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Home My WebLink About9474-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. Z ~' 9 a 0 rate -.Ig V >/ ~.~.~ T~IS CERTIFIES that the building located ~ ............................ Street ~p ~o.. ~ .~.( ~... mo~ ~o .... ~ ...... ~o~ ~o. ~ e conforms substantially to the Application for Building Permit heretofore filed in this office dated ,,JVL', 25, 197. .~.. pursuant to which Building rerm~ l~o ......... dated ........... ~.~.P.7.....~.~., 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 ......................... g h'~'{~K i~ L'~ .... ~'~ ~'~'~ ' ' FL'OD~ ........ The certificate is issued ~ .... ~.~}~ ~ .~ .... q. ~q ~ ~ H & ~ (owner, ~a=~' ~, l~t) of the aforesaid building. Suffolk County Department of Healih Approval ']z ~/= ~ -~e4 ~ V - 5 o - ~ ~ UNDERWRITERS CERTIFICATE No. '~E ~ b ~ ~' 5~ HOUSE NUMBER 7 OO Street '~ ]~ H ~ ~ ~ ~ LA ~ ~g ..................... *********************************** ~u FI~H S~Co~ WLO0~ ....................................... Building Inspector TOWN OF BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9474 Z Permission is hereby granted to: . ,~: >...:.~:.(:.!;: ........ ,>../j.~. ~.: ~ : .~.~ .~ ........ Building Inspector. ~ee ~...~..>.. ............ -Building ilnSpector FORM NO. 6 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 triplicate to the Building Inspector with the following; for new buildings or new u~e: 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 o'f 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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .~7--,~.... ~. C2/.../..~.. :~.. ~.. ..... New Building ..~ ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~.¢'~...~..~-~,..~.~. ......... ~~.~:~. ............................................ Owner Or Owners Of Property ..~_ _.¢;~,~1,,.....~..,....~. .............................................. Subdivision /~....~'.....~..~.~..2~..~./.~2.....Lot No. ~...~..,, Block No..~/. ...... House No ............. Permit No..~....~.'.7..~. ....... Date Of Permit.~?~...?2. Applicant .~.....~~...: ................ Health Dept. Approval .Z.~....~....~.Z..7.~.. ............... 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. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ~CATION [ SUFF. ,CO. HI*AL~T}~ Pl~l~T. APPROV&L I H.t., BUILDING DEPARTMEHT Exami.~ .............. ~ ........... , 19 ........ 7 /~[~? ~ ~ ~ ~~ti~ No ................................ o~ ./~ .. , . C ...~ .............................................. ................................................................. ............. ~ - ' ........ ~~'~'""~~t ~ JF~ 0~.. ~ ~.. / ~ ~ , (Buildi~ In~or) ~/~ ~~ ~PLI~TI' FOR BUILDIHG PE~ITu~~ ,, .... , rs ..... : ..... a i ' ' · ~['71[n e ,~t O, ~1~, =cu=,e p,~ plan = =ale. r. a=o=ing to · ~ plan ~m~. I~otio~.of lot ond of buildings ~ premises, relotionsh p to ~joining premiss or public stree~ o~ areas, ~ givl~ ~ detou~ d~rlption of I~o~ ofpr~e~ must be drown on the diogrom which is c, /ne worn c~r~ by this o~licoti~ moy n~ ~ comme~ before issuance of Building Permit. d. Up~ o~ol of fils o~lic~ion, fie Build~ Inserat will issue o Building Permit to the opplicont. Such permit~ sh~ll be kept ~ the premiss ~iloble ~r in~h~ ~r~gh~t ~e ~rk. e. No building sh~ll be ~cupi~ or u~d in ~ole or in p~, for any pu~ose whoever until ~ Ce~ificote of ~cuponcy sholl h~ve been granted ~ the Building Insp~tor. APPLICATION IS HEREBY ~DE to the Bud ~ ~ment for fie i~u~nce of ~uild?~ Zon~ O~inence of the T~n of ~thold, ~ffolk County, New York, and other applicob · ~, O~inonc? or ~gulah~ns, tar the constm~ion of buildi~s, o~iti~s or ~ temt ons, or for ~mowl ~ne oppfic~nt agrees to comply with ~11 ~pplic~ble I~, ordinates, ~ilding c~, h~i~ c~e, ~ ~uloh~s, ~ to odmlt outhoriz~ in~o~ on p~mi~s ~d i~ buildi~ ~r n~es~F i~Ktio~s. · ....... (Addre~ o~applicant) / State whether applicant is ~er, les~e, agent, a~hit~t, engineer, general c~ractor, electrician, plumber or builder. Name of owner of premiss ....~~...~......~~ If applicant is a co,orate, signature of duly authoriz~ offi~. Builder's Lic~se No ......... ~ .................................... /~O ~ Plum~r's Licen~ No ......... ~.~.~,.~ .................... /~ ~her Trade's Licen~ No ............................................... ~ 1. L~ation of la~ on which p~o~d work will be done. Map No.: ..... ~.~.~ ................. Lot No....~ ........... Street and Number ..... ~.....~/~....~:~ .......................................... ~ ........... ~ - Munlci~li~ 2. State existing use and ~cu~n~ of premises and intended use and ~cu~ncy of pried construction: a. ~isiting u~ a~ ~cupancy ~c~ b. Intended use and ~cu~ncy .......... ~ ~~...~~ 3. Nature of work (check which applicable): New Building...~. .......... Addition .................. Alteration Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ . .... '7'~ (Description) 4. Estimated Cost ....~....~..¢...,~..~...~.. .............. i ............... 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 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 alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ,,./:~..,~.. .................... Rear .....,~.~, .............. Depth ..~..~. ..... Height ...~.~. .........Number of Stories ........ ~.~ .................................................................................................. 9. Size of lot: Front ...... ,/~..,~... .................................... Rear ...... ~.~..~..'~... ..................... Depth ..... /.-~.5.~--.;. ........... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~'.~. ................................... 13. Will lot be regraded' ......~.. ............ Will excess fill be removed from premises: ( ) Yes (~ No Name of owner of premises/~...~..~...~l~~... Address/~/..~_aa~...~. ..... Phorte No ]4. Name of Architect .............................................................. Address ................................ Phone No ....................... Name 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. STATE OF NEW YORK, IS S COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contracf) 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 belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............. ................. No. 52-464372], Suffolk County Term Expires M~rch 30, ..... {]LIOl: ._ APPROVEDA~S NOTED DATE:~~ · exce~ by a Lleense~ P~'ofes. O{Jiee Of G,,,,','!o~ K. AbleCe, I __1 F ~r ',. J Oftie~ OJ "Alierc~tlon of this C~cume~t excep~ by a Licensed -d~n~l Engineer, Is ~on 7209. Gordon lt. Ahlere, P.'~.