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Home My WebLink About9391-zNO. ~ TOWN OF SOUTHOLD BUIL1)ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupency THIS CERTIFIES that the building located at ?..F.0.0...D.~..~. ~q..~..k ..... .~.0~ .~ Street Map No. -- Block No ...........Lot No. 7 ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............~.t4 .6 .... ?, 19.-7.~.. pursuant to which Building Permit No ......... dated ............/3..~..&.....~., 197.~.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to .... D./~. V, ! ~. ..... .RT..0..&...E..N..~. ...................... of the aforesaid building. Suffolk County Department of Health Approval ..... /V:..~.~ .......................... UNDERWRITERS CERTIFICATE No ....... bi... ?. ~ .' ./~ ./.,~...G. ..................... HOUSE NUMBER ~CO~ Street ~f~ ~1'~ ~ ~ -~'o^ ~'~ ....... ~... ~.~ ....... Building Inspe~or TOWN BUILDING DEl TOWN (THIS PERMIT MUST BE KEPT ON THE PREM[SEJ UNTIL FOLL COMPLETION OF THE WORK AUTHORIZED) 9391 Z Permission is hereby granted to: .D. ax, l~.3,~e.~.~ .................................................. .................... ~x...7.8~ ......... ~to~...B~.~k ...... .... ..B~..~...~ .an addition on existin cotta e & convert to dwell..~,.g unit to ...]-.: ....................................................... g. ~ ............................ at premises located at ~..~J~ ~JO,~ ~"ng~ ~ ..... .]~/~.~.. ...0;~.~,~:~ t{~d, ...... . .. ....................................... ~ckc~ue.....~.,~.~ .................................................................................... pursuant to application dated ................................. ~I.~......LJ~.~ ..... 19.....~ and approved by the Building Inspector. Fee, $~ ........... FORM NO. 6 TOWH OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application ~nust 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: 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 $5.00 2, Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 / Date ....... ~..~. .......................... New Bqilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property /.~. ................... ~......./~.......~......~.~.~.. ........... ~,.....L....:~ ....~/....~ ...... ~ .............. Owner Or Owners Of Property ..... ..~.../~..~/..!..~.. ........ .,/.~...~..t~...(~./~..~. ................................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..?.?.,~,.J.....~..... Date Of Permit ~./..~../..7..~.:...Applicant ..... j~..!......~...o...,~.~../~,..~.: ............................ Health Dept. Approval ,...~L/..:..~.,! ............................. Labor Dept. Approval ................................................ Underwriters Approval ..~'/./../.2,,~,.,o..~..~...~.~...~.,..~, .......... Planning Board Approval Request For Temporary Certificate ........................................ Finczl Certificate .......................................... Fee Submitted $ ....~_:.~.....O... ................. Construction on above described building and permit meets all applicable codes and regulations. / Sworn to before me this ................ day of ............................................ Notary Public ................................... County (stamp or seal) ~1 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 88 JOHN STREET, NEW NEW YORK 10038 YORK, THIS CERTIFIES THAT RXTUIm RXTURES RANGES OVENS EXHAUST FANS OTHEE APPARATUS: I smok~ detector Rot u~ter heates: 1-~. Sin,. S E R I C E 2 .~-1 GoodaXe Elee. lq.it, I, Box 1~ & Mn:tn Rd. lie. 783E 11 This certificate must not be altered in any manner;, return to the office of the Board if Inspectors ~ be COPY FOR BUILDING D.EPARTME. NT. THIS COPY OF CERTINCATI MUST NOT _BI ALTERED IN ~ MAJ~i~ .~./.~ , ~1, I.~ ~ TOWN CLKRK s OFFICK , . ~. . ~ ~_ ...... ,,Z/ I ~ppmv~ o/c ......................... ~ ........................................... ~~ ~/ ;~/~ ~ ~ ............................ ........... Date ~ ~. 19...~.Z... ~.~. ...... ........... , INSTRU~IONS a. This application must be completely fill~ in by ~pewriter or Jn in~ a~ s~mi~ in triplicate to the Building~ Ink,tar, with 3 set~ of plans, accurate pl~ plan to ~ale. Fee according to sch~ule. b. Plot plan showing I~ation of lot and of buildings on premises, relationship to ~joining premises or public streets or areas, and giving a detail~ de~ription of I~out ofpr~e~ must be drawn on the diagram which Js ~ of this application. c. The work c~ered by this a~lication may n~ be commenced before issuance of Building Permit. d. Upon approval of this application, ~e Building Ins~tor will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for insp~tion throughout the work. e. No building shall be ~cupied or used in whole or in pa~ for any pu~ose whoever until a Ce~ificate of ~cupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY N~ADE to the Building Department for the issuance of a Building Permit pursuant to thcf~ Building Zone Ordinance of the Town of Southold, Sulfa k 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 ir~ buildings for necessary inspections. (S'g ature of applicant, ~r~ame, if a corp~'~i~j ....... ~ ..... i'~'~d~;'~i'~ii .................. ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....-,,~y~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 w~i~h .proposed we~wil~e Street and NumberA,,el~.,~l.~.../~..~(~.... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ~ . , 3. Nature o'f work (check which applicable): New Building'. ................. Addition .....~ ...... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost E.~.~.~.~-~ ....................................... ~ 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 o¢ mixed occupancy, specify nature and extent of each type of use ......."~. .................... ,, 7. Dimensions of existing structures, if any: Front .....~.O ................... Rear ....,~. ..................... .Depth ~,.~-~. ............ Height ...... ~.~...~. ........ Number of Stories ...... ~. ....................... L....~..-.-~........~-~....~...-..~-.~.~.-'~.-,) ................................. Dimensions of same structure with alterations o,r additions: Front ........ .~.~...~ .................. Rear ....... ~..~..../ .......... ' ........... /..3 ........... Number of Stories ...../. ......... ~].~.,~,. Depth ........... ~...~-. ............. Height 8. Dimensions of entire new construction: Front ...... /'~'"'/"",z ....... = ...... Rear ...... /.._~....../. ....... ~. Depth ......./..~...../. ....... ~-~-* ~'.~' Number of Stories /. (..~...~.?,, ,S..~...~..~ .). .~, Size of lot: Front ..........,~([~J~..../. ................................ Rear .....~.,S~. .......................... Depth .....~....~'..Z ......... ...¢~.... of Purchase ~ "~..-~.-' "/.~. , Name of Farrier Owner .~.~l.~(.I,l). ....... .~.j.~,.~.~.lk~ ...... Date ....................................... Zone or use district in which premises are situa.ed ..1..~ ................... -f-- ....................................................................... Does proposed construction violate any zoning law, ordinance or--regulation: .....~..i~ ........................................... Will lot be regraded .......~:,[, .... _ ........ Will excess fil be removed from4~l,t, preEn.~,~ses ( ) Yes ( ~'~1~o Nome of Owner of premise~,~.'/~...~Z~,~ .................... Address ~.~..~_~.... Nome of Architect ................................. Address ./'./. ~...'/~.... Phone No ................ ,4. ..... 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 whether interior or corner lot. 10. 12. 13. 14. CTATE OF NEW_YOuRS, . [ c ¢ ~OUNTY OF ....!..~...~..~..O...~... ........... .............. ~ ~iIv..~.......~. ~.~...~... be ng duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ........................... ~.~.. ...... '('~i~c~i~"~'~'~',"~'~'~i~'~'r'~'~'.'i ............................................................... of said owner or owners, and is duly authorized to oerform or have performed the said work and to make and file this application; that all statements contained in t}~is 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 ..... ~l.t,~ ............ day of ............. &tig~,i.t, ................ , 1¢/?/ ..... Notary~-¢-'~'~. ,~. ~< Public,. ........... ~/~.,~ ~.....,.,., ....... ~J/"~',~ --,~/~' ~l&£~, .~,~¢. ...... County Te[m Expires Ms,ch 30, 19,/._.~