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Home My WebLink About8232-zFOKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z6889 .... Date ............ Fab ..... 17 ..... , 19'~.~. THIS CERTIFIES that the building located at . l~a,~- .l~oa~t. &. ~e~r~y .Pe~r~ Map No..~ ......... Block No...~ ...... Lot No, ~... ~hOlt.. ~,~ ......... conforms substantially to the Applicadon for Building Permit heretofore filed in this office dated ............ ~e~ .... ~.., 19.7~. pursuant to which Building Permit No..82]~. dated ........... 0e~...~ ..... , 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 .. P~iV~O.. (~.e8 Z~). g~g8 ....................................... The certificate is issued ~o .He~r~ .&. J.e~. ~a~h~ .... ~er~ ..................... (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of He~th Approval . .~,R, ............................. UNDERWRITERS CERTIFICATE No..~,R., ....................................... HOUSE NUMBER .... ~97~ .... Street ...... M~. R~4 ......................... 1~0 Aeke~t~ Pond ~ .... ........... ' ' Building InspeCt 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) N? 8~3~ Z Permission is hereby granted to: ........ > 191~..~, and approved by the pursuant to application dated ................................. .~-.-~....~. ....... ~, '-''-' Building Inspector. Fee $../.,.~. ................ Building Inspector FOR~[ 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 disposol--(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 end installatlons, 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 ]957), 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, 0ccuponcy 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 o 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 pete ..... New B~ilding ....~. ........... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. i e o Lane Location Of Property ..D.emnr. h ~l,..g.o.~:~r...M.~,;l,~..~.Q.~d...~..~..g.~;.~.~.~7;..~...~,~. .......................... C~'ner Or (~wners Of Property ....~eo~...I.....&..~.e~J~..~...~,a.~ ....................................................... Subdivision .............. .'...'. ............................................. Lot No.-..........*~" Block No. .......,....-' House No~.C).~,....... ,.. Ha~r~ ~( Permit No. 8.2322...Z.... Date Of Permit ..10..~gm?.~..Applicont ..~3~..~...~.,...~¢..~.h~ ............................ Health Dept. Approval .~..R.~. ................................. Labor Dept. Approval ...~.o...~., ................................. Underwriters Approval ..... .~g~T~ ............................... Planning Bo~rd Approval ..N.~..~ .......................... Request For Temporary Certificate ........................................ Fin~ Certificate ...~. ...................................... Fee Submitted $ ...~.~.O.~ ....................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .. ~....~...:...... ,~. ~ ................................................ Sworn to before me this ........ ...... ..... ?¥ ...... Notary Public ...~.~oun~ __3 TOWN OF SOUTHOLD BUILDING DEPARTMINT / ./ TOWN CLERK'S OFFICE Examined ...... ~/~.).~.....~. ......... ..<; 19./e,~ Approved .............. ': ......... ~..: ............. , 19....~.... Permit No,~..~,~__~. ....... Disapproved a/c " (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT ~ Oate ...................... INSTRUCTIONS~ ~ a. This a~lication must be ~mpletely fill~ in by ~ewriter oe in ink a~ s~mi~ in triplicate ~ ~ Bulldl~- I~tor, with 3 ~ of pl~s, accurate pl~ plan ~ ~le. F~ occo~ing to ~h~ule. ~ b. Plot plan shying I~ation of lot and of buildings ~ premis~, relation~ip to ~joining premiss or public st[~ o~a ar~s, and givi~ a detoil~ ~ription of I~ ofpr~ must ~ drown on the di~ram which is ~ of ~is ~hcatl~ ~ c. The work c~ered by this a~licati~ may n~ ~ commenc~ before issuance of Building Permit. ~ d. U~n appeal of this applic~ion, ~e Buildl~ Insp~tor will issue a Building Permit to the a~licant. S~h permi~ shall be ~pt on the premises ~ailable ~r in~i~ ~h~t ~ ~r~ ~ e. No building shall be ~cupi~ or u~ in ~ole or in ~ for any pu~e wh~er until a Ce~ific~ of ~cu~ncy~ shall have ~en gmnt~ ~ ~e Building Insp~tor. ~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town o.f. 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. 'f~e applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and admit authorized inspectors on premises and in buildings for necessary Inspections. .... ...... ......................... :. .......... :.. (Signbture of applicant, or name, if a corporation) (Address of applicant) State whether applica~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ...~..~..~.~..~.....~...~.,~.aG~...~/f~.~.~.~.~~ ................................................. / If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................. .~. ........................ ~ ..... Plumber's License No ................................................. Electricion's license No ........................................ Other Trade's License No ............................................... Location of land on which proposed work will be ,clone. Map N~;.,~ ...................................... Lot No ......................... Street and Number .... .~...T..~..~..~.......~.r..,..~...~..-~n~...~l~,~--~.~.a'~'.w:.. ............................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ............... X~.~4,~',~. ...... ~...~.../..~m....~,~;~.~...................~.~,d~.. ...................... ~ ............ occupancy ..... '".'... ,.~.. . .'~ .... ¢.~.~/~¢.'.2Zt~.. ...... b. Intended use and ...................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition ....... :~ ......... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) / 4. Estimated Cost ............. .,~...,~..'..~.....::. ............................ 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 ................. ,/..','i ..... Rear ............ /. .................. Depth .................... Dimensions of same structure with alterations or additions: Front .................. ~..../..J ....Rear ....... ....; ................ Depth ............... ~ ........ Height ............ ~ .......... ~....Number of Stories ............. d~ ................. 8. Dimensions of entire n, ew construction: Front .................................... Rear ............................ Depth Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ....................... : ................................ Rear .......................................... Depth ..;..; .......................... 10. Date of Purchase .................. ...,.:/......~..:J .................... Name of Former Owner ............ ;.....~; ....... i.: .......... /. ................. 11. Zone or use district in which premises are situated ...................L./. .................. ~. ....... J....~ .............................. ~...../. ......... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. 'Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nameof n ' // ' ~' /' ; ~ /' . , x . ~- Ow er of premises .................................................... Address .....:...? .................... Phone No .................... t,/. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor Address ................................ Phone No ....................... PLOT DIAGRAM 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 names and indicate whether interior or corner lot. STATE OF NEVV YORK, ~ ¢ 5 COUNTY OF ....... :t'"~":~':"'"'~ ....... f~' .................................... /. ........................................... ~....~ ........... being duly sworn, deposes and soys that he is the applicant (Nome of individual signing contract) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before me this .~'~day of .................................... :..Z..., 19 ........ ....... Notary Pubhc, . ............................ .~?~....: .............. County (signature of applicant)