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Home My WebLink About7915-zTOWN OF SOUTHOLD BUn.~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the buildin~ located at . .S/~ .Midd-lo. l~oad. (~t~7.) Street Map No.. ~ ........ Block No.... ~x ....Lot No..xx .... SouS,hold. · .E ,If., ......... conforms substantially to the Application for Buil&i-~ Permit heretofore ~ed in thl, office dated ................ l~y... ~ I~9. ?~. pursuant to which Buildl-g Permit No. ?9i.~Z · · dated ............l~y.....il.., 1975., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which t_hl, certificate is issued is . B~ina-s. bulldin~. (machine. ahop)..with .an. addi~iol~ ............ The certificate is issued to .. E~ward..lios.te~ ....... .~r~ ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . N.,R, .............................. UNDERWRITERS CERTIFICATE No.. l~,B, ...................................... HOUSE NUMBER ..... .Ifil ~1.. Street .. llidd~e. Road...(~CI~.I ................ FORM NO. 2 TOWN OF SOUTHOLD BUILDIHG DE P,4,RT,~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CGMPEETION OF THE WORK AUTHORIZED) ,o ...... ~....~:::::~?:'/.~:.':.'~i:i~ii~ii.~...~. ...... Building Inspector. Fee $~.~..~}i~' Building Inspector FORcM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N, Y, 1197] APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use' I. Final survey of property w~th 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 d~sposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters 4. Commercial buildings, Industrial buildings, Mulhple Residences and s~milar 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: 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 ....... ................. New Building ................ Additign ............... Old or Pre-existiqg Building ................ Vacant Land .............. Location Of Property ......... ./ ........................................................................................................................ Owner Or Owners Of Property ......... ~..c)....~.. ........ .!~.~.?...-1...~..~ ...................................................................... S~d~vis~on ..................... ~ ................................. Lot,o....~ ..... B,oc~ ~o...~ ..... ~/~ ~ ~ :.,. ~ t~_ . .....~.~.~.~...~.f.~?.~.~r,./~.~ .................... ~ermit Bio .'2. ....... :..2~ .... Date Of ?ermit ...... p....p ...... .......... ..................... ........... ...................... u~o~.~ ~r~ ...... ~....~.,.=, ..................... ~ng ~ ~p~o~o~ ............. ~..... ..................... Request For Tempor~ ~e~ficote ........................................Fin~ Co~ificote ..............~...... ........... F~, Submi~ed $ ..~.. ........................... Construction on above described building and permit meets all applicable codes and regulations Applicant ......................................................................................................... Sworn to before me this Nolary Public ........~/AL County (stomp or seal) B. 56' 7.~' 4-0' W. E] --: tAOL, t;,U.B~T ~FLE ^ = O. ~2 G-5 ~ NO. 1 TO~'N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Approved 19.?..~: Permit No ..... ~...~.../..~..~...~ ...... a. This application must be completely filled in by typewriter or in 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 areas, and giwng a detailed description of layout ofproperty must be drawn on the diagram which ~s part of th~s applicatio c. The work covered by this apphcation 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 perrr shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used ~n 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 fi 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 alterahons, or for removal or demolition, as herein describe The applicant agrees to comply with all apphcable lows, ordinances, building code, housing code, and regulations, and admit authorized ~nspectors on premises and in buildings for necessary inspections. (Signature of/iappi~ca.nt, or name, if a corporation) (Address of apphcant) State whether opphcont is owner, le,~, agen?/~rchitect, engineer, general contractor, electrician, plumber or build~ ..... :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ................................................... Plumber's L~cense No ................................................. Electncian's Lmense No ............................................ Other Trode's License No ............................................... /Zx ~ Location of land on which proposed work will be d.one Mop No ..... ~ ..... w.,~.,~u._.~.. Lot No ~..x ................. Street and Number ..... ..~../...-~ ....... ~~..~.~..fi. .............. ~ .................................. Municipality State existing use and occupancy of premises and re'ended use and occupo~ncy of nroposed construction' o Ex,siting use and occupancy ........ ....~....:~..~4.~.:?J ..... , ........ ~ .................................. b. Intended use and occupancy ........ ~.~ ................................................................ 3. Nature of work (check which applicable). New Building .................. Addition ........ .~ Alteration ............. Repair .................. Removal ................ Demolit~or, ............. Other Work ................................................. ~ ~o (Description) 4. Estimated Cost ...............Z/~'~' ~-'.~...L..'..~...~ ............ Fee ...C~....'.~) ....... ..~_..'. ............................................................. (to be pa~d on filing th~s 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 ex,sting structures, if any' Front .......................... Rear ................................ Depth .................... Height ........................ Number of Stories ...................................................................................................... D~mens~ons of same structure with alterations or addmons Front ................................... Rear ...................... Depth ................................ Height .......................... Number of Stories ............................... 8 Dimensions of entire new construction: Front ......... ~.~. ................... Rear .,/.~ .................... Depth .....~... ........... Height ................... Number of Stones ...... ~ ....................................................................................... 9 S,ze of lot. Front .:..~'.?S~ ....'~.. ................................ Rear .... .~....~/:..?T .................... Depth ~...J.?/.~.~/5.~....~. 10. Date of Purchase ..................................................... ~me. of Former Owner ........................................................ 1 1 Zone or use district m which premises are situated ...,n,~...~.Z-~'-L .................................................................................. 12 Does proposed construction wolate any zoning law, ordinance or regulation' ......,~.....g. .......................................... Wdl Iot be regraded ~"..~..... ~ W'II exce s fill be removed fro ' e ' ( ) Yes ( ) No 1413 Name of Owner of pre~i~'.""---.';.".~..~ .. ~(.~ ......... Address ..i...~.~ ..... 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~catt whether inlerior or corner lot STATE OF NE-~/'~O~<.,.~ ~ S $ COUNT .............,,~,~= ~,.,,~,,,u~, o,~~"~-~/C";'"'~"~"~""~["~]~ning co~i'~'~')' ........... be,ng duly sworn, deposes and says that he ,s the apphcan above named. ~. ~ He ~s the ........................................... ~~ ....................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the smd work and to make and this application; that all statements contained ~n th~s apphcehon are true to the best of h~s knowledge and behef; that the work w~ll be performed m the manner set fo~h m the apphcation filed therewith Sworn to befor~ t~: ~ ................. ....... ....... Nota~ Publ'c, . ................ ~~~... Coun~ ........................... - No. 52.4522~26 - Sjffoik County ~n~m~s~oa ~p,r~s M~rch 30, 19 .~