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Home My WebLink About7893-zNO. 4 TOWN OF SOUTHOI.r~ BUILDING DEPARTMENT Town Clerk's Off, ice Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at ! ~.7.~...~.~.~..~..~..~...~..~.~..~.~.. ~e~e~~' Map No ........ '-T. ....Block No... ~ ..... Lot No .... --Z.. ........................ conforms substantially to the Application for Building Permit ~heretofore filed in this office dated . .~.~,. ~.~. .......... , 19 .... pursuant to which Building Pemit dated . ¥~.~.I-~.~ ............ , 19..., was issued, and confoms to all of the req,,ire- ments of t e applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .... [~..~.~. ~ .~..~ .... ~. ~.. ~. ......................... (owner, 1~ of the aforesaid building. ,~, Suffolk County Department of Health Approval ..... .~.1:..T.~. ....................... UNDERWRITERS CERTIFICATE No ....... k~.. ~ ~ .q..~..?. ?. .................... HOUSE nUmBER . .~ .~. ?..~... S~eet....,).0.C. ~ ~. :~'.,..C. ?..~..~J~...~?.'.V. ~--.,,. .... ..~~.~.. ...~. -..~...~. ~. ..... Building Inspector FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) No. 7893 Z Permission is hereby granted to: Ba~e...Cau~tr~e.tio~..Co..X~. A/C.....Ber. bert Arm .................... .~c~u~hold ................................. at premises located at .....N./...~....~..9..o...~..e.~...g..~..e...e..~....D..~...~.~.e. .................................................................... ...................................................... ~uth~l~ ...... N. ~Y., ....................................................................... pursuant to application dated ............................ J~l~.~ .......~.J~ .... 19..~..~.., and approved by the Building Inspector. Fee $...'J. ~'.,.Og. ......... Building Insp7 ! FORM NO. 6 TOWN OF $OUTHOLD , 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 w~th the following; for new buildings or new use: 1. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dJsposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildJngs, Mulhple 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 ]957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing oil 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. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare (3 certificate. C. Fees: 1. Certificate of occupancy 95.00 2. Certificate of occupancy on pre-existing dwelling or land use 95.00 3. Copy of certificate of occupancy $1.00 Date ........~...,~, ...T.......~.O...(.,..!....~.Z:~.Z New B~tilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locotion Of Property ..(..~..7....~......?..?..C..~...E.~r. ........ .~...~'~...E....~.../~. ...... ..'~.,..q~....~..~.,./ ......... .~....O..?..~...H....D...L....~. ............... Owner Or Owners Of Property ........ ..~...k.'~,.-~,.,'~....E...Tc,..T- ....... ..~.,..~..~ ................................................................... Subdivision ........................... ..-Z. ................................ LoJ: No....qT. ....... Block No. ~ ........ House No.{.~.~. Permit No 7..~...~..~....Z-.. Date Of Permit .H...~..'(.../'.~k.e.7.?.Applicant .... .-~..~. ....... ~..~..~..T. ........................... Health Dept. Approval ................ ../~....-:..,.~.....: ........... Labor Dept. Approval ..................... ../~...i~ ................. Underwriters Approval ........ .~. ....................... .~.?.~.....Planning Board Approval ............ .~,../..;...,~......~ ......... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....... ..~.,.~ ................ Construction on above described building<~ p~-mi~s/a~ _applicable codes and regulations. Apphcant ..~.~.~....,~ ......................................................................... Sworn to before me this ~ ~ O 7~ ~:~ 0.. cT. I ~0 ~ ~0 0 0 0 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Perm,t No ................................... APPLICATION FOR BUILDING PERMIT Date ,~...~...~.../..zT. ..... ..~....~.. ................... , 19..~.....~... INSTRUCTIONS o Th~s opphcatlon must be completely filled ,n by typewriter or in ink and submitted in triplicate to the Buildi, Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premises, relat,onsh~p to adjoining prem,ses or public streets ~ areas, and gwing a detailed description of layout ofproperty must be drawn on the d~agram which ~s part of th~s applicotio, c. The work covered by this apphcatlon may not be commenced before issuance of Building Permit d Upon approval of this application, the Building Inspector will ,ssue a Building Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No budding shall be occupied or used in whole or in part for any purpose whatever until o Cerhf~cate of Occupan~ 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 tl 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, os herein describe The apphcant 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. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, ~_~q~neer, general contractor, electrician, plumber or buildc If appljcG~ is a coca,ate, s/~ture of duly ~thori~e~ officer. ...... (Name aKd jtitle of ~cqrporat~officer) Bu,lder s Lic~ No ....... ~Z~.Z ...... ~. ..................... Plumber's License No ................................................. Electrician's License No ............................................ 2 Other Trade's License No ............................................... kocabon of land on which propo~d work will be done. Map No ............................... Lot No ...................... Street and Number ........... ..~(...~....c'../.~.~.~.4(.......~...~....~..G....~.... ~."..k/,.~...~......~.....~../.~.~'~.~.~. ................................. Municipali~ State existing use and ~cupancy of premises and intended use and occupancy of proposed construct,on: a ~isiting use o~ occupancy ........... b Intended use and occupancy 3. Nature of work (check which applicable) New Budding ................. Addition.............~' ..... Alteration .... Repair .................. Removal ................. Demohhon .......... Other Work ............................................ (Description) 4 Estimated Cost .... ~.. ~.,. ~E-:~. .............................. Fee .. (to be paid on filing this application) 5. If dwelhng, number of dwelling units ........ ../. ............... Number of dwelhng un,ts 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 .... 7 ~7..~.~ ............. Rear ...¢..~.. ......................Depth ,..~...~.. .... Height ........................ Number of Stories .... /..?~ ................................................................................................. D~mens~ons of..~same structure w~th alterahons or odd,hans Front ........... ~ ......~ ............Rear .... .~.~.~ ....... Depth ......... .~.."~. ............ Height ........................ Number of Stories ........ ~..'~,,~ .............. 8 Dimensions of entire new construction: Front .................................... Rear .... ..~.~.~' ................. Depth ...~.~....~-z.. ........ Height ...... (.~'. ......... Number of Stones ....... ~. ...................................................................................... 9. Size of lot Front .............. /...?.~..~ ........................... Rear ..... './.7..~.~ .......................... Depth ..~.~..~..-....?...,.~.~... 10 Date of Purchase ...................................................... Nam~of Former Owner ..................................................... 11. Zone or use district in which premises are s~tuated ........ .~...~.,~.f~2~...~/.:J.~'Z.Z~.../,,~ ....... , ............................................ 12 Does proposed construction violate any zoning law, ordinance or regulation ....~.~.~.. ......................................... ,/ 13 W, II lot be regraded ...... ~'9...,. .......... Will ex~ess fill be removed from premises: ( ) Yes ( ~)~No .t1~- ~f,~ 14 Name of Owner of premises ...~.E.~E._~.~......m. ,~.../~. ........... Address ..¢;~./.,~.~ ............... Phone No ...................... Name of__A/Fc~'_t~ct ...... 4~-.~/~/~.1~.~....'~/ ~../~J~ ...... Address ................................Phone No ...................... Name of Contractor ....~.f~. ~.~. ~--/~'..~., Address .... .C..~,. ~ ..... ........ ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and ~nd~cate all set-back dimensions fron property lines. Gzve street and block number or descr~phon according to deed, and show street names and indicot~ whether interior or corner lot STATE OF NEW )/ORK-/,/~, ~ ~'* I c c COUNTY OF .~.~'~'° ............ ~-~.~.~..~.~7.....~...' .... ~ ............................. be,no duly sworn~ d~oses ~nd says thor he ,s the ~pphc~n (Name of ind~wdual s~gnmg contrac~ above name. He ~s the ................................. ~.~.~.~ .................................................................................................... (Contr'actor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and this applicahon; that all statements contained m th~s applicahon are true to the best of his knowledge and belief, an, tha~ the work will be performed m the manner set fo~h m the apphcation filed therewith. Swor~re~ me this ~~~ ' m ....... ...... ......... ..... , ........... ............ JUDITH T. ~OKEN x~oto~ Pubhc, SPate of New t i//i l ,I