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Home My WebLink About10796-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..Z..1.0.0.6.6. ......... Date .... ~..~..y. ?.6: .................. ,198..0. THIS CERTIFIES that the building ................................................ L ..... Off Montau~ Ave. Fisher Island ocauon m ~'roper~y hJJsJ ~/oi ...................... '$'JeJi ....................... h3~ie~ County Tax Map No. 1000 Section ...~.0. ....... Block .... .7. ......... Lot..6. .............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. ?.~..g~..~.~.. 9. ? ........ , 197..8.. pursuant to which Building Permit No.. ~9.7.96. ~ ............. dated ....~i .u~...y. .~.~. ~. ............... 19~.q., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... °.99..f~.~y.. 4w.e!~.~..~g..w~..~h .a..e.o.k .~.q..~.~n. .............................. The certificate is issued to . .~..e.~.g.e.. a.~.,.. 9.n~..ff...em. ~.o.e.. ~.o.y.e.n. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N.A. ...................................... UNDERWRITERS CERTIFICATE NO..N.A. ............................................. Rev 4/79 Building Inspector FOR~ NO. 2 TOWN OF $OUTHOLD I~UILDING DEFARTM~NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING 9ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1O796 Z Permission is hereby granted to: 41~ , Building Inspector. Fee $ ........................ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. 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 otherpertinent 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 ............. Old or Pre-existing Building ~'-~' Vab'ant Land Location of Property .~/~... ~..,, .~. :' .~::~x..,~......~.._ ...... '~'-~ $ ~-~'~-?'~;~let Ow,er or Owners of Property ....... ~ .~.~ ........ .z-?~-. ~'.~ ........ .....~..~. -~. ............ County Tax Map No. 1000Section ........ .(..L."3... Bl~k ....... '7' .... Lot .... ,(~. ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No..(.~.7.¢.~..~-DateofPermit 7/~...~,/..J~..Applicant ..... .~..,~,-~. .... ~.~..~.~4~,-¢-~ ....... Health Dept. Approval (') /~ ..... Labor Dept, Approval ~'/~ Underwriters Approval ......... ~, .~, ......... Planning Board Approval .... .~J./,L,~r~~. .......... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ...... .~., .~.~.~. ................ Construction on above described building and permit meets all ~ab~d, es and regulations. FO~ NO. ! TOWN OF SOUTHOI.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y'. E×am~ned ............. ~?...'.~.~ .... 19.~...~.~ Disapproved ale' . .......................... '"~"'"'""~"~i~"~'Z'"'--'"J'-Z.L'"Y"~ .............. ....................................................................................... ~ ................ (Building Inspector) Applicotlon No. a. This application must be completely filled in by typewriter ge 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 or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is port 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os 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. ............... :....' ...... ............ (~ 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~,...~..".~.~/.~:~........'~Z~....~[..~....~.~.~.~.~.~.~.~.~*`~.....~..~.~[~..~.~~'~~.~..~.~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... l. Location of land on which proposed work w~.~e done. Map No.' ,..,..~.:~......~.,...= ................... Lot No ......................... Street and Number .............................. __....~.~...~.?~....~....~.z. .~. Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exis~tin~ use o.d occupancy .................... ~..~Y../4,...!.~..~.~ ....................................................................... b. Intended use and occupancy ............................. ~.~..!~.~..~-~"'~/~'~ ............................................................................................. 3. Nature of work (check which applicable): New Building.. ................. Addition .'~...~....~...... Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................... ~!'~O O . Fee ~ (Description) 4. Estimated Cost .......... .~.......,., ......................................... ............................................................................... / (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 imixed 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 .............. Numb, er of Star es ............., .............. ........................ 8. Dimensions of entire new construction: Front ............ /...[.. ................. Rear ..... /.. .................... Depth ...~...~.. ................ Height .....l ............. Number of Stories ..~.w., ........................................... :";'"': .......................................... "~ .......... ~-~_'Size ,of Io~,l:r~ ............... ~'~,.. ........ ~....~... ................. Rear ............ ~....~.......~.. .............. Depth ..... /...¢~....,~.. .............. ~:)~ Date of P~chase~ ............ ./..~..~ ....... Name of Former Owner,, ............ . .~....z...~-.'~...~...~.L ................... ~district .XN. pr~'mises situated-- ~....~..~..~..~....~../.?..~../...~.. L 11.I Zone or use in wht¢~ ore ................ .................................................... 12. Does proposed constructionNJ~iolate any zoning law, ordinance or regulation: .......... ~....~.. .................................... 13. Will lot be regraded ....... ./(~.,.~. ........... Will excess fill be removed from premises: ( ) Yes (/~) No 14. Na me of Owner of premises ~..~..¢.~....~..~.....~..~z..c'..~.....~...e .~...~...'~.... Add ress .......... : ...................... ......... Name of Architect .............. :.~. ....................................... ~,~l~ss ................................ Phone No Name of Contractor ............, ................. --- ~ ........ F...~.~!~...~,~dress ................................ Phone No ....................... Locate clearly and distinctly oil buildin.~,,~w~i?etP~er existing or proposed, and indicate oil set-back dimensions from property hnes. Give street and block number or descriptio~ a~ording to deed, and sho~, street n~m~ and indicate whether interior or corner lot. STATE OF NE~/-~¥.~RK~ COUNTY OF ....~t~ .............. S.S above named. He is the .......... ~ ...... ~ ........................................................................................................................................ : (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed ~he said work and to make and file this application; that all statements contained in this applicction are true to the best of his knowledge and belief; and thor the work will be performed in ithe manner set fo~h in the apphcation filed therewith. Sworn to before me this I