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Home My WebLink About7368-Z~OWN OF $OUTIIOLD BUn~IN~ DEPART~O~IT Town Cl~k'* O~i~ so h a, Y. CertifiCate Of Occul: ncy Map No.. ~ ....... Block No..~ ..... Lot No..~......~l.t.~.h.o..~.~... ~.,.Y.o. ......... conform~ substantially to the Application for Butlaln.~ Pm~nit heretofore flkdin this ~ dated ..........,II~Y.....1..., 191~.. pursuant to which Builalng Pm~tt No, .?~.(~. dated ...........Ju~y .....1., I9.7)+, was issued, and conforms to all o~ the require- ments o! the applicable provisiolm of the law. The occupancy for ~hich this eertl~eate is The certificate ~s issued to ...-4,3~...~9..~...T.'.~...c~...s..C ..~..u3....~.t ..... . .0~..e..r.~. ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Depa~i~ent of Health Apl~oval HOUSE NUMBER .~.~.0..~ ...... Street...D.?p.o.t....I/~..e.. Outcho~me Butkli-fl hu~ector ~ FOu. M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7368 Z Date .................... ~1,~.....~1 ................... , 19.~t~.. Permission is hereby granted to: ~'b,o~ a..&.. ~,a4=e .... ~t[~k~ ......................... ........ .C~tcho~ua ................................................. to B.~t.~L. ne~. · a s~l,c ~'k.t,~0J~ i. · .b~..).~ ~.~g ....... Fe~..B4~o~a~e .............................................. at premises located at .~/.~..~It:p.O.~..L~,FI~ ......................................................................................... ........................................................ ~.u~;e,,~ .................................................................................. pursuant to application dated ......................... ~1~,~' ........1 ............. 19..~..., and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town CIcrks Office 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 Inspector 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 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 1957), Non-conforming uses, or buildings end "pre-existing" land uses: 1. Accurate survey of 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: i. 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 ................ Addition~ . ,m .~ ,~OId or Pre-existing Building ...... ..~..... Vacant Land .............. Location Of Property ........ ~...~.....c~.......~.~~~.~ ^ -- '~'"" ~~'""7/' ............................................. Owner Or Owners Of Property .~.~,~.6~.....~...L:~-,_,cch-~.......~~~'. Subd,v,s,on ......... ............................................. Lot No. Hou,e Permit No....~...?...~....~'...~.. Date Of ?rmlt ..~//.(/Zl...Applicant .A...~....~... ~~- Health Dept Approva ~ ~ Labor Dept Approva ~.~ii~.'~iiiiill ................. Underwriters Approval ......... ~.?..'~.:..~.....'~..../.../~/.~ ....... Planning Board Approval ..... .~....J. .......................... Request For Temporary Certificate ........................................ Final Certificate ........ ~. ............................ Fee Submitted $ ~' ~ Construction on above described building and permit meets all applicable codes end regulations. Applicant ........ ~ ....... Sworn to before me ~ .......... o, Disapproved a/c · .This _Ipp./ication _mu, st he_completely filled in by typewriter o~. in ink end ~ in triplicate to the Buildi~[: ~. ~Pl~_~la.n showing..fl~i;~ buildings on ~ '' Jlalmises or public streets m *teO~ aq~l:~ving a detoil~~M~l~ ofproperty m ~., -ic~tr~pall' of this applicatio~ c. The work covered by this application may not be commenced be;~e I~s~uan~'~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 ~ shall have been granted by the Building Inspector. i~ .A,P..PLI ~CATIC)~N .IS HEREBY MADE to the Building ~t for the issuance of a Building Permit Durluant to rrm u.a~ng Z,l~lLJ~djl:lance of the Tawn of Scx~t~old, Suffoll~ Exilinty, New York~ an~o.~.~ c~,;;,~,;. La~, .,,eg ,.o~, .for the construct!on of buildings, additions or alteratmns, or for removal or clemolJtlon, as herein desc,~4 . ._pp !,can? agr.ees to comply w~th all app!icable laws, ordinances, building code, haaslng code, and regulations, and aamn' aumonzed inspectors on premises aha. . ...... · ($i~Ibtbre of applicant, or name, (AddreSs of applicant) State whether applicant is owq. er, lessee, agent, architect, engineer, g neral contractor, electrician, plumber/~or builder. r If applicant is a corporate, s~iSnature of duly (~f'-~norized officer. ~ (Name and title of corporate officer) 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 ~..~..O..7~'.......~w4~.1~.~.. ................................................ ~..~...~'..~'.~.j~..U~' Municipall~ 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 ........ ..................................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost ....... .~...~.v~ ......................................... Fee ~[..,~.rOO .......................................................... (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 ................................ Height ............................ Number of Stories ................................ 7.~. ~/ 8. Dimensions of entire new construction: Front ..... ..~.~. ........................ Rear ......~/..~. ................. Depth ...................... Height .J...~../. .......... Number of Stories ..................................................................................................................... 9. Size of lot: Front ....... ~'~O' Rear ...~.~. ................................. Depth ....4~....~.....&..~. ............... 10. Date of Purchase .~.V.G.....~..f....L~.].~ ................... Name of Former Owner .~...~..R.~.~....~.,...C,.Y.t~I..u.~./. ..... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ../~..~ ................................. i ............. 13. Will lot be regraded .....~....~) ............... Will excess fill be removed fro~mp~eT~m~es: ( ) Yes ( ~ No 14. Nome of Owner of premises..~.9.~1~.~....C,.~'~.~./~.~.) ......... Address ~,~:C.#.9.~.~.~...~. Phone No. ~.~..~'/.~..~.. Name of ~ .,~./~.~.~...~..~.~./d4~.~.! ............... Address ~.~'-~.~.I~Z.. Phone No.~.~.~.T.~.~..~..~... Nome of Cantractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensiBns from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 1 o0 ][.2oo / " 1' STATE OF NEW~I'ORI~.,/ / ! ¢ S ..'~..../:.~...~...'~...'...'~,</,~,......'~..~.../~,~';~z....'~ ........... being duly sworn, deposes and says tha~Lh~the opplicont~ (Name of individual signi~J contracf) above named. (/ i / (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 ti,ar the work will be performed in the manner set forth in the applic~tiDn filed therewith. /~ , Sworn to before me th,s' ~ ~:~/-~/~. ..... ~)'~'~-~ ....... .......... . Notary Pub ic,~..~;~...~.).,~County ...... -~'.~-~.-'~--...-...~fr~..;...'~..~..~. ....................................... / ' "'3 ~ (Sig~fature of app icant) FLORA S. LUCE Commissi~¢~ Expires March 30,~i~ ~/~