The URL can be used to link to this page

Home My WebLink About9378-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Otfice Southold, N. Y. Cerfi[icate O[ Occupancy t ....... .~. ................. Street THIS CERTIFIES that the building located a .apN~,/J~./: .... ~loek no .... ~-....LotNo.~. .... ~.~..~~.." conforms subs;~ntially to the Application for Building Permit heretofore filed in this office dated ... ~'~'~t'' ~ ~"" 1927. pursuant to which Building Permit No. dated .... !~.[~/:P~,...~.~'...., 19~.~., was issued, and conforms to all of the require- // / ments of t~k¥ applicable provisions of the law. The occupancy for which this certificate is issuedis ~..//~..~c~.,~;~-~,~.'.~.c--~¥*~>-.-:~:.I .~.~'~'~ .%.~..~....<...-.-.-.-.-.-.-.-.~-......~.~/:. ~,~,~.,.,~.~,~" ~, ~..~ ~s~u~ ~o. ~.o~,~.~....'.'.'~'.4.' i ~ ii ...... .~... (ortner, lessee or tenant) ' o£ the aforesaid building. Suffolk County Department of Health Approval .~. UNDERWRITERS CERTIFICATE No ............................ ;.~ ............. (THIS PERMIT MUST BE,KEPT ON THE PREMISES UNTIL FULL CGMPLETION OF TRE WORK ~UTHoRIzEa) N? 9378 Z Permission is hereby granted to: A, S:[nterl:~t~,-5~i~uF...I)$P.-~o~l~..~c...'.~fc.~'em~'l~e~l~ ........ t4a~t~*~ue~ .................................................. ......................................... ~.~t:[tuck ....... ~.,~ ................................................................................ pursuant to application dated .............................. ~r.....~.~,)...., 19..~.~.., and approved by the Building Inspector. FORM NO. $ 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: 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: 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 Date ...Z ..~.//.. ~/.~..'~. ................... New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ,,~jr~C~Z~,.¢'~. ~..~.~ ,S. ~ ~'.~...'~. I.T.v .......................................................... . .~ Jo., ,, ~. ,,,, .~.~If; .................. Owner Or Owners Of Property ....... ]..V..o...~....~..~..~.~R.~.....~J..:....~(~..~...I..G..~.y. ....... ~...~..., Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...?..~2..~...~. Date Of Permit ~/~./.zJ.~..2..2....Applicant .............. Health Dept. Approval ~..~ ) ~ .............. : ............................ Labor Dept. Approval ..............~....(~ ........................... Underwriters Approval .../.~.'..~...!?.L.~..d...(~ ................... Planning Board Approval /~' /~.~ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ...,~../....~. ....................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ...~.! ......................... : ................................................. Sworn to before me this ~/ A'/~fy~/~ ~ ...... 2;.~... day of ................ 7.~....../.Z. ....... l.. (stamp or seal) Notary Public ...... ~6~'~/~/~.'./~/... County TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ................................. -- Disapproved a/c ........................ ~;..~.:~< .................................. APPLICATION FOR BUILDING PERMI~, INSTRUCTIONS This application must be completely filled in by typewriter ox in ink and submitted in triplicate to the Building I~spector, with-3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship to ad oining premises or public streets or and giving a detoile~ description of layout ofproperty must be drown on the diagram which is port of this opp ication. areas, 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 o 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 Southald, Suffolk County, New/~and other applicable Laws, Ordinances or ~ Regulations, for the construction of buildings, additions ar alterations, j~¢ for rCnoval or demolition, as herein described. ~'~ The applicant agrees to comply with all applicable laws, ordinances, J~Jilding 96de, housing code, and regulations, and to ~ admit authorized inspectors on premises and in buildings for neces~4~ry in/.~o/e~tions. Z~ /~) ~t~ (Signature of ~ppJ~cant, Dr name, if a corporatio~ .............. ....................................... - (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi ectrician, plumber or builder. Name o~ /rot premises ..¢ ........ ~.,~'.~.....~~ ..................................................................... If appli.~...~.n.~///~~ _~"-* sC~l~orpCr,~te, k'gn~ature~ '-~"~-~.°f duly authorized officer. ~,~ amE ~fndLt, ffle of corporate officer) Builder's License No ..................................................... Plumber's License No ............. Electrician's Licanse No ..... Other Trade's License No ....... ~ .............. Location of land on which proposed work will be_done. Mop No.: ...~..~.~.,~./~d',~~'"~9¢/') ~.¢~ Lot No ......................... Street and Number ~.~...*¢) ¢J' r.S...~..~..' ~¢..~ ~'~ ...... .Cd..~....~]~-- ~..¢. : ............. ............................................................ ~: ................ Muni~i~alit~ ........ State existing use and occupancy of premises and in.tended use and o~upancy of proposed construction: a Exisiting use ond occupancy ........ :1~..~:.~. .... '"~"~~l~ ~~ .......................... b. Intended use and occuponcy ............................... ~~-.~..~......~.~~ 3. Nature of work (check which applicable): New Building .................. Addition ....... ~,.....,_. Alteration ............. 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 gf 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 alterqtions or additions: Front .................................... Rear ............................ Depth ................................Height ............................ ~'~ ~'"~ ~ ~r~/~c.~Number of ~r~j~ ................................ 8. Dimensioasof entire new construction: Front ..... C:J*.....k..-.4.-./ft....~t...'ff.....:....Rear ............................ Depth ........................ Height .................... Numb~er of St~)ries ................................................... ~'"! ................................................ ~.~ ~ ..... 10. Date of Purchase ....... ..................................... Name of Former Owner ........................................................ 1 ]. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ./~....1~. ......................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premisesL( ) Yes ( ) No Name of Architect ....... ~..,.~, .............. ,q ............................. Address ....................... ,,.,Phone No ....................... Nome of Contractor ........... Addres . Phone No.~...~.~.:?...~:..~./..O 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 .~ corner Jot (2 ,~ ' * ~ // / ~TA3E OF NEW YORK, COUNTY O~.~.q~...~:.Z.....~ .................... .~.g.~...O~¢~.~._.~ .......... '. .................................. being duly sworn, deposes and says that he is the applicom (Name of individual signing contract) abow~ named. He is the ................ &g.~..~P.~...~P.~¢.%g.[ ................................................................................................................ (Contractor, agent, corporate officer, etc.) of sa.id pwner or owners, and is duly authorized to perfbrm br 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; and thatehe week will be performed in the man'er set fo~h in the application filed therewith. Sworn to before me this .............. ~.~.%~. day of ....... .~.~ ........................... , 19.7.~.., BOTARY PUBLIO, State el ~ew No. 52-8125850, Suffolk