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Home My WebLink About9654-z1~0~'e~' NO. 4 TOWN OF $OUTHOLD BuTm',I31NG DEPARTMENT Town Clerk% Office Southold, N. Y. Certificate Of Occupancy TH/S CERTIFIES that the buildin~ located at ......... _ ..~../q./f?j., .~.-~..~.A..~ Street Map No .... .~..7-7 .... Block No ........... Lot No ..... ~.~'. ......................... conforms substantially to the Application for Building Permit heretofore fried in this office dated ............~.~_ .T.(...~. ~/., 19.7..~. pursuant to which Building Permit No. ~ ...... g ~'Y'. ?. dated ...........~.~.....-~._., 19.7..~., was issued, and conforms te nll of the require- · merits of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... A .... ~¢~ ~, .%F.~. ?..'!-. ....... .?.u. ! .~. R !.~..~. ................... (owner, of the aforesaid building. Suffolk County Department Of Health Approval ...........' .......................... UNDERWRITERS CERTIFICATE No ............................................. Z~OUSE ZC~BER ....... i.~ ~g. Street ~-r~ Bu.fl. ding Impeeter Tow~O~ 'SOU~HOLD BUILDING DEPARTAREelT TOWN CLERK'S OFFICE SOUTH'OLD, N.' Y. (THIS ..;P~:R~I-5'.~UST.. BE KE'pT ON. THE 'PP, EMISE$ UNT L ~ULL Permission is he{e~y grohted to: c b.r · ~r,~ ~. ~C.~ ~ ..... ~ ~. ..~,~,~-. , ~ ) ..0 . _ ..................................................... ................... :.,...~...... ................. ' ....... ~ ........ L ......... : ..................................................................................... ' · ' · t,~ SP~ ~' ~ ...... ~. -.-~ ............... ;7 ...........:- - -. . [ ' . ' '.' ' ' ~ :~ ?V 19.Z.~ and. approv~ by .the pu~uant tO. application ,dat&d ................................................. ~ ....... , Buildiing Inspecto~ ' FORM NO. S TOWN OF SOUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPBGATION FOR CERTIFICATE OF ~OCCUPANCY A. This apph n be , r OR 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 dispcsal--(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 building, 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April ]957), Non-conforming uses, or buildings and "pre-existing" land uses: i. Accurate survey aT 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 3, Copy of certificate of occupancy $1.00 $5.00 Date ~ 7- ~ / ~ ? ~- New Building ..~....~?.~.~.. ....... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ....~'.././~.../..~.~...~.. ...... /~..~..~'~./~.. ............ /'.~.~.-~.-.~..~../.~..~...~.. ................................................... Owner Or Owners Of Property .,;?.,./.~.~.~'../-J/.~. .......... ~../X'...~..:.~.,../(:..~.~;(.(;~.'.~ .................... .~.; ........... .~ ..................... Subdivision ................................................................ Lot No ............. Block NO ............. House No ............. Permit No......~.~...¢~Date Of Permit .~. ,z~,~ ..~C~ppJicant .................................................................. 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. Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) ~ORM NO, 1 TOWN OF $O~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned .................. .~..~......~.., 19.~.~ Application No...~.?..~...~Z ................ Disapproved a/c ................. ~~,~..~; ..................... (Building 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 iot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drown 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 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 Lows, 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. ........... ................. (Signature of/ap~:fnt, or name, if a corporation) ........ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ~.~ ................................................................................ If applicant is a corporate, signature of duly authorized officer, . ............ Builder's License IXio ............ ~/.../'.. .................................. 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.: u.-rcc~c~....~.,.,.;-~cw.~:~,~. ,t~. Lot No, Street and Number. .......... Munlcipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and eccuponcy ......... '...~..~.~T ........... b. Intended use and occupancy ................................................................................................................................ j/ 3. Nature of work (check which applicable): New Building'. ................. Addition .....~.....'"-- Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... crv (Description) 4. Estimated Cost .........L.¢..?..~...~.~....~. ........................... Fee (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 cars ............... ~ ............................................................................................................ 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 ......~.....f.~. ................ Height ........ /......L~. ........... Number of Stories ...~ .................. 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............ "~..~..~¢... ............................ Rear .......................................... Depth ...... ~..~....~.. ............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ......... ¢~.....%.....-~m....¢&~. ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ....... /..~.¢....U.. ..................................... 13. Will lot be regraded ....~..~ ........... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ,J..d~...,~~ ........ Address . .~..~ ........ Phone No. ~...].~L..~..~.~.~. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..~....~...~....7..~. :¢~'~d. ~ ........ Address ~/'O~,~R~/d-'"/,~,,~/ ...... Phone No. PLOT DIAGRAM L~'~"" P Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street end block number or description according to deed, and show street names and indicate whether interior or corner Io~. STATE OF NEW YORK, ~ c c COUNT'C. OF ................................ ~;"~ , ~"' "'~'--C.~/~.....~..-~'r¢¢~....~/¢~...~ ....................... being duly sworn, deposes and says that he is the applicon, (Name of individual signingna contrcon racf) above named. He is the ............ C....~ ...................................................................: .......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed 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; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .~ ~..-~... day of ..... ~ .............. , 19./~... /¢~) ~---'"%, . -'~' _ Note ......, ..... Coun ............ ~ /~-/'~-2,~ /~ ~ ~:~ignature or appficant) ~ - ROTARY .~UBLIC, State of New Yorl~ . J~esldln~[ In Suffoll( CoUnty No, 52-7155315 ~,ommlssion Expires March $0, IL--~'~