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Home My WebLink About9499-zTOWN OF SOUTHOLD BUU.nlNG DEPARTMENT Town Clerk', Of[ice Southold, lq. Y. Certificate Of Occupancy THIS ~RTIFJ,I~S that the building located at.~..~./~ Street No..'.. conforms substantially to the Application for Building Permit heretofore filed in thi~ office dated .......~.../~ .~..., 19.?..7 pursuant to which Bui]dlng Permit No. ?f.f~. ~' dated ~ / -~ 19 .?., was issued, and conforms to all Of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ued ,-, ...........................~ ..... ~ ........ , ........................ The certificate is issued to. ~.. r.: ............................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval /(j ' ~'- UNDERWRITERS CERTIFICATE No ............ , ........... ~ ........~ ...... ~.../~ HOUSE NUMBER / '~/~ ~~ ~'"' ~ iff/ .............. Street...~..,.~ .............................. TOWN OF BUILDING TOWN CL~RK'S Om~E SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9 99 Z Date ............. . ............. {).C~ .......... .13 ........ , 19..~.~.. Permission is hereby granted to: ............ ~o~t,~a ]..c~, ................................................ to ,..~?~ .~,q .. ~,~,~.:.,~'.z.: ~...v. tL.~.9.,...(, .e:.e...c.'.e. ,~ .~.~::~Z .)....~,~:~'.~Z?.'. .................................................................. at premises located at J,~f;...[.~:i.......~.bt).¥....'LS.~t:~t;~ ......................................................................... ......................................... I~'.~...ClzL~.~;~z'...~:z:i~,~: ............ ~ox~;Y~3.~ ............................................... pursuant to application dated ......................... L:r.d;.....J.~ ......... [...., 19.,?.~..., and approved by the Building Inspector. Fee $...,I.0.,.O.Q ........ ,'" [: ' '~; ~)~, Buliding;j~SPeCtor ........... FOItM NO. 6 TOWN OF SOUTHOLD Building Delm~tment Town C~ei'ks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructlons 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 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. Dote 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 ~and use $5.00 3. Copy of certificate of occupancy $1.00 Do,e .... New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ...~..~.../..~.~.~..~/.c.~......d,~./.~..,: ....... .~. ...... .%~....~?..',~(,./...~.Z'.~.~, ..~.~.....~...~. ................... / Owner Or Owners Of Property .....~..~:(?.,.'.~/....~./.~......~...~..~..!Z~./......! .................................................. Subdivision/~/.~./.(~.~.0../.~ .~.~'/".-.~..~g,.7~....q.,~Z'~.~,../.... Lot---' --' No....~...~..-- Block No ............. House No../...z~.~.~.~ Permit No..~...~...~'.~/.~. ~. Date Of Permit ../~..~./.~}dZ~ZApplicont .~.4-~.~......~..~...~...;/~..4~,'~,~,/. ............... Health Dept. Approval ...... ~..........- ~. .......................... Labor Dept. Approval .... ~ ...... Underwriters Approval .............................................. Planning Board Approval ..................................... Request For Tempora~ Certificate ........................................ Final Certificate .......................................... Fee Submitted $ Construction on above described building and per, it meets o~L applicable codes and regulations. ~_/ // // Applicont .. ~..~. ~! ~/~....~d]. .................................. ~'"'~'"'"Z"~;Z '~ .......... Sworn/~,?to before me~ ,-/~r ~7~'~t'~s ......... ,...'~.. day of ...,,..,.ft..{.;..:;........,.... ............ (stamp or~se~al]f Notary Public ....... ;.-\.'~4Y-'7..*~ ........... County TO~VN OF $OUTHOLD " , "'' BUILDING DEPARTMENT ........................................ , .................................... ~s~pproved ~/c ...................... ~ ....... ~ .......................... .~ ......... ........................... ................................. APPLICATION FO~ BUILDING FERMIT INSTRU~IONS a. This application must be completely filled in by typewrite~ 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 od oining premises or public streets areas, and g v ng 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 part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to_ admit authorized inspectors on premises and in buildings for necessary inspections.~,~ (Signature of applicant, or name, if a corporation) Southold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. builder Frank Basanta Name of owner of premises .................................................................................................................................................... If applicant 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 Trade's License No ............................................... '4~ ~ f~ D~,- -~;(z ( Location of land on which proposed work will be done. Mop No.: Harbor Lights Lot No. ¥1 Street and Number ...... g.,~,,JrJD. D,e,,,~,..,,D,?,.~,e.. .............. ~.?,¥,.,~,.~...o.?;~. ........................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ...... ¢,.~.~,~.~,;[xq§ ....................................................................................................... b. intended use and occupancy ............. .s...~..~..~...!~J:.~?.t....d-...e.~..a:.o.~.e. ct....t~..e:?...a..g.~ ....................................................... 3. Nature of work (check which applicable): NewBuikJing' ....~.~. ....... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition...- .................. Other Work ................................................. (Description) 4. Fstimated Cost ................ .~..~.~.....~.~.8...0..0. .................... Fee ...~..0..,.~.0. ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..,...o..~..e. ................. 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 ....... ,~2 ........................ ReQr ..... 3~2 .................. Depth ....... 2~ ............ Height .................... Number of Stories ozte .......................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..!!.A.~!...c~zLs.~. ............................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. Jkq ...................................... 13. Will lot be regraded . ......... ~'.~ ........... Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name af Owner of premises .................................................... Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ..~...e..o.....~.~.a:..s...~..e..~.~ ........................... Address Bo~l. thold 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~,~, I¢S COLJNTY OF .... ~..~.f..~..~ ff..~. ........... ...................... .~..e...o.....~.~..~.s.~..e..~.~.~.. .......................................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named· B~ll~e~ 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 ail statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ~day of 19..~.~.. .................... ................ ..................... , , Nota~ blic, . .................... ~.~.~ g.~ ............. Coun~ .... ~.. ,cggT~ ............................. NOIARY Pp~IC, State of New ~o~ No. 52.4~4372J, S~[tol~ Tmm ~pires March ~, 19~