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Home My WebLink About10284-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...Z. 97P& ......... Date ....O.q~ob.e~...~ ................... 19~.9. THIS CERTIFIES that the buBd~g ................................................ ~tion of ~p~y ... ~.9~?~Y. ~. B~ ....................... Ore.~npor. t.. Hou~ No. S~t H~I~ ~ty T~ Map No. ]~ ~ction . .~ ........ Block .... ~ .......... ~t ..... ~7. ......... S .... Cleaves ~o[n~ - ~ec. 1 ....... uom~aon ............................... F~d Map No. ~...Lot No... ~.~. confo~s subst~t~y to ~e AppUcation for B~d~g Pe~it he~tofo~ ~ed ~ ~s offi~ dat~ .... ~. ~.~ ........ ,19 ~ p~nt to w~ch B~ Pe~it No .... ~a~ ........... dated ... ~. ~ ................. 19 ~., w~ i~ued, ~d confo~s to ~ of the r~u~mmts of the app~ble pm~ions of the law. ~e occup~cy for w~ch ~s ce~fficate ~ ~u~ ~ ......... ~ ~ificate m i~ed to ........ ~?Eq .~. ~9~. ................................ of the afores~d b~d~S. Su~o~ County Dep~m~t of He~th App~ ............ ~/~. .......................... ~EEWR~RS CERTIFICA~ NO .................... ~/~. .......................... Building Inspector Rev 4/79 FORI~I NO. ~ TOWN OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10284 Z Permission is hereby gronted to: .................................. ~....~....G.A~:~.~Z ....... / ~ 7 ~o Building Inspector. Fee ............ /~oo - Building 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 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 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 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 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.../.~?/.~./.7 ~.. ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~'~. ~...J~., ~ .~...~..~.~..f...~..~'-.~..~ .... ~~.~ House No. Street Ham/et Owner or Owners of Property ~/~.~..~r.. ~ .~ ................... Countg Tax Map ~o. ~000 Sect[on ............... Block ............... kot .... ~ .......... Subdivision ..................... 7 ........ Map No ....... Lot No ............... Permit NoZ~¢. Date of Permit 7.Applicant ...T .... [ ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Ce[tifical;e ..................... Final Certificate ~ Fee Submitted $.,..~, ~:~ .~. ................ Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 TOWN OF $OUTHOLD ? Z , BU,LO,NG ,EPAR'r,,,,EN (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,2~- 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 of property must be drawn on the diagram which is part of this appli- ~~ cation. 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. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy~ e. 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. (Signature of applicant, or name, if a corporation) : "~. : , ,,,~- . ~/,.. ('"'o ,.~' : , ...~. c "7'~ o..(~,. ~ ,'~ ~; ........ Nmne of owner of premises ...... . ~ . ~ . '. ~. X%. '~, . ¢~: .... t',~&, . . .~.... . ............................ (Name and title of corporate officer) Builder's License No ........... ~..-:.. ........... Electrician's License No. ,~:<,~.; .~ ....4,-~'.,::. ¥:,..(.'/. ,4 i, ~ Other Trade's License No ...................... Location of land on which proposed work will be done .... {~5~ 7.6 ~ ~ ..... ~..~.~ .................... House Number Street Hamtet '>' ..... g.7. County Tax Map No. 1000 Section ~. ~ ............ Block ................ Lot .......... Subdivision ~ ~.~( ~- ~ ~'--C}'/xJ/ Filed Map No. ~ ~.~.~ ¢~ Lot ..... ~ .~.~. ................. (Name) State exist~g use and occupancy of premises and intended use and occupancy of proposed construction: ana o= an y, f .... ............................. b. lntendeduseandoc~upan~y Z~.':..~.: .... ~. .~.-...~I... O'~'j' ................ 3. Nature of work (check which applicable): New Building .......... Addition....14....".~/ . Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ ~, o o ~ (Description) ,,'2 o CO "" ./55 4. Estimated Cost... ~-~.~ ............................... Fee .................................. (to be paid on filing this application) $. 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 natu.re and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front.. ,,~., 5/. :'. ...... Rear . .2, .~.: ...... Depth.. ,,i~: G3. J .~:: · Height ............... Number of Stories .............................................. ~ .......... I)]mens]ons of same structure w~th alterations or additions. Front .,~ .q .............. ea ........... ~ ........ De th ~' ()" HeiSt /~ t_. (~ t Number of Sto~es ~ / } .. 8. D~mens]ons of pnt~re new constmctmn: Front .../.,,~. ~. (e.:.. Rear . .g~., ~..Z... Depth .. ~:~ ........ Height . []..-... ....... Number of 8tones .... (./.) ................................................ raze of lot. Front ... 4 ~ .............. Rear .... //. f .............. Depth .............. 10. I)ate of Purchase ............................. Name of Fo~er Owner ............................. 1 1. 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 ............................ Will excess flu be removed from premises: Yes No 14. N~e of Owner of premises ~&z',"~ ' ".: 2 '~ ~ ~ , v~. ~ , ~- ' ....... 7 ~ ' K:~ ', ~ ~.,~ ~.. Address~,d., Name of Architect ....................... .,... Address ..... ...: ..... ~....',: ', Phone No ................ Nme of ContractorU"/~ ~?/-4/" 'j,: t,,. ~:'.i'c' ,~ .~i:).2eV~v/.. .. Address .,~.~ ~. ,~,~5;oJ.,;:,/., ,,m ~, Phone No..~. PLOT DIAG~M Locate clearly and distinctly 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 NEW YpRK,, . . COUNTY OF. ~;¥:f:.l:;/.?..,. :./:~... a,a ~:--' ~) ,) : :" ," ~ t. J; ,, / ] ~' ~ ~2 being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ......................................................................................... (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. Swo~n to before me this ......... · :.:../..~ ........ day of .... :7' '~' '" ........ Notary Public, . ........... :.. : .:~ .' County 'M I,IR lief, NO'~ARy PUBLIC, Sfafo of New York No, S2-4'522026 - Suffolk Comm[ssion Expires March (Signature of applicant)