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Home My WebLink About9606-zTOVN OF SOUTHOLD BUIIIImG DEPAR'I'M~qT Town Clerk*,, Ofiee Southold, N. Y. Map No .............Block No ........... Lot No .................................. conforms_ suImtanflally to the Application for Build~r.g Pernflt heretofoee filed t~ this office dated ....D.e.c..~..b.~.F...2.9. .... , 19..7ff.. pursuant to which ButMtn_a Pmnit No...9.6..0.S.Z. meats of the q)plieable provisions of the law. The occupancy for which this oertifle~e is Tb eerttfimte is ts~_ed to .......... ~h~l.~e .~o. Iil~g ............................ ~ County Depm-i~ent of Health Approval .................................... UNDgRWRI'I'~ C~RTIFICATE No ................... ~/a ...................... HOUSE ~. ~,O0 ......... Street .... .~e.~. }il~-l. ~oi~ .................... .......................................... M~.~i,~I~,..~.~..'/'qr.~ .............. ..... ......... TOWN BUILDING TOWN CLERK'S OIFI~I:E ? SOUTHOLD, N. Y. N°. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9606 Z Oate ............................. .....~....~.., ~...?..../ Permission is hereby granted Building Inspector. F~ $../.2...~ ....... l~OltM NO. 6 TOWN OF $OUTHOLD Building Delm~tment 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 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: I.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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ~ ~'~'J)?lr I o Date ......~..~ ...... ~...~...j.. J..~.2 ,~g .................... Old or Pre-existing Building ............................ Va_cant Land ......................... Location Of Property .,..~'..~.~.J..~.Jd ........ .~.l..~.~ .......... ~.~......~.L~.~ ....... ~.~.(~.~ ............ ~,.~,,~,~.~ Owner Or ~ners Of Property ..,.~,Jff.~.~.~.......~.,.i.~..~.~, ........ ~..~.~.J[~.~.C.~.....~.~.....(~ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~...~...~...~..'.~.. Date Of Permit ~..!~.~....~.~,~Applicant ...... .C~,..~...A....~.~.~, .~.' ....... 4~. ...... ]~.J....~....~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..~.~...F. ................. Construction on above described building and permit meets all applicabl~ codes and regulations. Applicant ............. : ............................................... Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) Iq Io¢o · · uildin s whether exist ng or proposed, and indicate al set-bock d~mens~ons ~rom Locate clearly and d~st nctly a. II .b .g ' ~ ........... ,~' ,, a deed and show street names and 'ndicate property lines. Give street and block number or aescnp~,,~ ........ ~n~ t , '------'--'---'~~ whether interior or corner lot. /,~l~.~. P~oA~ k. tj ~ ' . STATE OF NFW,~P,~,,('Z~ -~' 1SS '~S,. /v. ~¢/~ ~., ~, ...... . .......... ....be!ng'duly sworn, deposes and soys that he is the applicam IPOll,~ NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ ~ "~ '> cry ? Approved ............. 'X ........... i~:~.f! ........ 19.~Zi~. Permit No ..... ,(,~.'~..,,(?..~.i~ ....... Disapproved a/c APPLICATION FOR BUlLDlWG P[R~IT INSTRUCTIONS Application No..../..(:;.(-~..J ................ o. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 or areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or otterotions, 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. (Signature of applicant, or nome,~f a corporation) .... '. ......... T..T'/~t~ ........ .r4z.~. ............................ ~ ....... '..~,.? ......... (Address of applicant) / I I State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. O ~ ................................. .~'..~..~..~ ................................................................................................................................................... Name of owner of premises .......... .C~...fl .~..~,./,.~,.S ........ ./~...,.......~...!.~.~.....~... ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................. ..O.. ............................ Electrician's License No. o ~J /~ ~9~ /o00 Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ...................... . .............. Lot No. /~ ..................... Street and Number .............................................................. ~ ,~ ....... c~ ...................... Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy . b, Intended use and occupancy property lines, Give street and block number or description according to deed, whether interior or corner lot. 3. Nature of work (check which applicable): New Building. ................. Addition ..... ..~' .......... Alteration ............... Repair .................. Removal .................. Demolitior', ....................Other Work ................................................ ,.., 4. Estimated Cost ~¢¢'o o :.?...?. .. Fee /¢--~-~-- (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ........................... Numbcr of dwelling units on each floor ............................ If garage, number of cars ............................................ 6. If business, cormnercial ar mixed occupor,cy, specify ,inl'ltre and extent of each type of use ......... ~..e.?..t.,..E...~. .... 7. Dimensions of existing structures, if any: F~or,t ....... /..~'..z../..~ ...... Rear ~/, - Jo Depth .................... Height ........................ Number of Stories ............................................................................................................ Dimensions of same structure with altmations or addiiions: f'ront .................................... Rear ............................ Depth ' Height ............................ Humber of Stories .............. ; ................. 8. Dimensiaas of entire new construction: Front .... /..6, ................... Rear ....../...4 ................... Depth ....~..q .............. Height ....... (./. .......... Number of Stories ........ 0..~,~- .......................................................................................... 9. Size of lot: Front ....... I.f,I.. ~3....F.,.~, ..................... i~x~ ~..o..:...~,...F...?,. ............... Depth 10. Date of Purchase .... ~'~¢.~.,...,~..2,.....(.'J.(-..~ .................... blame of kormer Owner .~..8.~¢..~..~.....¢......~..(..~...~.,.8...~.>~...6. ......... 1 1. Zone or use district in which premises ere situated ..~,~u. &.~.L.6..'&.6. ........ .~.z.!...~.~.~..i..d...¢.:~.~.....~.6..~..(.~.,.~...R.~.,Sj,I ........... 12. Does proposed cor~struction violate any zoning law, ordinance or regulation: ......... .~..d. .......................................... 13. Will lot be regraded . ....... ..~..q ............... Will excess fill be removed f_rom pre~ises: ( ) Ye, s (~) No 14. F4arr, e of Owner of premises ,...C~.H.,&&f,.~..S......,.~..,.J~t.¢¢..~ ..... Address No~. ~..,~;[~:.z..~.~.:.¢.~.'~,/ Name of Archit.ct ............... ,~. .................................... Address ..... ';Tz~...~....~'.&.~..... Phone No ...... ..5¢..L.~..!.~,. .... Nome of Contractor ............ ..~...~..../=..~ ......................... Address ............. ~/~....w.).E, Phone No....~¢...~...¢. ...... PLO]- DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from end show street names and indicate STA1 .:. OF NEW YOI),K, CaUl -f'"(' OF ................... ..x-. ......... ..... .(>- ?.~.~......~L_....:....~.~f~. .......................................... bemg duly swam, deposes and says that he is the applicant (Name of individudJ/signing contract) obovt named, kle is~ the .............~ ................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or haw~ performed the said work and to make and file this (~pplication that all statements contained in this application are true to the best of his knowledge and belief; and tho the work will be performed in the manner set forth in the appl cat on filed therewith. Swan ~re me this ................................... .......... ...................................................... ...................... ~. DAWSON PUBLIC, State of New York 52-464372t, Stlffolk County