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Home My WebLink About9241-zFOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . .0slprey Nes~:. Road ...... Street Map No. ~leo,v.e$. P.~ Block No ......... Lot No. 12 ... Gl'.~onpo~; ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... l~y 1.1 · , 19.~v]. pursuant to which Building Permit No. 921+1~-. . dated .... l~.a.~r...11 .. , 19~.7..., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is.. p~'tvat~ .aoe~sgor~. ~torag, l~u~tldi~ ....................... The certificate is issued to Xsaa~ I~l*oaJ. ...... 0m~l' ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I~,R.. ..................... UNDERWRITERS CERTIFICATE No..N; .R: ..................................... HOUSE NUMBER . ~+~ ..... Street .. Ot~lll~o~r. ~e$~;. tload ..... I~l'.eenlm~t .... I~OR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE $OUTHOLD, N. Y. BUILDING PER~IT N°. (-rHiS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9 ~ Z] ~[ Z Date ............................. ~ ..........~.~! ..... , 19..~.~.. Permission is hereby granted to: r,e_~t~..~.~.~.....~...~.~e....Z..~.e.~.~ .............. ............ ~.~.~....i ........................................... Building Inspector. F~e $..~.0..;(~. .......... Qt premises located at ........................................... ~z~;~..~e~---:~- ......... ~ee~t ............................................. pursuant to apphcat,on dated ........................... ~.~..: .............. , lcd. .., and ap~rove~d by the FOnM NO. 6 TOWN OF SOUTHOLD ~ Building Depmtment Town Clerks Office Southoid, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY hutructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the fallowing; 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 disposals(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 buildmg. 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 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 /~ \ ..... }2 .... New B~ilding ~" Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locot,on of prope .... ............................ Owner Or Owners Of Property ............. ..~...~. ................ ~....-~..~... ............................................................... Subdivision ...~..'./..~...~...L/.~;.?. ...... ~/...~.~. ............ Lot No. ~..~.. .... Block. No ............. House ~No~ .......... Permit No...~..o~...~..J'...~... Date Of Permit ...~/~/~/~.,./~pplicant .../~.. ..... ...~...~....~,...,,~..,.i~..,~.... .......... Health Dept. Approval .....~...~..~. .............................. Labor Dept. Approval ....... ..~..../...~.. ............................ Underwriters Approval .............................................. Planning Board Approval .,.,............. ....................... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..~.. ........................... Sworn to before me t~... .......... Construction on above described building and perm~ meets all ap. plic. able c~odes aod r. qgp~tions. .... Applicant ......... ~ ................................................................. (stamp or seal) Examined ........................ j. ...... , ....... , ... Approved ................... ~..~ ......... ½.~ ....... , 19..?j. FOILM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI. Y. Permit No...~....~....~..../..,~ ..... Application No. ?...~..~../../. .............. D~sopproved o/c ............................................................................................ u (Building-Inspector) / APPLICATION FOR BUILDING PERMIT Date .... Z~..,4_~ .......... .L!. ............... ~9...7...;. INSTRUCTIONS o. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Buildi, 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 premtses, relationshtp to adjoining premises or pubhc streets areas, and giving o detailed descriphon of layout ofproperty must be drawn on the diagram which is part of this applicotic c. The work covered by this application may not be commenced before msuance of Building Permit. d. Upon approval of this application, the Building Inspector w~lJ msue a Building Permit to the opphcant. Such porn 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 a Certificate of Occupan shall have been granted by the Building inspector. APPLICATION IS HEREBY /vLADE to the Building Deportment for the issuance of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances Regulations, for the construction of buildings, additions or olterohons, or for removal or demolition, os herein describe The apphcant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulations, and admit ~uthorlzod inspectom on premises ond in buildings ~or n~esse~ i~ections. ..... ' (Signature of app~[~"~r na~'e~ if ~"~r~';~;~'~ ..... ................................ ('~;;;;' ;F ;~i~;;~ ............................ State whether applicon;~ is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or burld.' .......................................................... ............................................. Name of owner of premises .............. /~...~'..~..~. ...... 2~.....J?...~...~?..~.. ..................................................................................... 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 ............................................. at he r T rade,s License N o ~..~/~12.C///~..,~ ..~;~...1~ ¢..4~?' ~ ,~.. ~?/?~. ~-' ~ ~~ ~ ~R~ ....... ~ ........................ M~ No ~'~ ~';~ o~ ~ 1. Location of land on which proposed work will be done. p : .................... ; .............. L, No ...... ~..., ......... Street and Number ..... ~~...,.~...~r. ....................... z~..~.~.~ ..... ~4~.~(.~.~).;/..~L~:. ........ ~ ~/~ ~ Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of ~roposed construction: a. Exisiting use and ~cupancy ................................... ~..~ .............................................................................. b. Intended use and ~cupancy .............. ~.~. I ....................... : .................................................................... property hnes whether mter~or or corner lot 3. Nature of work (check which applicable) New Buifdmg ................ Addition .................. Alteration ............... Repa,r ................ P,e mayo I ~/...4...~. ~..~...~'. ~'~emoh t,or. ................Other Work ................................................. (Description) 4. Estimated Cost ................... .~/...~....~...~)...*...]..'~.. .............. Fee /~ (to be paid on filing this application) 5. If dwelhng, number of dwelhng umts ............ ./. ........... Number of dwelling umts 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~mens~ons of ex~stmg structures, if any Front ........................... Rear ................................Depth .................... Height ....................... Number of Stones .............................................................................................................. D~mens~ons of same structure with alterahons or addmons. Front .................................... Rear ........................ Depth .......................... Height ...................... Number of Stories .............................. 8 Dimensions of entire new construction' Front .......... .-/..~.. .................. Rear ........./..~ ............. Depth ....?. .............. Height ..... .~ .......... Number of Stones ............ ./. ............................................................................... ~ ............... 9 S,ze of lot Front ............... ..~...~. ......................Rear ....... /...~...~ .......................... Depth ...... ?..?..?. ............... ld. Date of Purchase ....................................................... Name of Former Owner 11. Zone or use distr~ct in which premises are s~tuated ..................... :~'~.: ............................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation: .................................................. 13. W~ll lot be regraded ........................... Wdl excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of prem,ses ...~...~..~. ...... /~...~...~...~...~ .............. Address ~.".,..~.~I~Z...~.~., .~1.:..~..' Phone No.~...7.~..Z..~..~..:~..f Name of Architect ............................................ Address ................................Phone No ..................... Nome of Contractor .. ~..../'1 ..~.....e. ~.~ .).~ .................. Address ..... .?..~.~.~..~.~..~.,~..~..;.~.' Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex[sting or proposed, and red,cate all set-back dimensions fror G~ve street and block number~or description according to deed, and street names and indicat STATE OF NEW Y'ORI~.. -- ~ S $ COUNTY OF ..~.~i~..~.'.0.~.. ........ f __ ........... zx~z.~ ..... .e.~..~.~.c~. ................... ~,.~ ~.,~ ~.. ~ ~.~ ~ ~ ~ ,~ ~ ~,,~. (Name of individual s~Dmng contract) above named ] He ,s 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 ~ke and this apphcatian; that all statements contained m this apphcat~on are true to the best of his knowledge and belief; an ~~etpemer,s ~/~Cr~rwiHb~h~erfO'~ the manner set fasb in the apphcation~ filed therewith. ......... .... ............... , / /' / . , . .: : : ................. ............ No, 52-4643721, Suffot~