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HomeMy WebLinkAbout4156-z FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N? (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) pursuonrt to opplicotion doted ...................................................... '......, 19 ........ , ond opproved by the Building Inspector. Fee $~?...~7' FORIVf NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. TEMPORAllY Certificate Of Occupancy / N~27~ ....... Date g~e 29 .., 19 .... E/S Cox ~eck THIS CERTIFIES that located at Street Map No. ~ ........ Block No ..... Lot ~ Matt~tucE N.Y. conform~ ~ub~miaHy to the ~ Permi~ h~retofore filed in this office d~ed Mmy ~ 19 7' ~s issued, conforms to aH of the require- ments of the applicable provisions issued is Private one The certificate is issued to . .R©. of the aforesaid building. Suffolk County De~ House # the law. The Adamson O~mez* (oWnez for which this certific~t%ia ..... or tenant) Health Approval June 28~ 1971 by R2Villa Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter~R ink, and su[~mitted l~ to the Building Inspec- tor with the following; for new bu[Idlngs 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 Unde~rwriters, 4. Commercial buildings, Industrial build[ri§s, Mu{tip[e 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 requiremer~ts where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 building~s or premises, or other pertinent informa- tion required to prepare a certificate. Copy of certificate of o, Updated C.O. Fees: 1. Certificate of occupancy $25·00 -- BUSINESS 850.00 ACCESSORY 810.00 2. C~rti~ on pr_g:e_x, isting dwelling $ 5 0~0_.0~ ~pancy ..... ~5--]'-b~-'---~-e~5 years $ ]0.00 NewC°nstructi°n ...... O Location of Property . .f~...¢~.'.. Hous~ No. Owner or Owners of Property County Tax Map No. 1000 Section Subdivision .~ q'~b o Permit No. ~,~,.~.G~,. O Health Dept. Approval or Pre-existing 8u ............ Vacant Land ............. Street '' .7.0. ...... loc .. ,.. ...... Lot...¢./.?. ....... ¢.~ ..... Filed Mat) N8 ........ . . .Lot No .............. t 'Z~' ' .Applicant .......................... · .Labor Dept :Approval Underwriters App/~al ...................... ; ·Planning Board Approval Request for TeMporary Certificate ..................... Final Certificate ,~ Fee Submitted $ .~ .................. Construction on above described building and permit meets all appficable codes and regulations· ;FORM ,NO I /~'~. 'TOWN OF 8OUTI"IOI, D BUILDING DEPARTMENT ,/~: TOWN CL n 'S OFFICE Examined .................... 19 ;. 7. Apppove,d .......... .~. ......... 19 .... Permit No....~....(..~. ..... .~ Disapproved a/c ......................................... ...................... ................ Application No...~..! zC'z - APPLICATIQN FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Ptotplan showing location of 1~ and of buildings on premises, relative,ship to adjoining promises or public streets or area~, and giving a detailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this application may ~t be commenced before issuance of Building Permit. d. Upon apuroval of this application, ~he 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.{n whole oN in part for any purpose whatever until a Certificate/d Occupancy shall have been granted by the Building Ins pector. APPLICATION IS I-IJ~J~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ~one Ordinance of the Town of S~uthold, Suffolk County, New York, and other applicable Laws, Ordinances or l~egulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described· The applicant agrees to com ply with all applicable laws, ordinances, building code, housing code, a~d regulati.0ns. (Signature of .applicant, o~ name if a corporation) · ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber o~ builder ................................................................................................... Name of iowner of premises. ~:... ~&~ ......................................... If applicant is a corporate, signature of duly authorize d officer. (Name and title of corporate officer) 1. Location of land on which·proposed work will be done. Map_No ..... .~.~ ..~.. .... Lot No....~,. ......... Street and Number....~./~...'..~..../~..~-....c,~....../~...~..~,.... C..~.~. .0.,..~..~. .................. Municipality 2. State existing use and ~coupancy of_premises an d intended use and occupancy of proposed ~onstruction. :: U,u:e ...................................... ~3. 4. 5. 6. 7. o 10. 11. 12. 13. Nature of work (check which applicable): New Building ........ Add.i~ion ...... t.eT ....... Repair ......... RemOval ........ Demolition ........ Other Work (Describe) .~..'.~:.~ .-; ...... Estimated Cost ..... ~.,~...O.....~.... Fee '-~-Cr'O ',i ............. (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 ................................................. ' ......................... If bus/neSs, commercial or mixed occupancy, spec ify nature and extent of each type of use .............. 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 ......... Dimensions ,of entire new construction: Front ..... ~ ....... Rear ~ 'I~ ! r~ Height Number of Stories ~ ............................ ...................... Size of Sot: Front ....~...~....~ ..... Rear'. .... .'... ....... Date of Purcl~ase ............................... Name~ F~'m.~wner ...~..~.~~. ....... ~one or use district in which p~emises am situated .......... ~...~. ............... ~'! i~ .................. Does proposed eon~wuction violate any :m~ing law, ordinance tlr regulation.* .. !.Y. ..................... N~e of Owner,of p~mises .[...~'+....~..~ .0~-,~dre~ ...~.~ ......... Phone No ............ Name of ,~chiteet ............................. ~ddress ...................... Phone No ............ Name of Contractor .... ~.~ ....... Address ...................... phone No ............ PLOT DIAGRAM . clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions ' lines. Give street anal block number or description according.to deed, and show street names and whether interior or corner lot. STA'~ OF COUNTY OF individual signing cant a.bove named. He is the ...... of sa~d owner~or owners, and is duly authorized to perform file this application; that all statements contained in this · being duly sworn, ,deposes and says that he is the appli- y, agent, corporate officer, etc.) the said work and to make and to the best of his knowledge and belief; ,and that the w~rk will be p~ed in the mann er set fortl/in the application filed therewith. Sworn to before me this NOTARy PUBLIC, Sta~ No. 52-061S100 Suffolk Commission ~pge~ i~!arch (Signture of applicant)