The URL can be used to link to this page

Home My WebLink About7862-zFORM NO. 4 TOWN OF SOUTHOLD BI]II,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z.~..~.0.~ ...... Date ........... .Feb ..... 22..., 19..~6 THIS CERTIFIES that the building located at . 8a~.t~lre. t~'.~y ........... Street Map No. $~l.~lr. ~lock No ........... Lot No, 3.6 ..... g~t~l$~k.. ~...~, ...... conforms substantially to the Application for B~lding Permit heretofore f~ed ~ this office dated ........... ~il.. ~9.~. pursuit to which B~ldMg Pemit No..~6~. dated .... l~rt~..3~..., 19. ~, was issued, ~d conforms to ~ of the req~ ments of the applicable pro~sions of the law. The occup~cy for which this ce~ificate is issued is . P$1vtte..~. ~ .d~ill~g. N~h. addi~.i~ .................... The certificate ~ issued to . .~~ .~q~ .~ ~. ~U~ ...................... (owner, lessee or ten,t) of the ~oresaid building. S~olk County Department of He~th Approv~ .] ~s ............................. U~ERWRITERS CERTIFICATE No... ~13~ ..... ~. 6...t~ ............... HOUSE NUMBER . ~ ..... Street ..... ~$~$~..~Y. ...................... FORM NO. ~ TO~'N 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? 7862 Z Permission is hereby granted to: ...~T.....(-L.r..~.,,..~.,r:.~.~. ..... ..¢........~..q?..~ ..... ,-T..~ ...... ..~./.c~ ......... ~t.!.tj.?,LL~...~.? ...... $./~..~..~..(.<.. .......... ....................................................... ~..~...~....L..~.....¢...c.!..< .............................................................. pursuant to application dated ...................... ,/~...,f~,...~..!...L. ........ ~.~..., ]gZ?.%nd approved by the Building Inspector. Fee $ ........................ Building Inspector FOB~M NO. $ TOWN OF SOUTHOLD ~ Building Department Town Clerk/ Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This apphcation must be felled in typewriter OR ink, and submitted in DUPLICATE to the Budding Inspector with the following; for new buddings or new use: 1. Final survey of property with accurate Iocahon of all buddings, property lines, streets, aha unusual natural or topographm 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 buddings, Industrial buildings, Multiple Residences and similar buildings and installations, a cerhflcate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed szte plan requirements where applicable. B. For existing buildings (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 Feb,, 24, ~976 New Bqild~ng ................ Addition ......~.. ........ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... 25D...Sal.~a:~-r~...~,~'~E. ...................................................................................... Owner Or Owners Of Property 9/~.l_].~.am So,ok Subdivision ..... .8.~.]...~.~.~'..~.....~...~.~.~.~.~.~ .................... Lot No ....~.~.. .... Block No ............. House No ............ Permit No..,7..8.,6...2. .......... Date Of Permit ..~'...2..~../.~.5..Applicant ~..~..~..g..~..rt..~.~.."~.H..~.~.~.~.~.~.~.~.S..~..rt..~.~.~.~ Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .... ,~ .................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ...~X, ................................. Fee Submitted $ 5°00 Applicant ..,,,..,tx-d.O.-,~....'~.......~...~,.'-:.~..~...',,,~ .................................~-'~-z/'/~7 ~ Sworn to before me this .... .... ...... ......... Natary Public ......· · .~k~. f'. rcA~.~f.:~. .... County (stamp or seal) ..... -"~ ? ":i~',~HErI!'NEW~ Y, ORK BOARDt OF" FIRE,~,UNDERWRiTER,,S' "' '" '"~'!'ii''! ' I~q~ly th~ el~tri~al equipment as ~escribeE below' and introduced b~ t~ ap~h~ant named ,~ IL? ~,t ,William,,jj~ ~lS~ok~, 129~;Salt~z~e Way, ~Mattit,uck, L.I. wasexaminedo~} '";~'~'~ 'lO ~' 3~K I' *r'"wandfqundtobei~ompltanc~jwJttttherequirementsoJthlSOO~r~{ '"FIXTURE I~' DI~ ~ OUTLETS I · row. c:.E. c's omc, ×om ned .................. -"' .......... ~pr~ed ................. ~ .......... , 19 ........ Perm t No..~....{ ................. ~ D~sapproved a/c ....................... ~.t, ....... ~ ............ ~ ............. ~)~ov~..g~..~r~~ ........................................................... ~'~ ......... ~'~uildi~"~;~;;;i ................................. NOTIFy BUILDING DEPARTMENT A~_pp ATI ~D~6S'2&6OINsPECTioNs:~AM TO ~PM FOR R~QUIR.A LI~ ON FOR BUILOING PERMIT 1 BEFORE BACKFILLING FOUNDA. d t FION OR START FRAMING o e ................................................, ]~ ......... ~' BEFORE COVERING PIPELINE INSTRU~IONS ~, FINAL WHEN ~OB COMPLETED ~?s~tfcat,o~ ~ b~c~tete~r fil~ed ,. by ~pe.riter or i. i~k ~nd submitteJ in triplicate to the ~uildiJ Inspector, with 3 s~t~ of plans, accurate plot plan to ~ale. Fee ~ccording to schedule. b. Plat plan showing Ioc~tion of lot ~nd ~f buildings on premises, relationship t~ ~djo~ning premises or public streets · areas, and g~ving a detail~ descnptmn of I~yout ofproper~ must be drawn on the diagram which ~s par of th~s ~pphcatio c. The work covered by this application m~y not be commenced before ~ssuance of Building Permit d. Upon ~pprowl of this ~pplication, the Building Inspector will ~ssue ~ Budding Permit to the ~pphc~nt. Such peru- shall be kept on the pr~mises ~vailable for inspection throughout th~ ~ork. e No building shall be occupied or used in whole or in p~rt for any purpose whatever until ~ C~ific~te of ~cupan, shall h~ve been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances. Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. I .x"~_P (Signature of applicant, or name, if a corporation) ............................... ............................. State whether applicant is owner, lessee, ogent, architect, engineer, general contractor, electrician, plumber or builde ~ame of owner of premises ).Z:L .L.>.i..(:..~::.'' ...... ~..!: ....... ~:....~ ....... If applicant is a co~orate/ s~gnature of duly authorized officer. 5~ ~ m~c~[~ (Name and title of corporate officer) '/--~ Builder% License No ..................................................... ?~ ~ ~ Plumber% License No ................................................. Electrician's License No ............................................. Other Trade's License No , Location of ;:::: w~::~ ::::::~ ~ ' . ............................................................. Street and r . . .~~...~.=...-~i ........................... 2 State existin~ use and occupancy of premisesrand intended use ~nd occupancy of proposed construction: .... ~....::!~: ..... '...: ........................................................ b. Intended use and occupancy 3. Nature of work (check which applicable) New Budding ......... Addition .................. Alteration ........... ~.... Removal ........... Demohhor ................ Other Work ................................................ Repair ........... J~ I(., .,/-~ -. \¢'~ ?J (Description) 4 Estimated Cost .......................................................... Fee ................................................................................ (to be pa~d on filing thru apphcahon) I 5. If dwelhng, number of dwelhng units ' ...Number of dwelling 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~mensions of exmtmg structures, ~f any: Front ........................... Rear ................................ Depth .................... Height ........................ Number of Stones ............................................................................................................... D~mensions of same structure with alterahons or addmons' Front ................................... Rear ................... Depth ................................ Height ...................... N,.u, rgber of Stones .............. , ................. 8 D~mens~ons of entire new construction: Front ....... f .......................... Rear ........................... Depth .................... Height ................... Number of Stories ......................................................................................................... 9 S~ze of lot: Front ...................................................... Rear ........................................ Depth .............................. 10. Date of Purchase ....................................................... Name of Former Owner ...................................................... 11. Zone or use distnct in whmh premises are situated ............................................................................................. 12 Does proposed construchon wolate any zomng law, ordinance or regulahon .................................... ~,. .............. 13 Will lot be regraded ............. ,., ............ W~ll exces~s fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ...................................... ; .......... Address ................................ Phone No ..................... Nome of Architect ............................................ Address ................................ Phone No ..................... Nome of Contractor ......................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and dmtmctly all buildings, whether ex,sting or proposed, and indmate all set-back dimensions fro~ property hnes G~ve street and block number or description according to deed, and show street names and indicai whether interior or corner lot STATE OF NEW YORK, ~ S ~' COUN , _?r ...... ..................................................................................... being duly sworn, deposes and says that he ~s the apphca, (Name of ind~y~dual signing c,,on~tracf) above name, d. ~ f He ~s the ............................ ~ ................................. '...': ................................................................................................ (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and fi th~s applicahon; that all statements contained m this apphcahon are true to the best of h~s knowledge and behef; ar that the work will be performed ~n the manner set foffh in the apphcation filed therewith. ~ to before me th,s ~'(r, " ....................... day of ................................. , 19. ~' , .... Nota~ Public, . ................................................... Coun~ ............... ~ ....................................................... ~.,,~ ........... (Sigp~ture of applicant) lrOK~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...................... ,Z -- .p.cot,. -rov. . ,F;" z .o ................................. ~op ................... ...~ ......... , ! ........ Permit No ..................................... Disapproved............. ,.i Tm'~ a/c ....... ~i~' ............................. iiii'i ....... iii ......... i ......... "AP~RO~/~O"~S'"~O~ ...... " ..................... ;~ ...................... DATE ....... FE:Et.p' ' ' Y _.___,Z~.~--- ' ~-'" ._i_~/__~B~' 'ATBY "':?" ' ................................................................... (Building Inspector) NOTiF¥~BUiLDiNG DEYAV,~nnc,-- 765-2660 9AM TO 4PM FOR REQUII~- APPLICATION FOR BUILDING PERMIT / ED ,NSPECT'ONS: S/..~...~... 1. BEFORE BACKFILLING FouNDA- TiON OR START FRAMING Date ................................ , 19 ')~' 2. BEFORE coVERING piPELINE 3. FINAL wHEN JOB cOMPLETED INSTRUCTIONS ~L .,,~,,~[~i~aPP ' ' be completely filled in by typewriter or in ink and submitted in triplicate to the Building S~Fl~l~'e~tor~ w th 3 sets of plons, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upan 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 port 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 Southold, 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (S'gnature of applicant, or name, if a corpor~iic~i ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ame of awner of premises ...................... ~[['~s~D~ant is a corp~ate,~ L,~,sjgnat~ of d~ ~auth~ized officer. Builder'~ k[c~se No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. ,~Duz.~ ' ~' Other Trade's License No ............................................... Location of land on which proposed work will be done. Mop No.: ~/ /~ ~' ~)~ Lot No..;..[...~....,~.. ........ Street and Number Municipality State existing use and occupancy of premises,,e~l intended use ~nd occupancy of proposed construction: \ '_ a Ex stng use and occuponcy ,(~......~t~...~.!...-~........~....~...~:..~.!.?.'~.~.. ................................................... b. Intended use and occupancy ...... ..,c~,./~Lsft~..~,, ...................................................................................................... 3. Nature of work (check which applicable): New Building,. ................. Addition ....~........ .... Alteration ................ Repair ............ ..~.. Removal .................. Demolition ................. .~?her Work .................................. -,~ I . -- ~ (Description) .... 4. Estimated Cast ........~..~ ..................................... 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 entire new construction: Front ......... s~....~, ................ Rear ...... ~....~ ........... Depth ...... ~...~.~ ........... Height .................... Number of Stories ............... J ............. ... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ]4. Name of Owner of premises ....~...)...t::~....~/j~...~ .......... Address ................................ Phone No ....................... Nome 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 all set-I~ck 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. STATE OF NEW YORK, ~ c c COU NTY,,./DF ................................ .................................... being duly sworn, deposes and says that he is the applicam individual signing contracf) above named. (, He is the .....~..~......~...~ ........... .~..~::~.~,~...~... ......................................................................................................... (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 thar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this~1~).~,,, ~.j Notary ................................................... County ..... .N-~...~.~':......'~.......~..N..~,~)~.~... .............. Public,. (Sig~,~ure of applicant)