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Home My WebLink About3047-zFORM ~0. 4 ~'OWN OF SOUTHOLD ]~UILDING DEPARTMENT · ~OWN CLERK'S OFFICE $OUTHOLD, N. Y. r:I:'I~TII:'IP. ATE O~ OBI~UPANEIY o. ;~i~ ';~'~;}FIES that the building located ~t '.~.'?.'.~iii~i ii¢.'~iiiii'. St~/~ Map No.r...~...~..~Iock ~o...~ ....... Lot ~o. ~....~~ ~.. conforms substantially to the Applicati,on for Building Permit heretof, ore filed in this office dated .... ...Id....."..'" ....... 1 .... pursuant to which Building Permit No .......... dated .......................... 19 ..... wa.s issued, and conforms to all of the require- me.uts .of J~t~e apjglicable provisions of the law. The .occu!;kancy f~or which this certificate is issued is O"',,'-.-.~.~.-t-,,. ~ ..~... ~~..~..~..... ......... ,~ c~rt;ii:~' '~' ~:~;'~ '~~ ~'~'~.. ~~.. ~~ (o~vner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Ap~rovaI ......................................... BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3047 z Dote ..................... Permission is hereby granted to: ..]~one~d..A~ki~som ......................................... ....... ~o'~...~ie.e~ .. D.d .............................................. ......... ~e~t; 5£ ~-~o ~ ................................................ to ....~..z..d....~.~.~.~......e..rt.e....~. o~.L~...~.~o.;~.~ L~ ................................................................................ at premises located at ..~.~...~.~ ........ ~-r~...~,.~{~ .................................................................. ~ ....... ............................... P,. mo~.~...~,o~(L~ ........ ¢~,t;e~hog~t~ r. · · .;~:,. ~.. ............ : .............................................. pursuant to application dated .......................... Ap~.~.~. .........~ ........... 19..(~., and approved by the Building Inspector Fee $..IO~.OQ ......... Building Inspector SUFFOLK COUN~f DEPAEiI~ENT OF HEALTH Date TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ~ (Give deed lo~ation) ~ have been inspected by this Department and found to be satisfactory. DistriCt En$inee~ District Emgine~r FORM NO. 6 TOWN OF SOUTHOLD E~ujldJn{~ Department Town Hall Southold~ N~Y. APPLICATION FOR CERT~EICATE 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 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 tl~e Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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 $15,00 3. Copy of certificate of occupancy $1.00 4.Vacan~ Land C.O. $5.00 New Building , ~'~ .... Old or Pre-existing BuiJdin~ ............ Vacant Land House No. ~ /) S~reet CounW Tax M > No, ~000 Section ............... BlocA ............... Lot Perm t No Date of erm t Applicant Fea th Dept Approva ~ ' ~ Z~ ~ ~ '- Labor Dept Approval ~.T.~f, Unde~riters Approval .... ~, ........... Planning Board Approval .. ,~ .. Bequest for Temporary Certificate ..................... Final Certificate ,, Fe~ Submitted $ .... ~, Construction on above described building and,F'e~it meats a/IJ-~ppl~j~ble c/o~des and regulations. Applicant... A(-¢~¢~~:'~ ~-,,,/~~ ........... Rev. 10-10-7a FO~M NO. 1. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....................................... ~...~....'~.. ~ , 19 ........ ~ 6 Approved ....................... !.l. .............. , 19....~.. Permit No....................,........ Application No......-~..ff..(/..~ ............ APPLICATION FOR BUILDING PERMIT Date ............ ./?.~...~/. ?........?.. ........................... , 19....~..~.. .... 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 o detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by }his 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. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, arch tect, engineer, general contractor, electrician, plumber or builder. Name of owner eT premises ....... ~ ................................................................................... ~ .................................................. If applicant is a corporate, signature of duly authorized officer. (Name and titfe of corporate officer) .... ........................ 1. Location of land on which proposed work will be done. Mop No.: ~ ~ ..O..~..~.~Lot No.: Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... . .~. ·. -~....Ct....~...~.~...'..~', .... · .~.....~..!.~...~.~. · ................................................................. ~ .......... b. Intended use and occupancy ................... .~. .~j). ..................................................................... 3. Not,ure of work (check which applicable): New Building .................. Addition .................. Alteration .... ; ............. Reppir .................. Removal .................. Demohtlan .................. Other Work (Describe) .......................... , ............. · /~ ~o6 0 4. Estimoted Cost .............. .,~ ........................................... Fe~ ..[ .......... ; .............................................................. : ............. ~ (to be paid on filing this application) 5. If d~elling, number of dwelling units ............................ Number of dwelling units on each floor .............. ' .............. If g~rage, number of cars ............... ~ .................................................................................................. ' 6. If ~usiness, 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. Dim[ensions of entire new construction: Front ......... ~.~ ..................... Rear .........~.~. ............. Depth ....~.~ ............. Height ~...~ Number of Stories ....... ~ ........................................................................................................... ........................... ..................... ...................................................... 1 1. Zon~ or use district in which promises ~re s~luotod ....... ~ .........~ ................................................. , ............. 12. Doo~ proposed construction violoto ~ny zonln0 Iow, orSlnance or r*~ul~tion? ......... ~ ............................ ~ ............. U~o o* Architoct ..~:~.%~(ff~.,~.~....~: ............. Addms~ ..~.~.~.~.5~.~. ................ Phone ~o. PLOT DIAGRAM Locat~ clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from proper? li~es. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF (q. EW~YORI~, - ~, ~- COUNTY OF ..~h2~,Y.,~...°..~!.,~., ...... ~ ~'~' ..................... ~..~..~. ~ ~ . being duly sworn, deposes and says that he is the applicant (~ame of md~wduol s~gmng opphcahon) above named. He is the .... ~ ~ ~.~ / . (Contractor, agent, corporate officer, etc.) of said ownbr 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 application filed therewith. Sworn to b~ ~ me this ................. , .......... , ........ ..................... Notary Public, ..~...~...~~..~ Cogn~ -- (Signature of applicant) ~ota~ Pubhc, State al New York No 52-0344963, Suffolk Cmmty Comrmss~on Expires March 30, lg~