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Home My WebLink About7905-zl~O~ NO. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~.,.~t9 .M. 0.P.r,t . .~o.~.D...-r?...~..~),. Map No ....... -... Block No...-- ...... Lot No ..... .-- ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~. DY.. 19 .7. pursuant to which Building Permit lgo. dated ...... ~.~ ~ty~ ..., 19.7. b.~ was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...gC.C£ S$.o.~'.y .... -t~v.~.t.O.t.~.,.~,~.... .(.&..e.~.~..~.~.f?.~?.r) .............. The certificate is issued to ......... L..~ .t/.I ......~.~. ?..~. ~.t' ...................... (owner, of the aforesaid building. Suffolk County Department of Health Approval .... ./5.[ .-.~.: ................... HOUSE NUMBER .... ~1~.. Street /~.~.~'??.... :.~.~..A.~....-~.~...~..h.X.Y. tf...fy(.... Building Inspector FOi~/ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI-HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7905 Z Permission is hereby granted to: ..... ~...~..e.~..~. ................................................. ........ , ..~f, ko:lA ................................................ to..~...~...l~..~.~.)....~...~:~t,~. ........................................................................... at premises located at ...~...~..O..t..~..t...O...~.~....~.O...~.~...~...O..~.~...t'...O...~.~...~......e~.. ............................................. ................................................ ~.o.~..a......~.:.~.: .............................................................................. pursuant to application dated .......................... ~ ..........~. .......... 19,~...., and approved by the Building Inspector. Fee ~..~..O...,.~ ........... FO~t NO. ~ TOWN OF SOUTHOLD , Building Departmmtt Towe Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY lestructions 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 disposals(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 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 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: I. 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 ........ ., .~....~........~..~...(2...~.....~. · New Bclilding u'J Addition Old or Pre-existing Building Vacant Land Location Of Property ........................................ , ............................................................. .! ........................ ~- Owner Or Owners Of Property .................. ..~. ......... ...~....~....~....!.~.~..~./ .................................................................. Subdivision ...................... ,;.::~ .................................... Lot No. -- Block No. ~,. ......... House No.,..~....I,,.'~,.,? Permit No. ~.~...~..,-~.... ..... Date Of Permit ..~...~....Y~...~./.,Xi~A-~Tcant .... ~'. ...... ..~..~...~...'../. ............................... Health Dept. Approval ~ .% ~ ..... Labor Dept. Approval ............... '....../~...:....~... ................ Underwriters Approval .N./~..~..~...~.~.. ....... ~.~../.,.,Planning Board Approval .......... ./,,~.,..'....~>... ............... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ ........... ~...~ ............ Construction on above described building and ~rmit meets all ap[;dicc)ble codes and regulations. Applicant ............................................... Sworn to before me this 9/? { ? C ................ day of ............................................ (stamp or seed d~O Z-- Notary Public .................................... County FOU, M NO. ! TOWN o, SCUT.OLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE MUTHOLD, N. Y. ....................................... , Disapproved a/c ~....~..,,~ ....................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Thts application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi, 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, relahonship to adjmnmg premises or public streets areas, and giving a detailed descriphon of layout ofproperty must be drawn on the diagram which is part of this applicatio 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 pern 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 Occupan. 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 tl Budding 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 describ; The applicant agrees to comply with oil 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, lc4f a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build L~v-: L Pn',",-',- Name o~ owme~ o~ premises .......... ~ ........... ~ ........ ~...~ ............. Jf applicant ,s a corporate, signature of duly authorized officer. ~ (Nome and title of corporate officer) Builder's License No ..................................................... Plumber's License Ho ................................................. Electrician's License No ................. ] ........ ~~ Other Zrade's License No ............................................... 1 Locahon of land on whict~ proposed work will-be done. Map No ................................. Lot No ..................... Street and Number ................. z.~.~.?.~.~.~.z.?.?:~]~.z~.:~.~.~?.~.~.?..~.?.~.~..~.~.d;~.~.~.~ ............................................. Municipality 2 State exmtmg use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy .................................................................................................................... gre6nhouse b. Intended use and occupancy ........................................................................................................................ 3. Nature of work (check which apphcable) New Budding ....~ .......... Addmon .................Alteration ......... Repair ................Removal ............... Demolmor. ......... Other Work ............................................... (Description) 4. Estimated Cost ..................... . ~ .8. .0. . .0. ... . .0. .0. . .................... Fee ....................................................................................... (to be paid on filing th~s apphcatton) ,5. If dwelling, number of dwelhng umts ...................... Number of dwelling umts 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 ex~st~ng structures, if any: Front ......................... Rear ................................ Depth ............. Height ........................ Number of Stones ..................................................................................................... D~mens~ons of same structure with alterations or addmons: Front .................................... Rear ....................... Depth ................................ Height ........................ Number of Stories .............................. 8 Dimensions of entire new construction' Front 3.2 t , Rear 3.2 ~ Depth '15 ~ Height .....~.~ ........ Number of Stories ......... .°.~.e..../.~.). .................................................................................. 9. S~ze of lot: Front .................................................... Rear ...................................... Depth ................................ 10. Date of Purchase ...................................................... Name of Former Owner ....................................................... ! 1. Zone or use district in which premises are situated .......................................................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation' . ...... mD. ........................................... 13 W~II lot be regraded ....... ~.O. ................ Will excess fill be removed from premises: ( ) Yes (3:) No 14. Name of Owner of premises Z~e~r~ T,. 2er:~, --,. ~ort;h ]~v-ie¥' 755. 3199 .................................................. /~aaress~6.~.~...~T]~.:...~.;.~.~ Phone No ...................... Name of Architect ............................................ Address ................................ Phone No ...................... Name of Contractor ............................................ Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, 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~cat: whether interior or corner lot STATE OF NEW)~OR, Kz'.., / /'cS ....................................................................................... , .... being duly sworn, deposes ond soys that he ~s the opplicar (Name of individual signing contracf) above named He ~s the ..................................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and fil this apphcation; that afl statements contained m this apphcation are true to the best of his knowledge and behef; an thor the work will be performed m the manner set forth tn the apphcation filed therewith. Sworn to b~ze me th~s ........... ....... ..... Noto Public,. ..... ..... ..... ............... ~ (Signature of applicant) J/ ~' JUDITH T BOKEN Notary Pul)Itc, 5tct~ cf New York No 52-03449~3 CornmJsslon Expires Me,cS