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Home My WebLink About7695-zFORM NO. 4 TOWN OF $OUTHOLD BUH.t~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z?.~..~. ..... Date ............... .l[a. ~...~ ....., 19. THIS CERTIFIES that the building located at . .T...o~n...Hsr.b.o.~. ~ ....... Street Map No.. ~ ........ Block No... ~ ..... Lot No, . ~....S911.t)~01d...1~ ,]~., ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ Ja~. 20.., 19.?~. pursuant to which Building Permit No.. dated ............ .J.a~.....2~...., 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 . p.r.X.v.a.t.e..o.n. ~..f.s~. ;[~y..~lw.eJ, l:~ug. ~;Xth. &dditXon. & .&lta~.&t:kom ...... The certificate is issued to . .,)'ORU. &,. ~res.ter. 8: .Cee ilia. l~rester ..... Owners... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N ,R.: ............................. UNDERWRITERS CERTIFICATE No..p.s.l[~d..XBg ................................... HOUSE NUMBER ...~..~ ........ Street .. T.o~r~. It.~.~.bor. l~ne ..... Snuthold ...... I~OBM NO. ~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7695 Z Permission is hereby granted to: ...~v. elm..~ta~. ............................................... .................... (G..c,3~t~.~t ............................ .......... 14t&t&..P3~d~ ........................................ t .o~J.~...~ ..~.44;t .~.~...a....~ra~...~.~..t.J,..~ ...~..~.,.~.~.~..4~.!~ ...................... at premises located at ....~....O~...]~.~..~.~.J~..~JJ~l~l ................................................................................... ....................................................... ~iCmt, hoXd.... J.,Y ~ ....................................................................... pursuant to aPl~ll~:otion dated ......................... ~TJJL...20 ............. , 19.~.., and approved by the Building lnspectc~. ' ' Building Inspector [ FORM NO. S TOWN OF SOUTHOLD , Building Department Town C:lcrks Office Sou~hold, 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), No~-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 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 ~ J Date ................................................ Additib/ New Building ................ .on. ~..~.~.~ld or Pre-existing Buildin~ ...... Vacant Land .............. Location Of Property .~./~.~..~...~[ .~'...~.~..../~.......~...~......¢~......~: .......................................................... Owner Or Owners Of Property .~C~.'././.'~...../..!.......~....~...~~... .................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. 7.~..~.~....Z-,.. Date Of Permit/7...~plicant ~.~~. Health Dept. Approval ............................................ Labor Dept. ,a~proval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinGI Certificate .......................................... Fee Subm,tted $ ....~...~. ........... ~, ........ Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ............. o, Notory Public ..~~... County INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 adjo n ng premises or Public streets o~ areas, and giving a detailed description of layout ofpraperty 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 appl cat on, 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the i~iludln.g. Zon,e O~,dinance. of .t. he T, ,o~n.,o.f. Southo. l.d.,. Suffolk Cou.n. ty, New York, and .other applicable Laws, Ordinances or Thg ar,,o, ns, .tar the c.onsrruct?n o.t. Du~a~ng.s., add*hans or alterahons, or for removal or demolition, as herein described. e opp.canr agrees ro comply w,th al~ app,cable laws, ordinances, bul d ng code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. 63 Clinton St ~ite ?lai~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pJumber or builder. Name of owner of premises ~To]xn A. ~ Brestez' 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 ....... .~r~.~'. ......................... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: .............. ~ ..................... Lot No ....... ~ ............. Street and Number .... .~I~Z~.~B.~]~.Q3:..~.I~II ........ ~lD~t~;hO'~L~L....~l'.e.~ ............................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy Dwelling b. Intended use and occupancy . ..S....a~...e. with addition & Alteratio~ 3. Nature of work (check. which applicable): New Building.. ................. Addition ....~ ...... ~lt~ration .....~ .... Repair .................. Removal .Demolition ............. ~ ...... Other Work '" ription) 4. Estimated Cost .................... .11..~.0...0..0.....+ ................ "..Fee .....~..t.0..O.. ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....q~e .................. 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 ........... ,8. ....................... Rear ......8. ..................... Depth ...... .1...b(. ............. Height .................... Number of stories ..~;~10...: ......................................................................................................... 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 ...A.....(;1,~.~ ................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~ ............................................ 13. Will lot be regmded' ......~.O. ................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..~DJILIL.~Z'.ei.~.t, ez~ ..................... Address ..,....~Q~I.~;J:I.Q~,.~. ..... Phone No ....................... Name o~ Architect .............................................................. Address ................................ phOne No ....................... Name of' Contractor ......... ;.....a&~e. ................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ ¢ c ....................... .~f)JJl,JJ..~'.JlJ~.l~JJ~'. ................. , .......................... being duly sworn, depots and~ys t~t he is the applicom (Name of individual signing contmc~ above name. (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly aut~rized to perform or have performed the said work and to ~ke and file this application; t~t all statements contain~ in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set foffh in the application fil~ therewith. Sworn to before me this ........................... Nota~ Public, State of New Yo~ No. 52~0344963 Suffo k Count/ ~mmi~on ~pires March 30,