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HomeMy WebLinkAbout1727-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Ofrice of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date ............ ~u..ly..3.! ............. 19 .~.5. THIS CERTIFIES that the building ...a.d.d..5.~.i.q~... .................................. : ~75 Westphalia Rd. Location of Property ... 5.55. ................... ~. 97.~.q~..&xr.e.: ........... Fi..a.~.5.~..ug.k... House No. Street Ham/et County Tax Map No. 1000 Section . . . '1. ~.'1 ..... Block ....... .'1 ....... Lot ...... .~ .......... Subdivision ................ X .............. Filed Map No...x. ..... Lot No .... .~. ........ conforms substantially to the Application for Building Permit heretofore Fried in this office dated ......... ~ay../4 ....... 19 .G.~ pursuant to which Building Permit No ..... .5.7..2.7.Z ........... dated Hay ~ 19 .G.~, 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 ......... Addition om am existing dwellimg. RICHARD ANGREES & WI~ The certificate is issued to ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval ........... Ixl/& ........................... UNDERWRITERS CERTIFICATE NO ................... lxl/& ........................... Building Inspector Rev. 1/81 FOl~M 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) N.° 1727 z Date ................... ~lll~......ll, ........................ 19....~. Permission is hereby granted to: Ilor~..Bnt,.tez~o~th ...................................... ............... ife~tphat~a.-~ ................................. ....................... )~at~:', ~me~: .................................... to .. ~ Id.. ~n.. &dd;l,.t~,o~.. on...at~..e~l~t~r~., d~e.~ .t:!.~' ...................................................... at premises located at ..Ig/.S.....Ig~tlsl~_.l.ia.....Road ........................................................................ ....................................................... Mat, t~t,u~..lf,.~., ...................................................................... pursuant to application dated ............................... ]~'"'Jl' .................. 19.62,., and approved by the Building Inspector Fee $...~,OO ........... Building Inspector FORM NOel TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned ...... ........ , Approved .................. '..~' ................... , 19...:/...Permit No. ,~/7~- 7 Application No ............................. OK C of INSTRUCTIONS a. This application must be completely filled in by 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 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 progress of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been gr,,anted by the Building Inspector. APPLICATION 1S 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. ies and regulations. (Signature of applicant, or name, if o corporation) ........ (Address of applicant) ~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number .~.~~¢~..'....~'..~~....../~ ....................................................................... Municipality State existing use and occupancy of p~[emises and intended us~ and occupancy of proposed construction: b. Intendeduseandoccupancy~&.......~......~..~;~:~.;...~:......~....... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .....Zz~....... ..... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 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 natureond extent of each type of use ........................ ~ ...... 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. Size 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 violate any zoning Iow, ordinance or regulation? ...................................................... 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... 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. ,~.0C}¢ 12 '~''~ _~2z._~,¢~ STATE OF NEW ~OR~(/ COUNTY OF ..~...) ........... Z~...~. ............................... being duly (No,me of individual signing application) sworn, deposes and says-that he is t e applicant above named.~q-le is the ......... -.~ .................. 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 contairl~E~jn this application are true to the best of his knowledge and belief; th t th r m H L and a e wa k w~ll be per(~,r.~et~l~. ~I[~G I~q~¢[r~et forth in the application filed therew th. Sworn to before me this ,, 5Z 8344963, Suffolk Coun~ ~ ~ . uu,m],~pir~s ~arch 30, ~ ~ ~ ~ ............. ,....:.... oo~ of ................. ~U.~ ......... , ] ~..~,/~ - ,.~ ~- ~ ~ . ] .J .............................. Notary Pub ic,~.~2.~ ....... ~ (Signature of applicant) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 13971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ~ ~ 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- t~ons, 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 "preexisting" land uses: 1. Accurate survey of p~operty showing ail 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 other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4. Vacant~/Land C.O. $5.00 Datey~...~.7~../'..~...~..~ ........... New Building . .~.. ....... Old or Pre-existiqg Bl~ilcJing_ ............ Vacant Land Location of Property..\.L~. ].~ ......... .~ .~.-~.~X<.Ck..' ..~., ................. House No. Street Hamlet Owner or Owners of Property . .~x....~.(~ .... ..~. ~.~.~.....(:?...~.. i..~. .............. # County Tax Map No. 1000 Section ../.."~../. ....... Block ..... ./ ......... Lot..~ ......... Subdivision ........ .~ ...................... Filed Map ,o .... X .... Lot No...~ ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... .V~.. ............... ,5.-0? Fee Submitted $ ............................ Construction on above described building and permit meets all app!icable cod_e%and regulations. ........... ....... r_,.,,- ...............