The URL can be used to link to this page

Home My WebLink About3024-zFORM 1~0. S TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I~OWN CLERK'S OFFICE SOUTHOLD, N. Y. O£1~TIFIOATE OF' O00UPANI]Y No...Z. '2~76' · Date ................ 0~'tObOr' 2~..., 19~6. THIS CERTIFIES that the building located at .t~//.I~t. ~ol'~h.llaylr&ew...ltd... Street Map No..:gJl:X ....... Block No ...... :g~t~-..Lot No..Y~,X .... gOll~;l'to[l.~l'l~ 'N'*X, ........ conforms substantially to the Applicati~on for Building Permit heretof, o~e filed in this office dated ............. l~al'0h i. ~.2, 19..66 pu.rsuant to which Building Permit No. 3021+. -Z. dated ............... }/tax'ell--.2~9.66, was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .occupancy f~or which this certificate is issued is . Pr:[va~;e .otto · i~ra:t.l'y, rlwe:k'l~.rig .......................................... The certificate is issued to ...... Joseph' 6htpl~O '('~j '~'~essee0Wl~e~£or .................. tenant) of the aforesaid building. Suffolk County Department of Health Appmoral ...... &l~{~llZ~.. ~.~..~.c)6~...B3r.II.,..V.:[.'t ~a · ~Jf)~'": .....&'<¥~/'?'~;I ............. · · l-'~' u," Buil~ling Inspecto~~ FOE~[ 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? 3024 z Permission is hereby granted to: pursuant to opplicatidn doted [ ......... .~:..[%.., ~:..,.:~['.i..[.~ .'. ~r~ o ~'oved by ;~be Building Inspector . ' Fee FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate 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 featu res. 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-e_xist!n_g" land uses'. 1. Accurate survey of peoperty showing all property 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 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 er land use $ 3. Copy of certificate of occupancy $1.00 Date ....... New Bu,ldmg ..... ~.~. .... Old or Pre-ex,st,ng Budd,ng(Z) ........ ~ 'Vacant Land : ........... Lo pty ..¢...¢. .......... ............................... ,.,, ........ Owner or Owners of Property ~~ .~"..~-~. ~~ ................ County Tax Map No. 1000 Sec~on .~.~ .~. ...... Block ..~. (ZP~.~ Lot...~. Z ........ Subdivision ................................. Filed Map No. ]~.~ ,..Lot No .............. Permit No~:~7 Date of Permit ~,/~App licant* Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. ~ .., Request for Temporary Certificate ..................... Final Certificate ................. Fee Submitted $ ............................. Construction on above described building and permit~mee~s all appl~cable~co_de~ and regulations. SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure J (Give deed looZa~ion) - located have been inspected by this department and found to be satisfactory. Dtstriot En~Luee~ ~ District FOP~H N~. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....~~........~......., 19...~..?. Approved ........................................ , !9 ........ Permit No ................................. Disapproved ~~ ....... ...................... ................................. ^PP'IC^TION FO~ ,UI'DING PERMIT Date .............. Z ./.,~z Z,/~ ........... ~ .......................... ..... 19 ............ INSTRUCTIONS o. 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 propertymust 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 part for any purpose 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (S'g ~pp ' ant, or name, if a~orporation) State whether applicant is owner, lessee, agent, architect,~e,,~gineer, general contractor, electrician, plumber or builder. Name of owner of premises ~.~/.-...-. ..(~..-..-..-. ..................... · ' 5~e of duly ~ ' 'zed offi er tf applicant is a corporate, s~gnature o au~y autnor~ c . (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................ ~f....:...~,t.... Lot No: .................... r _4? ' ... Street and Numbe .................................... ~ ........................... : .................................................................. Municipality 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 ............................................................... ~ .......................................................... 5. If c If c 6. 7. Din' Hei Di~ Dep 8. Dirt l-lei! 9. Size 10. Dot 11. Zon 12. 13. / Nalure of work (check which applicable): New Building .... ~ ..... Addition .................. Alteration ....' .............. Repjair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ . .............. Estimated Cost Z. ~ 000 ~ (to be paid on filing this application) welling, number of dwelling units ..............~. ............ Number of dwelling units on each floor .............. , .............. otage, number of cars 2,- ' : ,usiness, commercial or m~xed occupancy, specify nature and extent of each type of use .................. ' .............. ensions of existing structures, if any: Front .......................... Rear .......................... Depth .............. i .............. ht ............................ Number of Stories i ~nsions of same structure with alterations or pdditions: Front ................................Rear .................. i .............. ~h .............................. Height .............................. Number pf Stories ........................................ ensions of entire new construction: Front '"l ...... ~)' ............... Rear .......... ,~.9~.[.(./.../.(.. Depth ...... ~.~. .............. iht ........... {. ............... Number of Stories / of lot: Front ............................ Rear ............................ Depth ................................ of Purchase ........................................................ Name of Former Owner .......................................... ; .............. or use district in which premises are s~tuoted ................................................................................... .............. Doe' proposed construction v o ate any.,~,on nm aw, ordnance or regu at on? ..., ......... ..~...../j ............ ] .. Na ~e of Owner of premises . : ........... Address .. No ...... Na ~e of Architect ................................... ~ .~./.~ .............. Address ................}ii~.~'~ ~'~' Phone No ....... .............. Na ~e of Contractor .................. Address Phone No ..................... PLOT DIAGRAM Locat~ 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 ondl indicate whether n,ter or or corner lot. STATE OF' NEWjY~RK,// ,~//_ / c c ...... .~..~ ........ ~ .be ng du y sworn deposes and says that he is the ~pplicont ............... ~e'~ ~ d...~.~.I. ~ig nj no applicoti~n..~...~ above named. ' .................................................................................................................................... .............. (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 land file th s cpplic:etion; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed Jn the manner set forth in the application filed therewith. , Sworn to Ijef..or~e this ~ -- : ............. ...~...~......-~d2y-~of ............... ~. ~.~..L.,q 19..~....~.. ~ ~,~ I . - ........... .............................................. .............. Notary Public, ...~.'.~~,;.~4--~c n.t~' /~ _ .~ (S[i/clnature of applicant)