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Home My WebLink About7912-zl~O~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z67.53 ..... Date ........... Qq$ .....29 ..... , 19..~.~ THIS CERTIFIES that the building located at . .OeIx.t. er. ~.tr.9$.t. .......... Street Map No.. Z:X ....... Block No...X~ ..... Lot No, xxx ...Mai;%.ltuck .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... May. ... 9.. , 19.7~. pursuant to which Building Pemit No... 79.1..2~. dated .......... .P~. Y.....~..., 19..7.%., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P~iva.te, o1~ .f~m~ ly. ~welling .wi~h additio~ ................... The certificate is issued to .. A~e.r.~t.o..B.~.~.~$ .t~. ...... 0~0~.1~ ....................... (owner, lessee or tenant) of the aforesaid b,,flding. Suffolk County Department of Health Approval ...N.,.R.. ............................ UNDERWRITERS CERTIFICATE No...~.,.R.,. ...................................... HOUSE ND-MBER .... .1~..0~. ..... Street ....C~?..~.e.r...S.t?.e.e..t ........................ ' r ~ Building'--Inspector ~ lvOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE $OUTHOLD, ti. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES uNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7912 Z Permission is hereby granted to: ~o .... ~a~.:l~..~m..aaa~.~toa...(.g~.a~e..&..~.~s~a~F) ..... oa--~rat~tl..a~e.~.:~g. ...... at premises located at .... J~/.J~..C~g~:J;$~...~J.~ ....................................................................................... /~ ..................................................................... ~.a~:tu,~ k. ..................................................................... pursuant to application dated ............................,~..~. ......... .~.. ......... , 19...~.~.., and approved by the Building Inspector. Fee $ .~J. ~.,.~. ........... ............. .................... ui aing IrJ~ector ( FOILM NO. $ TOWN OF $OUTHOLD , B,,ilding Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ~nk, 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, aha unusual natural or topographic features. 2 Final approval of Health Dept. of water supply and sewerage disposal (S-0 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 Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te 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 New Building ................ Additmn ................ Old or Pre-existing Building ................ Vocont Lend .............. Owner Or Owners Of Property ,,~.,,,.AT...,~.,~.,~.,~r~.~] .......................................................................... Health Dept. Approval ............................................ Labor Dept. Approval ...~ ..................................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ...... ~ ............................ FinoJ Certificate ......................... ~ ............. Construction on above described building and ~ermit meets all applicable codes and regulations. 5worn to before rna this . .~ _ ~ ~-.~ ~ day of ~.~.....~..? ~ (stamp or sea,)~., , .......... ..... "T /JJ ....... FOR,_M NO. ! BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTHOLD, N. Y. ...... Application No. / APPLICATION FOR BUILDING PERMIT Date ........................ INSTRUCTIONS a Th~s applicat,on must be completely filled in by typewriter or ,n ink and submitted in triplicate to the Buildir 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, relationship to adjoining premises or public streets c areas, and giving a detaded description of layout of property must be drawn on the d~agram which is part of th~s apphcatio, c. The work covered by th~s apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl issue a Building Permit to the applicant Such perm 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 Buflding Permit pursuant to 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 apphcable 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 a corporation) ................................ ....... State whether applicant is owner, lessee, agent, archttect, engineer, general contractor, electrician, plumber or ........ ........................................................................................................................................... Mamo of ownor o~ premises~.~....~.~.~: ................................. If applico,~ is a corporate, signatu~l~, of dqJy auJhorized officer. ~ ........ [N~-:~-'~le of corpo-'"""-"-"-~:f~'~'~i~'~ .......... , , . /. ~,lder ~ L,~e No .............................. ~~ ..... Plumber's License No ................ ' ................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map. No ' . .......................... Lot No ...................... Street and Number .C..~...':'../../...~....'~........~.../..: ...... ..... ]. . ~..~. .: .~. .. .__ :. ....................................... Municipality State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a Exisit~ng use and occupancy ...~. .... ./. ................................................................................. b. Intended use and occupancy .... ...~.~.~....~.....m~-... ................................................................................................ 3. ture of work (check which applicable). New Building .......... Addition .................. Alteration ............. Repair .................. Removal .................. Demoht~or .................. Other Work ............................................ ,-. ~ (Description) 4. Estimated Cost .......... ~....f/. ,.'~.. :!: ./..~...........~. ................ Fee .... f.. ~..~ ............................................................... (to be paid on fihng th~s applicat,on) 5 If dwelling, number of dwelhng units ......................... Number of dwelhng umts on each floor ........................ If garage, number of cars ........... ~ .................................................................................................................. 6. If bus,ness, commercial or re,xed occupancy, sp,ec~x~-y- nature and extent~ of~.each type of use .................. :, ...... 7. Dimensions of ex~stmg structures, if any' Front ....... ? ...~. ............. Rear ..... .~..~ ............... Depth ......... ~ ....... Height //' / Number of Star,es / D~menstons of sam, e structure wtth alterott~o~s ~ oddtttons' Front ............ Depth ......... ;~.../. ................. Height .......................... Number~ of Stones ......... '/'"' 8 D~mens~ons of ~ntwe new construction Front .... .';...( ..... , ................ Rear ........?...:z .............. Depth ........ ~ ....... Height ...,/../..*.-- .......... Number of~ories ............ ./. ......................... ;" 'm;-~ ......................................... v ............ 9 S,ze of lot Front ...... /..'.Z..~ ............................... Rear ..... .~..Z..2 .......................... Depth ....: .......~ ................ 10. Date of rurcnase ................ : ................................... marne o~ former uwner ........................................................ 1 1 Zone or use dtstnct in which premsses are situated .... ./..~..; 12 Does proposed construction wolate any zoning law, orOnance or regulation' . ...... ~..:./.:': ......................................... 13. WHI Jot be regraded ...... ff../.~ .............. WHI excess fill be removed from prem~se~z.( ) Yes ( ) No 14. Name of Owner of premises ........................... :...~ .................... Address ...: ..........: ................. Phone No ....................... Name of Architect ................................. ..~. ........ Address ........................~..~.. Phone No ...................... Name of Contractor ...................... ~. ................. Address ........ z..' ........ : ........... Phone No. PLOT DIAGRAM ' Locate clearly and distinctly all buildings, whether existing or proposed, and red,cate all set-back dimensions frorr property hnes Gwe street and block number or description according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW Y~RK, /S S COUNTY OF ....~/~.:.,..~.' ............................................................................................ being duly sworn, deposes and says that he ~s the apphcam (Name of mdiwdual signing contracf) above named· He ~s the ........................................................................................................................................................ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ts duly authorized to perform or have performed the said work and to make and file th~s application; that oil statements contained m this apphcahon are true to the best of his knowledge and behef; an~ tha~ the work wtll be performed tn the manner set forth tn the apphcatton filed therewith Sworn to before me th~s / '(Signature of applicant) JUDITH 1", BOK~N '-r, Pu hc St-~ of N.z'x Yorl~ ina 52-6~4:L3 Suffolk County Cornmlsaon Expires March 80,