The URL can be used to link to this page

Home My WebLink About9369-zNO. 4 TOWN OF SOUTHOLD BU~.DING DEPARTMENT Town Oerk'~ Office Southold, N. Y. Certificate Of Occupancy No.Z,7,8,0. ·~ ....... Date .............. ~tl&,t~t.. 3..., 19. ?2. THIS CERTIFIES that the building located at ...... ~/e~Lls. ttoad .......... Street Map No... ~ ....... Block No....x~. ...... Lot No.. X~... P.e. co~;J,C.. ~.,.~t .......... conforms substantially to the Application for Building Permit heretofore filed in ~hi~ office dated ............ ~Tu~.....~.lt 19..77 pursuant to which Building Permit No..~369~. dated ............ ~..20..., 19.??., was issued, and conforms to all of the require- ments of the applicable prov~ions of the law. The occupancy for which this certificate is issued is .. ?r£vate..one. £aml~y .d~.ll~g...~ltl~ ~dd£t~on...edecO) .......... The certificate is issued to . .l~r. ~ .l~rs. J~d~J~ .Foy. ...... .0~mers ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~! ,2.. ............................... UNDERWRITERS CERTIFICATE No..N, R, .............. : ........................ HOUSE NU1VIBER ..... .~.90~ .... Street ... I~lls. ~oad ......... 7eeon~e .......... · ....... (THIS PERM T MUST BE KEPT ON. q'H£~PP,£MISE$ UNTIL FUL COMPLETION OF THE WORK ^Uzl'~(~l~[l~), ',i No. 9369 Z Permission is hereby granted tg: at premises located at .....W.~.~,~.~I....~..gJ~.~ ...................... , ............... ~ ........................................................ Peeon~e N,Y pursuant to application dated .............................. ~)~....:~......., 19...~/.~., and approved by the Building Inspector. Fee $.~..~.~ ........... FORM NO. 6 TOWN OF SOUTHOLD Building DelMftment Town Clerks Office Southold, N. Y. 11971 APPLIGATfON 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, AAultiple 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: 1. Accurate survey aT 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 $5.00 Dote . ,. ~., .,~,,¢~. ~ .~..~, ,,,../, .t.,. ~,., .~.. ?.?,, New Building .................... Old or Pre-existing Building ........ · .~.... ............ Vacant Land ............................ Location Of Property ..... ~.~..~.~.~.....~..~....~......,~.....~...~,...~...~..~..?...~.. ........................................................ Owner Or Owners Of Property ......,~..Z'~.....~.....f~..L.."~......~...~....~f..,¢..~......~...e..~.. ................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..~,,~,.~.~.~.':~,.. Date Of Permit ...~t~,.? ,/~.).?Applicant Health Dept. Approval ................ ~../.~.. ................ Labor Dept. Approval ............... ..~f'.-t.~..~ .................... Underwriters Approval .................,.'~.~.. .................. Planning Board Approval ......... .~.,.Z,/~,.. ................. Request For Temporary Certificate ........................................ Final Certificate .......... ~ .................... Fee Submitted $ above described building and per~L~ts all a~icable codes and regulations. Construction on Applicant ~.~;~.~ ......... ~,,,,,,,~--~,,,,,,',,,,',,,,.,,,,,,,,,,,,,,,,,,,,,,-'"'=--"-~--~,~~ ~ ....... Sworn to before me~ ......... ]. day of ............. ,_y. uq . .............. ,1 .......... (.amp or Notary Public ...... ~ ............. County I~B,M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~x~,~ ..... ~..=.~.~ ...... , ~..~...~. .... ........ ....... Application No ................... Disapproved o/c .~..~=.....~ ............ APPLIGATi !~STRU~IONS a. Tht~ gpplig~H~ m~t ~ ~it~d in triplicate ~o the Building~ ~: ~Jgt premises c. The w~rk ggy~m~ b~ thl~ ~ Permit. d, Upon qpPmwl of thi~ c shallb~ k~pt ~n the e. ND h~JJ~iR[ i~ port fo~ any pgTpose wh~eyer until a Certificate of ~cupancy shall have been gmnt~d by the APPktCATIDN IS HER~Y M~g~ t~ ti~e Buil~i~ D~p~tme~t for ~ i~s~oc~ ~ a Bu,[ding Permit pursuant to the ~.ild~ng Z~,e Or~innnge ~f th, T~n pf ~th~!d, ~ff~!~ ~o~ty, N~w Y~,~k,'66d ~ d(6.1i~able Laws, Ordinances or ~egul~tigns, f~r the c~mtmm ~n ~fh~ d n~, ~it ~ns ~r h t~r~t[~; '~ ~b~ r~gYq~ ~r ~o Jtion; as here n des~r bed admltTbe~ .~PP~th~r~efl. ' c~t. qgm~. nm~t~r~t~ gnmp, ~pY prom S~ate whether gppIj~nt is gwn~r~ Jtq~ef~, ~ent~ ~qrchitect, ~n,~ip~er, g~ge[~l contmctpr, electrician, plumber or builder. ...... ....................................................................................... ~// (Nome and ~itle of cq~qrqte officer) Plumber's License NO ................................................. El~t~j~ioo's No OtheF Trade's L cerise Nq ............................................... h,~ ,~, ~ : ~.. ~..e..~. ~ .~ 4 .~.....................,.......................,............................. Municipali~ 2. State existing :gse ~nd ocq~p~ncy of .premises ~nd igt.egded Vse ~n~ qccupanc/ of pro?sed construction: a. Exis[ting gse .qnd ~c~p~cy ........ ~....~.<.~....~.~ ....................................................... b. ,Intended use nod ~p~ncy .................................................................................. ~ .......................... 3. Nature of work (check which applicable): New Building. ................. Addition ..' ................ Alteration ................ Repair .................. Removal .................. Demolitior ............. ........ Other Work ................................................ ~/ ~ . ,¢~ ~ (Description) 4. Estimated Cost .......... ~ .........~ .............................Fee ..........~ ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... / ............... Number of dwelling units 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. Dimensions of existing structures, if any: Front .......... .~....~....! ........ Rear ........... ~..~...../. ......... Depth .... ~..~...~ ....... Height ........................ Number of Stories / ............................................. Dimensions of same structure with alterations or additions: Front ........ ~...~. .......... ~, ........... Rear ...... ¢~..~... .............. Depth ........ . .-~-..~. ................ Height 8. Dimensions of entire new construction: Front ......¢....-~;..~r., ................ Rear .........~ ............. Depth ..... ~.~...~.. ........... Height ...... /..~.. ....... Number of Stories ....... .¢~..~.~ ........................................................................................... ~ ..... 11. Zone or use district in which premises are situated ........ ..~... ....................................................................................... 12. Does proposed constructio?~io[ate any zoning Iow, ordinance or regulation: ...... ~...O... .......................................... .13, Will lot be regraded ........ .~(...~.. ............ Will excess fill be removed from premises: ( } Yes ~)'~o Nome of Contractor ../.~'.~.~.~....~?.~... .~¢¢~.~z4.¢ ..... Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK t S S COUNTY ,OF ,~i'.~'./?.¢.¢.~.!.~.. .......... ¢ ' ........... ~./(~¢..~%....i/..~..../.~.~...~./.~.~.O,,_.. ............................... being duly sworn, deposes and says that he is the applicanl (Name of individual signing contract) above named. Fie is the ......... ~...f~..~.~ ....... ~f~...~./.~¢:~ . ....... ~...../¢~--.~.~¢ff...f~.' ........................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed/the said work and to make and file this application; that oil stoteme~z~s~,contained in this application~~his knowledge and belief; and that' the work will be performeC~[n the~manner set forth in the ap/~icotion fJle~ therewith. ') Sworn to before me this k //'1 ~, ~, k, / ~ Notary Public, . ................ unt~t ..~ .......................................... ~ ................................... x ....... ~~f/M~~_ ~i~"~'~'~u re of applicant)