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Home My WebLink About9590-zFIHI, M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No ............. Date ............................ , 19 .... THIS C~TIPI~S that the building located Map No ............. Block No ........... ~ot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... , 19 .... pursuant to which Building Permit No ......... dated ....................... , ., 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 ........................................................................ The certificate is issued to .................................. · ................... of the aforesaid building. Suffolk County Department of Health Approval .................................... UNDERWRITERS CERTIFICATE No ............................................. ~ODS~ ~ .............. Se~ee~ .......................................... B~lding Inspector -roW~ BUILDING 'PERMIT (THIS PERMIT MUST BE KEPT ON ~HE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9590 Z Permission is hereby granted to: ~/ ~ . .., · / ,,~% · 'x'~'Y ............................ ~ ............. 0 ......................... Building Inspector. · Fee $./.....i%. ........... ~ .... Bu Id n ,. ~. g · : ' :' TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector 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 installations, a certificate of Code compliance from the Architect ar Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior ta April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey af 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 3. Copy of certificate of occupancy $1.00 New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....~..~.~./....~..:.~'.?. ....... ~/...~....~Y ........ ~.~.x[1.~.'. ................... ..~,~.Z~.~:.R.'~'./.?..~./...x~...~./~... ................. Owner Or Owners Of Property .....~.~...R(LC~..~ ....... ~../>.1..~/.~....~.. ...................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No..~..~.~.~.. z_ .............. Permit No. ,,..~,:,.,~. ......... Date Of Permit Health Dept. Approval ............................................ Labor Dept. Approval ................................................ '" t~ 2~0~ · Underwriters Approval ......... ~ .........................Planning Board Approval ........................................ Request For Temporory Certificote ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building an~ perm,it meets al~applicdble codes and regulations. ....................................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County i ~ ' ~'~, ~:-,: ~THE,, NEW YORK: BOARD, OF, FlEE UNDEgWB ITEES~ , ~- ', ~---.:~ ~! ~?1:' q~i:!;; ~!~ ~ -~ :. ~ . ~' '' :' BUREAU OF ELECTRICI~- , ,-~ ;;~--~L~:~'.~ ;i ~ , ,, ',- .- .?~$":,':-~ ...... -'~ :~ ...... d ' .85 JOHN,STREET. NEW, YORK, NEW YORK 10038 , 'Date ...... hcat,onNo, on le 9~4387 ,, = o~y ~ ~t~l eq~pmen~:~ dedcdbed'~l~ and i~t~uced by~t~ appllcan~ ~ o~ ~he ab~ ~pp~atlon;~dmb~r in ~he pre~;es of, : "- ~- ~eorge B~i.~zs~ I~jands..:'Y~;~, Lane,-~o Bayshor~ ~Rd.,.~e~nPOn,~,,,L.l.,:.:_./'~: was exam~d on ~ ~ r ~ I ~ _~ ~ ~fo~.d to be ~ ~o~a ~th ~ ~eq~e~f identified by' ~:h~¢~'edentlah LRED~o©w\ L~ ' ~, 55"40'¥0"F=. - 50. I' " u. s% ° 4o' '5o" Nv. AT "A',26-1JAM 0 M 0q!J& T'ow~J OF GOUT~JOL:~, SeAL.F=: ZO:-- I" i6~Alq D Vi2W LAkJ~ ( pm~ vA'f'e BUILDING DEPARTMENT ~'/'~' ~"'-'~ />~/,a~~ ~,~ Tow, CLmes OPF:~ ~ ~ ~ ~/~-~~ ~ SOU'mOLD, ,4. Y. ~ ~,.//~,'~ ~/~ A" cation No ~? C~ ~ P~ ' ......................... ~'""T' A { c ' · ~-~ -,~., ./~-~.-~.~- _ · proved .......................... 4 ........ ,. ,,.Z?.. ,..,t .o r ? D ~ppr~ o/c ~ -~' .................. ~ ................................................... ..~...~.: ........... ~~~ ~~ ~ O~ a d~" -. ~ APPLICATION FOR BUILDING PE~IT INSTRUCTIONS a. This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plofls, eccurate 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 o~ ~ areas, and giving a detailed description of Ioyout ofproperty must be drawn on the diagram which is port of this application. c. The work covered by this application 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 permit-' 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 Occupancy~ shall have been granted by the Building Inspector. B .A.P. PLIC~ATIO~N ,IS HEREB. Y MADE to the Building Deportment for the ssaance of a Building Permit pursuant to the~ uiming Lone ~rainance at the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~- Regulations, 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 to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ~u~Z ~ Name of owner of premises ...~...t~..?..~....-~ ......... ~...~......~..~l.....~....~. ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... ..~......~....~... ........................ Plumber's License No. ~ Electrician's License No. ~ Other Trade's License No ............................................... 1. Location of land on which proposed work w be done. Map No.: . .~.....~.~ ............................ Lot No ......................... Street and Number ~../o ..~..~.A.~....,~..~/ ~//.~.c~ ~ ~,y~?~ Municipali~ 2. State existing use and ~cu~ncy of premises and intended use and ~cuponcy of pr~osed construction: - ~. ~isiting use ~ ~¢up~nCy ~ ............. ~.~ ............ ~ ............................................................................... b. Intended use end ~cu mc ~d~X' M~//~ ~ Y ............. ~ . ...~ ..........~.. ................................ 3. N°tUre of work (check which applicoble): New Building'. ................. Addition .................. Alterotion Repoir .................. Removol .................. Demolitior ..................... Other Work .................................................... (Description) - Fe 4. Estimated Cost .... .L..~,Q~...~. .................................... e ../ ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. / ........... Number of dwelling units on eoch floor If gorage, number of cots ............................................................................................................................................. 6. If business, commerciol or mixed occuponcy, specify noture ond extent of eoch type of use ............................ 7. Dimensions of existing structures, if ony: Front ......... ..~....~.. ........... Reor ......... .~.......¢~.. ............ Depth ...... ..~:...~.. ...... Height .../.....~... ............ Number of Stories ............. / ............................................................................................... or additions: Front ....... ~...~'. ................... Rear .... .~...~.. ............ Dimensions of same structure with alteratipns Depth ...... .~....~.. ................. Height ......................... .~....~... Number of Stories .......... ~ ............. 8. Dimensions of entire new construction: Front ........ ~.....~'.. ................... Rear ...... .~.....~.. ............ Depth ..~',:...~.. ........... Height ....~.~ .......... Number of Stories ...~ ............................................... , .................................................... ~ ...... 9. Size of lot: Front ............ ~..~ ................................. Rear ........ .~.~..~...~. .............. Depth~.....~...~ ......... 10. Date o~ Purchase ....~ .............. ~ ....................... Name of Former ~ner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: .......... .~..~. .................................... 13. Will lot be regraded . ........................... Will excess fill be removed fr~ premises: ( ) Yes ( ) No 14. Name of ~ner of premises~..~...~/.~....~ .............. A~re~ ~~ Pho~ No ....................... Name o~ Architect .............................................................. Addre~ ................................ Phone No ....................... Name of Contractor .~.~.~.~.~..~'.~ff.~.C,~ ....... A~ress ..~.~.~g~.~... Pho~ NoJ Z/ 2 PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set,ok dimensions from prope~y lines. Give street and block number or description according to de~, and show street names and indicate whether interior or corner lot. STATE OF NEW~'O)~/ ! c c COUNTY OF~: ...... ¢¢'¢ ,.. ............................................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ................................................................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; end that the work will be performed in the manner set forth in the application filed therewith. SwornT,,~o~ re____ me this ,~ , I ' ............... ....... , Notary fublic~..~:.~'?~nty ~-.'-'~".~..:.-..: ..................................... ~' ~/ / (Signature of applicant) JUDITH T. TERRy No.~arY Pub/c, S~a~e o' ~' '- ,. ' . '.~'*~,~3 Suf,"o;k Cou-~, F°mrmssl°n Expires March 30, --~.l