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Home My WebLink About9188-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.~7~"07...-....--.-- Date..~. ........... ,19 .... located at ~o ~L~V[ THIS CERTIFIES that the b~ld~g .... ~ Street Map No .... ~ .... Bl~k No. ~ ...... Lot No .................................. conforms substantially to the Application for B~lding Permit heretofore flied ~ t~s office dated ... ~ ~ ~ ... , ~. pursuant ~ which Bu~d~g Pemit No.. dat~ ...................... , 19 ...., was issue, ~d conforms to ~ of the reqn!r~ ments of ~e applicable pro~s~n~ ~e law. Th~ccun~cy fo~ ~ch.~~ ~ed ~" ............... ~'~',' ~' ~' ~'~" 'i~uc~ ~ .......................... · ~ ee~fie~ ~ ~ued ~o ...................................................... 8~olk County Dep~ment of aoalth ~pr~a~ ~ ......................... HOUS~ NUM~ ....... S~e~t ......................................... B~Iding ~speetor FORM NO. ~ TO~VN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9188 Z Date ....................... ~I~-'-1~. ....... -]-~- .........19.~:. Permission is hereby granted to: ,Glo,7.ia~..P~l.t= ..................................................... ...... _;~ ...~, ....... ~eo~e ................................ located at ...4~-~llq~e~...~a ........................................................ : ........... : ............ ~ ..... : to o~lJcat~on dated ........................ ~,4.%.u...4~ .......... , 19..~., o~ approve~ bY the l~O~ltM NO. 6 TOWN OF SOUTHOLD ~ Building Department Town Clerks Office Southold, N. Y. 11971 APPLiCATiON FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. 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. C~ommercial 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 inspechon 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 $1.00 Date .... ~..~.~ .'o...s..~.....5..:....]:..9. ~..7. .......... New Building ................ Addition ..Z....~..~ ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property .............. ~..O..~.~,~..D..V...T',.E.~.,.A,...V~.~U..E.. ...... -~....P..e,.?,.o..~,.~.~ ...................................................... Owner Or Owners Of Property ....... .G...[..o...~.$..a;...~..:.....~..~...]..~..z. ........................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No...:.~....~.....Z. .... Date Of Permit .~/...]-.~/...7..7...'..'Applicant .................................................................. t Health Dept. Approval .-'~.'I-:'~.': ................................ Labor Dept. Approval ................................................ Underwriters Approval ..£~..~ ................................... Planning Board Approval .~..-..~..: .............................. Request For Temporary Certificate ........................................ Final Certificate ..~ ....................................... Fee Submitted $ _5..L).(J .......................... Construction on above described building~;'mit meets ali dpplical~le~ cc~de~!~:l~ regulations. Applicant ..~.~,.~....:,.': .................................... ~.,...~,..~ ................................ Sworn to before me this (/ ~d% W~ ................ a. 7 .......... : .......................... Notaw Public .... 7 ...... ~7 ........... C~n~ ~ ' TOWN CLERK S OFF E ~ ' Disappre~ed a/c ..~ ......................................... ~;~ ~ INSTRUUIONS ~~pplicot~on must be completely filled in by ~pewriter o~ in ink and submitted in triplicate to the Buildi~ Inspecto& with 3 set~ of plons, occuro~e pl~ plon ~ ~ole. Fee ~co~in~ to sch~ule. b. Plot plan shying Iocotlon of lot and of buildings on prem)ses, relohonshmp to adjoining premises or public streets , areas, and giwng ~ detoil~ description of I~yout ofproper~ must be drown on the diagram which is po~ of this opplicotio, c. The work covered by this opplic~tion ~y not be commenced before issuance o~ Building Permit. d Upon ~pprovol of this application, the Building Inspector will issue o Building Permit to the opphcont. Such perm sholl be kept on the premises available for inspection throughout the work. e. No building sholl be occupied or used in whole or in port (or ~ny pu~ose whatever until o Ce~ificote of ~cupon~ sholl h~ve been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterot,ons, or for removal or demolition, as herein describe, The applicant agrees 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) ~ ~ ~' ~econic N.Y. 11958 .... ......................... · ............................................... (Address of applicant) State whether opplicont, m owner, lessee~ agent, architect, eng. ineer, general contractor, electrician, plumber or builde Owner Name of owner of premises .... g~D.:~ig,...~,...~.~.~. ........................................................................................................ If apphcant 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 Zrade's License No ............................................... Location of land on which proposed work will be done. Map No .................................. Lot No ..................... Street and Number ...... S.o~¢l.~r&e~..~L~ez~ze .......................................................................... .2..e...e..o..~.g. ...... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Exisiting use and occupancy .... .~..~.J~,~.~.~.:~L.O.I~....--. ............................................................................................ b Intended use and occupancy S~.e 3 Nature of work (check which applicable). New Building ............... Addition ...~. .............. Alteration ............. . Repair .................. Removal .................Demolit~or ................Other Work .................................................. 4 Estimated Cost ...;~..2~.0Q. ......................................... Fee / ~'"?~"- (Description) (to be paid on filing th~s application) 5. If dwelhng, number of dwelhng umts .... J;, ................. Number of dwelhng units on each floor ......................... If garage, number of cars .................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7. D~menslons of ex~stmg structures, if any Front .. 5~..r ................... Rear -.-.5~:. ...................... Depth ..3.01 ........... Height ._l.J~. ................ Number of Stories .... ,1. ................................................................................................ D~mensions of same structure with alterations or add~hons: Front ..... .,5~.'. ....................... Rear .... 4P.m .............. Depth ......6...0. ................ Height ...~(~ .................. Number of Stories ..'J. ............................ 8 Dimensions of entire new construchon. Front ....... 4,2 ........................ Rear .... 2~¢ ................... Depth ..~O .............. Height ...... .0. ..... ).... Number of Stories ..... O. .................................................................................................. ! 9 S~ze of lot' Front ...3.88 ............................................. Rear ....... ~8-~.t .......................... Depth ..2.00.0 ................. 10. Date of Purchase ...... r,T.~ ...... 1.c~."[,l. ........................ Name of Former Owner 11. Zone or use d~str'~ct in which premises are s~tuated ................................................................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation' .~.Q ................................................. 13 Wdl lot be regraded ...~.O. .................... Will excess fill be removed from premises: ( ) Yes ( ~ No 14 Name of Owner of prem~sesq'....CT..]-..O.~.~.....~..~....I~.v.~.~ ........... Address~.e. cD..,-q.;i ~...~..,~'.,,. Phone No. Name of Architect ...no~ ................................ Address ................................ Phone No ..................... Name of Contractor . .~..e.~.:~ .................................... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether ex~sting or proposed, and indicate all set-back dimensions fror property hnes. Gwe street and block number or description according to deed, and show street names and indicat whether intenor or corner lot C]-AT~ OF NEW~u~olkO , t S ~ x ' ~OUNTY OF ~-S ~¢r~ \\~ .......................... ~ ~-.Q ~'.i~,.. ~.,...~'.~ ~.i~ ...................... ~ng (Name of md~wdual s~gnmg contract) above nam~ duly sworn, deposes and says that he ~s the-~pplicar He ~s the ................................... .o...~...e~. ............................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and fil th~s apphcation; that all statements contained m this apphcohon are true to the best of his knowledge and belief; an thor the work wdl be performed in the manner set forth m the apphcation filed therewith. Sworn to before me this /,,A,~/,) ~ ..........Notary"l"5"~"~'"Pubhc, day of .......... ~..~.qt~.:~Q.~,~'A'i:?'~'~']"' ............. ' 1977'~ ~ )C~L,~ ~ ~].c'~ ' ~-~' .....~ ............... ....... County ~>~-..'~.. ~~ .............. ." ...... ~~.'?......1~. ........... ELIZABFTH ANN ~'IEVII~E~ NOTARY PUBLIC, Slat.. of New Yod~ No 52-8t25S50, Suffolk Couj~.~