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Home My WebLink About7953-z -'='--.'F-~ ,., '. ~ ..,..-.......,'~,.. ._~_ n_.._ """;::,'''' .,~~?, ",,-,,''',v:-:~{-;r~.'_;;~''''-'- _ J(O. , TOWN",,," SOU'J.'BOLD BUILDJNC.DEP~ Town Clerk'.. Otfioe Soaolcl, N. Y. - . .J ),''''-:'.::'; "'-.:.-'... Certificate.OfO~cupancy No.z7P.~....... Date ........... .t'fAY.. .271.::.;. ....19.16. THIS CERTIFIES that the building loca~ at Ji~.W<ttEli-viaw .l)r1-."...... Street Map No. .~."..... Block No. .~~.... .Lot No. . xxx ... Southo.ld.. ~~.~......... conforms substantially to the Application for Building Permit heretofore filed in this office dated"..""....... ;:;:s. .2';'", 19. 7~. pursuant to which Building Permit No. '195'3.4.. dated ...........,. !'.'\Y.. . ~.7... 19. 75.. was issued, and conforms to all ~f the require- ments of the applicable provisions of th!! law. The occupancy for which this certificate is issued is .. ?~~:r~ :t.~ . ?~~. .~~~1f)..Y. . g.1'1~.l),tllg. . \d.th. an .add.1.t1on. . . .. . . . . ~ ... . . . . 1 v . The certificate is issued to . .~~;n~~. . ':J~;J..1~j,I,1139n .... .. .w.ncr. ... . . . . . ........... .... (owner, lessee or tenant) of the aforesaid building. Suflolk County Department of Health Approval IS..J\................................ UNDERWRITERS CERTIFICATE No. fl...;;,....................................... HOUSE NUMBER . . .1.1.50.. ..... Street.. . .W01toIlvim.' .j)r!'\'-e.................... .............................".......""a.. ...a"....a...aa....".................... A~ -.-" " ' 'r.!} / i(l /"'>.^. ........ . 'B~ciing' fus~; '7' ". .. .. _ '.,_wo. ..;,,:>.,'....-'c^,.~, -..; ~';""'-_." .- -_s";".,;,.-:i,..:' FOILM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT Q-HIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COA4PLETION OF THE WORK AUTHORIZED) 7953 Z Date ....................... i~,4~. ....... 2~. ............. , 19..~.~. Permission is hereby granted to: ...~....a:...~:~.m .~.~I.. ~tt :Lk~ s.ox~ .............. ................... M~ter.~i~..~r. ........... ~2e~.~. ~ol~ to ....B.B.~.~.d.... ~3..~,~l.;l..t~.O~.. D~.. ~x:Ls ~ng-.. d ~.e LTL i~g ............................................................. ~t premises located at .... ~/.~..,~;P_..~.v. fe.~..D.l~.~.v.~ .......................................................................... ................................................................... .S...q .'4..t;.b p 1.Q,.....~L,,.7..,, ............................................................ pursuant to application dated ............................ }f~ ......... 2-~- ..... , 19...~.~.., and approved by the Building Inspector. Fee $.'].~.~,.Q.O.. ........... .............. 2. .......... ~.1 ......... Building Inspector [ · 'ORM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opplicohon must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate Iocahon 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 Underwr,ters. 4. Commercial buildings, Industrial buddings, 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 sJte plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex,sting". land uses: 1. Accurate survey of property showing oil 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 inspechon of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. CertifJcate of occupancy $,5.00 2. Certificate of occupancy on pre-existing dwelling or land use $,5.00 3, Copy of certificate of occupancy $1,00 Date ....Ma~-..g6v...zg~ ................ New Building ................ Addition ...~...~.~ ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ........................ ~-.~.~...~P.~.~.~,.¢.~...[D.~.~.,...~fl~t.*'r,'.]~O.~.~,...~.,.,*., ............................... Owner Or Owners Of Property ...~z~,..~..t~m.s,,..~a.e]...[[r&.],k~.~son ...................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No ~Z.9.~..7. ......Dote Of Permit ...~/-~.~./.?.~.Applicant .~(,z'.,...~.~:~,~.,...$~.u. eZ...~$Z~.~.o~ ..... Health Dept. Approval ........ ...~....(,..~.. ........................ Labor Dept. Approval ..............'..~...:.'!,,~. ..................... Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tempo~ry Certificate ........................................ Finczl Certificate ..... ~:;7~.c. ......................... Fee Submitted $ ............................ Construction on above described building and permit meets oil applicable codes and regulations. Appli cont ..... ~ .~.~...<~. ~....~;~./.,/,/,/,/,/,/,/,/,~..~W~...~.. ........................................... Sworn to before me this ~ dayof ~'1~...~ /~ Notary Public .... ~. County (stamp or seal~~ Z 70 ~y Approved ........... .'.:..~.. ....... .~.I .......... , / FO~ ~0. 1 TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19. Z~.TPermi, No..~..?...~.....~.,....~ ....... Dmsapproved a/c ................................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This apphcation must be completely filled in 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 Iocahon of lot and of bumldmgs on premises, relationship to adjoining premmes or public streets areas, and gwing a detailed description of layout of property must be drawn on the diagram which ~s part of th~s applicatio. c. The work covered by this application may not be commenced before msuance of Building Permit. d Upon approval of this apphcation, the Building Inspector will ~ssue a Budding 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 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 ~ssuance of a Building Permit pursuant to t} 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 apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Sig~ture of applicant, or name, if a corporation) (Address of apphcant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises ..... .~I~e.1..]aT::L]-~s.o~ ......................................................................................... If apphcant is a corporate, s~gnature of duly authorized officer. \ (Name and t~tle of corporate officer) Builder's L,cense No ..... g.~.~.~ .................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1 Locahon of land on which proposed work will be done. M~p No ............. ~ .................. Lot No .... ~ ........... Street and Number ....~.~.~..~.e..z'...~..~...e.~....g.?..~.-v...e. .......... J~p.g,.~Q~l. ............................... Municipality 2 State ex~stmg use and occupancy c~f premises and intended use and occupancy of proposed construchon' o Extorting use and occupancy ...c~.~e~].J_D~. ................................................................................................. b. Intended use and occupancy ....... ~.a..~...e..,..~..~...~..~..9,T~..fi,.c,].c]..J,,~Q~,..-....[3.o'r'c.h ................................................ 3. Nature of work (check which applicable) New Building ................. Addition .... ~ .... Alteration ............ Repair ................. Removal ................ Demoht~or, .................... Other Work ............................................... (Description) 4 Estimated Cost .................. ~.0...0...+ .............................. Fee 1..~.,...0~.. ....................................................................... (to be pa~d on filing this application) 5. If dwelling, number of dwelling units ...... one ............. Number of dwelhng units 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 D~mensions of ex~stmg structures, if any' Front .......................... Rear ................................Depth .................. Height ........................ Number of Stones .................................................................................................... D~mensions of same structure wtth alterations or add~tlons' Front .................................... Rear .................... Deplh ................................Height .......................... Number of Stones ............................ 8 D~mens~ons of entire new construction. Front ........ ~.br ....................... Rear .........2..LL- .............. Dept~ ...... ~ ............ Height ................... Number of Stones ....... O~e ......................................................................................... 9. S~ze of lot Front .................................................. Rear ..................................... Depth ............................. 10. Date of Purchase ....................................................... Name of Former Owner ........................................................ 11 Zone or use distr~ct m which premises are s~tuated . .tJ~JJ...~.e,, ................................................................. 12 Does proposed construction wolate any zoning law, ordinance or regulahon: ......... .~...O. .......................................... 13 Wdl lot be regraded ...... Z~9 .............. Wdl excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..l~er~Lte.)...=~.i...~.J:~o~ .......... Address ..... ~..9_~.l;.~.o.~.¢. ....... Phone No. ..................... Name of Architect .................................. Address ................................Phone No ...................... Name of Contractor ........ 8~.~te .............................. Address ................................Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and red,cate afl set-back dimensions fron property hnes Gwe street and block number or description according to deed, and show street names and ind~cat, whether interior or corner lot STATE OF NEW YORK, ~ COUNTY OF .... ~.£O~, ......... _ S.S .................... ~O~t..~.....1~f.±-~.~.9~ ............................... being duly sworn, deposes and says that he ~s the applicon (Name of indiwdual s~gning contract) above named He ~s the ......................................~...:...~:.J:~.~6~. .................................................................................... (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 fil this apphcation; that all statements contained ~n th~s appl,cat~on are true to the best of his knowledge and behef; an that the work wilt be performed ~n the manner set fo~h m the apphcation filed therewith Sworn to before me this .................... ~day of ............... ~b~ ........ , 19. 2~. ,fi ~~~ , , , Nota~ Public Suffo~ ~un~ ................ ~..~~ ........................ ~~~ / (Signature of applicant) NoJa~ public, State ~f Ne~ Y~rk