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Home My WebLink About9441-zTOWN OF $OIITHOLD BI.m'.nlNG DEPAR'r~,~IT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z79~.? ...... Date ........... 0.ct.. 2~ ........ , 19..7? THIS CERTIFIES that the buildint[ located at flaky..al; ................... Street Map No... xx ....... Block No.n ........ Lot No. 0~x. ~lvieni;..I~,-Y. ............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ...........Sept. 6 .... , 19. ?7. pursuant to which Building Permit No. dated ............Sapt.. 6.., 19..7.7, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is. P~.lva.t.e. gar. age. ~ .Sto~.age..bul,l,d$~t~ ............................... The certificate is issued to . Ar.l;h~l~..14 ,. 51~,th. ~; .~'1£.~....o~l~.r.$ .................. (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval N,P~ ............................... UNDERWRITERS CERTIFICATE No... I~I ,I~. ..................................... HOUSE NUMBER ..... . .~.0. ..... Street..li.a..v,j..S.t.r. ?.e.t. .... .qr..i.e.n.t. ............... Building TOWN OF SOUTHOLD BUILDING DEFARTMENT ~'TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE Pp, EM SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9441 Z Date ........................... ~qe~t~....6 ........... , 19.~.~... Permission is hereby granted to: .,a. ];'..~ .,{ ;A,i ~...,o t~i.i. ~V'~ ...................................................... ......... 3'1'-" ~ tez~iev.. ~ ........ . .Htmt~ -~n~c cm' at premises located at ..... ~,Z..~..~a.v.y-..4~ ........................................................................................... .............................................. ~.l'~t~.....l~.~.~.,. .................................................................................... pursuant to app{Jcation dated .......................~.~.~t,.....~, ................ , 19..~.~'.., and approved by the Building Inq~ector. Fee $..lO..,;,,',~ .......... Budding Inspector FOR34[ ~'0. 6 TOWN OF SOUTHOLD Building Department Town Glerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apptication must be fitted in typewriter OR ink, and submitted in tet~te to the Building Inspector with the following; for new buildings or new use: I. Final survey of property with accurate location of oil 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 o7 property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner es 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. Fees: 1. Certificate of occupancv SB.00 2. Certificate of occupancv on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ........................................ New Building ~ ....... Old or Pre-existing Building ........................... Vacant Land ................... Locatlo'n Of Property ~ .~<~....4../.~;~..~..~,.~. ........... ~ ~' (~ ....... ~..I. ............. L~/~ / /.....,~.'....~..,' ................................................ Owner Or Owners Of Property/~-~.-.~...4)./~/.~....~.../l'~../......;/-~)....Z../.-/../'~"~:.~..?'.....?-.../J'..~'.../......7~ .............................. Subdivision ................... ~ .................................... Lot No ..... ~.Block No....~-.L... House No ............. Permit No.~.I.~.~.Z..~.. Date Of Permit ~..~..~../.'~..'~....Applicant ~...~....~...~....~;..~....~/.....~.......~.. .................... Health Dept. Approval ....... .~. ................................... Labor Dept. Approval .......... ..~........~. ......................... , . . .. Underwriters Approval ......... .~. ....... .~. ........................ Planning Board Approval ............. : ........... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ~ dPW Construction on above described building and permit meet~ oil applica~?~ codes and ~egulations. ....... i.~'~ay of ...~,¢~ ............ (stamp or sea,~ L ~ ~gSr~° l~O~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............~ .......................... , Approved ,~ I:: , . I9.1~.'..~. Permit No..~i ................................ Application No ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets 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 of property 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 q~ 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~j' 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 code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. ~ (Signature of oppli~cont, or name, if o cprporation) ............................ ..... State whether applicant is owner, lessee, ~gent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................... Name of owner of premi/ses ....... ~(:.'..~..~'~:?.:,....Z~....~.~':.':.4.~....~....:I'~/.. .............................................................. I1' eppJicant is a corporate, signature of duly authorized officer. (Name and title of corporate~,ficer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... o~ .~z~ ...~...., 1.Location of and on whch propoyd ~.~.~o~r.k(~i~ll be done..~p N ; ...... iiiii' Lot No i[;!;; ;[i;[;;[;;;[; [ Street and Number ............... :~.::'.~...:..:.:.~ ....... · .~.'::i-..~'~.. ....... C.~-::..z.....:............................. I ' Municipali~ 2. Store exisHn~ uso ond occuponcy of premises ~ intende~so ond occup~nc~ of proposed construction: a. Exisiting use and occupancy ..................... ~ .......... ~ ........ ~_,..C ............. ............... ?/ ........ ....................................................... 3. Nature of work (check which applicable): New Building. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... O,t,h e~r Work ................................................... 4. Estimated Cost ......... C~.~..~..:~ ~ ................. 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 occupanc~Z~ n~ure 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 ............................ ~-N~?~ Stories ................. ~..~. .... 9. 11. Zone or use district in whic~premises// are situated ...~~.~ ....................................................... 12. Does proposed constructio~olate any zoning law, ordinance or regulation: ...... .................... ~ ................ 13. Will lot be regraded ......... ~ ............ Will excess fill be removed from Bremise¢ ) Yes ('~) No ~ome of Architect .............................................................. Address ................................ ~hon~ ~o ....................... Nomo o~ Controctor ............................................................ Addross ................................ Phono ~o ....................... PEOT DIAGRAM Locote c~eoH~ ond d~stinctl~ oll bu~ldin~s~ whether existin~ or proposed, ~nd indicate oll set-B.ok dimensions from property lines. Give street and block number or description occordino to deed, ond show street names ond ~hethor i~terior or rorner lot. STATE OF NEW YORK, [c c A COUNTY OF ...... ...~ ............ .,~ '/~ ~- .~ Z'/ .......................... ~.~,~,,.,~ .................................. being duly sworn, deposes and says that he is the applicanl (Name of individual signing controcf) above named. ~ , He 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; that all statements contained in this application are true to the best of his knowledge and belie~; and that' the work will be performed in the manner set forth in the application filed therewith. Sworn ~o before me this ........ 'h4 ....... ...................... , .) % Nota~ P~I c, ~ ......... ~,. ................ Coun~ ......... ~~...ZZ.(..~Z.~..~ ................... '~/ ~ ~ ' / I (Signature of applicant) ~ARY E. DAWSON ~ N~A~PUBLIC, State of New York ~. 52-46437~1 Suffolk Countunty T