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Home My WebLink About7935-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No. Z../~.~6. ...... Date .............. May... 2/t ..... ,19.?.~. THIS CERTIFIES that the building located at · 0.1~ - Ju.l-e · La~ .......... Street Map No. ;~:~f:; ....... Block No. , ;~,: ...... Lot No..x~K ...Ma. tti.t~ack.. }(,]'., ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... : AY... .1 , 19..9.[ pursuant to which Building Pemit No. ?9.~Z.. dated ....... _.a~.....~ .6. .... , 19.~.~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Pr. ivat.~ .on.e..fa~d.l~. d.~ellLug..wi~h .add;Ltion..~deck) .............. The certificate is issued to . 2.o.~er.t./.. ~hy!i$..(]r~,h .... D.~mers ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . k,,~, ............................ UNDERWRITERS CERTIFICATE No..~[...R.: ....................................... HOUSE NUMBER . ...1~78 ~ ..... Street .. (~,0,:.)..0lc..Jule..[ une. ................. ..... ~ .J ~,.~ .... ... ;(~:_~fl f~.)~/ ........ 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 COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ~ ~ .... ~~,.'x..~__/i ...... '-,/,..x~ .............. ~ . ........................................................... Z2...~.~_/..~>g ................... '; ..................... i~'i ..... i ................. iiiiiiiiii~ ......... .~iii.i';i~Liiiiill ..... '~'!i! ........ ;; ............ ~ ....... Building Inspector. Pee, .z'~......~.. Budding Inspector FO~ NO. $ TO~VN OF SOUTHOLD , Building Deportment Town Clerks Office $outhold, N. Y. 11971 APPLICATION FOR C£RTIFIGATE OF OCCUPANCY Instructions A. This application must be filled In typewriter OR ink, and submitted in DUPLICATE to the Budding Inspector w~th the following; for new buildings or new use 1. Final survey of property with accurate location of all buildings, property hnes, 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 cert,ficate 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 ~ote ....... ...~....~.~...../..~..../.~.?..C New Building ................ Addition .........~... .... Old or Pre-existing Building ................ Vacant Land .............. Locat,on Of Property ..... ...x~....c~..~?~.. ........ ..~.~.~.sZ.....~.~..~' ...... ~...~....~......../~..~.~.?..~..~..~..~....~. ....... ~..; ......... Owner Or O~ne, Of PropLT. ..... ~.~.~.-~....~...~.*.;.~. ...... ~..~.~..: .............................. Subdivision ...................... .x.~ ................................ Lot No ....... ~ Block No.....~... ......House No..~..7...~.v~' Permit No ...'7...~..~..~ ..... Date Of Permit ...'~./~/...~./..7~....Applicant .Z¥..~...~....~.'~..~.~...'~.. ..... ..~....~...~..~....: ............... Health ~t. ^pprova, ........ .~.l.~ ........................ ~o, ~pt. ^ppro~o, ......... ~.../...q. .......................... Underwriters Approvol ................................. Planning Boord Approvol .................... Request For Tempora~ Certificate ........................................ FinoJ Certificote .......................................... Fee Submitted $ ..........0~...:...~....~.. ............. Construction on above described building and l~mit meets all appl~'ole codes and regulations. Sworn to before me tJ~Js f TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..........~,~.C ............... ' ~7.,,~... Applic,tion ~proved .......... ~/Z.~ ................ 192~ Permit No..Z~.~.~ ..... Dmapproved o/c .............................................. ..~ ...................................... ..................................................................... ............ .................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This opplicahon must be completely filled ~n by typewnter or in ink and submitted in triplicate to the Buildin[ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing locahon of lot and of buildings on premises, relahonsh~p to adjoining premmes or public streets oi areas, and gwing a detailed descriphon of layout ofproperty must be drawn on the dmgram which is part of th~s application c The work covered by th~s application may not be commenced before ~ssuance of Building Permit. d Upon approval of this apphcotion, the Building Inspector wdl issue a Building Permit to the applicant Such permi shall be kept on the premises available for ~nspectlon throughout the work. e. No building shall be occupmd or used in whole or in part, for any purpose whatever until a Certificate of Occupano, 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and iN buildings for necessary inspections. .... ¢...z.t..*..,:. (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu/Ide, ........... ............................................................................................................................................................ Name of owner of premises ..~...~...~...~...~...~.....4.:.....~. ..... e~.V.t).:$.....8 :...G.r.a [.b ................................................... if applicant ~s a corporate, signature of duly authorized officer. (Name and htle of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electricmn's License No ............................................. Other Trade's License No ............................................... Location of land on which prooosed work will be done. ~ No .... ~ ........................ Lot No ....................... Street and Number .'~......~....7 .~.-~.... ......~..~..~...f~.-: ........ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Ex,siting use and occupancy ....... .~'..~..~:~2 ~... X ~. ~ .(...~. ~:..n C,..~. ................................................................ b. Intended use and occupancy ....... ~.~.fL ~.....~ ~. ~ ,.'5...~ ~.~ .~.~ ...~..Y..G. · ..'~. ·...IC~x,(.~.~(x..~ ~ ..~...c. :.o..¥. ............................... 3. Nature of work (check which opphcable). New Budding ............... Addltton ................ Alteration ......... Repmr ................. Removal ................ Demoht,or ............... Other. Wad< ~......~.~ ..n..~I ~ £.!.~ ....r,..~.~..~.t ~. ,~4 ............................................ _ '"P"'"l '" ¢' ....... .DZ... ............................................................ 4 Estimated Cost (to be paid on fihng thru opplicahon) 5. If dwelhng, number of dwelhng umts ........................ Number of dwelhng 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 D~mens~ons of extst~ng structures, ~f any. Front ....................... Rear ................................Depth ................... Height ........................ Number of Stories .................................................................................................... Dimensions of same structure with alterations or oddmons. Front ................................... Rear ..................... Depth ................................Height ........................ Number o_~f_S~ones ......... :~....; ..... ,, ! 8 Dtmensions o.f ,entire new construct,on Front .... ~ ..,..~. ..... Reor ...,~..~.. Depth,~'~./~'~. ..~..~ ~ . Height ..... /.~. ....... Number of Stories .......... ~ ....................................................................... ;:=.~, ..... Size of lot Front ......... --.-- __ .~,,~-~'/"~"~ ............................... Rear ...... //..~ ................. J.-- ~"~Depth ..... /..---Z._~ .......... Date of Purchase ..~/'~/.,~c~...Z,..,Z..~..~... ........ Name of Former Owner J(~,...~...:..~'iJ~,/~..."~ ........... 9 11 Zone or use dtstr~ct in which premises are situated ...'..~.....~ ..................................................................... 12 Does proposed construction wolate ony zoning Iow, ordinance or regulation 13 Wdl tot be regraded .... ,~..¢~ .............. Will excess fill be removed from premises: ( ) Yes ( ~,No 14 Name of Owner of premises ................................................ Address ................................ 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 ~nd~cate all set-back dimensions fron property hnes Gwe street and block number or descr~phon according to deed, and show street names and indicate whether interior or corner lot ,¢¢"/ ..................................................................................... being duly sworn, deposes and says that he ~s the apphcam (Name of mdiwdual s~gmng contracf) above named. He ~s the ................................................................................................................................................................... (Contractor, 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 application; that all statements contained ~n th~s apphcohon are true to the best of h~s knowledge and belief, one tt',a~ the work will be performed in the manner set forth tn the opphcabon filed therewith. Sworn to b~e me th~s ....... /~....."'~...... ,day of .......... ~ ....... ' 19'"~"~'-'"' ~.,,~l .............................. ...................... Notary P u b I i~.~ ~~.~....~...:(.~._._Cou nty N~tary Pubhc, Slate of New York No 52-03449,~3 Suffolk Counly,_ Commission Expires March 30,