The URL can be used to link to this page

Home My WebLink About9234-z· OR3~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, ~. Y. Certificnte Of Occupnncy No. ZT~ ...... Date ......... ~ ..... .~g..., 19 THIS CERTIFIES that the building located at . ~.1~..R~.~.~I. .......... Street Map No. X~ ......... Block No..:g~ ...... Lot No.. ~ ..... C~t~hog~.. ~.,~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~pl* .~., 19.7.7. pursuant to which Building Permit No. dated ......... l~a~.... 6 ..... , 19..7~, was issued, and confo~ms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . F~V&~e. ~i~g .poo3..w~.th. t'en¢~. &. a~.~e~sCX~rz ................. The certificate is issued to . ~.. ~O..~.~l~ ..... .O~71.~.x*. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval l~I~, .................. UNDERWRITERS CERTIFICATE No.. ~9.... ~r. 20... ~ 9.7.7. ............... HOUSE NUMBER .... 800 .... Street ...~thol~.so~ ~cl ...... ~;uho~e ......... Building Inspector · 0~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT '¥ CT'HIS PERMIT,,,~%UST BE KEPT ON THE PREMISES UNTIL FULL - COMPLETION ~ THE WORK AUTHORIZED) ~,;>~ , ~,~, ,, ?~--.- ...... ~-.-xt~--.:.-..: ................................................................................................................ Oremi~es located Ot ,.,,..lJjjl~jJ--~-.~ ........................................................................... ~.?:.,:.,~ ............ ,: ........... ~~,..~I,..~., ............................................................................. to,. c~pplic~atibn- dated -.-JJl~"~' ..................... : ....... : ........ , 19.,.., and appro~ved by the FORM NO. 6 TOWN OF SOUTNOLD , Bailding Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled m typewriter OR ink, and submitted in DUPLICATE to the Budding Inspector with the following; for new buildings or new use 1 Final survey of property with accurate location of all buddings, property lines, streets, one unusual natural or topographic features 2 Final approval of Health Dept of water supply and sewerage d~sposal--(S-9 from or equal) 3. Approval of electrical installation fram Beard ~,f F~re Underwnters 4 Commercial buildings, Industrial buddings, Mulhple Residences and s~mdor buddings and ~nstollat~ons, a cerhficote of Code cornphonc~ f'orn the Archnect or Engineer ~espon~ble for the building 5. Submit Planmng Board approval of tempi, ~ed ~,te .qa~' ,eqb~rements where ~pphcoble For ex~stmg buddings (prior ~o April 1957~, N~' ~r'~r,,- -.. ,,s~, or hu~ld~ng~ and "preexisting" land uses or topographic features 3 Dote of any h~.N,r~g formahon required to C Fees I Ceruficot~ of .ccug~.,~ ~ ~S0O New BHddm Addmon Locat,on Of Propeqy Owner Or*nets Of Properly ,'4 r'gs a, [;rem~se~, cr other Health Dept Approval ... Underwriters Approval . ~"~~~.' Request For TempO~ry Certificate ............ ....... / Construction on above des.cribedrbuilding and prr Applicant .......... ~ Sworn to before me/~is ........ ....... Notary Public ..~f~ .... Founty tnb-r DeFt Approval Phmntng ~ourd Approval ,/~.. F,nal Cert,f,cate ~--.~**'~. ..... . ..... '- -~'i~ the ollo vin~ l~a~io~ RXTURE, TIMECtOCKS~ : MU LT[-;OI.~Tt I~ : ' SYSTEMS:." NO. Ol~ FEET ~ ~ SERVICE.D S~ONNECT<- '~ ~ fic co,m '~a~e - Examined Approved TOWN OF SOU?HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. o4_ C.o. I Permit NO..~,....~..,.,,~,~,..~.,,.,~, ......... Disapproved a/c ................. ~....'.= ........................................................... Application No. ~.~....'~,...~.. ............... (Bui-ldi~g Inspector) APPLICATION FOR BUILDING PERMIT iNSTRUCTIONS a. This application must be completely filled tn by typewriter ov in ink and submitted in triplicate to the Buildin~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plat plan showing Iocahon of lot and of buildings on premises, relationship to adjoining premises or public streets al 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 apphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Build,ng Permit to the applicant. Such permi~ shall be kept on the premmes available for 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY M~DE to the Budding Department for the issuance of a Building Permit pursuant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New ~Y. er~and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterations, 9~Xfor re/naval or d~nolitjon, as herein described The applicant agrees to comply with all applicable laws, ordinances, I~dilding ~de, housir)~'cod~, and regulations, and t, adm,t authorized inspectors on premises and ir~ buildings for n~ces~ry in~/~tions.,~//' ,~/////~ f~/' ~/ ~I ,~ ......... ..................... (Signature of applicant, orname, ifa-"'~rporatio~i (Address of applicant) State whether applicant is owner, lessee, agent, architect, engin electrician, plumber or builder Builder's License No ........... .'~....~.. ............................. Plumber's License No. Electrician's License Other Trade's License No ............................................... Location of land on wh,ch proposed work will be done. Map No. .... ~ ...i..~ ..~.... ............... Lot No......'~. Street and Numb.~~~C?~..~...~..¥.~. ..... ~L~c{'. ...........'" ~"'~' '~~~'""P'~ ................................Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction' o Exisiting use and occupancy ....... ~....'~ ,~:., .'.. ~..,4:;~...C,_.c~ ................................................................... b Intended use and occupancy .......... .~,,,~.....~.../~73~ ........................................................... /b/ J Iqcture of work (check which applicable). New Bu,ldmg ......... Add,t,on /...f'¢. ~...""'i'. AIterat,an Repair ................ ~ej~val ............. .... Demohtlor ........... Other Work ........................... ~.~.(.,.,.._. ~ ~ ...... (Description) 4 Est,mated Cost ~.~ ...... -..~...'.'3 ................Fee .... /..% ........... (to be pa:d on filing th:s apphcat~on) 5 If dwelhng, number of dwelhng units .......... ./(.. ......Numbcr of dwelhng units on each floor .. ..~: ::;.,, ,:;... If garage, number of cars .......... / .................................................................................................... 6 If business, commercial or mixed occupancy, specify nature end extent of each type of use ............... 7 D:mers~ons of exist:rig structures, If any: Front ............... ~.-~: .... Rear ....... ;;:C.':Z ................. Depth ...--'.. .............. Height ....................... Number of Star:es .......... .'~ ........................................................................................ D:mens:ons of same structure with alterahons or addihons Front .................................. Rear ................... Depth .............................. Height .......................... Number of Stor~es ........................... 8 D:rnens:ons of enhre new construchon' Front ..... ' .~. (F..¢.:./. ........... Rear ...........................Depth .............. HeiGht ............... Number of Stones .................................................................. 9 S,ze of lot Front ..... /.. ~....O ........ Rear ../'~......~. ......... Depth ../..~. 10 Date of Purchase ...... ¢'.(./.~/~..~.....~ .................... Name of Former Owner ...................................................... or use district in which premises are situated ..... ~c;;;;;;...;=- ...... C~.I~. ..... ~ ........................................ I Zone 12 Does proposed construchon v,olate any zen,rig law, ordinance or regulation ........ /flt..~.....~ 13 Wdl lot be regraded .../.J,~)..O/ ............. Wi Il excess~ fill be removed from premises: ( ) Yes~(k~) No 14 I',~ome of Owner of premises ...(~_.:,z~ ....... ..~.~....~.~.1.~...~/.C ..... Address ................................Phone No ....................... Name of Architect ...... ~ .............................. r.. Address ................................Phone No ....................... h:,-m,m- of Contractor .. '¢ ..... i' .,¢ ...... Address ..:~(.~.f... Phone N PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether exmtlng or proposed, and Indicate all set-back d~mens~ons from prop;rt~ hnes G~e street and block number or descriphon according to deed, and show street names and indicate whether rater,or or co~ner lot ~T~\ [ E OF NEW ~),qi~/. ~ ~ S S CGUN'FY O~....f ' .............................................................................. being duly sworn, deposes and soys that he is the appllcanl (Name of mdwldual s~gnmg contract) above named Fie ~s the ................................. ~.....~...) ............................................................................................... agent, corporate off,cer,~ of so~d owner or owners, and ~s duly au~nzed to perform or have per~rmed /he said~ork and to make end thru apphcahon, that ah stctements contained m thts apphcchon are ~.to t~ best afros know~dge and behef, tha~ the work wdl be performed m the manner set fo~h m the apphcat~n fde~erew~th/ ~ ~ Sworn to bef~e me th~s / / /~ ~ / // .. ....... , ,zz / /%i/// / / ........... ........ / ........... .... JUDITH T. TERRY ~ ~ign~ture of applic~t) ~O~ PubJlc, ~8[e of New York No 52-0344963 Suffolk Cou~ _! Z l-4. S4 ° 5~' ZO" ~. - 1'70.0 PP. QPEP. TY STACK