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Home My WebLink About8183-zFOKM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate or'Occupancy THIS CERTIFIES that the building located at . .8/8..I~.~l.n..R~I..(.1~2~:)... Street Map No... 7,~ ....... Block No.. Xx ...... Lot No. ~X... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. 8.~p.~.../)., 19..~.~ pursuant to which Building Permit No. 8.183Z.. dated ............. ~eP.~...8.., 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 . .B .u..s.~.n.e.s. ·s. .a. qq .e.s~.qr.y..b.u.i.l.d~g..~.ith. ~,'1 .a&lition .................. The certificate is issued to . .~.~.e.e..t;..Iu..~l.b..e.r..~?.~. ..... ~.e.~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .1~. ,R.* ............................... UNDERWRITERS CERTIFICATE No..N,H.. ........................... : ......... HOUSE NUMBER ...... .7.~500.. Street .. Main. Road. (RT~). fl~oeno~l .......... .. ............. Building Inspector FORM NO. 2 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) Ne 8183 Z Permission is hereby granted to: .Z~.~... ............ ~.....G------ ............... .................................................................. ,~~~.:..~.¢ ................................... pursuant to application dated ............. : .................... , 1 ..... and approved by the Building Inspector. TOWN OF SOUTHOLD , Building Department Town Clerks Office Souti~old, 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), Nomconforming 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 Date .......... New Building ................ Addition .......~.. ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ..~../~:.....~..~..~./.../~..,..~/..~...~...~.7.~.~.,..~..~-~Z~ii~z~..,~..~,./~,z-~.. .................................. Subdivision ................................................................ Lot No. ' ' Block No..'.:':~ ...... House No.~.O ' &~ a Date Of Permit Z/(/Z~.~...Applicant Permit ~o ................... Health Dept. Approval ............................................ Labor ~pt. Approval-' Underwriters Approval ..... ~ ............................ Planning B~rd Approval ~. ...... ~J."; .......................... Request For Tempora~ Ce~ificote ........................................ Fin~ Certfficote .......................................... Fee Submitted $ ...... .:7';.J ..................... Construction on above described building and permit m~ all~gpplica~e c~es and regulations. ............................................. Sworn to before m~ .......... ..... Nota~ Public~~ Coun~ FORM NO, 1 TOWN OF SOUTNOLD BUilDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E~om,ned ........... '~:':2">' ~ ............ ' '~ :' ~ Application N (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ., a. This application must be completely filled in by typewrite[ o~.ila ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accord~ng to schedule. b. Plot plan showing location of lot and of buildings on premises, rel0tionship tc~ adjoining premises or public streets o~ 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 I]uilding Inspector. APPL CAT~ ON S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Sulfa k County, New York, end other appl cable Laws, Ordinances o~ Ragu at OhS for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The a icant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to PP ' · · ' t' admit authorized inspectors on premsses and m buildings for necessary mspec ~ons. (Address of applicant) State whether applicant is owner, lessee, agent, Qrchltect, engineer, general contractor, electrician, plumber or builder.' If applicant )s a corporate, signature of du. ly authorized officer. (Name and title of co~tSorate officer) Plumber's License No ...... r,~T~'..-~,,, ..................... Electrician's License No..~(.,/~ ..................... Other Trode's License No ............................................... Location of land on which proposed work will be done. M~No.: .... ........ ............................. .... State existing use and occupancy of premises and incended use and occupancy of proposed construction: ~.,..,......../.. ....... ,, ~....~~ ... b.Intended use and occupancy ........ .............................. .s. Nature of work (check which applicable); New Building.. ................. Addition ....... Alteration ................ Repair .................. Removal .................. Demolition ............ :~.... Other Work ................................................ .... -- ~~(~ ~ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each flqor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, sp~re~ and extent of~e of use ........... .~,..~. ........ 7. Dimensions of existing structures, if any: Front ....... ~ ...... Rear ........... ,~a;~..~c. ....... Depth ..4'f..(.,,3. Height ........................ Number of Stories ...................... ; .......................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ....... : ........................ Height ............................ Ngrnber of Stories .................... ~, .......... 9. S,ze of lot, rant .............. .......................... Rear ....... ........ Depth .¢=~r,~..~.(~ ............... 10. Date of Purchase ........................................................ Name/4~ Former Owner ........................................................ .11. Zone or use district in which premises ore situated ............ (,,7~2,~..., .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ,..~...t~'~. ........................................ 13. Will lot be regraded ..~.~.: ............. Will excess fill be removed from premises: ( ) Yes ("4) 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 all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether iaterior or corner lat. STATE OFA., - ;,NEW-.~YO'~' t ~-, ~ S S COUNTY ucC,,....-~...<.~'.-,..L .~ ......... f ', ................. · ."Z'~.."J...~...I.Z!.~...?.J. ........ .",.,,,..0..~.),~... .............................. being duly sworn, deposes and s~ys that he is the applicon, (Name of individual signing contrac~ above named. ~ .......................... "O ........... '~d;~fF;;;;F,";'~;~;,";;;F;;;;;';~ff;;';;';f;'.~ ...................... ~ ................................ 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 h~ knowledge and belief and thor the work will be performed in the manner set fo~h in the application filed therewith./ -- ~ / ...... ....../ ' .... :"~F .................. ' ........ ~ ' .................... ............. ~ ~ ~ / J. ~ ,~ / ~ (S}gnature of Epplicogt) ' ~, 52-8~25850, S~tlol~ Cou~ DATE ANDERSEN CORPOI~ATION SALES REPReSENTaTIVE GEORGE A. PULLIS 8 C ,OR~t~EI~ STREET PORT JEFFERSdN .~'ATION, N Yi 1 ! ??e AREA CODE 51e 473-8173 .108