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Home My WebLink About7945-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icafe O[ Occupancy THIS CERTIFIES that the building./kDD~ETlO3I ..................................... House No. Street Hamlet County Tax Map No. 1000 Section .... :L22 ..... Block ..... 2 ......... Lot ..... 2;L ..... :..-;-- Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ·..I~..Y..2.0. ............. 19..7.Spursuant to which Building Permit No...7. ~.4.5.Z. ............. dated ..... .Y~..Y..2~) ................ 19 7 5,, was ~ssued, and conforms to all of the ~equirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... The certificate is issued to .. ~',~I~Ya~E~. ~T&C'I~Q~q~4(~o~,n'e'r,__ 'l~s~e'dr't3t~a'n't) ...................... of the aforesaid building. N/A Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO.. Iq/A Building Inspector Rev. FORM NO. 2 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ('THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 7945 Z Permission is hereby granted to: ...... ..~...~.../..~~.......~..~.~.~..~..~./_ ~ ...... ./. ~.~.~.....~ ~...~....~,~.. ~.n...~.. . ................................................. ~.~/~ ..~.~. ..~.~.:::...~...~. .......................................... Building Inspector. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southoid, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use --?re-E×~-st±ng C. 0. $1_5.00 3. Copy of certificate of occupancy $1.00 Vacanf, land C.O. $ 5 · 00 ~S~- Date .. ~/."'.~..-'..oc~ .............. New Building ............. Old or Pre-existing Budding ~[~J.,'.~'~.~).. Vacant Land ............. Location of PropertvHouse ~' ~)'/~'No. ................ ~' '~" '~'~'~' ~S~'tr'e' ;[ A'~I/' ~' ~ .... ' l/'"~J~ ~'["/'"7"'('J"(:""~':" t/~'~'H6rnlezz Owner or Owners of Property ...~.~. ~. ~ .~-~;....~'..-~.. ~ b.E ¥..-'~.. ~7~.~. . .'~. ~.~.~ ~. .............. County Tax Map No. 1000 Section ....//?~...~. ...... Block .. ~:~. .......... Lot...~.~..~. · ~:,~/'. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant . .~.b¢.'c"'~-.. ~7/,. ~. z~..~',5': ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ~.i ................... above described budding and pP~rm~t meets all apphcable codes Applicant ........... Rev 10-10-78 TOWN OF SOUTHOLD , Examined ........... ............. ppro ........... ............ , BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE D~sapproved a/c ............................................................................................ ( u'd' g p / APPLICATION FOR BUILDING PERMIT Date ..........~...7/....~.?.. ................ , , 9..7.~...~ INSTRUCTIONS o This application must be completely f, lled ~n 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, relationship to adjoining premises or public streets ~ areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apphcatlo, c. The work covered by this apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding Inspector wdl ~ssue a Building Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e No budding 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 ti Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable 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~p~licant, or name, if a corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budd~ Name of owner of premises ......................... If apphcont is a corporate, signoture of duly authorized officer. (Name and title of corporate officer) Budder's License No ...... ~...j .............. ~ .............. . Plumbers License No ............................ ---~...~....~.~..-~ Electrician's License No ...' .~.~';'~.~..-EJ~..¢. Other Trade's License No .............................................. Location of land on which pro~osed_~work will be done. M~p~No ..... ~....L';:..-r'm.. ................ Lot No ........ ..b.Z ..... Street and Number /~..~... ~........~/.~.'~.C.~.~.Z~....~...~.~r.~. ............................... / nnumc~palit-y State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisit,ng use and occupancy ........ .~'. ~/~.....~../f~/~Zg../. ~/... ~(~.~. ~/~.,/~. ................................... b. Intended use and occupancy .................. ..~. ............ , . 3 Nature of work (check which applicable). New Building ................ Addmon .............. Alteration Repair .................. ~oval .................. Demolmor.....,,~.. ......... Other Work ............................................. ,~ ~- ~ -- ~z'~-.-,~--- ~'~ (Description) 4. Estimated Cost ............ .~......~...J.....~(.'....~......'~... .................. Fee .....'~... ......................................................................... (to be pa~d on filing this application) 5. If dwelling, number of dwelhng units .................. Number of dwelhng un,ts on each floor ........................ If garage, number of cars ....................................................................................................................................... 6 If bus,ness, commercial or re,xed occupancy, sp~l~nature and exte~ ~i~each type of use ..Z.~.~....~ 7. O,mens,onsgf~xl~t,ng structures, if any: Front ...~, ~'.~ ............... Rear ................................Depth .................. Height ..... (...%~/. ............ Number of Stones ..... .................... ,~./c~. ................................... ~.~ ....... Dimensions (~f same.~t~ugture with alterc~tlOJ~ or additions Front ............. ./...~.~.,.~.. ....... Rear ...................... of Stones Depth ......................... Height ................. /.~_~.~mber .......... >g~ ............... 8 D~mens~ons. (~f e, pt~re new construction' Front .... ~ .......... , ............... Rear ............................ Depth ............... /fro ~x~/= t ' Height ................... N u~)b,~r~c~or,es ................................. ~,/,~.~-~ .................................~...~.. ............. 9 S,ze of lot Front ........ r C-~.~.~.~ ................. Rear ............................ f.~.,t~:~t~...~r.6,~.,~q.. ......... 10. Dote of Purchase ...................................................... Name of~rr~r Owner ........................................................ 11 Zone or use district in which premises are s~tuated ................................................ ~/~t .............................. 12 Does proposed construction violate any zoning law, ordinance or regulation: .. ,lilt re red ..~.....(~. ~ ...... II f I e re fr re ,se 13 W' o be g ed ...................//~/,_~.l.4~'l~.~..:;j.i .~.i'JArl e~xcess LL Ip moved om p rn s: ( ) Yes ( 14 Name of Owner of prem,ses .....~......~......v...~....J~...:...'~.....'~...:.'..:..~..:.. Address ................................ Phone No ....................... Name of Architect ....................................... Address ................................ Phone No ....................... Name of Contractor ....................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether ex~stjng or proposed, and red,cate all set-back dimensions from propertYwhether intenorhnes' GWeor cornerStreetlot°nd block number o~. descnl~)~n accordmq. ? _deed, and show street names and indicate STATE OF NEWY~qK/j' ~/ ~cc COUNTY OF .~~.(~..[ ~'~ ........................................................................................... being duly sworn, deposes and says that he ~s the apphcan (Name of md~wdual signing contracf) above named He is the ................................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of so~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and ill, this application, that all statements contained ~n th~s apphcohon are true to the best of h~s knowledge and behef; on, tho~ the work wdl be performed in the manner set fo~h m the apphcat~on filed therewith. Sworn to before me this ~ ..... .... o, ................. ( --, ............ (~ig~ture o applicant)