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Home My WebLink About8159-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~;7~ ...... Date . ........... NOV ..... 3 ...... , 19..~6 THIS CERTIFIES that the building located at ...Cl~iStOl~hel,. S.~ ........ Street Map No.. X,X ........ Block No. ~ .xx ..... Lot No .... :~X .... Southolg[ .... N,~E, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. &rig...1.[ 19.7-~. pursuant to which Building Permit No..81 ~9~. dated .......... Aug.. -21 ..... , 19.7.~, 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.i-rate .el~e..f. aml.l¥ · dwelt Lug. vi. th. addtt.i~n ...................... The certificate is issued to .Wal.tel'. & .14al, tly~...B~I~;t®I'f&el~I ..... 0t~ers ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N,R,. .............................. UNDERWRITERS CERTIFICATE No. N~8~be .... Dee. 9" 19~'~ ................... HOUSE NUMBER ..... J~fl~O .....Street ...; -{3ht-~:zt~opher · S~ .................... ' ' Building Inspector ~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8159 Z Date ....................... /~13~ ............ 2.$ ......... ', 19..~..5'.. Permission is hereby granted to: E a s.t.~i~d..i~ °~:~e ~..izm.....Ax~....Ha~gr..,~...~ar~yn Butterfie~d ................... .......................................... to ..~.uild...a~..add:Lti~n...ozz..exiat~z~g..,Ctw~.ll&n~ ......... '. .................................................... at premises located at ..~P~..J,a~o~lb~e.E..j~.t. ........................................................................................ ...................................................... ~3outhold ...... ~,3,'., ...................................................................... pursuant to application dated .......................... AU6.....~I ............. , 19...7.~., and approved by the Building Inspector. Fee $....'l. ~.:..0..0.. ......... ..... [..T ......................... ~:~ ............. ",]. ...................... Building Inspector FORM NO. $ TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept, of water supply and sewerage dlsposal--($-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 1057), 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 $1.00 8qilding ................ Addi/tion .....~..... ...... Old or Pre-existing_Building ................ Vacant Land .............. New Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Health Dept. Approval ............................................ Labor Dept. Approval ................ ---T. ............................... Underwriters Approval ................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FineJ Certificate .......................................... Notary Public County Construction on above described building and p,ermit meets~ all applicable codes and regulations. Ap p licant ..... ~/~..~...,~..~..~..... ~,~.~.~....~...~...1. ~~.. .......... ., ......... .... ~~, O$S[D SEAL SHALL N TOWN OF SOUTNO'D ,¢?~ '~/~ ~. ~,~-~ BUILDING DEPARTMENT ,~ ~ ~- ~. TOWN CLERK'S OFFICE ~UTHOLD, N. Y. ~x~,~ed ........ ~..~ ....... , ,,~.. ~ ~,o,ed ............ :: .......... .~..L ....... , ,~..~.~.[,.~,, No...az..az.~ ......... v Application No......~.~./....ff...~.~ ............. aX APPLICATION FOR BUILDING PERMIT .~-.../~ ..z.~ Date ........................................... , 19.. 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets al 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 Deportment for the issuonc~ of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of opplicOnt, or name, if a corporation) --J ,' .. .......... State whether applicant is owner, lessee, agent, architectl ~-gineer, general contractor, electrician, plumber or builder. ........................................ , ....... ...................................... '~l';~'~"~;'~n~r of ~;emises ............. .~/....~..~...~:.~.~..~...i ...................................... If applicant is a corporate, sign~4~Ore/ef' duly autho~rized office . (Nome and tilde of cor~'orote of' Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ........................................ Other Trade's License No ............................................... 1.Location of land on which prop, f)sed~ork will be done. Map No.: ....................... (..; ............. Lqt No ...... :...,x~ ............ Street and Number Municipal ty State existing use and occupancy of premises and infended us~ and occupancy of proposed construction: a. Exisiting use and occupancy /'~ .~...~.~'.~./.~z.~.~.~2/~''-~..... ~, .............................................. b. Intended use and occupancy ~ ........ '"."~.~L.~_~.~.~...:.....: ................................. / 3. Nature of work (check which applicable): New Building.. ................. Addition..,..-- ........... .. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost ................... ~.~.,..O. 0. O.,...u...~. ................ Fee .g.~/...~ ........................................................................ (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 tructure with alteration or additions: Front ..... :...~...~.. ..................... Rear ..~..C ................... Depth ........ .?....~.~. .......Height ......... ./..~..~.. ............ Number_,f, of Stories ......... ..~.,......, ............ Dimensions of entire new construction' Front . ~.ff...,.. .............. Rear ....... .'Z/.~..y. ........... Depth ...~..~...]r~../...~..~/~/ .. . / Height ........ ~'../.. ..... Number of Stories ................................................................................................... _.,~ __,.,~"7" .............. 9. Size of lot: Front ............ .~...~..O. .................................. Rear .......... ~.~. ......................... Depth ....../z)~...°/C~....°~.. ......... 10. Date of Purchase ................. ./.~.'...~.. .......................... Name of ,Fgrm,er, Owner ..,.:;: ................................................. 11. Zone or use district in which premises are situated ........ ..~.....O...~..~.~.q~..~.. ...................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ..~...O. ............................................ 13. Will lot be regraded ..... ~...~...~. .............. Will excess fiIl, be removed from__pre~ises: (~'~' Yes ( ) No 14. Nome of Owner of premise~¢.~..~...~..././~....'~..~.~..~...¢.~./.'~'./..~... Address~..~/~...~.'~.q..~..¢~.. ......... Phone No ....................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ...'.'.'.'.'.'.'.'.~.~/~.~.~..~....r~..~.~...~.~...~.. .......... Address .~d.Z~.. ......... Phone No. ~.~..~....~.~..2.../.~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all 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 1at. / ~TATE OF NEW YORK, /~ ~ _/~ / ~ ~p _ r2 ,//~ (J~ of individual signing q~tract) ,~ above namef~ // ~ ~/~ .... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and/C6 mok]~ ~nd fi this application; that all statements contained in this application are true to the best of his knowlj~ge and bi/lief; ar tho~ the work will be performed in the manner set forth in the application filed therewith. / Sworn l'o before me this , / / of .................. . /7 ri.Z---'( Nota pub,c,. ..................... Co,n , .............. No 52,8125850, Suff01~ Cmmtv. ~erm E~pif~ M~te~l ,~0. l§~