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Home My WebLink About10071-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy .3~68 No.z.! ............. Date . .I~ c.~.IrlbolL .1.4 ,..1.R8/~ .......... , 19... THIS CERTIFIES that the building... ~.~o. ~n. g~r.~go..kn, r~.R~, y~.~, ........... ~tionof~pe~y ~.~5 Q~.k~N~ ~y~ ~9P~9~ - ~ou~ ~o. St~t H~let County T~ Map No. l~0 ~ction . 70 ...Block 3 .~t 3 Subdi~on ............................... F~ed Map No ......... ~t No .............. confo~s substant~y to the Application for Building Pe~it heretofore ~ded ~ ~s offi~ dated December 7 197~ pursuanttow~chB~ld~gPe~it No. 10071Z dat~ .... ~e.c.~mbe~.. 13 ........... 197~., was issued, and confo~s to a~ of the req~rements of the app~cable pm~Jons of the law. ~e occupancy for w~ch t~s ce~ificate is i~ued ~ ......... ...~p..~C.~.~n rear yard rep[ac~n old s~ora e bu~[d~ ~ ............................. ~ ......... ~ .......... ~..... ~ece~Jfi~te~uedto ...~..~:.~.~.~.~.G, Hered~h '' ~ ro~, a~g~b~'g ~ ................ of the afore~id bu~d~g. Suffolk County Dep~ment of ~ealth Approv~ ............ ~/.~ ...................... ~ERWR[TERS CERTIFICATE NO .............. ....# ~ 4 3 7 ~ 7.q .................... Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPAR?MENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLET[ON OF THE WORK AUTHOR[ZED) N°. 10071 Z Do'~e ..... .c~...., ~9..7.~ Permission is hereby granted to: .............. ~ .,,,-z4~..- ~..?,.-~4. ............ ,o ...... .,cr.~-,~,....~...;,~, z,. ... 'cxx~ . .....~, ~.. ... ~-~.~ ..x.~,.~.x.~... .. ~~ ... ~~;.x,,~,~. . x. . .~4r. . .,f,4,,~. . . .., ~~,~, ~. .... .................................................................................................................. pursuant to ~pplicotion doted .......... , , ond opproved by the Buildin~ Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 featu res. 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 installa- tions, 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 informa- tion 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 Date . ./?../~..~.: .'/.~. ?.~'. .......... New Building ~.~ .~.¢~./.gz¢. Old ~g Buildingf'~4.,f¢~ .... Vacant Land ............. Location of Property ./~,~..~... Z~ ~.ff'J~l~-Fz¥.~}'~*.E ......... ,~?..:~,~.z~/~.'. ................... House No. Street Hamlet Owner or Owners of Property . ~, ~./.[..~,..,~.'Z./~.~4t~'/c'~:~., ~/~, ~.~..~'~.~/~.~.~ ................ County Tax Map No. 1000 Section ..... ~../-) ....... Block .... .~. ......... Lot...~.'~. ........... Subdivision ................................. Map No ............... Lot No ............... Permit No. /.~(2.-~./... Date of Permit £,,z~.~f~ ./ f~.~. .Applicant . ~/,y/'¢. x~.?~?.~.~.',{' ................ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval/~.~./.~/V~¥./.~. ?~. ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submittad ~. ........................ Construction on above described building and permit meets all applicable codes and regulations. Applicant .... ~. 4~t/': ~/"~ ........................... FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Disapproved a/c .................... ~ ....................... ~, ................... : ................. (Buil6ing Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 of areas, and giving a detailed description of layout of property 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 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 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. ........ i~'i~g~'~'~"~f applicant, '~r ~'me, if a c~;~ra~i~;~'f ........ State whether applicant is,owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... .... . ................. ................................... I ................................................................................. (Name and title of corporate officer) '2 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 No.: ........................................Lot No ......................... Street and Number ...~.~.~./~.~...~,,..~.~..~.~.,.~.lg.~..~..~,~,.(.,~.., .......................................................................... ./j {~'~-- --. Municipality State existing use and occupancy of premises and in,'ended use and occupancy of proposed construction: a. E× s t ng and occupancy ........................................ b. Intended use and occupancy . .~...~....Q../~-..-- ~.. ~ .... :- 3. Nature of work (check which applicable): New Building ...~ .......... Addition Alteration ................ Repair .................. Removal ..~ .............Demolition .................... Other Work ..................................................... (Description) ~ ; r,,~, .... 4. Estimated Cost . .,~.~.~.f,.~..Z .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ./. ................. Number of dwelling units bn each floor ............................ If garage, number of c~rs ........ ~ ................................................................................................................................. 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 ........ ~.~,..'. .................... Rear ..... ,~..2..: ............... Depth Height ...:Zl././. ......... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............... ~.~.,:.,z~..: ............................. Rear ......... ./.~,,' ...................... Depth ...J,..~.'~.,~ ................. 10.' Date of Purchase ......... ~ .............................................. ~,,'. i- ' , ~l'~rne of ,Former Owner ........................................................ 11. Zone or use district in which premises are situated ...~.~b.: .~..,~d~ ............................................................ 12. Does proposed construction violate any zoning law, ordinanceZ or regulation: .~ ............................................ ~3. Will lot be regroded ........ ,/./.:.;,. .......... Will excess fill be removed from premises: ('~) Yes ( ) No 14. Name of Owner oF premises ./,.././~:./../'4.'JXKz../..//.'.~ .................. Name of Architect .............................................................. ftaoress ................................ ~'none Name of Contractor ......... ~'~.~,~.x~.~..~ .................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly end distlnctly 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 NE~Y~, coub r¥ OF .... ;~.Z,;....~~~...: ........ : ....... ...... being d~ly sworn, de~ses and s6ys tho~' he is the oppHcam ~] (Name of individual signing contract) above~amed. He is the .......~.~~) ........................... : .................................................................................................................. (Contractor¢ agent, corporate officer,, etc.) of said owner or owners, and is duly authorized to perform or have performed the s~id 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; and thor the work will be perfo~ed in the manner set foffh in the application filed therewith. Sworn to--re me this ,. o, ............ , o/ ocr~. , ! i' old ShipTa~'d La,. ~Th~s cerfifkote,m~sf no/ be a~y