HomeMy WebLinkAbout3857-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHO~.D, N. Y.
CERTIFICATE OF OCCUPANCY
No..~J2~3 .............. Date ..................... J~J~ ......... .~.~j ........... , 19..~.~..
THIS CERTIFIES that the building located at .....J...~........~....~.Jl .~....Z~.......[~... ........................... Street
Map No, -gLtr~ ............. Block No....:lOOl ............ Lot No....Jl~[ ......... [a~I:J,.,Na~iJ ...... .JifY. .......
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.......... : ................................ ~[~I~IL~.. ....... ~).~ 19..6~ pursuant to which Building Permit No....~.....
dated ............... ~"""A~rl'~.~ .......... I)~ ...... , 19.68., 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 ........
\
.... it~.4 va.t,e., erie ~..f4tm~y ..d,w~l..~.~.ng. ..........................................................................................
The certificate is iss~ued to ....J~,~l.~Jll~t,..~tO~13KtJJ[~ ................... .{)NfJJ,~.~. ..........................................
~. (OWner, lessee or tenant)
of the aforesaidIbuilding' HoD.App:r~l,e.3. &l~ 1~! 1968
Building Inspector
FORi~ NO. 2
TOWN OF SOUTHOL~
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? 3857 Z
Dote .................................... , 19 .......
Permission is hereby groT to: ...... .
....................... ~)~ .................. ......................
to ~.. ~..~...{~.~.~ ...................... ....: .................... : ...................................
Building Inspector.
Fee $, -?,.?~. ..........
SCHD
SUFFOLK
COUNTY DEPARTMENT OF HEALTH
: Am~st 15~ 1968
Date ,,
Bldg. permit No. 38~7
TO WHOM IT
MAY CONCERN:
The sewage
disposal
facilities for a structure located
at F,,/ $ Sh~nvard Lane
(Give deed
location)
have been inspected by this department and f~und to be satisfactory.
Owner0 Sigmunt Sosnowski
Builder Mauro gnte~rises Inc.
Di~lc~' ~nEineer
FORM NO. 6 ~
TOWN OF SOUTHO~D
Building Department
Town Hall
Southold, N.Y. 11971
765- 1802 :
APPLICATION FOR CERTIFICATE OF OCCUPANCY
L., [OW,N OF SOUTIk*~LD
Instructions
A, This application must be filled in typewriter OR ink, and sdbmitted m ilmammma to the Building Inspec-
tor with the following; for new buildings or new use:
1. Final survey of property with accurate location of all b~itdings, 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 buiMings, 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 re~luirements where applicable,
For existing buildings (prior to Aprit 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.
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
5. Updated C.O. $15.00
$15~.00
Date .......................
New Building .... ~ ....... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ....... ..~.. · ,~.' .¢.~....~,..(~Q,..~,..~.'. ~:',¢J~ ...............
House No. I , St, (eet ¢~ Hamlet
Owner or Owners of Property,...~.O.~..~..0..P..0..~'.~..nh.~.[ . ~" ~L~ . ~). ,~.
County Tax Map No, 1000 Section .... ~.? ....... Block. ,! ....... Lot ..... /..~. ........
Subdivision ................................. Filed Map NO ........... Lot No ..............
Permit No.~.~..~.?. ~, Date of Permit .......... Applicant, i.2~.~?. ~...~.O..~..~.0..[~..~, ·~.'
Health Dept. Approval ........................ Labor Dept. Approve ....
Underwriters Approval ........................ Planning Boa?d Approval ......................
Bequest for Temporary Certificate ..................... Final Certificate .....................
Fee Submitted $..\ ...........................
Construction on above
d scribed budding an,~perm~t meets a app lcab e codes and regu atlons
..................
Rev, 10-10-7e - i'
Exam,ned ..~/~"~. ~
........................................ , 19 ........ Permit No .............................
TOWN OF SOUTHOLD
BUILDING DEPA~tTMENT
TOWN CLL~K'S OFFICE
~, N. Y.
19...~.
Disapproved a/c .............................................................................
.......... (B~ ...............
APPLICATION FOR BUILDING PERMIT
................................. ......
INSTRUCTIONS
a. This application must be cor~pletely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or publ c streets or
areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the progress of the work~
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New Yor~k, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as here n described,
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations,
($'gnature of applicant, or name, if a corp~ratian)
.... ............ ....... ...........
(Address of applicant) 0
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner of premises ..... ~..~...?..,~,~..,_..~_.....:.._...~ .......................................................... .....
If applicgnt is a ,e,orporate, signature of duly authorized officer.
......... ............. ...................
(Name and title of corporate officer)
1. Location of and on wh ch prop_osec[w~tk w be done Ntap No.: ~..~-r~::~..: ........ Lot No' ~...~ '
Street and Number ....~..~.~.....~...~....../.~....~..~..~....~../.~..,~..~.~: ........................ v u . Municipelity
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~ ~ .........
b.
Intended
occupancy ...~.~....~ ......................... ~ ..................... ;'ii ......
use
and
3. Nature of work (check which applicable): New Building ...~ .......... Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
0,
4. Estimated Cost ..... /-~.T~.~...O.. .................................. Fee
(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 ............................
7. Dimensions of existing structures, Jf 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 ....~...~. ........................ Rear ...... .~..~. .............. Depth .....~'..~..,,[....~.. ....
Height .................... Number of Stories ..... i../ ............................................................................................................
9. Size of lot: Front ...J....r~.. ................. Rear ...... /...~...O.. .................... Depth ...~.~.~.......p~ ..........
10. Date of Purchase ........................................................ .Nome of~Formqr, Owner .....-~.qL\' ...........................................
12. i ..................
13. Name of Owner of premises ~ ....................................... i
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ..-~..~..~.....Address~.~..~<.~'~/~.../Y....../~... Phone
No.~...~. I..~...~..,~. 0
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-l~3ck dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW ,Y-DEF-~.. O~
COUNTY Of ...~~......$~'~'
above n~med. He is the ................ ................. ~~ ...........................................................................
(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 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 Jn the application filed therewith.
Sworn to b~r~e this
................ of ........
. . ¢/' , ...... .........................................
Notaw Public, ~.]..J~...~..,.~. County / (Signature of applicant)
~ARIO~ ~- RE6ENT
~OTARY PUBLIC, State of New Yor~
~o 52-3233120 Suffolk Coun~o
~ ~¢ras ~rch 30,
RE-DAT£D,
MAP Of PROPERTY
GUAF~ANTEED TO:
RICHARD WILHELM
AND ASSOCIATES
LAND SURVEYORS
Center Moriches, N. Y. 11934
Tel. 878-0120
RE-DATED,
SITUATE
MAP OF PROPERTY
~-.4~5T ~-//g~.~/~o.4/
TOWN OF'
GUARANTEED TO:
JOJ~ NO. _8207~
PER
RICHARD WILHELM
AND ASSOCIATES
LAND SURVEYORS
Center Moriches, N. Y. 11934
Tel. 878-0120