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Home My WebLink About9247-zFOII~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, BI. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .lq: Ba~v.:ie? .&..~?.~.o..b.~..L..a. Street confoms substantially to the Application for Building Permit heretofore filed in this office dated .... .Ha..y..~.6, 19.7~. pursuant to which Building Permit No. 92..~?.~.. dated M~.y t6 ............ , 19/.t.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N,R, ................... UNDERWRITERS CERTIFICATE No. N. :.R., ........................................ HOUSE NUMBER ,. 63.6.0 . .N: ~ t.o,, .~.~y.l.e,¥ .............................. 20~0 Jacobs Lane Building Inspeett)r I~ORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby;ra~o: - ~ ~ ~ .-.~ ................... ~ ........ ~ .................... ,.....~, ,o .... ~.....z~.~ ........ ~ ........................ .y.. .............................. at pmm,,e, i~,~ ot ...~..~;~. ..... ~~~ ...... ~~ ................................ ~-~:pursuant to~.~application_._~ . .dated~ ~ ...... ...................... ~ ' I~ ......... . 19 . , end.~.gpproved by the Bui~din~ Inspector. ~, FOltM NO. 6 TOWN OF $OUTHOLD , 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 DUPLICATE to the Building Inspector with the following; for new buildings or new use: ]. 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 dlsposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buddings, Multiple Residences and similar buildings and installations, a certificate of Code compl,once 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 B~ilding ....~ ...... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. · ocation Of Propert ...... .......... ......... O ner Or O ners Of Prope, ....... Subdivision ................................................................ ~"/,,/- Lot No../...~.. ..... BIoc~_/jNoL~ ............ H~ie No...3..4.~..?..~.) Perm,t No ~. ...... ~.....~.... Date Of Perm,t 2/./.:~./..::~.....Appl,cant ......... ~./~.~.~ ....... r~.~.~.~... ................ / . Health Dept. Approval ............................................ Labor Dept. App~3vol ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .....~.......:.~ ................... Construction on above described building and permitFe~ts all app.l, icable ,~6des and regulations. Applicant ................. ~,-.~.~ '~..~. ~ ...~/~LL~,.....~, ......................... Sworn to before me_this .......... ,,~.. day of ~...~..~.~ ....... 'stamp °r se~"c~ ~/.~/~ Notary Public .........~ County / FOR3( NO, ! TOWN OF SOUTHOI.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, ~o~,~ ........... ~....z'.~...., ,~.~..T.. ~pro~ed .................. :~. ......... ./..~....., ,~,7.Z.. ,erm,t No...g.>...~...Z..,...,~... ....... D~sapproved a/c ~ ....... .~......~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No....~...'~...~....~. ................ a. This application must be completely filled in by typewriter 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 adjoining premises or public streets or 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 application may not be commenced before issuance of Building Permit. d. Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant. Such permil 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Buildmng Permit pursuant to thr Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with oll applicable laws, ordinances, building code, housing code, and regulations, and ti admit authorized inspectors on premises and in buildings for necessery inspections. ~ r ... .,,// (Signature of applicant, 6~/'narr~', if a corporation) .. .~...~... _~.. ~Z).~.~?..~.~ .... / (Addre~s~ of applicant) State whether applicant is owner, lessee,~nt, architect, engineer, general contractor, electrician, plumber or builder ............................................................. ~.'..~.<~2~.l .-...ts.. .......................................................................................................... ~o~o~owne~o~e~,~es ........ ...~.~.~.~z...~..~.../).~..~..-.~x~.~..~ &./.~.~. ............ 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 ............................................... Location of land on which proposed work__ will be done. Map,. ,,N-° ~.. ~'.~..~.~... .................. Lot No.~.~...:~...'~ .............. Street and Number .... .~.(fl..-~ ......../~.~....c~.. ..... ..~.~ ...... ~..('~?:...¢.~m.....~......,~... .........,~..~ . ....................... q --~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Exisiting use and occupancy ......... /...~../. .~ .................................................................... b Intended use and occupancy .......... .~. ~v'/~..Z....r~.:~ ........ ~ ................................................. 3 Nature of work (check which opplicobJe). New Building .................. Addlhon ...... ._. .......... AIt~erotion .............. Repair .................. Removal .................. Demoht,or .................. Other Work .-~Y.~...~.'..~../'..~...'... ................ (Description) 4. Estimated Cost ................................. : ........................ Fee .~..~. ................................................................................. (to be paid on filing this applicahon) 5 If dwelhng, number of dwelling umts ...........................Number of dwelling units 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 Dimensions of ex~stmg structures, If any' Front .........................Rear ................................ Depth ................... Height ........................ Number of Stories ............................................................................................................ Dimensions of some structure with alterations or addmons. Front .................................... Rear ........................ Depth ............................... Height .......................... Number of Storms ............................... 8 D~menstons of ent, re new construction' Front ................................... Rear ............................ Depth .................... Height .................. Number of Stones .......................................................................................................... 9 S~ze of lot Front .......................................................//~,//'~7'-2 Rear ................................. ,~../~./~.z~;_~?:'"~ .... Depth ........ .¢....f...; ............ 10 Date of Purchase .... ~.:l ~.x'..~. ......................... Name of Former Owner ~.ff~.~.~r~....~-r...~...-~<~.~...c.P .......... 1 1. Zone or use distnct in which premises are s~tuated ............................................................................................. 12 Does proposed construct~n./v~v~iolate any zoning law, ord,nanee or regulation' .../~J~.. ............................................. 14. f emio~o ...~,.~?...,¢....--..-~.-~.~.,,.~.;....- ,~m,~e,~-,.,~.~.~, ~..~.. ~:~. r.one N . . Name of Architect .................................................... Address ................................ Phone No ...................... Name of Cantractor ...................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fron property lines G~ve street and block number or description according to deed, and show street names and indicat: whether interior ar corner lot STATE OF NEW ~0R-JG ,-~ ["'S COUNTY OF .... .CZ..'~,~ ~. ~.'./..t ......... ~ .......................... .L...~..~.:~.f~~~ ............... being duly sworn, deposes and soys tho, he is the applicon, (Name,df mdiwdual s~gning contract~ above named ~' He is the ................. ~.~t.2.~..c.'....~. .............................................................................................................................. (Contractor, agent, corporate officer, etc ) of so~d owner or owners, and is duly authorized to perform or have performed the sa,d work and to make and this application; that all statements contained m this applicot,on are true to the best of h~s knowledge and behef; one that the work will be performed in the manner set forth m the apphcation filed therewith Sworn to before me th,s ,/~ .......... /..~,.A..?.~. day off..~,~.~..T.~-. ................ 19.~.~. , / ~ .... · .............. .................... Nato. .... ........................ Coun .... ~ARY E. DAW~N N~ PUBLIC, Sta~ d New York No, 52.46~372L Suffolk ~u~ Term ~pi~s March 30, 19 ~