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Home My WebLink About7856-z FORM/NO. 4 / TOWN OF $OUTHOLD BIJ-ILDING DEPARTMENT Town Clerk's Office $outhold, N. ¥. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ,., .~!~, ...... }.~. ~. ?]. ~ ..... Street Map No ........ 'W. ....Block No. ~ Lot No, conforms substantially to the Application for Bugding Permit heretofore filed in this office dated ....... ~. r.~.....,~.., 19.'7. ?.'-pursuant to which Building Permit No. ?.~..~..~.Z- dated ......... '.~.?.~2...2..F..., 19.~. 5.~was issued, and conforms to all of the req~re- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... ~ .C.C..k~. ~.~..q.~ :,: .... ~ .~..~ ~ .~.! ~?.~. ...... (.~.~. ¢-.~ .~..~. ? ~?¢~ ........ The certificate is issued to ...~.~..W..k.,..~.'.a. tf.,Z....c:~?.~.~.~..~..'..-..~.. ~?..a?..~.. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... ~...'~.~..-. ................... UNDERWRITERS CERTIFICATE No ........... ./~f...e..~..~.'~ ........................ HOUSE NUMBER ...... ,~.~..~.. Street ..... !~,. '..~...~. .... .~..-[..~...~.~...~. ........... ................................................ .................. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7856 Z Date ......................... Apt. il ....... 2~ ......,19..~..~..~' Permission is hereby granted to: ~.d.~,,...~.~.~ztg.....A/~...Ce.z:l..~,:tr~, .................... ................... .qz1.~.r~.~. ....................... at premises located at .... ~-~-...-~'~.-~n~j--¢-~ .......................................................................................... .................................................. Or&ent ....... i~ ................................................................................ pursuant to application dated ..................... ~p.ln.$.~......~ ............, 19.~.~..., and approved by the Building Inspector. Fee $.1.04~ ............ FOR~ NO, $ TOWN OF SOUTHOLD , Building Department Town Clerks Office $ou~hold, 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 w~th the following; for new buildings or new use: 1. Final survey of property with accurate iocation of all buildings, property lines, streets, aha 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 comphance from the Arch,tact or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B For existing buddings (prior to April 1957), 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 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 ~.....~....~....0~,../..~.C~ ................ New Building .... ...~:...c..~./.. Addition ................ O~d or Pre-existing Building ................ Vacant Land .............. ! Location Of Property .....~._.~..._...~..,.~....~..,.:...~...~..~'~-~'~O ~/ . .~'/ ....................................................................................... Owner Or Owners Of Property ..C.f/E./..,~...,. .................................................................................................... Subdivision ................................................................ Lot No ............. Block No ........ ~.¥.. House N .o~...~,.,..~... Permit No...,~,.~,~,.f..,~, ..... Dot e Of Permit ~/4 ?,/~.,?,.....Applicant/ '~'~-~f' "~" ""~" ' ' ' '~' ~'/ ............................. Health Dept. Approval .......... ..~./~. .......................... labor Dept. Approval .... .~..~'...~.. .................................. Underwriters Approval .......... ~...~/..~. .......................... Planning Board Approval ../ .~..~..~.. ........................... Request For Temporary Certificate ........................................ FinoJ Certificate .....~ .................................. Fee Submitted $ .....~..'..~ ..................... Construction on above described building and permit meets all~gpplicable codes and regulations. Applicant .......................... ..~7.~~ ....... . r' Sworn to before me this { ~ ~_ (~'7 ?..,W xx Notary Public .................................... County INSTRUCTIONS ~ a. This application must be completely filled in by typewriter o~.in ink and submitted in triplicate to the Building ~ Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee aocord,ng to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets of areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is port of this applicatlon. ~ 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. APPL CAT ON S HEREBY MADE to the Building Deportment 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 Ragu ations, for the construction of buildings, additions or alterations, or for removal or demolition, as herel.n descri .bed. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and ragu at,om, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or/~ame, if,a corpDration) ............... · ' ' (~ddress of applicant) State w/hether applicant is ow?er, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. /es. e C ................................................ ........................................................................ : ............................... Name of owner of premises ................................... 7' ...................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ~....2 ............... Plumber's License No ................................................. Electr~cmns license No ............................................. Other Trade's License No ............................................... Ma No Lot No ~ Location of land on whichpraposed wpr~will be donee p o~ ....... ~ ............................................. Street and Number ..~.....~...~........~..1....~ ............. ~ ..................................................... Municipality State existing use and occupancy of pre, raises and intended u~e and occupancy of proposed construction: & o. Exisiting use and occupancy ........... 7'-'~' ......... '~: ....... :"~'~' ........ '-'"~ ........................ '~ ............... ~ ................. b. Intended useandoccuponcy .~........~ ...........................~ ........................................................ Lq~... 3. Nature of work (check which applicable): New Buil~ling'. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition ......... ~ ........... Other Wo~ ..................................................... I 4. Estimated Cost ...~...t~.~ .......................................... Fee Z..~., -- (Description) ........ .................. 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each flor ............................ If gemge, number ~f ~m ............................................................................................................................................. 6. If business, commemiel or mixed occupency, speci~ n~ture end extent of eech ~pe of use ............................ 7. Dimensions of existing structures, if eny: Front ............................ Reor ................................ Depth .................... Height ........................ Nu~er of Stori~ ... .............................................................................................................. Dimensions of some structure with elter~tions or additions: Front ....................................R~r ............................ Depth ................................ Height ............................ N~ r of Stories ......................... 8. Dimension~ntire new construction: Front ....... ~......~.., ................ Rear ............................ D~th ........................ Height ...~.~. ....... Number of Stories ....... ~d.~. ..................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Fo~er ~ner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: 13. Will lot be regrad~ ............................ ~ I ~l~7x~ill excess fill be removed fr~ ~.:,,~Pm~i~esb~ ) Yes ( 14. Nameof~ner of premises..~.~.[...~.~.~ ................. ~ ........ A~m, ~....~.~.~.~. ....... ~ No. ~.~..~..~.~.. Name of Architect .............................................................. A~re~ ................................ Ph~e No ....................... Name of Contractor ............................................................ A~ress ................................ Ph~e No ....................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or pr~osed, and indicate all ~t~k dimensions from prope~ lines. Give street and block number or description according to de~, and show street names and indicate whether interior or corner lot. STATE OF NEW)'OBK,, _ t S S COUNW ' ............. ~.4~.&.U.~.~..~C~....../.~..,..~.~Z'.~..~..~. ........................... being duly sworn, deposes and says that he is the applicom (Name of individual signing ~ontract0 above named. He is the,.,,,.,.,,...,....,..,.,....,,.,...,.,."/~' 5 5'~..,,,~.....,.., ......................................... ~ .................................................................................... (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 are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the appllcotion filed therewith. Sworn to before me this ........................ .......... ' Nota~ Public, ...~,,. ........... County .............................. (~i~_.,.._~l~ii~')' ............................. ~ MURIEL B~~ NOTARY PUBLIC, Slate of New York No. 52-4522026 - Suffo}k Counfy Commission Expires March ]0 lq ~