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Home My WebLink About9855-zFORM NO. & ?OWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold~ N. Y. Certificate Of Occupancy No .... 3.368. Date .... D.ec ember . THIS CERTIFIES that the building located at .10, ~.00. So.und..V. ie~. Av.e.. Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... Jun~ ... ~) ....... , 19.7~ pursuant to which Build~g ~e~it No ...... 9S~SZ dated .... a%.~.y... ~.~ ........ , 19...78was issued, ~d co~orms to ~ of the req~ ments of the applicable provisions of the law. The occup~cy for wMch this ce~ificate is The certificate is issued to ............. ~...~n~ ............................... (owner, of the aforesaid building. S~olk County Department of Health Approval .............. ~ .................. UNDERWRITERS CERTIFICA~ No ............................................. HOUSE NUMBER ... ~.~.~0~ .... Street ........... o~.~%d. ~ie~~./~e .............. B~lding Inspector County T~x Number TOWN OF SOUTHOLD BUILDING DEpARTMmT TOWN CLERK'S OFFICE $OUTHOLD, N~ ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMiSE~ UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9855 Z Permission is hereby grantbd to: .......... ~,~...&.~..~.e~. ........... FORM NO. 6 TOWN OF $OUTHOLD 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- tot 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-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 p~an requirements where applicable. For existing buildings (prior to Aprit 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. Fees: 1. Certificate of occupancy $5~00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...~.LC..~....Z./z ./. ~¢.~..~ ........ New Building .... ~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ,5 ~c,;~,'/) ~O&-~ /1~- ~" /J/.d..~:.o..~.y'.../~..~.~.b. .................. House No. Street Hamlet Owner or Owners of Property . //.~,~,~,qyz...~.. ,~.~..~./.~'.D..~.~=..~x....~..,~,.~..~.~/.~.~-.~. .................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Map No ............... Lot No ............... Permit No....~..~.~5.- .~, Date of Permit . .~././.2://?.~.Applicant . . ,o.~'. ~.z5 ./~. ....................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Applicant .... ~..~ .............................. R.v, ,0-, 0-7e TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 ThisisIto advise you that the job under Building Permit No. ~-'~ issued to \1 o_~t/~/ on '7]~11.;R----~--CJ~C~o~:~ '-'~jdq- Ois completed and a fi'hal' inspection h'a~ has n~ been done. In order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form(s), return same to the above office with a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date. Thank you for your prompt attention. Very truly yours, Victor gessard Administrator VL:ec Enclosures FOB,B~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved July 21 19...7...8.. Permit No. 9855Z D~sapproved a/c ............... ~'~. ......................... (Building Inspector) 9855 Applicatien No ................................. APPLICATION FOR BUILDING PERMIT I NSTP, UCTIONS 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 oF 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 this application, the Buildirig 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 jr~ buildings for necessary inspections. (Signature of applicant, or name, if o corporation) / ................................ ........................... Name of owner of premises .~/../f....~..~..~.~.~..~.~.././.'~.~:~z.~.Z..~..~..~..../~?..~.?..~.~...q~.~ ................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License Na .......... .~.~.d.~ ............................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Mop No.:'. ....................................... Lot No ......................... Street and Number-~'~.U..x/~9.W. rZ~.~.u..ff..~[,..///~'.~..q.~../.-.....,L.~.2.~.~ ................... :~.~.~.f~.~.....~..'.~..~ .................................. MuniCipality 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 .......... ?..~..~.'.(.~.Z~:......~./../.~]~.....~?...,,~...~..~..~.~_~..~....?.~..~.~ ......................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... ,~ ~;~9 q~O (Description) ~ F~stimated Cost ............................................................ Fee /0 (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of ~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 Stor~es ................................ 8. Dimensions of entire new construction: Front ~ Rear ~ Depth ....... Height ........... ~.~.~ Number of Stories ...................................................................................................................... 9. Size of lot: Front ..................... (.Z~ ............................. Rear ...... (}.? ............................... Depth ..15.~ ........................ 10. Date of Purchase ............. ¢~.~(~.~ ......L~.~ ............ Name of Former Owner ~:¢.~,?N....~.~ ........................... i 1. Zone or use district in which premises are situated .................... ,¢~f4¢~;~FZ,.~ ........................................................ 12, Does proposed construction violate any zoning law, ordinance or regulation: ...... ~¢. ........................................... 13. Will lot be regraded . ........... ~.2. .......... Will excess fill be removed from premises: ( ) Yes (~) No Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. , ~ ~ ~ STATE OF NEW~O~ a~ ['S ~ ~ ~ COUNTY OF ...~.~...,.. f ~'' ~--~ ~-' /~. ~ '' /(Name of individual signing contracf) above named. He is the ............. ~,...~; ................................ ~ ................................................................................... (Contractor, agent, corporate~.) of said owner or owners, and is duly authorized to perform or have performed the sqid 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 that the work will be performed in the manner set fo~h in the application filed therewith. Sworn t~~this ~