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HomeMy WebLinkAbout2858-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .t///.S.....~p~)Ve...~~. ................................ Street Map No .......~.~ ........... Block No ...... ~ ............ Lot No, .~.~ .........~1~J~O~1,~.....,~,.~,~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office doted ................................... · Be~'~ ......... ~ ........ , 19..6~. pursuant to which Building Permit No ..... ~J~.~8,.Z dated ............................... J~'""8 ........ , 19...f~.~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .... P~lvat e...~e...~lil~...~ 1.11~ ............................................................................................. The certificate is issued to ..... .~i~O.~,~l~C..~O~;~0~ ..... .~I~ ................................................... " ' ~/(~wner, lessee or ten,ent) of the aforesaid building. H.D.Approval Feb. 23, 1966 b~ R. Villa Building Inspector ~k, FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2858 Z Date ........................ ~4~tellt~l~.....~ ...... , 19...~ Permission is hereby granted to: R~lge .. P~r · .lt~es...~.....A~.....¥~lc~nt .. l~onte~ol so Jr ....... t~a~l~][.1...Rd ................................................ ................. R.t.d~t......Iq~ :~ .................................. to ..Bu$.~l...ne~.. one.. f~a$.~'.-d~e.3:]:~ng .................................................................................... et premises located at ....~.[I ....... GF~'e-.t~ea~ ................................................................................... ....................................................... 8~utl~,-:~d ....................................................................................... pursuant to application dated ......................... .EJ~111; .......... J~ ............. 19..~., and approved by the Building Inspector Fee $..2~. t~O .......... Buncoing inspector ~ TOWN OF SOUTHOLD Bu ildin9 Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OB ink, and submitted ~ ~.~a to the [3uilding Inspec- tor wid~ ~he following; for new buildings or new 1. Final ~Jrvey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-($-9 form or equal). ,3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Muhiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning [3oard 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 pz~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as ~o 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. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 New Building ............. Old or Pre-existipg Building - .,,o ......... Vacant Land~ . ..... x ...... Hou.~ No. '~ ~,~ __ S c~,,.- SubdMs~on .............................. Fded Map No ........... Lot No .............. Heahh OepL Approval .................... Labor Unde~r~ers ~pprova( .................... P)annmQ 9oard ~pproval .............. Request for ?emporaryCertd~cate .......... Fmr~al Cert f ca~e~ .......... Fcc Sut)m,~[e(j S [, ~ I A, [1, iO 6D "- 0 A I;.ITt,~"D TO SUFFOLK COUNTT DEPARTMENT OF HEALTH Mldg. Permt% Nco TO WHOM 1T MAY CONCE~: The sewage disposal facilities for a structure located at have been inspected by this Department and found to be satisfactory° TOWN OF SOUTHOLD PROPERTY REC:ORD CARD VNER STREET WLb~GE D~ST.SUB. LOT N E ~, S ~ W TYPE OF BUILDING / S~S. VL. FARM COMM. CB. MISC. Mkt. Value ~ND IMP. TOTAL DATE REMARKS AGE BUILDING CONDITION ~ NOR~L BELOW ABOVE ,RM Acre Value Per Value Acre able 1 able 2 =ble 3 ~d[and mpland FRONTAGE ON WATER ~hland FRONTAGE ON ROAD ise~Plo~ DEPTH nl DOCK FOI~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEI~K'$ OFFIGE SOUTHOLD, N. Y. Examined Approved ........................................ , 19 ........ Permit No ....................... Disapproved a/c ............................... .~:.,, ,...,, ~ ~.,r: .~: :::~,. ....................................... ............................... .~ ....................... ~.:.> ....... ~¢::.'./...~ ........ ......................... 'c'6:%':~:~:;~;:; ...................... / APPLICATION FOR BUILDING PERMIT 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 pa:rt 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 o 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATFION 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, building code and regulations. ~ t , ......... (Signature of applicant, or nome, if a corporation) ............... ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder. ............................. O..~.~.~.~.-.fi ......... ~.-.~.TZ.~.:.~.~.. ........................................................................................................ Nome of owner of premises ........ .~ ....................... ~.~..~ ..................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done..Mop No.: ........................................Lot No.: ........................ O~ ~ ~/; r, q 006 ~ ~ ,~4 ~o Street and Number 006.. ~'P r, % ~ Munici~lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~ .......................................................................................................... b. Intended use and occupancy ~ ~ ...................................... 3. Nature of work (check which applicable): New Building ./.'. .............. Addition .................. Alteration ................ Repair .................. I~.rnoval .................. Demolition .................. Other Work (Describe) ...................................... ..... ...~...1200~ Fee . .. 4. Estim, area ~,osr ............... ) .............................................................................................................................. ! (to be paid on filing this application) 5. If d~,elling, number of dwelling units ............................ Number of dwelling units on each floor ......................... If galage, 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 .............................................................................................................. Dime[nsions of same structure with alterations or additions: Front ....................................Rear ......................... Depth ................................ Height ............................ Number of.Stories .................... , ........... B. Diminsions of ?ntire new construction: Front ......... .~..?...?. .............. Rear ...... .~....7....~.. ......... Depth ...?~..~......~.. .... Height ...... ./..~. ......... Number of Stories ...... ! ........................................................................................................... 9. Size :of lot: Front ......... 7...~..~.i ......... Rear ............. 2..?. .............. Depth / O~ 10. Datel of Purchase ............ !..~..~..~.. ............................... Name of Former Owner ..... ..~..:......./~.fffz.~....~...../~.. ................. 11. Zon~ or use district in which premises are situated ........... ~ ................................................................................ 12. Doesi proposed construction y~ol~ate any z2.ning Iow, ordinance or regulation? .......... .~.~..o. ..................................... 13. Na le of Owner of premises~.~.~.?~.~:'.~....../~..a.?....~.l~?..$.~.?Address ............................................ Phone No ............... nl NonCe of Architect ...~..~.'~,~...¥. ....... ../'~!..(i.~.~ ........... Address ..~..~..:.~.'..f...~.?~.~..'. ........... Phone No ............... Name of L, ont, ................. :: ................................................. ;'.....; .......................................... PLOT DIAGRAM ~ Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fr property li~es. Give street and block number or description according to deed, and show street names and whether i.nt,erior or corner lot. STATE OF] NEW,~R~I~/ t9~ COUNTY ]OF ..~:~..~'.~ .... ................. I .............. ~...:~ .................................... ~..~ .................. being duly s~rn, deposes and soys that he is the o ~.(Name of individual signing applicat'o ) abow, named. He is the ...... ............... (~ ~r, agent attic of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this applicatioo are true to the best of h~s knowledge and belief; that the w~rk will be performed in the manner set forth in the application filed therewith. ' Swam to ~efore me this [ ~ ~ ................ 7... ...... .......... ..................... 1 .....