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Home My WebLink About7824-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTME. NT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No..Z73~9. ..... Date ............ ]O't .... 1 ~..., 19. THIS CERTIFIES that the building located at E/S..Ole ~v~le La. & .W/~S~$[p Map No. X~. ......... Block No. m;~ Lot No, XXX... N~ttituck...N.Y~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... April. % ~19 75. pursuant to which Building Permit No.. dated .... Alit. Lt. 16 .... , 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 Aca~ssor~r .bu~,d~ng .(ba~ &. othars) .~ith~ .fencing ............... The certificate is issued to .J.q~n..3.~..e.~,qll ..... Ow~e~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval II,R, ................... UNDERWRITERS CERTIFICATE No. ~I,R, ...................................... HOUSE NUMBER .~ 205 ... Street .. 01e..Juftm .L~ .... Ha~;~%uek ......... .... M~me, l~Ol~,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT fi.HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 7824 Z Permission is hereby gronted to: 3.ob~..~f~ic.ich ............................................... ............ · ~e~.tt.~.,~ek. ............................................ to ~~z~yd~g~.~b~d~...f.ep`c:~`~.~&~ta:b~..~..f.~r...~.s~sy..~ac~ .. · - -~1 e.z,e e~,-..~e~e e- ~..l'~b'~:~:~.. ex~t: .d~g' ..aeces so-r~..b~ .1~ f:t~g. .................................... ot premises locoted ot ..... ~/~"~"'~1'~'o'~ ~"&"~/8"'~l'e'",~ut'a'"bane ......................... ........................................... ~tt£tmak .............................................................................................. pursuont to oppllcotion doted ...................... .Ap~.~.l...~ .............. , 19..7.~.., ond opproved by the Building Inspector. Fee $..1.~'...(]0 ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted I~ to the Building Inspec- tor 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~t~perty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion required to prepare a certificate. C. Fees: ~\ 1. Certificate of occupancy $5.00 ~2. Certificate of occupancy on pre-existing dwelling ~,3. Co, py of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... ~..~¢~'~..../~'7~..~.. 0!~'.~ ................. ~ ¢~-"~77./3~'~-~. .... House No. Street Ham/et Owner or Owners of Property ...... .~. J~ ~1/ .....~ l ~-z.~'.c, ['~J3 .............................. County Tax Map No. 1000 Section .../..-~.'~. ....... Block ... ~ ........ Lot .... ~,.,..~.. ..... Subdivision ................................. Filed Map No ........... Lot No .............. · App,icant .... PermitNo.."~'..2;.~L.?~. Date of Permit /¢~-.)~ /' / Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ................ Construction on above descmbed building and permit meets all applicable codes and regulations. Applicant...~....~....~. .................... Rev 10-10-78 I~OIC,~ ~0. $ TOWN OF $OUTHOLD , Building Department Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of all buildings, property hnes, streets, aha 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 ,nstallations, 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 Aprd 1957), Non-conforming uses, or buddings and "pre-ex~sting" land uses: 1.Accurate survey of property showing all property I,nes, streets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of build~ngs. 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 ~te ....~Z~ ...... /...~.,/..(..~..Z.~ ...... New Bctilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property .... S.~.c2.~-....~.. ...... .'~.../...~./~.-../.....~../-....~...../.'~'.. ......................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ........... Permit No,~...~..~,..~......~.. Date Of Permit .~..?/.~..~..~..Applicant ..x~.~./.L.../.~. ...... .~...~./~.('..C..../...C.....~.. ........ Health Dept. Approval ............. ~......~..; ................... Labor Dept. Approval ........... g/.:.~:. ........................ Underwriters Approval ................~.,...~.:. .................. Planning Board Approval .... .~.:.,¢~..:. ..................... Request For Temporary Certificate ........................................ Fincd Certificate ........................................ Fee Submitted $ .................................... Construction on above described building and per, it meet~all applicable codes an.~/ regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County Examined Approved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................................... ~ ............... ~;PLIC~~~;'~i;'~~'" ............... Dote INSTRUCTIONS a Th~s application must be completely filled in by typewnter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of buddings on premises, celat~onsh~p to adjoining premises or public streets o~ areas, and gwing a detailed description of layout ofproperty must be drawn on the d~agram which ~s part of this application. c. The work covered by this apphcation may not be commenced before issuance of Budding Permit. d Upon approval of this apphcat~on, the Building Inspector wdl ~ssue a Budding Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used m whole or in part far 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 Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, os herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in. buildi, ngs for necessary inspections. ((~Signature o app icont, or name, if aprporation) ......... .............. (Address of applicant) /'~/~-~7'! To," State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder .................................... ........................................................................................................................... Name of owner of premises ............. ~.....~.....~.....~.~ ...................................................................................... If apphcant ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) Builder's License No ........ ~ .................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1 Location of land on which proposed work wdl be done. Map No .............................. Lot No ......................... Street and Number 12.o. ......... ..... ............ Muni/e~ality State existing use and occupancy of premises and m~.ended use and occupancy of proposed construction: a Exisitlng use and occupancy ....... O...~....~.. ........ .~..~...8..~./. ....................~.y ~..~. ~....~...~.. ....................................... ................ ...... ....... ,Bz,. b Intended use and occupgncy .... t~-~¢~ ~--! ~ /'c7~-~f~/ O'c'~-7 ~;~,¢ / 3. Natur~ of work (check which applicable). New Building ............................... / Addition Alteration ......... Repair ............... Removal ................. Demoht~or. ............ Other Work ................................................. 4 Estimated Cast .... ~..."~..i..~ ~..~..:..~....~.. ....................... Fee .................... ~.~.~..~. ............ ~.~.r.i.~.t.i.~ ........... (to be pa~d on filing th~s apphcahon) 5 If dwelling, number of dwelling units ........................ Number of dwelling un,ts on each floor ..................... If garage, number of ~rs ..................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ....................... 7. D~mens~ons of ex~stmg structures, ff,a~y Front ....................... Rear ................................Depth .................... Height ....................... Nu~er of Stories ....................................................................................................... D=mens~ons of same structure w~th alterat~ens or additions. Front ................................... Rear ........................ Depth ................................Height ......................... Number of Stor~es ............................. 8 D,mens,ons of ent,re new construct,on Front .... /~....~ .~ ......... Rear .../..~..~.~ ........ Depth; ..... Height ..... ~....~.~Number of Stories ................... ~ ......................................................................... 9 S,ze of lot. Fro~t ........ .~..~.~ ................................. Rear ..............~.~.~ ............... Depth ............................ 10. Date of Purchase .... Z~.....i~.~...~ ~ ............. Nome of Former Owner ...................................................... 11. Zone or use d~str~ct in which prem,ses are situated ................ ~ .................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation 13 Wdl lot be regraded ........................... Wdl excess fill be removed from premises: ( ) Yes (~ No ~ ~ o~ ow~o~ o, p~o~,~ T~ g..~..3.z.~.(~Z~. .~ro~ .~.~u~.~ ...... ~ho~o ~o. ~.g.~-~ N~me of Architect .............................................. Address................................~ ~ ~hone ~o ...................... Name of Contractor ........................................... Address ......... = ......... ~..~.. ~;. ~.0.~t.~ .... Locate clearl and distinctly ~ ' r proposed, and md~cate el set-back d~mens~ons from prope~y hnes Gt ack number or description according to deed, and show street names and indicate whether interior or,corner lot ~o~ STATE OF NEW ~R~ ¢2~ icc ~A ~ /00 Iz / t/ COUNTY OF .~.¢ .......... ;f ..................... ~ ........ ~..~.l.~.;~t;....~. ..... be,rig duly sworn, deposes and says that he ,s the apphcam (Name of individual signing contracf) above named He ~s the ...................................... ~~ ..... t ...................................................................................................... (Contractor, agent, borporate officer, etc ) of sa~d owner or owners, and is duly authorized to ~erform or have performed the sa~d work and to make and file this application; that all statements contained in th~s apphcbhon are true to the best of h~s knowledge and behef; and that the work wdl be performed m the manner set fo~h in the epphcat~on filed therewith Sworn to before me th~s ~ . ff ~ ~ ~ / ...... ...... o, ....... ............. , /, ' ............... ELIZAgETH ~.N HFVJLLE , , ~ - / / NOTAR~ PUFLIC Slik' cfi F~w ~Or~ Term Exp,~es ~arc~ 30,