HomeMy WebLinkAbout2663-zNO. t
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN GLERK'S OFFIGE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No ....~..2:[~.1, ......... Dote ...................... ~,t,-~...22, .............. , 196~...
THIS CERTIFIES that the building located at]B~r..J~We~e.,..~lF, f~l;.~ ....................... Street
Map No...,J~ ..............Block No ........~ ........Lot No ............ .sJZ ...................................................
conforms substanhally to the ,~pphcation for Building Permit heretofore filed in this office dated
........................................ J~...~,~, ....... , 19.~... pursuant to which Building Permit No..~.~.~..~..~....
dated ............................. ~Z'X31%...%[ ...... , 19..~., was issued, and conforms to all of the requirements
of the applicable provisions of the Iow. The occupancy for which this certificate is issued ~s ........
............................................. ~jajne~a...l~:L,l.~cJ. ...........................................................................
The certfficate is issued to ............ ~.Oh~..F~L~t~ ................................................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
TOWN OF $OUT~O~D
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? 2663 Z Dote ~'*h ~ ,9 6~'
Permission is hereby gronted to:
................. 6,g~g~ .........................................
to ....... ~_~_~.,~n.. ad~! ~-t~on..on.. a~.. ~_~ ~;..~us4~a~ ~..1~i~ ~-~ .............................
at premises located at ..~.//~.....]~liJ~r...~:e~ ........ l~tf.:Lt~ok;~..~.~.. ...........................................
pursuant to apphcation doted .................................... ~..~ ....... ~],, 19.....~,~and approved by the
Building Inspector
Fee $...~i'~.(~ ...........
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
· ~outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
Ao
This application must be filled in typewriter OR ink, and submitte '.d-h-~ff_.,'pl[cctc 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-
tions, 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 "pre-existing"
land uses:
1. Accurate survey of peoperty showing all properW 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 safeW 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/ land use --t~r'e-E×±st,[ng C. 0. $115.00
3. Copy of certificate of occupancy $1.00 Xracant. :[and C.O. $ 5.00
/ /
Date ....... J ].~/.~. ..........
New Building ............. Old or Pre-exi~ing Building ~J.~.. Vacant Land .............
Location of Prope~
Owner or Owners of Proper~ ~.~.. ~~.~. ~. ~~ ....................
County Tax Map No. 1000 Section .. 1.~.~ ...... Block ... ~.~ ....... Lot..~lZ..I ........
Subdiwsion ................... Filed Map No ........... Lot No ..............
Permit No. ~G~. Date o ermit ..*A~..Applicant .~O~..~/]~.~ .~.. .........
Health Dept. Approval ............ ~. .......... Labor Dept. Approval ...... ~. ................
Unde~r~ters Approval ........................ Planning Board Approval ......................
Reque~ for Temporary Certificate ..................... Fina[ Certificate ...~~.
Fee Submitted $ .............................
Con,ruction on above described building and ~mit meets~p~cable codes and regulations.
Applicant. Z~Z:~~ ~Z~~~/------~--~~;~' ~' ................
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
×am,ned .....
Approved " 1c) ........ Permit No. , .~...~' ~ ~ ~.
Disapproved o/c ~...~ ...............................................
...................... ........
................... · .................................
Application No ..................... ...... . .
APPLICATION FOR BUILDING PERMIT
Date .............................. JJllJ~JJ ....... J~......, 19 ............
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink anti 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 o detailed description of layout of propertymust be drawn on the diagram which is port 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 port for any purpose whatever until o 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 alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with oil applicable laws, ordinances, building code and regulations.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State Whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Contraetor
Name of owner of premises ..... ..~..O..,h~........lg:...?.l:..~.. .......................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
I. Location of land on which proposed work will be done. Map No: ~ Lot No: 313D[
Street and Number ..... ~.....~...~..V..? ............ ...J~...t,..~.~...t...t~....k.. ..................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occu~anc· JJttll~.tleB8 ])tl:J. ld::J...l~.. .
b. Intended use and occupancy J~lle ~lth an &dditioll
Locate clearly and distinctly all
property lines. Give street and block
whether interior or corner lot.
3. Nature of work (check which applicable): New Building .................. Addition 2CY:,~Z. ....... Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
4. Estimated Cost ..........~.~..~'. ........................................... Fee ...... .~.o ................................................................................
(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 .]~.lJ,~e,f]l~ ...........
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 ..... ;tO,.. ................ Rear .....]..Q .................. Depth ........... ~T8 ............
Height ............................ Number of Stories ............................
9. Size of lot: Front ............................ Rear ............................ Depth ................................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
! 1. Zone or use district in which premises are s,tuated lq.....d£s~ ......................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation> nO
13. Name of Owner of premises ...~..ZZeizz...; ............. Address ........ ]~}a.l~J;.:Lt,~¢]c .............. Phone No .....................
Name of Architect ...................................................... Address ............................ . ................ Phone No .....................
Name of Contractor ...~.'3.aZ. ez'...]~Lclg.e .................... Address ......... ..~.(Z~.~.~QE, I~e ............. Phone No .....................
PLOT DIAGRAM
buildings, whether existing or proposed, and indicate all set-bock dimensions from
numbers or description according to deed, and show street' names and indicate
STATE OF NL~W YORK, ~
COUNTY OF ~..t~,£1:~t,~l~ .............. f S.S.
........................ ~ ' J~e~ ................................................... being duly sworn, deposes and says that he is the applicant
(Nome of individual signing application)
above named. He is the ..... ~.c?.~l.~:~f~.O.~.O~. ............................................................................................................................
(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 Jn 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 application filed therewith.
Sworn to before me this
................... ~ll. d~ Of ................... ~l~ .............' 1 9~Ill ~ ; ~ )[~ ~
Nota ...................