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Home My WebLink About7838-z~NO, 4 TOWN OF SOUTHOLD B~,~ING DI~ARTla~NT T~ ~k'~ ~ Sou~ N. Y. Certificate Of Occupancy No..Z.6.~.Q3 ...... Date .............Jttly.. 2 ...... ,19.?N. THIS CERTIFIES that the building located at .E/.~..~ain. P, oad .......... Street Map No...xx ........ Block No.. xx ......Lot No..xxx.. ~Otli;hojl,d.. }I.o.l[e ......... conforms substantially to the Application for Building Permit heretofore filed in ~hts office dated ........... I~F.. 22.., 19.7.2. pursuant to which Buildin~ Permit No.i...783]~Z dated ...........April..2~, 19 .... , was issued, and conforms to all of th~ require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... Pri~el;~..germs..(~,~qe~.~o.~..IJlL.~I) ................................ The certificate is issued to . .l~ry..(}gl~.~vd.....09~e. ll' ............................. (owner, lessee or tenant) o! the aforesaid building. Suffolk County Department of Health Approval Ii,lt, ............................... tnVDEaWa~TEaS CEaTLFZCATE ~To. 1~739/... ~lr.. aS. ~ 92~ .................. HOUS~ Ntr~a~Ea ..... ~.l.l.C~0.,, Street ...... .~..l.n..~..o~.d. ......................... FOI~M N~. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, ~,1~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7838 Z Permission is hereby granted to: .~....&~. ..... .~.~...u.. ~..~..~)..~ .~ ................. at premises located at ........................ ~.?.~..I..~./. ........ ~¢..~..~. ................................................................ .................................................................... ~.~.~ Z.!:!..q.~ .............................................................. pursuant to application dated ............................... J~t..~-~..~.!.~....~..~., 19~/.~..., and approved by the Building Inspector. Fee $ ........................ ......... ~:~.....: ..z~...:.../.~ ....................... Building Inspector FOII~I NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instruction; A. This apphcation must be filled ~n 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 d~sposal--(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 comphance from the Architect or Engineer responsible for the building. §. Submit Planning Board approval of completed s~te 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: I. Certificate of occupancy SB.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 / oo, ' ' New B~lilding .... ~. ......... AdditLon ............... Old or Pre-existing Building ................ · 'Vacant Land .............. ,oco ,o, .... Subdivision,~ ,,~'~ ~J ............................................. ~/~..7~... Lot//No ............. ~'~ --BI~-~'~' No.~. H~,~e Permit No.../..~..~.~.... Date Of Permit ...z.~..~..?../.~..~..Applicont .,~.......~...~..,.....~.~.~'...'YJ~r~.....~E. ....... Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fin~ Certificate ......................................... Fee Submitted $ ..... ~...'....' ....................... Construction on above described buildingland~/J~_ .ermit meets~~~/and re/~ations. Sworn to before me~'~, ...... ~. day of .f~V.....~....(..?...?..S..~, ........ (stamp or seal, ,~ '~ Noto P.b,c ...... V:. .......................... Count FORM* l'q'O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned .................... oproved .................. No. .......... D~sopproved a/c .... ~ ....... ..-~...................~..~:,. ...................................... (Buildtng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No....7...~....~......~.. ............... a Th~s apphcation must be completely filled ,n by typewnter o~ in ink and submitted in triplicate to the Buildin~ 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 adiommg premises or public streets o areas, and giving a detailed descnption of layout ofproperty must be drawn on the d~ogrom which is part of this application c. The work covered by th~s application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permi shall be kept on the premises available for inspection throughout the work. e. No build.ng shall be occupied or used in whole or ~n port for any purpose whatever unhl a Certificate of Occuponc,, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterahons, 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 admit authorized inspectors on premises and ir~ buildings for necessary inspections./-~-~x ....... (Address of applicant) State whether apphcant is owner, lessee, agent, archffect, engineer, general contractor, electrician, plumber or builde~ Name of owner of premises .................................................................................................................................. If applicant ~s 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 ............................................... Locohon of land on which proposed work will be done Mop No ................................ Lot No .................... Street and Number ............................ ~.....~..~...N.. ...... ..~...O...~.]~. ......... ) ...... _~oU 7tl 0 L~ .................................... ...... State exmting use and occupancy of premises and intended use and occupancy of proposed construction: a Ex,siting use and occupancy ONE ~A~IL¥ b(~/k-lLI N ~- ~Jt'-/'H AE'E'~. ........................................................................................... b Intended use and occupancy ...... .,~..L~...~....~ ........... ~.v .t.T..j~.. ......... ..L.~..~..~...~...T..%. ...... ..~..c..c..[.~o ................................ 3. Nature of work (check which applicable). New Building ................ Addmon ................. Alteration .......... Repair .................. Removal .............. Demolmor ............. Other Work ......................................... (Description) 4. Est,mated Cost ........ :?..i.~.....~... O 0 ..Fee (to be pa~d on filing th~s apphcat~on) 5 If dwelling, number of dwelhng units ........................... Number of dwelhng umts on each floor .......................... If garage, number of cars ............. ~ ...... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ........................ 7 D~mens~ons of ex~stmg structures, ,f any. Front ........................ Rear ................................Depth ................ Height ........................ Number of Stones ........................................................................................................ Dimensions of same structure with alterations or addmons Front ................................. Rear .................. Depth ................................Height ...................... Number of Stones ............................... 8 D~mensions of ent,re new construct,on: Front ......... __~.~, ............... Rear ............................ Depth .... ~ O. .......... Height ................... Number of Stones ..................................................................................................... 9. S~ze of lot Front ................................................ Rear ...................................... Depth ............................... 10 Date of Purchase ................................................ Name of Former Owner ..................................................... 1 1. Zone or use d~stnct m which premises are s~tuated ................ ~.,: ............ :' ..................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation' . ...................................................... 13 Wdl lot be regroded ............................ WHI excess fill be removed from premises: ( ) Yes ( 14 Name of Owner of prem,ses~...~..../~.......~...D....&r~...~..~....~...~. .............. Address ....~...?...~...H..?.~,.~.. ........ Phone No ...................... Name of Architect .............................................. Address ................................Phone No ...................... Name of Contractor ......................................... Address ................................Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions fron property hnes Gwe street and block number or description according to deed, and show street names and ind~coh whether interior or corner lot STATE OF NEW YORK, IS S COUNTY OF .......................... ......... .~..~.Z~.¥ ......... ...~:...0..~.~....~..~...~.. ..........................be,ng duly sworn, deposes and says that he ,s the applicon (Name of ~ndiwdual signing contraci0 above named He Is the ............... .0.....~....~...~.~ ........................................................................................................................ (Contractor, agent, corporate officer, etc ) of said owner or owners, and ,s duly authorized to perform or have performed the said work and to make and this apphcat,on; that all statements contained m th~s apphcahon are true to the best of h~s knowledge and behef, thor the work will be performed m the manner set fo~h in the apphcation fi]ed therewith. Sworn to before me th,s C { ~ ~ ............... of ........................... _ / Public f~~ ~~Z~;. ~~~ ~.. Nota~ , ..................................... ¥ ........ ~ ...~ ............................................................................ BLIC. sta e u~ ,