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Home My WebLink About3122-zPORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificat Of Occupancy No..~...~...~..~...~', Date ,J N lgTZ- THIS CERTIFIES that the bufld~g locat~ at ~ ~ ~ ~A I~ ~ I ~/ff Street Map No ..... ~. ~.~... Block No .... ~ .... Lot No..~ .~ ~..~...~.~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ./..~..~. ~..M .~., 19.~..~. pUrSuant to which Building Permit No. ',~.! dated ......... /.~....~. ?..~..~'.., 19~...., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .......A ...... .~.~..ff ...... .~.~. ?.. (r,..¥ ....... .~..~...E..~../:-.,.~ ~ ........... The certificate is issued to xJd M N ~ /-I P F ~'/~ ~ ~ ~1 (owner, lessee or tenant) of the aforesaid buff.ding. Suffolk Qounty Department of H~alth Approval N-~ . UNDERWRITERS CERTIFICATE No ......... .~'.:. ~ ................................... HOUSE NUMBER .... a .~?...'~...Street ...........~..~...~ ......~...'~. ?..V'.L.". ................. ................................... p. ....................... Building Inspector FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING D~:PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N9 BUILDING P~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3122 z Permission is hereby granted to: ~o~n..,~...l*,~:l'~nr~ ........... .....i,.::..:......~ .i...~...,, ', pursuant to application dated ................................. ~.~ .......~b.~. ....... 1'9.~.(~, and approved by the Building Inspector ~ee $...~.?..0...0. ........... Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTblENT TOWN I~LL 765-1802 APPLICATION FOR CERTIFICATE OF ,/OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of property with accurate lOCation of all buildings, property lidos. streets, and Unusual natural or topographic features. 2. Final Approval from Health Dept. of Water supply and sewerage-disposal(s_9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber Certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code C~pliance from archiuect or engineer responsible for the building. 6. Submi~ Planning Board Approval of completed site plan requirements. ;. For existing buildings (prior to April 9, 1957) uon-conforming uses, or buildings and pre-exzstzng land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state tho reasons therefor in writing to the applicant. ~- Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00 Additions to accessory building $25.00. Businesses $50.00. ' 2. Certificate of Occupancy on Pre-existing Building - $I00.00 3. Copy of Certificate of Occupancy - $5.00 OVer 5 years - $10.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 ......... · ..-.--........l{ouse . No. Street mnty Tax Map N9 1000, Section .. ~0 ~. ~, , / -~d~ ''' ith gep Appr i .......... derwriters Approval ............ · · Un anning Board Approval quest for: Temporary Certificate. Final Certicate. ~.~..'. ..... x ~PPL~CANT · ~-~2 ....... FOlm[ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved · ~ 19..../..~.. Permit No. 3.~'....~'.....~.......~.~:~?~ ~pp~ No..,~,,.,,/.....J~...~ ...... Disapproved o/c ................ APPLICATION FOR BUILDING PERMIT Dote 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 g v ng a detailed cleSChpfi0n of layoat'0f properb/must be drawn on the diagram which is port of this application. c. The work covered by this applica~i0n 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 Deportment 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 at e of ol~cant, or name, if a corporation) .................. ............ ....... .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~T..~.~../e(.....~..,...~,~..~...~.../~...~'...~....~...xg~... ................................................................... ~. ........... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ..... ~...~...../.. ...................... Lot No.: '..~'.~.....~.....~..~... Street and~Number ....~.~.~.. ....... ~.~. ..................... ~ .............. ~..~. ............ .~. .......... ~.. ....... ~. ................ .~/- ,,~ ~,.~' 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 occuponcy ...x~.~'.....~.~.~.~..x~..~.4~. ....... ~./.i/~. ...... ..~....~....~./.[..~..(~.~.~.. ............................... 3. Nature of work (check which applicable): New.Building: · ................. Addition / Alteration Repair .................. Removal .................. Den~:diflon.;...,.,.;.;;.,; Other Work (Describe) ........................................ 4. Estimated Cost (to be paid on filing this application) §. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ......................................................................... , ................................................................... 6. If busine~%., commercial or mixed occupancy, spa~:ify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ........~...~.. ...... i..:.. Rear ................................ Depth ...~.. ........ Height ........................ Number of Stories ............./.. ................................................................................................ Dimensions of same structure with alterations or additioos: Front ........ ~......3:... .................. Rear ...... .~.....~'... ............. Depth ....F.~..." .................. Height ........ ............Number of Star,es 8. Dimensions of entire new construction: Front ....... ~.~... ........ ~........, Rear ..... ~..~....~. ............ Depth ...~ ........... Height ....../..?. ......... Number of Stories ...... /. ............ ~ ............................................................................................... 9. Size of lot: Front ........ ~...7... ........... Rear ....... ~'..~..~... ................ Depth ......a~....~.?... ................ 10. Date of Purchase .,~.,'~.¢~../..~...;'......~....~...~.....~.. ....... Name of Former Owner ...~..~../.~..~'../~.....*~.. ........ ..~...~..?......'~... ..... ! 1. Zone or use district in which premises are situated ..................................................................................................... ~2.. Does proposed cah~truction violate any zoning law, ordinance or regulation? ........... ~....~. ........................................ 13. Name of Owner of premises .~7...~...'~...~...~.:.~.R.~.~.~'~L~..Address ~..~..~/....~..~..~.f...'~'....~.~..~...a~'...L. Phone No~..~.~.~.Z.~.~/ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~T~.~F~...~...~..~.~'..~.,..~ .~..~.. ......... Address ............ ~ ............................ Phone No ........~. ........... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or p~, and indicate all set-back dimensions from property line~ Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. OLP ~' ~ STATE OF NEW,~YOI)I~ ~/] I ~ ~ COUNTY ................ ~~ ,~ . ........ ;,~ .......... being duly sworn, dep_~e___-, and sa~ t~t he is the applicant (~ntmctor, ~ent, co~mte officer, ~c.) of ~id ~r or ~, a~ .is duly a~horized to ~rform or ~e pe~ the ~id work a~ to~e and file this applicatt~; ~at all statemen~ ~toi~ i~ this ~lic~ion are tree to the ~ of his ~wl~e a~ ~lief; o~ · ot ~e ~rk will ~ ~ffo~ in ~e ~r ~t fo~h [~ the a~lic~lon fll~ t~r~i~. S~m to ~f~ ~ ~is ~ /~ . ·