The URL can be used to link to this page

Home My WebLink About8208-z,/ FOENI NO. 4 TOWN OF SOUTttOLD BUILDING DEPARTMEBIT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy No. Z.~.206 ...... Date .. A.~'~.~..3! ............... , 19.7.~'. THIS CERTIFIES that the building located at N/$..i~3e~ln .Roa~. ~,Y~al'ion Street Map No..XA ......... Block No.. XX ...... Lot No ...... 73. e~., ...................... conforms substantially to the Application for Building Permit heretofore fried in this office dated .S®pt~mbe~ .22~ ...... , 19 .'~.~. pursuant to which Building Permit No. ~q~4.. dated .Sep.t.embe~ .2.~ ........ , 19 .~,5'., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P.o:ro~ .addi'tivI~ .~;~. P.:c:~¥a.%e. two. f. ami~ .l'e~.~4e~.c.e. ................ The certificate is issued to E ~k®. ~.apa,~..8;. J.o]an..V.o. ik!is .......................... (owner, ~) of the aforesaid buildingo Suffolk County Department of Health Approval ...I~/~K ............................. UNDERWRITERS CERTIFICATE No ...... ~/.R...(.no. .e..1.e.c.t..r~L.e.a.1. ) ................ HOUSE NUMBER ...1~7.6~ ....... Street ....E.a.i.~.L ~.o.~..d~..~$a. ~...F~.?.i.o.n. ~. I.',~.: .~: .... Building Inspector FOI~M NO. ~ TOW~ O~ $OUTHOLD 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? 8208 Z Permission is hereby granted to: I~k~...l~&p~ ~.. A..,.Co.lin. ~ ~ ~,a ................. ..... 37-L9....~ ......... .7.8..a~ .................................... ............ · ,Ta~a.oa. J/~;~. ....... ~.,:~ .,.....,.t .t ,3.~.a., ....... to ../~ehuil/t.&..enla~.g~...exia~i~g...PO~ah.-a~.-.aa~l.o.a-~.*.....(~.c...2ta~.~vlg ) at premises located at ]J./J~.~;~..H~ad. ........................................... {f.~jt~....l~.~.~;.~....~..q.~..ee ) ............................................................ Eaa.t,..lfa~io~ .......................................................................... pursuant to application dated ............................. . SeJ~t~...,.~,,. ~ ....... , 19:~,~...,· , and approved, by the Building Inspector. JJO~l Ney F~ $.~$.~ ........... FOR~[ NO. 6 TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, 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), 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 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 ........ ............ New Building ................ Addition..~,,, ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...,...,,~.,.~.~ .... , ........ : ................................................ Owner Or O~ners Of ~raperty .~i.~.' ...... ~ .1 .~ ....... I. J.,.~ ...................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. o, .............................. Health Dept. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning D~rd Approval ........................................ R~uest For Tempora~ Ce~ificate ........................................ Fin~ Certificate ........ ~. ......................... ...... .............. Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this / -- ~ ................ day of ............................................ (stamp or seal) Notary Public .................................... County 0 TOWN OF SOUTHOLI) ~ BUILDING DEPARTMENT TOWN CLIRK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................................................ APPLICATION FOR BUILDING PERMIT iNSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3.eet~ of plans, accurate plot plan to s~ale. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drown 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 Building Inspector. A~PLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the ~ _Buil-d!ng Zone. Ordinance of the Town of Southold, Suffolk County, New York, and other applic?ble Laws, Ordinances or _~t .~ulations, tar the construction of buildings, additions or alterations, or for removal or demollhon, as herein described. ~J · applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to,., admit authorized inspectors on premises and in buildings for necessary inspections~,~ ........ o ........ , ............... ............ ' (^ddre~ of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of nrem sas .~ ~ ~..~..e-..'.~.'_'~ (~..~.. -~o ~ ~ ~ o '~ i~ ¥, ~ ......................... if applicant Js 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. .............................................. 1. Location of land on which prop~ work will be done. Map No.: ........................................ ~ ......................... Street and Number .~..t,O~.L~..~'~tD. Om~+......L:.~L~.~. ............................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~.).~/~LV~J~.~,..~.~......~f~.~..~.~.~. .......................... b. Intended 10~ 11. 13. 14. Nome of Con Locate clearly ~ property lines. Give whether interior or ( ,Nature of wa k (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .......... J ........ Removal .................. Demolition .................... Other Work ..................................................... . .,~. (Description) Estimated Co., ...........'~....~.~...U.. ................................. Fee ......... ~j...J,~.. .................................................................. (to be paid on filing this application) If dwelling, n Jmber of dwelling units ............................ Number ~dwelling units on each floor ...--.~ ..................... if garage, nur ~ber of cars ............................. : ........... ~, .................................................................................................. If business, ~ ommercial or mixed occupancy, ,specj~'y. nature and exte0t of~egch type of use ........... ~.~ ............ Dimensions oI ~e~isting structures, if any: Front ....~..~....~...~. ......... Rear ....J,.(~)..~.., ............ Depth ..<~,.~..~ .... Height ..~J[:)..; ,.~...,: ...... Number of Stories ....~:))L~..~, ........................ :.:.....~..: .......................... ~..:L;..:....~.; ........... Dimensions o1 ~l~me structure with alterations or additions: Front ,..~,.~..~...~..,..i ........... Rear ...L~..'J:....~ ........ Depth ...~(~..; ~:.~. ............... Height of Stories ..... .......... Dimensions oj entire new construction: Front ..... .~.~..~..~ ................. Rear .....t.~...:J~ ....... Depth ..~..{~.....~....'~.. ~ . Hei"ht .L~..~ ~ * Number nf Stories Size ~f ';t:"~!~; iii...i...~.~....'~...~.~.,._.~ .-- ~ .~'~ ,/~.]iiiiiiii'""i'"'i Dote of Purchase ............ Name of Former Owner ....... Zone or use district in which premises are situated ........................................................................... L ~ ...................... Does propose~ construction violate any zoning law, ordinance or regulation: .... ~I~.C~. ......................................... / Will lot be rearaded ............................ WiLl excess fill be removed from premises: ( ) Yes ( ) No Name of Ownel of premises .~4/.~./~.~....~..~...~....~... ............. Address~..~....~.L.~....~..~'..~...~.~ Phone No. ~.~..~'..-/..~...~ Name of Architect ........... : .................................................. Address ................................ Phone No ....................... ~ractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM ~nd distinctly oil buildings, whether existing or proposed, and indicate a street and block number or description according i0 deed, and sho~ >rner lot. set~J~:ick dimen~ions from str~et--~e~s an~t indicate STATE OF NEW iS.S t /~i COUNTY OF ................................ 1' ............................................................... being duly sworn, deposes and says that he is the applicam ~e~named.(Name °IF individual slgning c°ntracf)/ the ............... 1 ................................................................................................................................................................. J (Contractor, agent, corporate officer, etc.) of said owner or o~ners, and is duly authorized to perform or have performed the said work and to make and file this application; thc~t all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Jl Swam to before methis / ~- .~ ~ / / J · ' F~ /~' U (Signature~plicant)