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Home My WebLink About8230-zTO~N OF $OUTHOLD BUrg.DING DEPARTM~NT Town Clerk'~ Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~eet~aters I~t Street Map No. 0~ient .!~. ~l~ck No ........... Lot No.. ~ .... 9~.e.~..~s. ~.~: ............. conforms substantially to the Application for Building Permit heretofore filed in thL~ office dated ............OCt...7...., 19.7.~. pursuant to which Building Permit No....~.3.~. dated ...........0c~ ..... 8..., 19.?~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which tl~L~ certificate is The certificate is issued to . .J~s~ .I,e~3~b~ ....... .0~tg~. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....N.~.P..., ............................ UNDERWRITERS CERTIFICATE No...Pg~a~...~.S ................................... HOUSE NUMBER ...... ~0 .... Street ....~.~...9~...t.e.~.s.. ~ ................... FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8230 Z Permission is hereby granted to: ~o~,~..]~or~2~.m..... &/C...l~ed...LeJ~vo~el* ....... ............ $~.~en$.....~ ,.¥., ....................................... ~o ..... ~All. d..s,n..,a~.~ i.t loz~..z~n...e xl s.t ~,n~, .~well/z~ ........................................................... at premises located at ....~gL~..~......O~,~te..~..,v...t~o...~&....Ofle~, ............................................... .................................................. ~ee...wa. te~s..).m~e- ............ ~$et, t ........................................... pursuont to opplicotion dated ................. O~t,.....~. ................... ,..**, 19...~2.~, ond approved by the Building Inspector. ouiming Inspector Disapproved a/c ................................................................. : ......... ; ................ b. ' Platpla~locatior~af 16t and0f bul_klin~en '~'pt~/ms. ,,ml~_.ap to adjolntng .prem~ or~ . _l~b~ areas, and gtYlr~,4ttatMd detcril~lan of ~ .MItNperty muet i~ drawn on the diagram ~ i~l~t oe thi~ ~R~Catlon Upan app~w~l 69 this applicizflon, the BUI~ I.mpJ~. ' ~iII I~ue a Building t,ermJt to shall be kept on the premises available for imp~.~ the work. e. No building shall be occupied or used in whole or In part for any purpose whatever until a Certificat~ of Occupancy shall have been granted by the Building Inspector, APPLICATION IS HEREBY MADE to the Building Department for the i~suance of a Building ~ ~ to the eu~[mng z~, o, dina~:, o~ t~ T~ of Sa,~o~_. ~ Court/_, N*~.Yo~ a~d .Oem ~ Regulatiam, for the construct!on of building, additt~ or ~.:~._.f~,r. ~ ..['e~-a. [ _o~'_.~,_all The applicant a~rees to c~,~,y with-a# appllc~ _ _bl~l~ ~ 0fdiC, ~ Code, houeing ca~, and admit authorized Inspectors on premises and In bulklln~ for necesmry impectiom. (S~l~re~of apphcant, or name, if ................... : ........... .............___.. ....................... (Address of applicant) State whether apl?lic .~0~i$ oWr~r, lessee, agent, architect, engineer, g~neml contractor,, el~-trictan, -~ or builder. Name of owner o'f premises ..... ~..~...~L.i~.i~ ............................................................. ~ If applicant is a cmporate, signature of duly authorized officer. I (Name a~ title of corporate o4Jficer) -. Builder's License No ................................. · ; .......... Plumber's License No ................................... ,, ............ Electrician's License No ............................................. Other Trade's Lic~ No ............................................... Street ar~l NUmber .....~'~r'~~~,~.....~....~.....~jjj,~....~.~...~.~~ ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occulxmcy ..~.:. ................. .~ ........................................... ~ .............................................. b. Intended use and occupancy ............................ ~. ..................................................................... 3. Nature of work [check which applicable): New Building-. ................. Addition ~ ' ' .................. Altleration ................ Repair Removal Demolition. .................... Other Work ~ (Description) 4. Estimated . . .: ................................ 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 ...~.....O...~. ......... Height ........... NO ,r of Stor es ..../. .......................................................................................................... Dimensions of same structure with alterations or additions: Front ..... ...'~....~..~. ................... Rear .....~'..~.. ................. Depth ...~...~..~ ................... Height ..Z.~.. .................. Number of Stories if 8. Dimensions of entire new construction: Front ...... .~...~ ....................... Rear ..... ~.....~ ................ Depth ...~-....L~ ........... Height ...... L~....~ ..... Number of Stories ..... /. ............................................................................................................... 9. Size of lot: Front .... L~.~..~ ....................................... Rear ...~....~...~....~ ......................... Depth. /....~.....~'..../. .............. of Former er ~/' ~ ....... 10. Date of Purchase ........................................................ Name Own ................... ~i ....................... 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 ill! be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...~...,...~ ....... Address ...~..~ ...... Pt~one Na~..~..~..~..-~...~..~'~.Z Name of Architect .............................................................. Acldre~ ........... Phone No ...... Name of Contractor ...~...~......~..~ ...... Address..~...~ ..... Phone No.~....~.~'..~....~..~l~. PLOT DIAGP, AM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street n~mes and indicate whether interior or.corner lot. STATE OF NEW, Y~,~,, ,_ iS S COUNTY 0;. ,,,~.~ .~.~..¢..i'Z ............. ........................... · ..~,~.;~.~ ................................. ~ ......... be ~uly ~orn, d~o~s and says t~t he is the applicam (~ a~ve n~ He is the (Comractor, ~t, co~ra~.o~ic~, ~c.) of ~id ~ner or ~, and is duly aut~rized to peHorm m ~ ~rfor~d the ~id work and to ~ke and file this application; ~ all ~atements con~in~ Jn this ~lic0ti~ ar~t~e ~ the be~ of his kn~ledge and ~tief; and tha~ the work wiJl ~ perfo~ in the ~n~r ~t f~h m the a~l c~ fll~ ~ th. Swam to ~om ~ ~is ....... ...... ' e .............. Nota~ Publ~, ............................. ~6"~."~,~'"' ~ e-(Signamr- of aopdcant) .................... FORM NO, S TOWN OF SOUTHOLD , Building Depo~tment Town Clerks Office Soufhold, 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-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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ........... New B~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....~...~.~.~....~ .................... ...~...~ ......................... Owner Or Owners Of Property .....~..~.....~ .......................................................... 6~ Permit No..~'..~...'..~...O...~... Date Of Permit -.~..~.'C?..~-Applicant . ~.~...~......~..~ ............ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate ~ Fee Submitted $ .................................... Construction on above described building and permit meets all appliogble ~odes and regulations. Applicant ...~:~ :.'i:~?~......' .~. ~....~'~~ ..................................... Sworn to before me this ../..'~..~.. dayof ~<}. / ~ /" ~/~ ......................................... (stomp or s~l) ~ __ Nota~ Public .............. ~f~.f.~ ....... Coun~ Notow Public Stero of New York T~r~ ~p~ros M~rc~ ~, ~9~