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Home My WebLink About8143-zFORM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ...Q~eenway. ~/e~ .......... Street Map Na~X'~e~ .AO.,... Block No ........... Lot No. 3~. .... .¢]l~i~r~; .. ~I.,.Y, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. &Ug .. ]3., 19 .~.~. pursuant to which Building Permit No..~.~lf3Z.. dated ............ A~g... ]3..., 19.?~., 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 . .. P.~.~.v2.~.e.. ,c.c.~.~ ~.oy.y.. B~.],I $!~y. b.tll~L(~:[r~g ............................ The certificate is issued to . .~..o.z.e. gh...T.~.~..~.o. .... ~.e.~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...N.,.I], ............................ UNDERWRITERS CERTIFICATE No..N.:.I~: .................. : ....... ,. ............ HOUSE NUMBER .... 9~0 ....... Street ... B~ee~.ay. l~/~st ..... Orient ........... uilding 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) Ne 8143 z Permission is hereby granted to: /~ / ...... ~....~~~- ........................... . ~/~.-...~.~.-~ ~ at premises located at ...... ~/....~..-K.....; ......... Building Inspector. Fee ,../...~.~ Building Inspector 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: ]. Accurate survey.of property showing oil property lines, streets, buildings end 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: 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 New Bqilding ....(: .......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....... Z~.7.~.....~d'~.~-ZZ'~..~..~//J.~.....~,.zdg~..~.. ...... 4~..~/~:.fi/..~..~, ............ ~"~-~/~/,JC~ Owner Or Owners Of Property ........ ~.....e/[/~;/...../.[.~. ~J~.~....~.~~. .................................................................... Subdivision ................................................................ Lot No....,~..Z.. Block No ............. House No ............. Permff ~o ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Ap ,,cont ............... ,......, .................. Sworn to before me this ~/ ['~ ~) ~.~h ...... day of ...... ¢*~,A~y..,../.~.ZZ.. (stamp or Notaw Public ............. fi~Q~ ...... Coun~ ~ No, 52.8125830, Suffolk t tem~ E~res ~,~c~ 30, APPLICATION FOR BUILDING PERMIT ote ..... .............. INSTRUCTIONS 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 lot and of buildings on premises, relationship to adjoining premises or public streets at areas, and giving a detailed description of layout of property 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 cede, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspe~:tions. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde~ Name of owner of premises "'"/~'~'~" ~1'"'"~' ' ' '~ ............................................................................................. / / f ~ If applicant is a corporate, sig~.c(ture of duly authorized"officer Electrician's License No~~ .................... ~.. Other Trade's License No~ ......... ~ ....................... ' ~ ,-, /7' Street and Number ..................................................... lc ........................................................................................... Municipality 2. State existing use and oO~Cupancy of p~and~.~ ~~°nstructi°n: a. Exisiting use and cupancy ........ ~...~.~..~ ................................ b. Intended use and occupancy ....................... /' ...................~ .............. / ................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................ Repair ................. Removal ..~, .............. Demolitior,.......J. .......... Other Work ................................................ 'J - ~ ~'/~,'~ ,,.,I ~ (Description) ' 4. Estimated Cost ................... .~......~,....~.. ......................... Fee ./....~......::" .......................................................................... (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, ~sC;~c..L~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 .................... ~' .~,"7"'~Nunj;iber of Stories ........ ~'~,~'*;.z; ........... 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .......... .~ ........ N u ~..,,~.' ,,,~ f,--S tg~i e s ./.. ........................................ u .. ~...,~,~....~.. ............................... ~,....,.-~ .,,,,... ~/i ....... R r / .) ..h t ! 9. Size of lot: Front ....... ............................................. ea .......................................... Dep h ........... ¢.... ................ I0. Date of Pur~:hose ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction ~,!o_lete 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 &Il set-back 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, rye's*"~ ~e/~ , aa 5'71 STATE OF NEW YORK, : [~ ~ ~/~ ~l~' ~'~" . COUNTY OF ~ a _ ' .............. ~(:~.~..(...,~.r[.~ ............... ~....~.~.,Ca...~,~,.,~ ............... being duly sworn, deposes and says that he is the applicanl (Name oP individual signing contracf) above named. He is the ................... :.:...t:.u/J.L*,/..'..4. ....................................................... ............................. .~.. (Contractor, agent, corporate officer, etc.) of said owner or owners, and 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 are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth, in the application filed therewith. Sworn to before me this ........ ........ of ............... _- , .................. , ........ , . Nota~ Public,. ........................... ',~',.,..~:~,~..J~ Coun~ ...... ~.~...'/.....'' ....... ~...lJ ......... -,'t.Z:'..¢'...i..~.~...C ............................ (-~ , ~ /" ~ ~'~' ~ ~ , ~ ~ (Signature of applicant)