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Home My WebLink About7823-zTOWN OF $OUTHOLD BI.m.~ING DEPART~t~':NT Town Cl~k'~ Og:ice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .~leti; .I,a~ll~ ............... Street Map No.0l.cl .~r.charclBlock No ........... Lot No .... t~&st. 14ario&..1~,~ ......... conforms substantially to the Application for Building Permit heretofore ~ed in thi~ office dated ............ .All. r..il...1~197~., pursuant to which Building Permit No.. ?.8.2.35. dated ...........&P~.ll...1~;., 19~.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi~ certificate is ~sued is. P~I¥~Q. on,e~ .family. ~ell~ng .with .a~. addi.t~ion .................. The certificate is issued to. 8a,lVet~A'~. D;l, lio!eamla ....... ol~er .................. (ow,e~, lessee or tenant ) of the aforesaid building. Suffolk County Depm-tment o! Health Approval . ...~. ;~.o ............................ m~DE~WRIT~_~S ¢~RT]~IC.~ No.. 1~..~6.9. ................................. HOUSE NLIMBER ... 2~.~ ....... Street ...~/eS.t..I~l~ ..... ~a$~..l~rlo~ .......... Building l-~zn. [ FORM NO. 2 TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ii. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7823 Z Permission is hereby granted to: ................ Sou~;hol~t ............................................. at premises located at .....~./...~....~...~..S...~....~...~...]~... ....................................................................................... ............................................................. ~.s..t... ~.r..t...o.~......~....~.:. .......................................................... pursuant to application doted ..' ................... ~.~.1......~.~. ............. , 19..~..,~.., and approved by the Building Inspector. Fee $...~. ~.(~. ......... Braiding Inspector FORM NO. 6 TOWN OF SOUTHOLD , 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 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 hnes, 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 cert,ficate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-ex~sting" 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 $].00 Date .... . .~, ....~....~....../...~... ,'~.... J ............... Bqildmg ........ ~ ...... Addition ........ ....~ Old or Pre-existin~Qg Building ................ Vacant Land .............. New · ,o,,o, o, _ , ......- ........ Subdivision ................................................................ Lot No ............. Block No ............. House No ........... Permit No.~....~....°~.......~..... Date Of Permit ...~..~.4)T-./~/~..Applicant .... ..~...:.....~...~..'....~.../.'......~....~...~_../..~.~.~z.,¢.~... ~' Health Dept. Approval~..Z~....~ ............. Labor Dept. Approval ..~.~~ ..... ~ ~-~n~e~ri~rs Approval ....... ~.~.....~.....-~.. ...................... Planning Board Approval .~~ Request For Temporary Certificate ........................................ Fin~ Certificate ....................................... Fee Submitted $ .................................... Construction on above described building aj~d permit meets all applicable codes and regulations. App,icant .............. Sworn to before mp-'r~is ...~..,L ..... day of¢~./.....~.....~..~...~..... (stamp or seal) , ~o~;,I,,~ ~,~ ~ ~ I.~f / ¥/' ' IPO~M ~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ..... .......... O ,6%oproYed ........................................ , 19 ........ Permit N .................... :.....~ .......... DisappraYed a/c ......... ..~..! ................. ~.'.~.. ............... ~ ........... ./..~.~....~ ........ Application No. / '~ · ~ APPLICATION FOR BUILDING PERMIT Date ............ , .~.~...r.~.l.. .......... ?.~. .......... 19...~..~.,.. INSTRUCTIONS a Th~s application must be completely filled in by typewriter or' in ink and submttted in triplicate to the Buildinf 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 ol areas, and giving a detailed description of layout ofproperty must be drawn on the d~agram which is part of this application c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector w~ll ~ssue a Building Permit to the applicant Such permi; 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 thc 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 alterat,ons, 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. (Signature of applicant, or name, i{ a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................... ...................................................................................................................... Nome of owner of premises ..~X~.l}...°.~.e.....D..$g.$.o..v.~.~ ........................................................................................... If apphcant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~........~..i...]:.~.~.~..s...o..~.. ....................... Plumber's License No ................................................ Electrician's License No ............................................. Other Trade's License No ............................................... 1 Location of land on which proposed work will be done. M~p No .......... ~.~.~. ..................... Lot No ........ ~.~Z ........ Street and Number .~/.,q..~/.es.t..T.~lzu~ .............. ~.~,t..~a.~..ien....~'~.,..xZ. ....................................................... Municipality 2 State existing use and occupancy of premises and m',ended use and occupancy of proposed construction: a Exisitmg use and occupancy dwelling b Intended use and occuponcy ........ .B...~..~..~e....~....~.~..~...~ ..8,~.,~..~...~..O..~ ..................................................................... 3. Nature of work (check which applicable) New Building ............... Addition ....~gr~.. ...... Alteration .......... Repair ................. Removal ................. Demoht~or. ................... Other Work ............................................... (Description) 4 Est,mated Cost ................... 1..0..0..0...~ ........................ Fee ....1,~....0...0. ...................................................................... (to be pa~d on filing th~s apphcahon) 5 If dwelhng, number of dwelhng units ....... IDle .......... Number of dweihng un,ts 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 Stor~es ................................................................................................... Dimensions of same structure with alterations or additions' Front ................................... Rear ........................ Depth ............................... Height ........................ Number of Stories ................................ 8 D~mens~ons of entire new construction Front .... 2.1..-.~ ............... Rear ..... 2.1..-.~. ............. Depth . 1.~ ..... Height .................. Number of Stories ........ OI'~ .......................................................................................... 9 S~ze of lot Front ......... 1-00 ..................................... Rear...1.(~.0. .............................Depth ..... .1.30. ................. 10 Date of Purchase ..................................................... Nome of Former Owner ....................................................... ! I Zone or use d~stnct in which premises are situated . ..!!~,.~!..~.~,¢ ............................................................... 12 Does proposed construction violate any zoning law, ordinance or regulahon: ....... mD ........................................... 13 Will lot be regraded ......... ~.e,~ ...........Will excess fill be removed from premises: ( ) Yes ( ~ No 14 Nome of Owner of premises ..~l~a.t, oz'.e..]2zLGJ. D~za~.&. Address ................................ Phone No ...................... Name of Architect .......................................... Address ................................ Phone No ...................... Nome of Contractor ..... ~;...~Jr...]'..~..J:~?°.~.. ............... Address ........ ~.o...~.~..~..o.~.ct: ..... Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly oil buildings, whether ex~shng or proposed, and ~nd~cate all set-back d~mens~ons fron property hnes Gwe street and block number or description according to deed, and show street names and ind~cat, whether interior or corner lot STATE OF NEV~ YORK ~ c COUNTY OF ..~...g.~..~'g.~]~. ............. fo S ............................ ~Q1D.~..~.:Z2J~iL~S~ ......................... being duly sworn, deposes and says that he is the apphcar (Name of ~nd~vidual signing contract) above named. He is the .......................................... ..b.~..~..e.?.. ............................................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and fi this applicahon, that all statements contained m th~s apphcahon are true to the best of his knowledge and behef, at that the work will be performed in the manner set fo~h ~n the apphcation filed therewith Sworn to before me this .................. ¢.~. day of .......... :..~ ............. , 19..2~. ~ ~ ~ ~,'__ // ..................... .......... Co,, .... (Signature of apphcant) ~OTARY PUFt',8 Stat" ~; i~~¢~ Yor~ ,L2~ ~ Surf ik C,, ,~ No 52 ~