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Home My WebLink About7810-zFORM NO. 4 TOWN OF SOUTHOLD BUH.DING DEPARTMENT Town Clerk's O~[ice Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ... I~.~..B.c..ah' .A.V.e. ......... Street Map No. ~ ....... Block No... ~ ..... Lot No...x~....8.o.~..th..o.e.d....N.:~... ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... AP.r.~..1...7, 19.7~.. pursuant to which Building Permit No. 78.?.~.... dated .... .~. r.~.. ~. , ~97~., was issued, and conforms to ~l of me requ~ merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . P.r.~.v.a.t.9. g.a~a.~...(.a..e.e.e.s..sg.r.~.)' .b.u_4..~. ~.~. g ........................... The certificate is issued to (:~eoX'ge W, l[~<~h wne~r (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ............................. UNDERWRITERS CERTIFICATE No...N.,.R.,. ...................................... HOUSE NUMBER ....... ~00.... Street ...14.~...~...v~..a~...A.~..e.. . .~..o~.~..h.o.l.d. ......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7810 Z Permission is hereby granted to: (~O~e..~c~t~ ..................................................... ....... ,~,,.tt, h old. .................................................. to ..]~u~-.].~d,..~.~..,ur~,~a,t;~...g~a~e ............................................................................................. at premises located at ..................... l~u~...1~tl.~.e,~t...~.~'~ .................................................................... ................................................................ .$.m,tt, b,~.],~ ....... ~.,,~ ............................................................ pursuant to application dated ........................~kp~'J.]~ ..... .¢) ........... 19~..., and approved by the Building Inspector. Fee $ .1..Q.,.Q..O. ........... FORM NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and submitted ,n DUPLICATE to the Bufld~ng Inspector w~th 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 ~nstallation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buddings 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 buddings 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 /- Building .....~.......... Addition ................ Old or Pre-existing Building ................ Vacant Land, .............. New Locotio. of Propert ................ ...... ...... Owner Or Owners Of Property ..~...{~....~......~..! .~..~ ........ ..~....C~...~.....~.....~.....~].:...~......~.~.(~..~...~ ........................... --- Subdivision ......................... ;.':.~..~. .............................. Lot No ............. Block No ............. House N Permit No~3.)..~..~... .... Date Of Permit .~.'~..~.':~$,~pplicant .......... ..~....~...~.~.'....~/.~.'.~'~'~)~....~ ............... Health Dept. Approval ............... ~..~..~,, .................. Labor Dept. Approval ............ .~...../..~ ....................... Underwriters Approval r Request For Temporary _ e Fee Submitted $ ...... ~...~.~. ................. Construction on above described building and p~ i~ 7:et~ all o/pp,lic~od:s ~ regulations. Applicant ..... .,-~..~ ..... .~,¢?~z...~.~ ........... ~ ...... ~, ............. Sworn to before me this day of ...~.~'~ .................................. (stamp or seal) Notary Public ............... --....~... ............ County / ? Examined Approved TOWN OF $OUTHOLD( ~ BUILDING DEPARTMENT'-..~ ~- ' TOWN CLERK'S OFFICE "~ $OUTHOLD, N. Y. ........... Disapproved a/c ................................................................................... ......... Z ................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing Iocahon of lot and of buildings on premises, relahonsh~p to adjoining premises or public streets ¢ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatlor c. The work covered by th~s application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will msue o Building Permit to the applicant. Such perm, shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupanc 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 th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors on premises and in, buildings for necessary inspections. .............. ...... ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, Name of owner of premises ........ ~.,~.~,/~'.....~.....~.~..~. ............................................................................................ If apphcant ~s a corporate, signature of duly authorized officer. (NQme and title of corporate officer) Builder's License No ........ .~.t~-'.~'...~.'....Z~./.--.~ ................ Plumber's L,cense No ..... ~.~......?..~.~.~..~-~-.~.~ ............... Electrician's License No..~./.,.~....~....~..~. ....... ..~.7'~//'/(~ Other Trade's License No ...... ~..~.~..~.. ............................. Locahon of land on which proposed work will be done M~p No~ ..... ~ .......... Lot No ' ..... Street and Number ....... L.~C. ..... ~.. .......... ¢~.~. ............... : ......... ~.'.~i~. .......... Municipality State exishng use and occupancy of premises and intended use and occupancy of proposed construction: o Exisiting use and occupancy ....... ~..~.J..~.~t~..¢ ..... .~..~..~.~.. .......... : ................................................................... b. Intended use and occupancy ........ ~t~.~./~..~, ............ ~.~, .................................................................... 3. Nature of work (check which applicable) New Building ~ Addmon Alteration . '. ...... : Repair ................Removal .................. Demolmor~ ....... Other Work ............................................... (Description) (to be pa~d on fihng th;s applicahon) 5. If dwelling, number of dwelling umts ..~. ................. :...Number of dwelhng units on each floor ......................... If garage, number of cars ......................................................................................................................... 6. If business, commercial or m~xed occupancy, spec;fy nature end extent of each type of use ..::: ...... :: .............. 7. Dimensions of ex~stmg structures, if any. Front ....... Z~.. ............. Rear ...... ~.~. ................... Depth .~,.~ ........... D~mensions of same structure with alterations or addmans Front ......-'~. ............................Rear ........................ Depth .......--_.. ....................... Height ~ Number of Stones - 8 D~mens~ons of enhre new construction' Front ....... ~ ~.. ..................... Rear .....~..~. ................. Depth. e~,.~ ......... Height ..... [.(~ ......... Number of Stories ........ J. ..................................................................................... 11 Zone or use d~stnct in which premmes are situated ........................................................................................ 12 Does proposed construchon wolate any zoning law, ordinance or regulahon' . ....... ..~...~. ...................................... 13 Will lot be regraded ........~J.~ ............. Wdl excess fill be removed from premises' ( ) Yes (Y~ No Name of Architect ......................................... Address ................................ Phone No ...................... Name of Contractor ......................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and dmtmctly all buildings, whether ex~stmg or proposed, and red,cate oil set-back dimensions fror property hnes Gwe street and block number or description according to deed, and show street names and indicat whether interior or corner lot STATE OF NEW YORK, ~ S S COUNTY OF . .................. ~..jg..c~....~..~r..~......~/~ ....... being duly sworn, deposes and says that he ,s the apphca, (Name ~>f indiwdual sigmng contracf) above named. He ~s the ................................. ..~?..~...~~ .-."./_~'~ ~¥~ .......................................................... v (ContracfTf, agent, corporate officer, etc) of sa~d owner or owners, and is duly authonze~ to perform or have performed the sa~d work and to make and f~ this applicahon; that all statements contmned in th~s apphcahon are true to the best of his knowledge and behef; tha~ the work will be performed m the manner set forth m the apphcation filed therewith. Sworn to before me this ...... c:;St ........... ........................... ...................... ~ ~j'///~--~,,~' ~/~ /'~ ~Sign. ature of applicant)