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Home My WebLink About8289-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Cerfi{icate O{ Occupancy No..Z.6~..~.~ ...... Date ............ ~T~ .... .~. ...... , 19. THIS CERTIFIES that the building located at . Sa~tta~r.e. l~r ............ Street Map No. Sal.taire. Esl~lock No ........... Lot No, . 2-9 .... l~atti, tUek...Ii,If., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Iiov ....il.., 19.7~. pursuant to which Building Permit No.. dated .......... 1~¥ .... l~..., 19.7~., 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.r.l.~.~.e..o.r~e..f.a~l[~-y..(tte.ellir~g. IC[t;h. a,dd~;~o~ .................... The certificate is issued to ...~Tat~as. lDt, I;Oltet~ ..................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~1,1~, ............................... UNDERWRITERS CERTIFICATE No ............................................. HOUSE NUMBER ...t0.00 ....... Street .. llaitalil'~ .~gay. ......................... FO~,~ NO. ~ 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? 8289 Z Date ................... J~y.e.....$~ ................... 19..~.~. Permission is hereby granted to: ~.~m,~Le ~'.a.. ~.ome $...~ n~.....AZ.L;...~a,r~ e,.~.. ~.:I. g on e s Southold ~a ~uil~ az~ addition on existing dwelling at premises located at ....~..o...~...~...,9-9.....O.&...]:..t,...&.~..r..e...A~..&..t...e.~ ........................................................... Saltaire '.'~ay kattituck pursuant to application dated ~ov 12 19.~5 , and approved by the Building Inspector. // ....... r''''r ............... :'".' ................ t ........................... Budding Inspector Boisseau Avenue Phone 516 765~2340 Southold, New York 11971 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 fallowing; 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, /Viultiple 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 19.57), 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 formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or lend use $5.00 3. Copy of certificate of occupancy $1.00 New B~ilding ................ Addition ......~.... ..... Old or Pre-existing Building ................ Vacant Land .............. Permit Date Of Health Dept. Approval ..... ;..-~.. .................................. Labor Dept. Approval ................................................ Underwriters Approval ..... ;..-~.. .................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate Construction on above described building .and.~l~ermit meets oil oDglicoble codes gnd regulations. Sworn to before me/this. Noto~'~'"PublicaOy ....... or "~//~.,~/~:~Coun~'""7": ~-v~"~,'"-",~ ~ , ........... (stamp or FOB~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFtC~E SOUTHOLD, N. Y. Examined ..... ~..../..~..~..: ........... 19..?..~7 Approved / ~-- 19. Permit No. Application No .......... 7........~'.. ........... ......................................................................................... / -'F 7 (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or?n ink and submitted in triplicate to the Building .~ Inspector, with 3 sets of plans, accumte plot plan to scale. Fee occordmg tq schedule. b. Plot plan showing ocat on of lot and of buildings on premises, rdlationship to adjoining premises or public streets o: areas, and giving a detailed description of layout ofproperty must be drawn on the diagrom 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. ~( 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 Southo d, 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 cede, and regulations, and to~ admit authorized inspectors on premises and in buildings for necessary inspections. .... ...... ....... .......... (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. Nome of owner of premises ....... J.~.~/'~l..~.~.~ ...........~...!;.~..ft'...i~d...~ ................................................................................... "~'~'°~o~'~'''~¢~'''1( applicant is a corporate, signature of du,/authorized officer. ~x, Builder's License No .............. J;J..~..~ .................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No ............................................... ~J~j-~C~-~ 1. Location of land on which proposed work will be done. Mop No,: ........................................ Lot No....%...J ................ Street and Number .....~...,~'),.~.,~.~"J'/..../~..~.........~...~..~...-' ........... ..-~..../~..-~./,-',"~"~.'?".'~'" ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .................................................. ~ ............................................................................. b, Intended use and occupancy ...... ./.....~..~../~......C~L/~../~..I~ ...................................................................... / 3. Nature of work (check which applicable): New Building.. ................. Addition ...~....... ....... Alteration ................ Repair .................. Removal .................. Demolitior, .................... 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 ..~'...~.. ................... Rear ..~.. ....................... Depth ~; ......... Height ........................ Number of Stories .../. ........................................................................................... ~ ............... Dimensions of sa/ne structure with alterations or additions: Front ....... ~J...~ ................... Rear .~'.,,.~,, .................... Depth ......~...~.,.....t. ............. Height ............................ Number of Stories .../. ........................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth .................... l' Height .................... Number of Stories .... ~....~....~.~.~.....k~;.t~.l.~.~.~...~`).~..~.~.~r~/~)~..~.-.~..~.~. ..... o~' 9. Size of lot: Front ......... J.~..~ ........................................ Rear ...]..O...~ .............................. 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 law, ordinance or regulation: ...j~'..~. ............................................ 13. Will lot be regraded ...~..0. ................ Will excess fill be removed from ~remise,s: ( ) Yes ()0 No 14. Name of Owner of premises ...%)./~.l~l..~,~.....J~?..I.,~...,../~....-~.. Address ..~...~...t.~..i..L.'t.~..~, ...... Phone No.-~'.~..?.~....'~.' Name of Architect .............................................................. Address ............ , ................... Phone No ....................... Name of Contractor ...~..r-R~.l~..~.~.~..~....jz.~...~..~,~....I.~.~..., Address ..~ff..~...~..,~,,'.,.~,.~., ...... Phone No.g..~,.~.~,'~,,~,.~.,,,,~. 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. ,~~..~...~1~.¥..~.. ............................. being duly sworn, deposes and says that he is the applicon! (Name of individual signing contract) above named. Fie is the C'"¢~/~I/~I'~,.cZ...(~.~/~ . . (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 th~s application; ~hat all statements contained in this application are true fo the best of his knowledge and belie~; and that the work will be performed in the manner set fo~h Jn the application filed therewith. ~ / ELiZABetH ANN NEVILLE fe~m [xpires ~f~u ~u, ~