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Home My WebLink About8342-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at lt,.0,.W ,. ~(/.$ Mair~..R.o.2d. .... Street Map No. X..X ........ Block No.. x.x, ...... Lot No, .~.....0.r.ip.n..t...~;.Y; ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... D. 99...~..8, 19.7.~.. pursuant to which Building Permit No .... ~.~.~.2.~ dated ..... B.~...1.8 .... , 19.?~., was issued, and conforms to ali of the req~ire- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P.r.~y.a~..e..o.13. e...~.a.m. 5..ly..~¥.o.]:~ .~. g ..................................... The certificate is issued to . .t~obe.?:g. D.e.~re.at ...0.w~e~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval t{ :~.l.o .............................. u oEawai as CEaZI ICATE no. .................................... HOUSE NUMBER . .29~3.[ .... Street .... .l.da.~.n..gg.a.d... 9?.$e.n..~ ................. Building Inspector MO]?.a~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8342 Z Permission is hereby grante,~ to:.~ - : ................. .0.~.~,~.~ ................................................ FOB~M NO. $ TOWN OF SOUTHOLD , Building Department Town Clerkl Office Southold, N. Y. 11971 APPUCATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ~nk, 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: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of build,rigs or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: ]. Certificate of occupancy :$§.00 2. Certificate of occupancy on pre-existing dwelling or land use $.5.00 .3. Copy of certificate of occupancy $] .00 New Bu. ilding ................ Addition b"~ Old or Pre-existing Building Vacant Land · ocation of Propert ............ ...... Owner Or Owners Of Property .... ~..~....~........~.f.~.~:.~ ............................................................ Subdiwsion ................................................................ Lot No ............. Block No ............. House No ............ Permit No...~...~..~/.~......~'.. Date Of Permit .~..~.~?...../~.~..~.~plicant ~.~......~.f...~..'~-:~....~.~.~ ....... Health Dept. Approval ............................................ Labor Dept. Appro~Yal ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Rncd Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicab~ codes and regulations. Sworn to before me this 7~" ;~' '~'// (stamp or seal) FLOYD F. KING, JR, Nofa~ Public Slate of NeW York No. 52-7267800 Suffolk Coun~ Term Expires F,~erch 30, 197~ FORM NO, 1 TOWN OF SOUTltOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Disapproved o~..~ ....... ~ APPLIGATION FOR BUILDING PEIU~AIT o,e ............. INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the BuildinC 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 m 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 thru application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector w~ll 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 o, 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 tc admit authorized inspectors on premises and in buildings for necessary inspections. '~ (Signatu~ of applicant~ or name, if a corporation; (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....,~....,.7...~.....~,..~ ........................... Plumber's License No.....~.....?.....~'.....?.~. .......................... Electrician's License No .... ~...~......~..../..~'~.'. ..................... Other Trade's License No ............................................... 1. Location of land on whichj~roposed work will be~done. M~ap No,: ..................................... Lot No...~ .................... Street and Number .....,<~...~..~.....~ ......... .~. .................... ...Z~..~ .................... Municipality 2 State existing use end occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ........................................................ 3 Nature of work (check which applicable). New Building .............. Addition ....V. ......... Alteration ..... Repair .................. Removal .................Demolmor ............... Other Work .................................................. / ~. ~c~ (Description) 4 Estimated Co .~t ..Z,~..~...~...~.~..~....~.. .................................. Fee ................................................................................ / (to be pa~d on filing tMs application) 5 If dwelling, number of dwelhng umts ....................... Number of dwelhng umts on each floor ........................ If garage, number of cars ................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........................... ..... ~......~. ................... Depth ~ :7 '* 7 Dimensions of ex~stmg structures, ~f any' Front ~-J ................ Rear .................... Height ............ Number of Stones .... ~ ............................................................................................... D~mensions of same structure with alterations or addmons' Front ....... ~ ......................... Rear ~J~" ! .Z ........... / Depth .... .~....Z ................... Height ..... Number of Stones .............................. 8 D,mens,ons of ent,re new construct,on' Front ....... .~ ~ ..................... Rear ............................ Depth ....~...? ~ ........ ¢' / Height .J. .............. Number of Stones ................................................... 9. S,ze of lot' Front ...J ~./~.~....~. .................................. Rear ..... /.~..~.../. ...................... Depth...L..~...~...~ ............. 10 Date of Purchase ..................................................... Name of Former Owner ....................................................... 1 1. Zone or use district in which premises ore s~tuated ...~.: .............................................................................. 12 Does proposed construction wolate any zoning Iow, ordinance or regulation' ~ ......................................... 13 Will lot be regraded ..... ~ ...... ~.. Will excess fill be removed frompremis, es. (~) Yes ( ) No 14 Name of Owner of prem,ses ~.'...~.,~.~~ ........ Address ....~...~ ........ Phone No.~...~..~...'7..~..?.-.?. Name of Architect ....................................... ~ ~/ .~ Address ................ ¢ ............... Phone No ...................... Name of Contractor..~....~...~..~...~ ....... Address...~..~~'~ ~ '~ ...... Phone No.~'...~...~....~...~...~..~.- PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether exmting or proposed, and md~cote all set-back d~mens~ons fror, property hnes Gwe street and block number or description according to deed, and show street names and ~nd~cat. ~vhether nter or or corner lot /. STATE OF NEW. I'f'O[~K,/ ........................................................................................ being duly sworn, deposes and says that he ~s the apphcar (Nome of individual sigmng contraetO oboYe named. He ~s the .................................................................................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the so~d work and to make and this application; that all statements contained tha~ the work wilt be performed ~n the manner set forth m the apphcat~on filed therewith Sworn to before me this Nota ....................... ~? ~LtL IT'd T BCKEN ~gna~ure or appucanv~ Notary ?ub[,:, Z.t~,.: ~f tew York No 52-0344y03 ~u[[ol'~ County Comrnl~lon Expires March 30, 19..~1