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Home My WebLink About8211-zFOlh%'l NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's OI[ice Southold, N. Y. Certificate Of Occupancy No. ~ ~7~ I Date ............. ; ........... ..., 19. THIS CERTIFIES that the building located at ............................ Street Map No... ~.[.~.~... Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. -'.~...: ....~19 .'. 7. pursuant to which Building Permit No ......... dated ....................... , ~ .... , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ssued is ....... ~..~?..~. ~ ~?.V.:( .... ~?'. ?.?~ Y..f: .............................. The certificate is issued to (owner, 1 of the aforesaid building. S~olk County Department of Health Approv~ ...' ................................. UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER ~ ~) ~ ~ Street ~:>IW E ~'~E T~0 ~, Building Inspector · 'OEl~f NO. ~ TO~N OF SO~T~OL~ 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? 8~I1 Z Permission is hereby granted to: ................ ~!~.~...~Lr..o..~. ..................................... at premises located at ...........~.~.p..~.....~.F.~..~....~g.l~l~ ........................................................... ;.a ................. ............................................................................ ~ut~o~ ............................................. : ................. pursuant to application dated .........................~1~ .......~. ........ , 19.~.~.., and approved b~ the Building Inspector. Fee $..~..0..[~ .......... / ' uilding inspectoat FOR~I NO. 6 TOW~ 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 in DUPLICATE to the Building inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of 011 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 instollation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, /v~ultiple Residences and similor 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 oil 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 $t.00 New BL[ilding ................ Addition ....~ ../... .....Old or Pre-existing Building ................ Vacant Land .............. Property ..... .~ ).v....~. ......... .~c..~..~.. ....... [.~..0...~...l~...,......~. t.'..~ .~..~ .~ .~.~..q...% ......................................... Location Of Owner Or Owners Of Property ..... ~'..'.~.. .......... ~.o..~..e.~;~..~,.,=. .......................................................................... Subdivision ........................... Lot No ............. Block NO ............. House No ............. Permit No. ~/.12...Z~.. ..... Date Of Permit ~./?..~'~....J../...Applicont .~.~...~...'C 4~. '..?..~c' ,~ ]~d' .................................... Health Dept. Approval .......................................... Labor Dept. Approval ...~..:....~.. . Underwriters Approval .~.~..:..~ ................................... Planning Board Approval ~/' j~ Request For Temporary Certificate ........................................ Fined Certificate ......... ~ ........................ Fee Submitted $ ..... .~.:...~...~.. ................... Construction on above described building and p_ermit meets all applicable codes and regulations. App cant .... ~ .... ........ Sworn ,o before me this ~ ~ ' ";'~2:~'~/~ '~ ~ ............................ ~-~. Z. ~7~/ ................ day of ............................................ (stamp or seal) ~ Notary Public .................................... County TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ,,~...,.~.,,..~:~... ........... 19...?~. Application ........................................ , 19- ermit No .................................... D~sapproved a/c ~~~-~ APPLICATION FOR BUILDING PERMIT Date. .;..~.. ..................... , 19..~...~...,Y~ INSTRUCTIONS a. This application must be completely filled in by typewriter or, in ink and submitted in triplicate to the Building Inspector, with 3 setg 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 al areas, and giving a detailed description of layout ofproperty 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 mi 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 what6ver until a Certificate of Occupancy~l shell have been granted by the Building Inspector. to the Building Department for the issuance of a Building Permit pursuant to the ~// APPLICATION IS HEREBY MADE Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or V Regulations, for the construction of buildings, additions or alterations, 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 admit authorized inspectors on premises and in buildings for necessary inspections. f applic if a corporation) - (AddresS' of applicant) State whether applicant is owner, lessee, agent, architect, engineer, geheral contractor, electrician, plumber or builder. ......... ~..~.c~.:~.z~....4, ............ ~_ .~.~/...4...~. ~.~..e,.:/. ~,.~. .......................................................................................................... Name of owner of premises .~]~2.~ ........... ~¢1...~. ............. ~./~..~.......~.q~.~ .......................................................................... If applicant is 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 proposed work will be done. Mop No.: .................. Lot No ......................... Street and Number ~../~/~.~-~ .........~.~...~..~, ........ /~t..i~. ..................... .~/~..~..C,.~.~...~.~...~ .............................. Municipality :2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ~e.~.~..~.~.~. .............................................................................................. b. Intended use and occupancy ........ ...~..~....~ ........ ~..~...~.....J) .............. ~;..,,,~..~'.~.~.~.(.~. .......................... 3. Nature of work (check which applicable): New Building'. ................. Addition .... ..........~ .... Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... zt~Q- (Description) 4. Estimated Cost ............................................................ Fee ../....((.. ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units 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 Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ...... ,..~.....~.. ........................................ 13. Will lot be regroded ....~...~. ................. Will excess fill be removed from premises: ( ) Yes ( ~ 14. Name of Owner of premises/~..1~,,..~../'3.,..,~,.~...~.....~..i¢. ......... Address .~./.~.~...~.t..e.~.....~.OJPPhone No ....................... Name of Architect .............................................................. Address ................................Phone No ....................... Nome of Contractor ..~.~,'~,.~).~, .'..~..~.....~...~..,~..~...~..~. ................ Address ../~..~..~....~'..9;~..../.,'.~... Phone No..~...~.,Y..'..,~,..~...~.4'" PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set~b~ck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whelher interior or corner lot. STATE OF NE),~T.O,[~.~_/i~ ~ S S COUNTY OF ~g;;;~,.~:Ttt~..k~ ....... ~ ' ..................... ~,~./~.E:J:..~C~ .......... ~l~.~..~.. ........... being duly sworn, deposes and soys that he is the applicam (Name of individual signing contract) above named. He is the ......................................... ~.~~..~. ................................................................................................. (Contractor, agent,--corporate officer, etc.) 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 his knowledge and be(ief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sw~n to before me this . ~ ...... . ............................... , ...... ~ .........r~ ....... ~,.....,..,~ .............................................. ~ ~_ ~ ' ~ (~oture of applicant) ELIZABETH ANN NEVILLE NOtA~ ~g~/J~ ~t~te et New Y~rk Yem Fx~ ~rch 3~,