The URL can be used to link to this page

Home My WebLink About7934-zNO. ~ TOWN OF SOUTHOLD BUH.I~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No .......... Date ..................... , 19 .... THIS CERTI'FTF,~ that the buildin~ located a~ ........................ Street Map No ........... Block No ......... Lot No ................................. conforms substantially to the Applicakiqa. for Building Permit heretofore filed in this office dated ................ 19 ..~/r.?.ursuant to which Building Permit No ......... ¥ dated ................ , 19 .... , was issued, and conforms to ~11 of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ............. ~b.~.~.,~ .... ~k~ ~'B'~ .................... The cert~ieate is issued to .............................. , .,....~..: ......... (owner, lessee or 'te~t) of the ~oresaid building. S~o~ County Department of Health Approv~ .............................. ~W~[~S CD~T[~[CATD No ............................................ ~OUS~ NU~ ....... Street ............ .... ..... ............................................... ..... Bffild~g ~speetor FO~M NO. 2 TO~N OF $OUTHOLD 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) N9 7934 Z Permission is hereby granted to: ...Z.~..~.L4.. ....... ~:.~?..(; ............................... ..... ~/.c. ....... ~.T.,~'...~.~: ....... ~.~:..t.....e..4/. ......... to ..~...I'~2 ....... £..~.T..( .......... /~ ..... .0.....~ ...... ff.~. ..... /. ~.y. ......... ~Ji~L..~.LL.t.~..C~. .................................... at premises located at I ~ ~,/.~, pursuant to application dated ..............................~t~t.:l: ..... /...~..., 1~..~....., and approved by the Building Inspector, Fee $....L~.~ ....... Building Inspector ~FORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office $ou~hold, 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 with the following; for new buildings or new use: I. 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 disposal--(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 "pm-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 formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $§.00 3. Copy of certificate of occupancy $1.00 Date ....... ...~...~...~.......(...~.4.../...~. Z..~.... New Bt~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........... ~..~....~. ...... ./..~'./..¥...~'.. ...... ..~....?X ..................... ...~....~.]...E.~..~...~.. ..................................... Owner Or Owners Of Property .l~0?~0 T~ "/ b~/~- ~.. ~ ~ Subdivision ................................................................ Lot No ............. Block No ........... -~. House No..~...O...C?.. Permit No .... ..~...?...~...¥....~D-ate Of Permit ..... .~./.(.~lT..?.Applicant ..... ~..~ ...... ..~.~..T.~ ............. Health Dept. Approval ............................ : ............... Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ ............ ..~....~ ....... Construction on above described buildingK~LEermit meets ~all applicable codes and regulations. Sworn to before me this ................ day of ............................................ (stamp or seal) Notary Public .................................... County ~ 7( TM IZ FOn, M ~i'0~ 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. D,sapproved a/c ................ ~.i~'i~'~ ............................................................... .......................................................... ....................... ~/....:(~.......x~..~"yi~,~.~.f~J ................ ~ (Building InspectOr) Application No. ~.?.~...~./.. ............... ; APPLICATION FOR BUILDING PERMIT I NSTP, UCTIONS a. This applicatmn must be completely filled in by typewnter or in ink and submitted m 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 premmes, relat:onsh~p to adlo:mng premises or public streets areas, and gwing a detailed descnption of layout ofproperty must be drawn on the diagram which :s part of this applicaho c. The work cavered by this application may not be commenced before issuance of Building Permit. d Upon approval of th:s application, the Bu:lding Inspector w:ll ~ssue a Building Permit to the apphcant 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 tJ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant 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. ( g ot 9~p~ nt, or,/Rame, if a corporation) .... ....... .............................. / (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build. ................... ..... .......................................................................................... Name of owner of premises ........................................................................................... If applicant is a corporate, s~gnature of duly authorized officer. (Name and tttle of corporate officer) Builder's License 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 ...~'.X44'..~......'~'.,~...;~...~..~.~C..~.~....,..~-.~r~....:__ ____ __ .......................................................... / / / Municipality State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction- a Exisiting use and occupancy ..... ..~....~...~.~ ..... ~'~.~../..~ .~..~'.- .~..'~"~.....~....~... ........................................ b Intended use and occupancy ..................................................................................................................... 3. Nature of work (check which applicable) New Building ................ Add~tion .... ~...... Alteration ........... Repair ................. Removal .................. Demoht~on .................Other Work ............................................... 4 Estimated Cost ..... .~.~..~.4~.....~ .............................. Fee .... / ~ '~'"'~ (Description) (to be paid on filing this apphcat~on) 5. If dwelling, 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 Dimensions of ex~sting structures, if any' Front ...... 2-:r...f~. ............. Rear .......... t'....xr. ............... Depth .....&.'...~_../.... Height ...... /.~r...r. ......... Number of Stones ...... .~..././.~...~ .................................................................................... D~mens~ons of sam~e structure w~th alterations or addmons' Front ........ ~.~.. ................... Rear ../...~.. .............. Depth ........... .~.~. ............... He,ght ......... ./...~...' ... Numrber of Stories ..../..././..~. ................ 8 D~mensions of entire new construction. Front .......... 2,~.~..., ................ Rear Depth .......... Height ................... Number of Stories .................................................................................................. 9 S,ze of lot. Front .......... ~...~'.. ..................................... Rear ......~..~...( . Depth ,/.~...~. 10. Date of Purchase ................. ................... Name of Former Owner ........... ..,~....:....C..t~..~...O...~....~...~.. ............ 11 Zone or use distr,ct in wh,ch prem,ses are s,tuated ....... ~...~YT..~ ./~e.~.C.~...~.~.~./. .......................... :-- ............... 12 Does proposed construction wolate any zoning law, ordinance or regulation .....~....~.. ........................................... 13 Wdl lot be regraded ...... ./..'~..o.. ............. Wdl excess fill be removed from premises ( ) Yes ( 14 Name of Owner of prem,ses ...,~.~q-~.~..?.~..~.~ .....~.../..~..-~'.¢~...... Address,~xx'~r-..~7~..efTY'.Z~.... Phone No..~.&.~....~.°... Name of Architect ......................................... Address ................................ Phone No ....................... Name of Contractor ...............................................Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and d,stmctly all buddings, whether ex~stmg or proposed, and red,cate all set-back dimensions from property lines Gwe street and block number or descnpt~on according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW YC~K,../ )/_ ~ S S COUNTY. ~ OF .... ../dj ./~.~,¢. //~.. · ..... ~' ......... X..~.~;~ ..... ~.~ ................................... be,rig duly sworn, deposes and says that he ,s the apphcam (Nam~of mdw~ual signing contrac~ above named He ,s the ........ ~.~ ................................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and Is duly authorized to perform or have performed the sa~d work and to make and ill, this application, that all statements contmned m th~s apphcat~on are true to the best of h~s knowledge and behef; an~ thor the work will be performed m the manner set fo~h m the application filed therewith Sworn to before me this ........... Z~ ........ dav~f ......... ~~ ............... , 19.~Z / ~ ~ ......... ............................ / / // ' / (S~gnatur~f applicant) ~MffY PUBLIC, State of New ~ R~rdmg ~ Suffolk County Clks. No 52-6086685