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Home My WebLink About8163-zlrO~M NO. & TOWN OF SOUTHOLD BUILDING DEPARTM~T Town Clerk% Office $outhold, lq. Y. Certificete Of Occupency No. ~Z ~7.~ Date ~'/ 2¥ 1~.b THIS CERTIFIES that the building located at .~.~ ....... ~ ~ ~, ,.~ ~. ~ Map No ............. Bl~k No ........... Lot No .................................. confo~s subst~ti~y to ~e AppUcafion for B~l~g Pe~t heretofore fg~ ~ ~ o~ce ~.U.~.. dated ......... .~.~., 1~-. p~u~t ~ w~ B~g Pe~t dated .........~ ~ .~... ~ ~., 1~.~ ~', was issue, ~d confo~ to ~ of ~e ~ ments of ~e appUcable pro~io~ of ~e law. The occup~cy for w~ ~ c~fficate ~ ~.~ ~. ~ ..... ~.~.~. ~.?.~.Y.... ~v.t ~. ~.,.~..~ ....................... ~e ce~fica~ ~ ~sued ~ ~.~.. ~.. ~ ~?.~.~. ~.~ ~. ~ .... ~ .~ ~. ~ ~.~.~ .......... of the aforesaid building. Suffolk County Department of Health Approval A/i~ OERTIF o. ............ .......................... HOUSE ~ER ........ !.~... Street... ~.6. L..e..~/..~..~. .... . .-~. ?.?..~. ............. gOd. Ho Building Inspector FOl~[ 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 COMPLETION OF THE WORK AUTHORIZED) N? 8163 Z Permission is hereby granted to: ...... }~.a z'.l......~,...}f.~3.~' ................................... ~outhold at premises located at .....q.O...]...O.~.~.~..~.......~...0..~.~......'.....~..~.~..~...0..~.....~..~...~. ..................................................... .................................................................. ~..o.~,t.h..o. ;L~....:~2~., ............................................................. pursuant to application dated ........ i ....... Jk~l~....~,~. ...................... , 19..~.,~.,, and approved by'the Building Inspector. Fee $.. ~. O. :..0.? .......... ( ' - Building InstrUctor ~ FORM NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Saul'hold, 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 dispasal--(S-g form or equal). 3. Approval of electrical installation from Board of Fire Uhderwriters. 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 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 D te .... ............... New Bqilding .......~ ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~,20 Colonic~.l tto~d. !~outho~tl. ;~e~' York 11971 Owner Or Owners Of Property ,,t~,,~L ~'. ,;~ ~llz~beth ~.. ~eenler Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~.~}.~ ....... Date Of Permit .~'z ..Applicant h~r~ ~. Health Dept. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning B~rd Approval ........................................ Request For Temporaw Ce~ificate ........................................ Find Ce~ificate .......................................... - 5,00 Fee Submitted $ .................................... Construction on above described building and permit meets all applicable cOdes and regulations. Sworn to before me this ~,, - - _ a ~4 ~ ~ ~ ..... · ....... x ....................... ~'"--'~ ........... [s~omp or seoI) Nota~ Public ..... ~.... Coun~ , TOWN OF $ou'rHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~" SOUTHOLD, N. Y, ................................... iii ............................. Disapproved a/c~ ................ ~_ APPLICATION FOR BUILDING PEI~MIT INSTRUCTIONS o. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 sete of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on pr.emises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagrqm which Js 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 (3 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 i~suance 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, os herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. .~~~'(S gnoture of appl cant, or name, if 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 ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... t. Location of land on which proposed worg will .be done. Mop No.: ........ ~,.....:.u.-..?.~...: ......... Lot No ......................... Street and Number ....~..o~.O.......~......{~..~.~:..}....~..!~....'..~v~.~i~i~;iii~ ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .......... ~ .................................................................................. b. Intended use end occuponcy ......... -~ ........................................................................................ 3. Nature of work (check which applicable): New Building'-...~... ......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ . (Description) - -o ............................................................ 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, 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 ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..J~....'~., ................... Rear ..I...~.....'~..."' ......... Depth ...~....."~.t"~ '' ........ · I-leight~:..."~..~Number~" of Stories ..................................................................................................................... -- ~ 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction 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 indicat property lines. Give street and block number or description according to deed, and whether interior or corner lot. all set-I~ck dimensions frorn ow strut ~ames and indicate STATE OF NEW-¥<-~ COUN'E-Y-.OF ..~.~.~...~,..~,,.~ ...... ~'.~'~. ........... ....... ....... ~.~..~.~.~. ........................ being duly sworn, deposes and says that he is the applicom (Name of individual signing contract) above named. He is the ....................................................... ~..~.~.~.~ .................................................................................................... (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 that the work will be performed in the manner set fo~h in the application filed therewith. Swor~t~e me this day of ~...~. ........................................ ........... Nota~ Public ..: ............................... ~.....~ ~ ~ .~;. ~oun~~..~ ............................................. % ............................................ ~,~/~~~ (Signature of app'icant) NOTARY PUBLIC, S~te COLI y Ho. 52.8~25850, Suffelk tg Term Expires March 30,