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Home My WebLink About7698-zmN~ 4 TOWN OF $OUT21OLD BUr~.nlNG DEPARTMENT Town Clerk'~ Office $oudmld, N. Y. Certificate Of Occupency No..Z7902 ..... Date ............ .S.e.p..t..2.1 ........ ,19..~,~. TH~S CERTIFIES that the building located at ...M~..i.n..R.q .a,d ................ Street Map No.. xx ........ Block No ....xx ....Lot No .... xx... ~as.t..M. arJ,c~z~ ........... conforms substantially to the Application for Building Permit heretofore ~ed in thi~ office dated .............. ,Tan.. $8 19.?.~. pursuant to which Building Permit No..7.6..9.8.Z.. dated .............Jt~.n...~.~..., 19. ?~., was issued, and conforms to all of the require- manta of the applicable provisions of the law. The occupancy for which this cerltficate is ~,~ued is. ?~ve~e..o~e../~eml~,~.. d~.e.a,l~g. ×lt..h..~.0..i.~lqn...~..a.l.~.e.~.a..~.~.o?. ...... The certificate is issued to .~..ely.: .~....~.o...r~a.. ~ .uT..t.o.n' .... .O×n.e.r.s ..................... (owner, lessee or tenant) of the a/oresaid building. Suffolk County Department of Health Approval ~ :.H.o. ............................... UNDERWRITERS CERTIFICATE No... p.e.n.d..i.ng. ................................. HOUSE NUMBER .... 12960 ....Street ..... ~lain .~toe~d .... F, ,. ¥~rl~, .......... ............................................... ...... ......... Building ~n~tor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7698 Z Permission is hereby granted to: ~: ~ .w..e,..z.~...~ ~.o..~ .................................................... .~t~,...~.~t~s.t .......................................... ........ ~gat,,'La g,t,~.. S.t,a.t, iam ........................... Build an addition .o...n. ~.x.~$..~..l.~.g ot premises located at ..~../..$...~..l..~.....R..O..~ .................. .......................................................................... Ea§t Marion N .,~.... pursuant to application dated .........................~.a.~......1..8. .............. , 1~.~......, and approved by the Building Inspector. Buddirlg Inspecto~ ~ORM NO. 6 TOWN OF SOUTHOLD , Building Department 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-ex'sting" 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 certlficote of occupancy $1.00 New Bclilding ................ Addition ...... ...~...**** Old or Pre-existing Building ...,~x~ ....... Vacant Land .............. Location Of Property ................. ../~..,~..../.../~......~...~.../~...~....../.../.~...~.~'./~.........,~....~,..~y../....~...'~... ............. Owner Or Owners Of Property . ..-~...~....~.~.,,~,...P......~......~........'~..~. ,/~,.~.?~....,~......./.'.:......~..,,~._/~.~..-~...~...~ ..................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~..~..~...~..... Date Of Permit ../../.~..../.~....O~'..Applicant ....~-.~..~.~...~.....~....~.~./.~..Z~...~....4~/. ................ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate ........... ~ ....................... Fee Submitted $ ...... ~.~....~...,~/. ............... Construction on above described building and._~t. ~m~e~)all applica~/~od~e~regulations. Applicant ............... ~..z.~..... ~...~.....~¢r~....,r...~....-~. _:.: ............................. Sworn to before me. the~.. ~ Notary Public/ ..................... ~.~.. Co,unty ~ ~ ~; ~ r'j~LIC,StateotNeWYalt~ I'm. 52-?'558540' Sud°lk [aim ~.xg~TaS Nlarch 30,19 TOWN OF SoIrrHOLD BUILDING OEP&RTMENT~ ~/~ TOWN CLERK'S OFfiCE xom n d ....................... (....., 1~..~ ..... ~ ~ ~ ~pr~ ............. ~.~ ....... , 19 ~..~. Pe~it ~n /~ ~ ~ ~ ................................................ ................................ ................... ................... ......................................... .......................... (Buildi~ In~or) INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Buikling~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on prem ses, relat onship to adjoining premises or public streets os areas, and giving a detailed description of layout ofpraperb/must be drawn on the diagram which is port of this applicafion.~ 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. APPLICATION IS HEREB, Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance at the Town of Southold, Suffolk County, New York, and other applic;able 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 Icnvs, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspectioa, s; (Signature pp icont, or name,"i~' ¢~7~i~i' ~ State whether applicant iS owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises....~...~.. ~'/~'Z 0........................ ~......... ~...,~/..~. ~...~.....~'... ....., dl~;.... ~...~...~....~...~..~.... ........................................... If applicant is o 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 pn~lp,,osed work will be done. Map No.: ........ Z~.~ ................ Lot No..~..~ ........... ~ Street and Num~r ........... ~....~ ....... ~.~ ........................ ~ ~/~ ~ M~icl~li~ State existing use and ~cu~ncy of premises and intended use and ~cu~ncy of pr~ed construction: a. ~isiting use a~ ~cupancy ...... ~[~......~.~., _ ~''~'"'"~'~x~ .... .'3C~Nature of work (check which applicable): New Building.. ................. Addition .....~.... Alteration ..~.~ ........T ..... Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) 4. Estimated Cost .......... .~e~4~..~. ..................... i .......... Fee ..... i ...... .L.~....~... ............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ../.......~ ....... i..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 ......... L.~...../. ............ 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 ...-;..~..~....~....~......../.~....7.~. ..................... Name of Former Owner ...~..~...~.~..~.......~......,~...~...~...,~..../...'?..~. ...... 11. Zone or use district in which premises are situated ..................................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded .........~..~..~ .......... Will excess fil be removed from premises: ('~ Yes ( ) No ~.4~ ~,e~6· No. 14. Name of Owner of premises .A~r.~.~.~.~..~......~.:.~'./~.A~.~..~.~. ..... Address~.~., .J'/.~ ~ ....... ~... Phone Name of Architect .............................................................. Address ................................ .Phone Nc~ ...................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setJoack dimensions from property lines. Give street and block number or description according to deed, and show~r~et names and indicate whether interior or corner lot. ~ ~ ~&~ STATE OF ~II_~/V YORK, COUN~F ...... ~ ........ ~'~ .............. ~ ........................................................... being duly ~orn, d~es a~ says t~t he is the applicam n/~ ~ i~i~d~l ~gning c~tra~ ' above He is the ................................................................................................................................................................................. (Contractor, agar, co~rate officer, ~c.) of said owner or owne~, and is duly aut~rized to perform or hove perfor~d the ~id work and to ~ke and file this application; t~t o~1 statements contoin~ in this opplicoti~ om tree to the ~t of his k~ledge and belief; on~ tho= the work will ~ performed in the manner set ~h in the op~lic~i~ fil~ t~r~i~. Swam to ~fom me this ........................ day of ............................................ , ~9 ........ Nata~ Public, . ................................................... ~n~ (SJgno~re of applicant)