of Contractor ..... .~....~../....~...' ...................................... Address ................................ Phone No ....................... ~ PLOT DIAGRAM L6ccte clearly and distinctly all buildings, whether existing or proposed, and indicat, e all set-back dimens!o.as..fro.m property lines. Give street and block number or description according to deed, and snow street names aha malcare ~ ' whether interior or corner lot. He is the .............. ~..~..~ ...................................................................................................... (~ntmctor, ~t, co,rate officer, ~c.) of ~id owner or owners, a~' is duly aut~riz~ to ~orm or h~e perfo~d the ~id work a~ to ~ke and file this appl~ation; ~ all ~em~ ~nt~ in this ~licoti~ are tree to t~ ~st of his k~le~e and belief; a~ ~r ~ ~O~ will ~ ~n~r at fodh in the ,~tion fll~ ~r~th.