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HomeMy WebLinkAbout1837-zFORUM ?fO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ....~],.~26 ............ Date ....................... No.~.emb~......21...., 19...62 THIS CERTIFIES that the building located at '"]~7'E/'"'~:~'/5~5'~"I}~$'~i~' ....................... Street Map No ...... XX,X ......... Block No...XXX, ............Lot No...Xx3r, .............. ~.O.~$/3D.],~.~...~.~.~ ............. conform~ substantially to the Application for Building Permit heretofore filed in this office dated ............................... u~13r· ...... .50 ............. , 19..6~. pursuant to which Building Permit No ..... dated ................................ ,I.~/1~.....,~0..., 19.....6~was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued 'i~ ........ ...... ~.r.~ra~..one...£a~l¥...~ell~n~ ......................................................................................... The certificate is issued to ..... ~.eth..g,o~.~aD~ ............. 0.~ne,~. ...................................................... (owner, lessee or tenant) of the aforesaid building, H.D.approval Nov. 20, 1962 by R. Villa ....... FOI~M NO. 2 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? 1837, Z Date .............................. ~I~,1~..... 30 ......... 19_62. Permission is hereby granted to: G. W;'Sm!th"~"8on~s'''Tn~'''''~/~'.E~e~h.. ........... ~5~U.~61-~;...N.;.y; ................................... to ' B'~'t Id" ~"~e'"f~mi'lF"dwe~T ~ng .................................................................................... at premises Iocoted at "O~Ub~'"P'~}[ .............................................................................................. ........................................... Oakwood'"D'J~ive .............. 8outh~l.d ..................................................... pursuont to application dated ...................................... ~, ...... .30....19.~.~.., ond approved by the Building Inspector Fee $ ~0~,'00 ........... Budding nSpec~(or' / FORM NO. 6 '['OWN OF SOUTHOLD Building Departme~t Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in [ypewriter OR ink, and submitted in duplicate to the Building Ins'pec- tot with the following; for new buildings or new use: 1. Final survey of property with accurate location o~ aH buildings, properW lines, streets, and unu~al na[ural 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 Unde~riters. 4. Commercial buildings, lndustrbl buikfings, Multiple Residences and similar buildings and tions, a certificate o¢ 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 axis[lng buildings (prior to April 1957), Non-conforming urns, or buildings and "pre-existing" land uses: ' 1. Accurate su~ey of peopertv showing aH property Hnes, streets, b~ildings and unusual natural or topographic featu res. 2. Sworn statement of ownor 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- lion 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 New Building ............. Old or Pre~existing Building ............ Vacant ~and ............. Location of Property ...... d.~2.c~. .... .~..~//.~..~.~....~..~//,~'~f~,.. ~..~ Hou~ No. Street Owner or Owners of Property Co n v'r ,o. 000 Se.tio .... .... , o.k ..... ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval Unde~riters Approval ........................ Planning Board Approval ............... Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted $.../.~: ........ ~ ...... Construction on above deseribed buHdin[~ an~ permit meets aH applicable codes and regulations. Apphcant .. ~.. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Perm,t No..Z /~;") '7 Disapproved a/c ................. ~...~~~~ (Building InspectorI App,,cot,on / 3 ? APPLICATION FOR BUILDING ~FRRMIT '~te''~ ~..~C7 ~.~ ~ ......................................... ~9.~., ....... INSTRUCTION6.~ a. This application must be completely filled in by typewriter or in ink and su6mitted 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 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 p art for any purpose whatever until a Certificai:e 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances /a~d regulations. //~ ~:..~.~r~.~.~.~....~..~ ...... ~ ......... ";'c'-'~[;~;'~'~¥'~[~Ilcant, or name, i a corporation, (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, generaJ contractor, electrician, plumber or builder. Name of owner of pre~,ses.....~~..~~ ...................................................................................... If applicant is a corporate, sigr~ure of du~l~' authorized officer. ...... ~'~ (Name and title of corporate officer) Location of land on which proposed workwill be done. Map No~...~.....~..~.~ ...... Lot No: .~.~ ........ 1. Street and Number ~,~v..~:~..~'.:.....~.....~.-~ ............................................... Municipality 2. State existing use and occupancy of p~mises ond intended use and occupancy of proposed construction: ' a. Existing use and occupancy ....... ~,../,,~....4_<~.~.: ................................................................................................. b. Intended use and occupancy ....... ~;. .......................................................................... 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 ......... ..~L~...C.'~..Cz.~......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 .../..~..J~ ............... 9. Size of lot: Front ..../..~...O ............. Rear ...... ./...'-.~.~ ........... Depth .~'...-.~..'~..~. ................ 10. Date of Purchase ..........~...~./...~...~...~....~T.. ................... Name of Former Owner 11. Zone or use district in which premises are situated ...... K~-~.~..~.~?.~.~..~ ................................................ 12. Does proposed construction violate any zoning law, ordinance,,~ regulation? ..,~. .......................................... 13. Name of Owner of premises.~.:~.~...Address~~..~..~..-.Phone NO ..................... Name of Architect ......... ~', /.,x ,,// ~ ,x'~~ ............. ' ....... .~,~_ ............. Address .......................................... ~. Phone NO ..................... Name of Contractor~../4','~-~~~.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 YX)RI~,/ _ ,,~ ,- r .............. ~,..~~ .............................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 applicon filed thg~wi~. ~ Sworn to before me this ~ ~o~ ~lt~ T ' . ~ ~//' ' ~ // .... ~ e Public, Sta~' 60~o .......... o, ............ ........