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Home My WebLink About9376-zFOR~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at . ~ .(X-~-~.....~.~.% ............ Street MapNo .... ~ .... Block No....~..~-....Lot No..~.... ~./~~.~...~. conforms substantially to the Application for Building Permit heretofore ~ed in this office dated ... ~ ....... , ursuant to which Buildin e~it Ho. . ~ X~ , 197l , was issued, ad conforms to ~1 of ~e requ~e- dated ments of the applicable provisions of the law. The occup~cy for which ~is certificate is issued is..¢~,~...~. ' ~~ .~...~:~;/~. (owner, lessee or ten.t) of the aforesaid building. Suffolk County Departmen~ of Health Approval ~f. ~ ............................. u~awa~,~as c~a~c~,~ ~o. ~.~..7~'.J ..... ~. ~. ~..~ t l ....... . Town BUILDING TOWN (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) TOWN OF SOUTHOLD , 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 DUPLICATE to the Building Inspector with the following; for new buildings or new use: l. Final survey of property with accurate location of oll buildings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disposel--(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 fram 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 to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. 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 $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 //. -. ~ . ......... ................. ./ New Bqiiding ................ Addition V' Old or Pre-existing Building ................ Vacant Land Location Of Property ........ .................. ...~.:.,. ............................ .~, .................................................. Owner Or Owners Of Property ..... /~.~....~. ..................... ..~ ........................................................................ Subdivision .~.~../~.,.~,. ................................................. Lot No...~..e..~..~.~-BIock No. ,.~',,~--/~,.,~,~, House No.~,.~....4~.,.~''' Permit No. ....Z..... Date Of Permi .............Applicant ~/(/~...J:...~..~....~.......,~../.Z.~...~...~....~... ............. Health Dept. Approval ../ ......................................... Labor Dept. Approval ............ /.~.../?...~ ....................... Underwriters Approval ~,.~.~.~..~,,.~.,.Z. ................... Planning Bo~rd Approval .... .~..'../...c,..~. ...................... Request For Temporary Certificate ....................................... Find Certificate .......................................... Fee Submitted $ .~~0'~ ................. Construction on above described building and pe,~r~nj,t meets all apRIj~_ble codes and regulations, ^pp,ica.t ................................. tO ~ ~-'~ ~ ~ Sworn before me 'his ~-~ ........ o, ..... ..... o, Notary Public .......... County .',THE NEW YORK BOARD Of FIRE UNDERWRITERS ' ! ';i' ' ' :' , - ' ,, ~ - 88 THIS CERTIFIES THAT , ~ Charles'Frazee, 18485 min ad.~Maeeieuck,~ -was e~amlned ~ ., !97 OTHER APPARATUS: R V I E Rulaad Ele. Co. , ' ''~ .... :'Per D ' :'' ~-~ This cerfificc~te musf not ~e olfered in any monner; return to the office of the Board if incorre~, lnspbdors m~y be identified by~crddenti~s. MA 7- T/TUCK ,5'c, F,c-OZ.K COUNT"6, lq. Y. /14,4//,,/ po i¢.el-t-I TOWH CURK'S OFFICE ~UTHOLD, H.Y. ~ ~~'~~ ~ Exam ned ...~...~.~.~ .., ,, ~ 7 ~ ~licotio~~ ~ ,.,.,, '-' "-'"',: ......... ................................................. ~ ..................... .~. ........................... ~ ....... ~ ~ ~ ,~ ................. b (Building Insofar) APPLICATIONiNsTRUCTiONs'OR BUILDING PERMIT~/' -~ "~l Dote.....~..~.....~.~ ......... , a. This application must be completely filled in by b/pewriter or in ink and submitted in triplicate to the Building~ Inspector, with ;3 sate 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 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 have 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, ~//nome, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. Tame and title of Plumbers,License No ...... ~.. ,.~~' Electricians License No...~.~ .......... Other Trade's License No ............................................... LOcation of land on which proposed work will be done. __Map No.: ....... ~ .............. :. ............... Lot No....~ .......... Street and Number ./~.~..~=.....~.~...~l~..~,dl State existing use and occupancy of~ ~ .,,premises and intended use ~nd occupancy of proposed construction: Exisiting ./. ~3. Nature of work (check which applicable): New Building'. ................. Addition .................. Arteratio~ ................ Repair .................. Removal .................. Demolihor ..................... Other Work ................................................... _~./ .,/. (Description) 4. Estimated Cost ............... ~,~,.4~2~. ......................... Fee ~..~. ................................................................................... ~ (to be paid on filing this apl~licotion) 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 ............... .;.....~;~ .... .... _'Z /'C~ " 2 ~ ~/' Depth ...Z.~.......~..... 7. Dimensions of existing structures, ~f any: Front ........~.. ................. Rear ...... ~ ...................... Height .....~,..~'....~,~.... Number of Stories ....... K.~Jg.~,~. ..................................................................... =...~..1 ...... ?> ..... .~ -- ear ~ / 0 D~mens~ons of same structure w th alterations or additions: Front .......... ~. ......... ~. ....... R ............................ Deptb ....... ~4~...~ ....... He,ght .......... ~.~...(~.....Nu~ber .of Stones ...... ./....~ .; .......... ),. , t~. ,, 8. Dimensions of e,n~re new construction: Front. ....... /.~,...,'~-.~.. ......... Rear ...... ~...~.....-T..~...... Depth ....1~...~..~. ....... Height ...... /,,,.~,,~., ' NC m~e r'~o f Stories ............ ~..~_~..... :':'J': Z .................... ~ ..................................................... Re a/,~¥~----_,,~'~. ~. ~'.~. ~.~...~ e pt h 9. Size of lot: Front ......... ,,.~"~....~..~'..~J~.l~..~-~'--~ 10. Date of Purchase ................................................... .'....Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............................ .~.'.'i" ': ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ 13. Will Jot be regraded ..... )~,~.... Will excess fill be removed from premises: ( ) Yes ("~No 14. Name of Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ........ ~ ....................... Phone No ....................... Nome of Contractor ............................................................ 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 STATE OF NEW YORK, COUNTY 0~:/...-.~......77 ....~. f"'~ ........... ~....~'~'..~ ........................... being duly sworn, deposes and says that he is the applicam (Name of individual si~ing contract) above named. Fie is the .~...~....~....~.;~ (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; tha~ all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~-~ .-.~..'...~...~...~day of .~...~. [~.. ..... , 19~... ~~....~:..~.~....~... .................... · ................... Coun ........................................ / .I~'/],RY E, DAWSON NOTARYC-°OBLIC, State of New Yor/~ No. 52464372t. Suffolk Coulli~t~. Temr Expires March 30, 19.