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Home My WebLink About8212-zFOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerlific le Of Occupancy No.Z?3.6~ ....... Date ............. ]q.~r .....~ ....., 1976.. THIS CERTIFIES that the building located at I~. {~.t..3BO&5 ..... .t ........... Street Map No.X~ .......... Block No.. ~ ...... Lot No, ~...~0~...~,~., .......... conforms substantially to the Application for Budding Permit heretofore fil~ in this office dated ................ ~ep~. ~..~ pursuant to which Building Permit No. 82.{.~.. dated ........ ~eP~.. ~6. ..... , 19.~., was issued, ~d conforms to M1 of the req~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued isP~$V~ .P~..$~.~Y. d~!~g .Wt~h. tddillon. ~ .~rat~cn ........ The certificate is issued to ~VF. ~. 8e~.. ~elOh ...... ~ers ................. (owner, lessee or ten,t) of the aforesaid building. Suffolk County Departmen~ of Health Approval N,~, ................................ UNDERWRITERS CERTIFICATE No. ~77~ .... ~. ~...]97.~ ................ HOUSE NUMBER ...... ~60 ..... Street . ,E~..Roa~ ..... flUteho~ ............. ~OIt~J[ 240. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N; Y, BU;LDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? $212 Z Permission is hereby granted to: ~c~...Y~z~.e~..... ~/..~...9~ ~.~:o~...T~.K. &...~ .... .................... C~t~eh~,~e ...................................... to ..... ]~u.:L3~L ..~.zL ~d~i~io~ .. c~.. ~r~Ls.~r~..0,t~e l. ltntg ........................................................... at premises located at ..~a.S~...]~J~d ............... ~.,],aea.~8...~e, lr~ .......................................................... pursuant to application dated ........................... ~e~).~.....[~[ ......... , !9.~.~.., and approved by the Building Inspector. Fee ~.{~ ............. FOR~ NO. $ 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 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 dispasal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences end 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 end 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 ................................................................................ ~ ....................... 7' .................... Owner Or Owners Of Property ........................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. " "c t Permit No..~./~J.....~z...... _ate Of Permit Health Dept. Approval ....... Z;7..~ .............................. Labor Dept. Approval ................................................ Underwriters Approval .... .~./.~.~,.~,,/.:,7..~. ...................... Planning BOard Approval d Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ ..~..~.: ........................... Construction on above described building an~Lgermit meets ~LL, o~licable codes and regulations, Applicant ........ . ,~.~. ,..~--~ ,~... ~ .~ .................................. Sworn to before me th~is~ ............ .~(. day of ....Y..v...~,.~..k.~~. ................. (stamp or seo]~'~ ~ TOWN CLERK'S OFFI *' ~ ~ * - Examined ...... ~ ....... ~ .... , 19.~.~.. Application No. ~/ ~ ~ Disapproved o/c ...~......~.~....,~.~~~~~~/' ~ ................................................ ........................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter~ ac in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat plan to scale. Fee occ0~ing to schedule. b. Plot plan showing location of lot and of buildings on premises, relbtlonship to adjoining premises or public streets or 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 ~oppiicotion may not be commenced be~ore i.ssuance of Btdlding Permit. d. Upon approval of this application, the Building Inspector will issue o 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 hove been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the 'Town of Southold, Suffolk County, rNew York, end other applicable Laws, Ordinances or 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. .... ........ __ ...................... ........ /~ L>~,.~~ ....... ~L~.., (~. / (Signature or applicant, or n~Lr~e, it o corporation, f "t' ~'/~ ~ . .,LS.~..o....?....? ~ ,a ..~:..~.~.},..A.,, ~. .6.u..T~:,f ~ ~ u.~.~.u,/tv ~" (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ~.. - - '~,~L .~... '.T..~.~ c 6 .. Nome of owner of premmes .. J..~J...O.I. .'t-. ..m~..t~ ....................................................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. ~// '-- P . .. Electrician's License No..~...~J.,~....-~...../T:... .............. Other Trode's License No ............................................... -- p ., ,~A~ T~o'~ /t'/tee'T~'~ Location of land on which proposed work will be done. Map NO.: .h..~.....~.~....T..:.....~. .............. Lot No ............ ...J~.... ...... Street and Number .....~.~...~.:..~..~.'.~:...~..~....~.~ ~..(~,..g~..,~.l ~x~;.~...~...I-.;./.:/..Y.~.. ................. Municipality Stale existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... .~...0~..~.. .'~r/cl.!./:..~........~..~.?..~..~J.Z'~. ........................................................ b. Intended use and occupancy ...... ~.,~Z-~ .......... ~...m,...% ......... L....T......E: ............................... ~'. ................ 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... ~ ~ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... '.~ ....... Number of dwelling units on each floor ..... ,~.'.;:L ................. If garage, number of cars ............. ' ........................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........ Dimensions of same structure with alterations or additions: Front .... .~.....~.. ....................... Rear ...... ..'~T.....~. .............. 8. Dimensions of entire new construction: Front ..... ~..../. ........................ Rear .......... .--., ............... Depth ........................ I-bight ...J....O. .......... Number of Stories ..... I~.N..~. ..................................................................................................... 11. Zone or use district in which premises are situated ........ ~.~.,,~..~.~..~'~..'.~.J.~..J~ ....................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... I..'~- ............................................... 13. Will lot be regraded . ...... j~..~.. ...........Will excess fill be removed from premises: (~es ( ) No Name of A ch~tect ...; ......................................................... -- "ur-' Address ................................Phone No ....................... PLOT DIAGRAM ~-U (~.~r/g" Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and blpck number or description according to deed, and show street names and indicate whether interior or corner / jr% STATE OF NEW, YORE, . I -- I''~' ~$' COUNTY OF ..~..~..I.=...~.-..~..L~.!.~ ...... ......... ~.~..,..~.~.~.~,~.,~ ............... ~ ................... being duly deposes and says that he is the applicam (Name of individual signing contrac~ above named. He is the ............... .~,~.~Z~.~.g..~ ............................................................................................................................... (Contractor, ogent, corporote officer, etc.) of sold owner or owners, ond is duly authorized to perform or have performed the said work and to make and file this, application; that ali statements contained in this applicatian are true'to the best of his knowledge and belief; and tha~ the work will be performed in the m~nner set foffh in the application filed therewith. Sworn to before me this .................. . Nota~ Public, . ............ ~.~f ................. Coun~ , ,,,..,~.~.~.Z..~..L.~.~.~Zf.~ ................................ ~ (S~ of ~nt) '0 .,