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Home My WebLink About8249-zFORM NO. i TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z6.7.73 ...... Date .............. II.~...~.0 ..... , 19.7~. THIS CERTIFIES that the building located at .. }//.5...0a.S®. ~1~ ......... Street Map No. l~: ......... Block No. XX ....... Lot No, lr~ .... Cu~.¢.I',ogU,~..N.,.3[, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... 0~.~....~ .6...., 19. ~7.~ pursuant to which Building Permit No.. dated ............. Qc~;...2C.., 19..~Z~, 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~iv~te. ac.ce ssa~%r. (~%orege)..bll~.ld~lag ............................ The certificate is issued to . Theo(lt~£e. ?.o!zz.~Li ..... 0~;,~z~c~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . li,[~, .............................. UNDERWRITERS CERTIFICATE No. }l.,~ ....................................... HOUSE NUMBER ..... 91+0 ...... Street ...~Ja~ .Lan~ ............................ ..... /.~,, ~.~.,~.iBuilding I~''''~~ ................. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 8249 Z Permission is hereby granted to: pursuant to application dated ' OC. T I~1, i~/~ ........................................................ y ........ , and approved by the Building Inspector. Fee $ ........................ Building Inspec~tor FOl~/ NO. $ TOWN OF SOUTHOLD. , Betiding Depmtment 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 end "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 $5.00 3. Copy of certificate of occupancy $1.00 Date .~ ........ ./. ~ ./..~.~. ~ ./..-Z.~: ~"~. ........ New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .~'/~ ~...r'/~.~..~ ......................................................... Owner Or Owners Of Property ...V.: .~'~r/,--.~.~:.~......~..~ ..................................................... Subdivision ................................................................ lot No ............. Block No ............. House No ............. Permit No...;;.....~...~..~... Date Of Permit .................... Appliaant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval Underwriters Approval .............................................. Planning Board Approval Request For Temporary Certificate ........................................ Finctl Certificate Fee Submitted ~ ,.~.. .................. ............ Construction on above described building and pern')~me~ts all appl~bl~cedes and regulations. Sworn ,o before me this ...~.2 ...... day of ~=~0.6.~ ........... i~.'~5~ (stamp or seal) TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exemined ~..... ~ Approved ..................................... , ]yoo....o Permit No. .................... ........ (Bu'z ;;'~';l~ting Inspecto ........ f ................ ' .... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or,.in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordmg to(schedule. b. Plot plan showing location of lot and of buildings on premises, relatio~ship 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 issui~ a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy building 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 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 ~r 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 inSpections. . . ~ ........ .e.~ ..~..: .................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... :[~.~'a,~d.o~....~.~.~'J.~.~k] .............................................................................................................. 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 ............................................. Other Trade's License No ............................................... 1, Location of land on which proposed work will be done. Mop No.: .................... ~,~, ................ ,Lot No ......................... Street and Number ..... '.-./.~..Qa.~e, ti..).,~,~me' ..................................................... ..C'~~.....~.~.~..x.:~.-. ........; ........... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ~.¢,.~,t,~.g.~,..9~. ................................................................................................... b. Intended use grid occupancy ............................ ~....~.........~5 ....... .C ................................................... 3. Nature of work (check which applicable): New Building~· ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... (Description) 4. Estimated Cost ............... .~.i~...~..~...~ ..................... 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 .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ............... ~ ................ 8. Dimensions of ~ntire new construction: Front ............... ~., ................. Rear ...... ~ ................... Depth../.O.. ................. Height ...... ~ .......... Number of Stories ....................................................................................................................... 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 ..................................................................................................... 12, Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . .............. ~-z/,, ,~ ,,/,~/:"~,' ........ Will e)cqess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises~.~....~.'..~..~..~.E..~..../...z~..Z'.~..¢;./~....~ ..... Address ................................ Phone No ....................... 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 oil set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and inaicate whether interior or corner lot. STATE OF NEW YORI(, ~ c c COUNTY OF ................................ ~'~"~ .............. ~.:.,~...~/...~'.......~...'~...~...~../... ............................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ......... ~.g,,~,',~/~:.,~.~.~ ....................................................................................................................................... (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 oil statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this / of , ., ........... ........ ....................................................... ~].~ ~c¢.~ v. ~.~:'~ (Signature of appl cant)