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Home My WebLink About9145-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupnncy THIS CERTIFIES that the building located at ...I~/$. l~in. ~e~l .......... Street Map No. ~ .......... Block No. ~ ....... Lot No.. ~ ..... ~.le~.~...~.,.~ .. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~.a~...30.., 19.~.~.. pursuant to which Building Permit No...~.]..1~.. dated ......... 14~1'... 30 .... , 19.77., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .. Pr. iva.t.e, one..family, d~.elling. ~ith..an. a~ditio~ ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~.R.~ ............................. UNDERWRITERS CERTIFICATE No. ~92.~ ..... l~ay..27.. 1977 ............... HOUSE NUMBER ...... .~8.6l+0.. Street. ·. l~in. Ro&d .... 0x, ien~ ................. Building Inspector I~ ' ~ [ III ' THE, NEw YORK BOARD OF FIRE UNDERWRITERS BUREAU Of ELECTRICITY '[' L David Brawner, s/side Main Rd.; W/g orien~ 'Point, Orient, L. tl~efollowlrtg locat~o,~ ' ~ Basement ~ 1st Fl. ~ ~n~ ~t. 0u~ side S~ctlo,~ ~loc~ OUTLETS IECEiT~CLES SWITCHES.., ~, DISH WASHERS EXHAUST FANS '""e°I'~'°reorchard St:'~'°h~°ff.. ,: I . ~ . . . Thi$ct;fkLe Orlent, N. Y. 11957 "Lic.#608E GENE~A[MAN~/G?~..~ ~ must not be altered in any manner;, return to the office of the Board if incarrect, inspectors may be ~de~tlf~e~ by~e[~ c~ede~t~a~s.' ~ TOWN OF SOUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application musl be filled in typewriter OR ink, and submitted in DUPLICATE 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-g form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings end 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 d~/elling or land use $5.00 3. Copy of certificate of occupancy $1.00 O te ......... New Btdlding ................ Addition ~ Old or Pre-existing Building ................ Vacant Land Location Of Property ..... :~ .............................. ~ .... Owner Or Owners Of Property--?...~'..~..-.~...~;...~~..~.J,~. ................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. 2/...~....~.~...~-... Date,/~Of Permit .?.~ff-.~.Z?.~...Applicant .~......~.Z~ ....... Health Dept. Approval ~... .................................Lobar Dept. Approval ................................................ Underwriters Approval /~...~...~,.~.~. ............... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Find Certificate ~ Fee Submitted $ .................................... Construction above on described building and permit meets all opplico, bJe codes and regulations, ........... ..~..~.....,.............................' ~ ~ ' Sworn to before me this ?~2~7 Notary Public ..... ?..'~ ~.~(..~.'i ......... County FLOYD F. KING, JR. Notary pu~Jic State o~ Now York /¥/ No. 52-7267800 Suffolk County Term Expires/~,\arch 30, TOWN Or SOUT.OLD TOWN CLERK'S OFFIC ~proved ................ ~:. ............. , Permit No ..................................... Disapproved o/c APPLICATION FOR BUILDING INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 oJ and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. areas, 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 a Certificate of Occupancy_ ~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a 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 all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inSPections. (Signatd4/e of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~~......~....y~ ....... ~ ~~~ ....................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. ~ Plumber's License No. ~ ~]2- ~ Electrician's License No. ~ /~ Other Trade's License No ............................................... ~ ~ 1. Location of land on which pr posed work will b~e done Map No ' ~ - ~ Lot No z '~ Street and Number ..... ~~.......?.....~.. ......... i ............... '.i.ii:ii:iii:.iiiii~i~......~iiiiiiiiiiii: Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy '/~¢~'~ b. Intended use and occupancy ................. 3~ Notate of work (check which applicable): New Building'. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior. ................... Other Work .................................................. ~' 0~)"O ~- ~ (Description) 4. Estimated Cost ............................................................ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Numbcr 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 ese ............................ 7. Dimepsions of existing structures, if any: Front ........... /. ............... Rear ................................Depth ..,..~.,.?,..~ ....... Height ..... '.~.....~...~. ......... Number of Stories ......... ~ ................................................................................................... Dimensions of same structure with alterations or additions: Front ,~ Depth ~ ~ / Height ...... ~.~....?../. ........... Number of Stories 8. Dimensions of entire new construction: Front ..../.,..~...(...~...~,( ....... ". ....... Rear ....L...L....~... .......... Depth // Height J ~' ! Number of Stories ] .................................................. 9. Size of lot: Front ....'..~...!...~......'?..,,~. ..............................Rear ........~,....O.,..O..,...~. ................................................. ~~.t...~..~ 10. Date of Purchase ........... '..~ .......................................... Name of Former Owner ...~..¢,..~.~...--r.,..~:~...-._:.:,r,~ 11. Zone or use district in which premises are situated ,~' 12 Does proposed construction violate any zoning law, ordinance or regulation: .~..~..~..¢~..~. .......................................... 13, Will lot be regraded ....,'~.~,~ ~ /~ ,-jWill excess fill be removed from.....~..~...~....premjses: ( ) Yes (,~) NL 14. Nome of Owner of premises .~...~..~.?....~..n~.~ ..... Address ...... Phone No.~....~..~ .............. Nome of Architect ..._.... .................... ......... Address ................. ~ .............. Phone No ....................... Name of Contractor ....~.,...~....~...r..:.,~....~z..z.z.., ........ Address ............... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, cind indicate all set-back dimensions from propcrty lines. Gi~e street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ?TA"I"7,' OF NEW YORK., / ,: S COUNTY OF ..,Z. Zz£.,E.~.¢./f ........... f :~'' ...................... i.....?...~..../~,...~'....../~...~.~.'~..¢...~.~'~. .......................... being duly sworn, deposes and s~ys that he is the applicani (Name of in~Jvidual signing contract) above named. Fie is the ...................... ~.~.~4.~ ..................................................................................................................................... (Contractor, agent, corporate officer, etc.) oF said owner or owners, and is duly authorized to perform or have pbrfo~med the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; end tk, a~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ....... ..... ....... ................. FLOYD F. KING, JR, [~ k:' P ' Nola~ Public State of No~ York No, 62-7267800 Suffolk Counly Term Expires March 30, 197~