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Home My WebLink About7851-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No.. Z.96~.'I .......... Date ................... A%lgu. S'b 7'.., 19.7.9 THIS CERTIFIES that the building ............................................ Location of Property ... 32~.0 ............ Pec~uash. Ave. ............... Cu~:chog~.. m.. House No. Street Ham/et County Tax Map No. t000 Section ...103 ...... Block ...'[3 .......... Lot ...Q26 ........... Subdivision... ~ ...................... Fi[ed Map No.. X ..... Lot No..X ........... conforms substantially to the Applicahon for Building Permit heretofore filed in this office dated ....... Apl~i~l, .28 ..... , 19 75. pursuant to which Building Permit No..~.85~. Z ............. dated ..... Al:ll?.il. 28 ............. 19.75, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ · m'~. acc. essoz~., bu_%tdin~ ..................................... The certificate is issued to ..... ff0tlll .&. D.o.l?.O~h~..t~k.o~kl ........................... (owner, I~~j~ of the aforesaid building. Suffolk County Department of Health Approval .1~O.~ Pequ&z'ed ........................... UNDERWRITERS CERTIFICATE NO ............. 11o.'[1 Peqni~'ed .................... Rev 4/79 · 01~ NO. 2 TOV~N OF SOUTHOLD I~UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. ?g51 z Permission is hereby granted to: ..~.~b~..BakQw~i ........................................... ....... C~;¢h~ .................................................. to b.~l~d..:~e~..R.=~v,a.[e..acc~e ~.s om~...b~J ~1 dJ_~ .................................................................... at premises located at ..~.~.~,~,J~t,..~...7/.;.~.~'.~.~...~.;LTP.,%~...~.~ ............................................................... .............................................................. C.u~.b-ague ......... .N...Y ........................................................... pursuant to opplication doted ........................Apr. i;L....28 .......... , 19...7.~., end approved by the Building Inspector. Fee $.']..Q.~...Q ........... Building Inspector{ Bo FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion 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 .~...c~./~....'-~. ~Z .~...~..~... New Building .? .......... Old or Pre-existing Building ............ Vacant Land .. Location of PropertY.House '~' ' No. '~' '~' ' '~' ................ ' '~- '~- ~)t~'~' 'Street'~' ' ' ~'~' '~-~'~'~'~'~'~'~'%~' ........ ~' 5~' '~' 'C~' ' '~'t~n~e't Owner or Ownersof Property .~.r4..~-~.~...y......~:~...d.../,~....~..~../~...~M.~.. ~.~../ ........ County T.ax Map No. 1000 Section ~Z~.4~.-~..'.. ..... Block ./~. .......... Lot...~. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.~7.~..~".]. . .'~'... Date of Permit ~.~.F~..-~.Applicant..~'-.~..~.~...~.~..~..~../.~..b~..~/.~.1 ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .~. .................... Fee Submitted $ ~-' O 0 Construction on above described building and permit meets all a~licable_codes~nd regulations. Applicant · · '~'(~'~' J~' ·'~ '~' ' '~ ~./~. · .~f~. ~. .................. Rev. 10-10-78 1 o3d- Approved ........................................ , FOI~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Applicotion No..Z...~...Z...! ........... Disapproved a/c .~.] ................................. ~:,.~.. _-...----~ ............................ ..................... (Building Inspector) APPLICATION FOR BUILDING FERMIT Date .... ~.l. 4 ......................... , 19..?...~. .... INSTRUCTIONS a This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, accurate plot plan to scale. Dee according to schedule. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining prem,ses or public streets at areas, and giwng a detailed description of layout of property must be drawn on the d~agram which is part of th~s 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 permil 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 Occupanc~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a 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 alterations, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and in, buildings for necessary inspections. .................... 4~Signature o,f o45p~h'cant, or .~m~co.rporation) ..... .~._ (Ad~s of applicant) 7' .... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ......... [ ...................................................... if applicant is a corporate, si~ture of duly authorized officer. (Name and title of corpo~rate officer) Builder's License No ...........~..~. .................. Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1 Location of land on which prac)Z~sed work w. lJ, be done~-. Mc~;~o~/~ .../n ................. ./r.,.] ..... I~t N~ ,~ ................ Street and Number ............ ..~...~...~/...~....~ ....... ~........~...0. i'...'..~..~....~-~......~. !'!. ...... ~..~..~/...'...'~... ......... 1, Municipality 2 State existing use and occupancy of p~~.ended use and occupancy of proposed construction' a Exis~ting use and occupancy .............................. ' ...~ .......... ,,.~ ................................ ..~ b Intended use and occupancy '~C,~-~-,' C4J/'/~ ~ ..~..'~' ~/' ......... ............................. : ............................... : ........ ...... ,...(/ ................ / ...................................... 3. Nature of work (check which applicable) New Building ~" ............... Addition .............. Alteration .......... Repair .................. Removal .................. Demoht~or .................... Other Work ............................................. ,_0~0~ (Description) 4 Estimated Cost ........................................................... Fee ..~../':/. ....... (to be pad on filing th~s application) 5 If dwelhng, number of dwelling umts .......................... 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 existing structures, if any' Front ..................... Rear ................................ Depth ................. Height ...................... Number of Stones ........................................................................................................ D~mensions of same structure with alterations or additions: Front ....................................Rear ......................... Depth ............................... Height .................... Number of Stories ........................... 8 D~mensions of entire new construction. Front ................ , ................ Rear ............................ Depth ..... Height .................Number of Stones ....................................................................................... 9 S~ze of Iot. Front ............................................... Rear .................................... Depth .................... 10 Date of Purchase ................................................... Name of Former Owner ....................................................... 11 Zone or use d~stnct in which premises ore s~tuated 12 Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13 WHI lot be regraded ....................... Wdl excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ................................................... Address ................................ Phone No ...................... Nome of Architect .............................. Address ................................ Phone No ...................... Name of Contractor ..................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stlnctly afl buildings, whether ex~stmg or proposed, and red,cate all set-back d~mens~ons fron property hnes Gwe street and block number or description according to deed, and show street names and indicat: whether interior or corner lot ~ (Na//~ o/f individual signing contracf) the ~.....4~&.~-.~.~ ~_~.,,.~ a',.a',.. He ~s ...................................................................................................................................................... (Contractor, agent, corporate officer, otc ) of said owner or owners, and ~s duly authorized to perform or hove performed the sa~d work and to make and fd this apphcat~on; that all statements contained in this apphcation are true to the best of h~s knowledge and behef; an thor the work will be performed in the manner set foffh in the apphcation filed therewith. Sworn to b~me this ............. o, ..... ........ '. ....... ......... ........ .... (Si~ature of apphcant)