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Home My WebLink About9456-zTOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z927/~ Date October 50 19. 78 THIS CERTIFIES that the building located at .4..50...Bg?.~n..R?.a.d. ......... Map No ..... .~7.6.!... Block No ........... Lot No ......... .~ ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...August... 2t, ...... , 19. -7.~ pursuant to which Building Permit No .... dated ...3e.p.t. emb.e?....16 ..... , 19...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 ..... .A.c.c.~ .s.o..r~.. BRi.1..rl.~.~ ............................................ The certificate is issued to ...... .If.d~...u~. ql..C..u~'..c..u~.. ................................. (owne~ of the aforesaid building. Suffolk County Department of Health Approval .............. ~/.R. .................. UNDERWRITERS CERTIFICATE No. HOUSE NUMBER .... ~5.0. ...... Street .......... .B.a.s,l.n...R.o.a.d. .................... Southold~ New York County Tax lVlap # 1000-81-1-17 & 81-1-18 Building Inspector BUILDING $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 9~56 Z Date ......................... ~.p,~ ........... 1'6 ........ 19...?,~, Permission is hereby granted to: · ~Ldmu~mJ,.. ~;.u~u~.~ ............................................. ...... )~.....',~'.~ o~..~.:,lL~....~-coa~l.~..... (4e el~o-~ ....... ~-~. ........................... at premises located at ..... ~.a~...~.t....,P.'~,~,d3.~...T4(~.~n.~..$~b ........................................................... .............................................. ~iZ.g..~asi,~.. £(,::~d ......... S~u~ho.l.d .................................................... pursuant to application dated ............. ~Rg .......... }j~ff(~....~. ...... , 19.~.:~..., and approved by the Building Inspector. FOBM NO. $ TOWH OF SOUTHOLD 13uilding Depol~ment 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 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 dlsposal--(S-9 farm ar 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 3. Copy of certificate of occupancy $1.00 $5.00 New Buildir~ .--:.:.'. ........... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ~.~`~.~:~.~.~.~t.;?.~?'.~.~'.~)~?~.~..~:~..~.!?/~.¢~;~?~`:?.'~`~t`&~.~.~.:~. .... Owner Or ~ners Of Properly ~.~%~¢~;~:~.A~Z~L[b~.~L~k:~:~::~?~`~ .............. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. ¢ Z~ ' Of Permit~....~..¢Z/~.Applican, Permit No..~......~...~..~... Date Health Dept. Approval ............................................ Labor Dept, Approval ................................................ Underwriters Approval .............................................. 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 ................ day of ............................................ Notary Public .................................... County (stamp or seal) Examined ......................................... 19 ........ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE $OUTNOLD, N. Y. Application No ................................ q. Approved .... ( .( ............. , 19. Z.Z Permit No. ~ ....................... ~ [ sapproved a/c .... ....... /' ......................... Z/ ~(Building Inspector) { 2, APPLICATION FOR BUILDING PEIU~IT °ate .... .Y.. ...... INSTRUCTIONS a. This application must' be completely filled in by typewriter ac 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 ar public streets or 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 port 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 o~ Regulations, for the construction of buildings, additions or alterations or for removal or demolition, as herein described.~ The applicant agree~ to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ~..~ ~)~ ~t(~5 ~q~ i(Address of%.,4~ ,applicont)t~ e~,~ ~ ,) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Bu,lders I,, ens o ~ Electrician's License No ............................................. Other Trade's License No ............................................... ]. Location of land on whichpro~posed WgJl~ will be done,~op h~o.: ........................................ Lot ~)~a ........~ ....... ~ ..... Street and Number-=~....~...~..'.~...~...~;.; ............................................ ~ ...... Municipality 2. State existing use and occupancy of premise~s and in~ended use~and a,,ccupan~,/of proposed construction: o. Exisiting use ond occupancy ........ ./ .......................... .... b. Intended use and occupanc¥~~ ~ . ~ .......... §. Nature of work (check which a ble): New Buildi ............ Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost .................... ..~¢.....4~...~.-..~Fee Z. ~.....~: ..................................................................... ' '~" (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: Fror,t ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. D~mensions of entire new construction: Front ..... .~..,~..%~ ............ Rear ..... .~...~...~ ....... Depth ,.~.% .............. Height ,,/~...~ .... Number o~Stories ........ ¢~ .............................................................. ~.~// ........... .~ ..... 9. Size of lot: Front .......... ........ '::~ ..................... Rea,'._...z..../.. .............. ;~.,... Depth....--~.~ ..... 10. Date of Purchase ...... of Former Owner .~~.~~.. · 11. Zone or us; district in which premises ore s,tu~ted ............................................................................ ~: ...... 12, Does proposed construction violate any zoning I~w, ordOn~nce or re¢ul~fiom ...... ~ .................................... ~3. Will lot be ,egraded .....~: ....... Will excess fill be removed from premises: ~e, ~ No 14. Name of Owner of premises ....................................... .. ............ Addre~ ................................ Ph~ No, ...................... Name of Architect ............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ A~ress ................................ 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. ETATE OF NEW YORK, ~ c c COUNTY OF ................................ f"'" ..................... .~,.'~...~.~....~.....~.....~.~....~...~'~t,.,I .................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the .......................... ;.~ ................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui9 authorized to perform or' have 'performed the said work and to m~ke and file this application; that alt statements contained in this opp]ication are true to'.the best of his knowledge and befief; and tk. ar the work will be performed i'n the manner set forth in the application' file8 therewith. Sworn to before me this ~ ~ ..... day of ..................., o_ Nota~ Pu~c, . ................ ~ ................................ Coun~ .....~~.....~.~ ........................... ~//~ 7~ / ~ (Signature of applicant) ' ~ E, DAWSON ~OfAR~ ~ ~ ~t ~ew Yor~