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Home My WebLink About7712-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Of[ice Sonthold, N. Y. Certificate Of Occupancy No.~fi323 ....... Date ........... F.e]~....6. ........ , 19.7.5. THIS CERTIFIES that the building located at . I)awla. Drt.va. .............. Street Map No.C~¢g.~¢. J~t Block No ..... ~.~..Lot No.. 21 .... Or~Dpgr.h. [,i,Y' ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... ~ob .... 6..,, 19.7~. pursuant to which Building Permit No..77J dated ....................... Feb 6 , 19. ~., was issued, ~d conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .I. ri.~t~...one. La a~ 1~: .dw~.lling. ~t. ith. an. a~ditio~ .................. The certificate is issued to . .ggr.rT. -¢?~$rR~g ....... ~r ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... ~}..~, ............................ UNDERWRITERS CERTIFICATE No...~'~.'~ ..................................... HOUSE NUMBER .... 7~ ~ ...... Street .. P~. P.~Y~ ............................ Building Inspecto~ ....... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7712 Z Permission is hereby granted to: ............. D a.~,~...D.:V .................................................. ............... ; .............. O~'.o e~pox*:t- ........................... ~ to J~i:L~ .. n~.. ad~i.ti on...(.de'ek )... ozt...e:~1~st~g...d~efLl~ .....: ............................... ~ ........ at premises located et ]~.~..~.....~.~..~.]L~i~V~..l~.~o...l~eO..,Z.~.~- ........................................................ ................................................ D.~..D. ri~. .......... .(l~'~enpor.~ .......: ........................................... pursuant to application dated ...................... ~.~b ......... _6. .............. , .19.~.~[.., and approved by the Building Inspector. Fee ~.~.. 0.0 ............. FORM NO, $ TOWN OF SOUTHOLD ~ 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, anci unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical installation fram 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. Far 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 $$.00 3. Copy of certificate of occupancy $1.00 New B~4ilding Addition /v~ Old or, Pre-existing Building Vacant Land · o o,,on O, ....................... iiiZii'.'.ii Owner Or Owners,,~Of Property~-~.....~..~/ ........................................................... :oc ........... ............. Permit No...~..,,~.(.......~...~ffDate Of Permit ...~.~.~-~/Z..~...Applican, .../~...~ .~....~., ..),. ........................ Health Dept. Approval ......... .~...:..(.~..: ...................... Lobar Dept. Approval ......... .~..Z../.~r. .......................... Underwriters Approval ........ /..~.,~..!.~.:~: ...................... Planning Board Approval .....~..../.,~..C. ........................ Request For Temporary Certificate ........................................ Fined Certificate ......... ~..: ......................... Fee Submitted $ ..~...~.~ .................. Construction on above described building and~p,ermi~~ c~Jes and regulations. Applicant .~. ................................................................................... Sworn to before me this '~ ............ ...~. day of ...~':~......./...~..~...~ ...... (stamp or seal) Notary Public .................................... County ~OEM NO. ! TOWN O~ B~IL~ING D£PA~T~£NT TOWN C~LERK'S OFI=ICE Examined ....................................... , 19.?..~..~.. Application No. ................................ Approved ........................................, 19 ........ Permit No. Disapproved a/c ........ ~.....~--" (Building Inspector) APPLICATION FOR BUILDING PEP, MIT INSTRUCTIONS a. This application must be completely filled in by typewriter off in ink and submitted in triplicate to the Building 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 premises, relationship to adjoining premises or public streets or 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 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. APPLI.CATION 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, New York, and 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 to. admit authorized inspectors on premises and in. buildings for necessary inspe~Hons~..~. ......... i 'i ...... ............ PP State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~..~'.~.-.~ 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 ............................................... Location of land on which proposed work will .be dane. Map No.: ...... .,t~.,,.~..?...~.. .................. Lot No..../.../. ................. Street and Number ~ .~. ~. ?. ·..~.'.. · .~. · .~. !.?. · .~. · ................... ~~'" ........................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... ~)U.J;~..~. "'~ L-L,~ ................ g '.~. ~~ ........................ .......... b. Intended use and occupancy ¥-'/& ~,~'O (-~~ . '"" 3. Nature of work (check which applicable): New Building,, ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ..... I~...~..~_...q .......................... \ (Description) F / 4. Estimated Cost .................... ~ .......... ~ ............................ ee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Numbcr 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~F Fo~r~O~er ........................................................ 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 fUI be removed from premises: ( ) Yes ( ) No 14. Name of ?wrier of premises ..~.~.~. .'..~.~.~...~.~ddress ..'~.1..~.~.~[~.~... Name or Architect ............................ h ................................ Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-~ck 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 Y~R!~/. ,~ I ( S ~.~o L COUNTY .................. ~'~.~.:...'.....~':...~ ................................... being duly sworn, deposes and says that he is the applicant · (Name of indivi~al signing contrac0~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized ~o perform or have performed the said work and *o make and file this application; that aH statements confined in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set foah in the application filed therewith. Sworn tobefom me this ~