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Home My WebLink About9206-zFOKbl NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .Qr.e.e.n.w. aY. E~s.t ........... Street Map No~'me~ .&O .... Block No ........... Lot No..~ ... 0~i~l.t...I~,X, ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. &PR .. ~,-~, 19.7~. pursuant to which Building Permit No..~.20~. dated ........... &pF ..... 2~., 1977.., 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 Pti.rate. &aOllaOl"'y..(.ItO2'&ge ). building ............................. The certificate is issued to . .lq. ~!.l.1 .ala..I,~. G],b.b$ ..... .O~leF. ............. . ,: ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .I~,R., ............................... UNDERWRITERS CERTIFICATE No..N,R, ....................................... HOUSE NUMBER ...~[37~. ...... Street . Gl'e.~..E&~.~ .... .0~$elx~ ........... ,.. Building Inspector FOR~ NO. 6 TOWFl OF $OUTHOLD , Building Deportment Town Clerks Office $outhold, Ft. 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 buddings 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: 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 $5.00 3 Copy of certificate of occupancy $1.00 New Building .... ..~. ......... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~~z'~e~qX~&~'~]~R~'~1~~*~Z~ ...................................... Owner Or Owners Of Property ...E~L~-L:L~...~a...G;Lb~.fl ............................................................................. Subdivision ..Gr.~..~,..4k~;~.~.;~...~t.~...O~,;L~ ............ Lot No...~.T ...... Block No ............. House No ............. Permit No....g..~..O..G. ......... Date Of Permit ..~..-.~,.~..-.~.?...Applicant .~:L~L~,~..~n...~Lb]~.~. ......................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate ............ ~ .................... Fee Submitted $ ..~...~ .................. Construction on above described buildin~L:l p~fr~it meet_~L/~l op~ab~l~c/9~tJes and regulations, Sworn to before me this ........... .~.. day of .... ~ ...... .~- ................. (stamp or sebl~ Notary Public ......~.~... County FOB, M ~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .............. r/i/ ..... ...... , Approved ............................................... . Permit No ..................................... Disapproved ~..::: ~..~....;~.~----~ (Budding Inspector) APPLICATION FOR BUILDING PERMIT Application No ............................... INSTRUCTIONS a This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildi, Inspectoz, with 3 sets of plans, accurate plot plan to scale. Fee accordipg to schedule. b Plot plan showing location of ~ot and of buddings on premises, relationship to adloming premises or public streets areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio c. The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the apphcant Such porn shall be kept on the premises available far 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 Occupan. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ,ssuance of a Building Permit pursuant to ti Budding Zone Ord,nance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ~ The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and ir~ buildings for necessary inspections. (Signature of applicant, or name, if a corporation) William L, Gibbs - Owner N., .....ll. d? ............... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budd Name of owner of premises ........ .W.i...1..1...i.~...L.*...~.i..b...b..s. ................................................................................................ if applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's L,cense No. ~ - Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License Na ............................................... 1. Location of land on wh,ch proposed work will be done. Map No .......... .~.0..GQ .............. u'-' Lot No ...... ~ ......... Street and Number ...... .l...~.Z.8..~.G..~.e.~.e~.n...w.'a.~r.~.~.~.a..s..t..*~.~..?.~...e..~..t.J~.~.~.W~9~E$~.~$.~ .............................. Municipality State existing use and occupancy of premises end intended use and occupancy of proposed construction; a Ex,siting use and occupancy ................. .~.~.~TL~.~ ................................................................................. b. Intended use and occupancy .................. ].~.~'...flhet~l~ .......................................................................... 3. Nature of work (check which applicable). New Budding ....... ..~ ......Addition .................. Alteration Repair ............... Removal .............. Demohhon .............. Other Work ................................................ (Descr,ption) 4 Estimated Cost ................. Fee ~- (~ (to be pad on fihng th~s apphcabon) 5. If dwelling, number of dwelhng umts ....... ~ . .Number of dwelling units on each floor ....................... If garage, number of cars .................................................................................................................................. 6 If business, commercial or m~xed occupancy, speofy nature and extent of each type of use .......................... 7 D~mens~ons of ex~stmg structures, if any' Front .................. Rear ................................Depth .................... Height ........................ Number of Star,es ........................................................................................................ D~mensions of same structure with alleratlons or addmons. Front ................................... Rear .......................... Depth .............................. Height ....................... Number of Stories 8 D~mens~ans of entire new construction' Front ..... ~Q..~'.~O.~ ............ Rear ...10..f'~,~ ........ Depth ...~t fOe,~.... Hmght .~.. ~e~.t, ..... Number of Stones ............................................................................................................. 9 Size of lot Front ......... ,'k~.~...~.~.f~.~. ......................Rear ..... 35.8. ~.e~.t; ................ Depth ...... ],~0..~e.~ ...... 10. Date of Purchase ........ ~..9..~ .............................. Name of Former Owner .~Z,.e~:~-..~.~'l ~,~r .................. I 1. Zone or use district ~n which premises are situated .......................................................................................... 12 Does proposed construchon violate any zoning law, ordinance or regulation ~TO 13 Wdl lot be regraded ........................... Will excess fdl be removed fr~.~r~er~: JB5) Yes ( ) No ]4 Name of Owner of prem,ses ...'~.~.~.]...~.~.m...~.~...~.~..lp.b...s .......... AddressO.z1.;L~.~.~,..]~r ......... Phone No.~.~...~..'T.~.,~.9..?.... Name of Architect ....................................... Address ................................Phone No ...................... Name of Contractor ................................... Address .......................... ~ .... Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and red,cate oil set-back dimensions from property hnes G,ve street and block number or descppt~on according to deed, and show street n~mes and ind~cme whether interior or corner lot L~ "r ff ~' /c~ / STATE OF NEW ¥-GBI~/J., ,.~.$~ S COUNTY OF .......... '....W~l,.l.l~a~:],..~.~..~.:~]3.13~ ................................... being duly sworn, deposes and says that he is the (Name of mdivdual s~gning contract) above named. He ~s the ........................... ~.~.~ .............................................................................................................. (Contractor, agent, corporate officer, etc ) of sam owner or owners, and ~s duly authorized to perform or have per~ormed the said work and to make and file this application; that all statements contained ~n this appiicahon are true to the best of his knowledge and belief; and tha~ the work w~ll be performed m the manner set, forth m the~hcation filed therewith. Sworn to before me this ~ ( ~ / / ....................... .............. ~ . ~ ~ ~ ~ ' '- ~ ~ (S~gn~u~ of applicant)