Loading...
HomeMy WebLinkAbout289-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z J.2.5.9..0 .......... Date ...... .J.u.l.y..6 .................... 19 .8.4. THIS CERTIFIES that the building .... .0.n.e...f.a.m. } .1 ¥..d/. e..1.Z.~.n..g ..................... Location of Property ..... .~ y.~.q..s.~A ! % .~.~.~.~. ~...~72.~. ? ? ................... .c/. ?.~ ??..~?.. House No. Street Ham/et County Tax Map No. 1000 Section . .1.3.7. ....... Block ...q ............ Lot ~..0.0..&.. J .0.1 ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Perrn~t heretofore ~ed in this office dated ..../tp?.! ~..2.1 .......... 19 .5.8. pursuant to which BuiI&ng Permit No. {).2.8.9. ................ dated · ./~ P ~',~.% · ¢ .q ................. 19 ~ .8., 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 ......... ·.. 9~a.~. ~ ~m~ y..d.~.~ Z. Li.n.g ...................................................... The certificate is issued to ........ Ar ¢ h~.n. ~ o..lip. ¥. ,Jr.,. &..~.% I~ ¢ ............ (owner, ~ 1~!~s~6,~ .......... of the aforesaid building. Suffolk County Department of Health Approval ....... Iq/.3, ............................... UNDERWRITERS CERTIFICATE NO ............... #.N..2 .~ ).4.6. 9..A.u.~ :..3.0. ,...~ ).6.2. ......... Building Inspector Rev. 1/81 FO~F~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PER/rUT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 289' Z Permission is hereby §ranted to: pursuant'to~ applicabon dated ...................... ~]JlF~],''-,~'[ ................. 19~8...., and approved by the Budding Inspector Fee $ ~0~.00 ........... [ ' Building Inspector FORM NO. 6 i , TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be fdled m typewriter OR ink, and submitted in duplicate to the Building Inspec- tor w~th the following; for new buddings or new use: 1. Final survey of property w~th accurate location of all buildings, property lines, streets, and unusual natural or topographic features 2. Final approval of Health Dept, of water suppl,/and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buildings, Industrial buddings, 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 s~te plan requirements where applicable. Bo For existing buddings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pcoperty showing all property lines, streets, buildings and unusua~ natural or topograph lc 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 ~nspect~on of buildings or premises, or other pertinent ~nforma- tion required to prepare a certificate. F ecs: 1. Certificate of occupancy $5 00 2. Certificate of occupancy on pre-ex,sting dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date...~. ;~..~. ) ./. ?. ?. ( ..... New Budding ............ Old or Pre-existing Building ............ Vacant Land ............. House No ~ ~' /~ , i Street ~ , Hamlet Owner or Owners of Property ~/~.~ ~..~.~ 7 ..... '.2.~... ~./. ................ Subdivision ............................ , .... Fded Map No.~ ........... Lot NO .............. Permit No...~., ?. .... Date of Permit Health De~t. Approval ........................ Labor Dept. Approval ......... / ............... Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate //' Fee Submitted S ~.'~. ~ ,.3 ...................... Construction on above described budd,ng and/~,?~/e/~s all apl~cable/c~ei]~:l regulations. Applicant .. .~. ...................... Rev, 10-10-78 FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ........................................ 19 ........ ~-, ~. Approved ........................................ 19 ........ Permit No.....~.~.~ ..................... Disapproved a/c .............................................................................................. Application No ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in bv typewriter or in ink and submitted in duplicate to the Building Inspector. 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 port of this location. 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 progress of the work. e. No building shall be occupied or used in whole or in port for any pu?pose 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ................ ................. (Signature of applicant, or name, if ia cc~rporation) ......... ' .................... ............ ............ '" State whether applicant is o~r, ,f.~/..~es;ee, a.~,.~.~g~t, architect, engineer, general contractor, electrician, plumber or builder. ' :i, Name of owner of prem'ses...~..L.:J:..:.L ............................ :.~ ............................................................................. If applicant is a corporate, signature of duly authorized office~. (Name and title of corporate officer) /' 1. Location of land on which progosed work will be done. Map N : ............. : .............................. o r~o: .......... ~ ......... ~rree~ aha rqumoer ............................................................................................................. ~ ..................................... Munlcipolity 2. State existing use and occupancy of premises and~jntended use and occJ, l~ncy~f proposed construction: a. Existing use and occupancy ........................... E..~~...~.......:.....;.~ ............................................... b. Intended use and occupancy ............................ ~_~.~...7..~........~...~. ........................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost../...~. ....................................................... 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 .............................. Height .............................. Number of Stories ................................ 8.Dimensions of entire new construction: Front ............................ Rear ............................ Depth ............................ Height ...... .~....~...~ .......... Number of Stories ...... ~ ................ · . ~9 t~ 9. S~ze of lot. Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ..... /....:. ................................. 11. Zone or use district in which premises are situated ./..~. 12. Does proposed construction v, kola~te any izoning law, ordinance or regulation? ......... .j..V.'.~ ................................... 13. Name of Owner of premises..~rD.....~....'~.....~...:.~....~.~. ...... Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .......... ..~f.....~:~ .............................. Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~'01)1~, ~1/' ) S S COUNTY OF . .;~.:.'~'/~'~....."~...,.) ' .................................. ~..~:.: ......................... f.....~ ............ be ng duly sworn, deposes and says that he is the applicant (Name of individual signing applicat~n) ~ ____ above named. He is the .......................................................... ~z;~;~ ...................................................................... (Contractor, agent, corporate officer, etc.) of se d owner or owners, and is duly authorized to perform or have performed the said work and to m~e and file th~s apphcat~on; that all statements contained ~n th~s apphcat~on are true to~ b~o h~J knOwlddg~ 6nd behef; and that the work will be performed in th~man~ set forth in the application Sworn to before me this _ _ ~~' ......... .......