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HomeMy WebLinkAbout4246-zFO~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No... Z. ~461. · Date ......... /~pr;t-~.. -16., ......., 19. Sa THIS CERTIFIES that the building located at .905. l~e~.r~ .I~lvcL. ....... Street Map No ............. Block No ........... Lot No.. ¢l~..ecml~ort, · .~-, 1[..r .l~ew..York. conforms substantially to the Application for Building Permit heretofore flied in this office dated ....... A~rkl~.. ].6,. , 19 69. pursuant to which Building Permit No. 4246 .Z. · dated ........ /~l~r~. ·. ~t6o. ., 19.69., was issued, and conforms to all oJ[ the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...~tcc:®azor.l/' .Du&J~cl~tn~ ............................................... The certificate is issued to .. ~l~.],.~.am. ~.o..C].arR~ ................................. (owner, lessee or tenant.) of the aforesaid building. Suffolk County Department of Health Approval .................................... Building Inspector FOB. M NO. ~ TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 246 Z Permission is hereby granted to ..A..?..~.'!...~.. 19..~,...~.., and opproved by the pursuant to application dated .................................. r.L .............., Building Inspector. Building Inspector 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 l~ 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 the 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 topographie featu res. 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 ~efre'~ ' ' ling $15.00 ~./..~..~../..~.. (-,~:~Cobv of certificate of occupancy 4 . Vacant Lan~ C~ Date ........... New Building .... ~ ...... Old. or ~re-exis?ng Buildi~ ~. ........ ~yacant Land ............. HoumNo. I 0 l/ ~ . ~ ~ ~ ~ ~~ ~ '~ Street ~ ~ ~. ~ , ~ Hamlet ....... ...... ' ....... ¢ ......... ....... [iled Ma0 ...................... Heohh ~e0t. A00rovol ........................ kabor De0t A0Oroval ....................... Unde~r~ters A0pro~a~ ....................... ~lannin~ ~ard A~0roual ...................... Req~esl for Tem~oror~ Certificate ................. Fmol Certificate ..................... IF~ORM ,NO. I TOWN OF SOUTHOLD BUILDING DEPAR~T TOWN Cv.-~'Rw"S OFFICE SOUTHOLD. N. Y. Disapproved a/c .................................................... ~ (Buil(~ing Inspector) APPLICATIO~N FOR BUILDING PERMIT 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 lo~ and .of buildings o n premises, relatio~mhip to adjoining premises or public streets or areas, .and giving a detailed description of lay out of property must be drawn on the dia~3n which is part of this application. c. The work covered by this application may r~t 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 fo r inspectRm throughout the progress of the work. e. No building shall be occupied or used in whole o~ in pa~t for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS 1-1J~Y MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone On:linance of the Town of S~thold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of build ings, additions or alterations, or for removal or demo- lition, as herein described. The applicant agrees to corn ply with all applicable laws, ordinances, building code, housing code, and regulations. -(~ignature of ~l~licant, or name if a corpo auo ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .............................................................................................. S A L--- Name ~of owner of premises ............................................................................... If applicant is a corporate, signature of duly authorize d <ffficer. (Name and title of corporate officer) ]~o 1. Local}on of land on which proposed work will b e done. Map No ................. Lot No .............. Street and Number . ~...~... .......................... .............. ~{~i~i~'~li£~; ................... 2. State existing use and occupancy of premises ~ d intended use ~ ~eu~ey of ~ ~m~ction. a. ~ist~g use and occup~cy / ~1 / ~ ~ ~ ~ / 5 ~ ~ ~- b. Int~ded ~ .~d ~cup~cy ................................................................... 3. Nature of work (check which applicable): New Building ........ Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Other Wo~'k (Describe) ...................... 4. Estimated Cost ......... .~..5..O. .............. Fee ...... ~.. o~--... (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, spec ify nature and extent of each type o 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 Six,ties ..................... 8. Dimensions of entire new construction: Front / 0 Rear / d) Depth Heighl .... .p. ..... Number of Stories ............................................................ 9. Size of lot: Front ....... ./.~..b.--... Rear ' .,. Depth ...~..?Z. ~ .... 10. Date of Purchase .... ...~/'....A~..O..~. ..... ./~. ~.~....Name of Fonner Owner . ..d~..b'. ?..~...~'~"--' ' . .~.~..ff..~..C.~'.... 11. Zone or use district in which premises are situated .... / 5 k-A/-f! A L-. 12. Does proposed construction viola'ce any z~ning law, ordinance or regulati~? 13. Name of Ownerof premises ./~..>q . CL~'/~t--Address)~-$~F~'/~' ~'~'/~-- No. q77'2D-~! ......................................... k'none ........... Name of Architect .................. ./. ........ Address ...................... Phone No Name of ContracWr ............... / ....... .... Address ...................... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set.back dimensions from property lines~ Give s .treet and block number or description according to deed, and show street names and indicate whether interior or Mt~ o $ ff' STA'r~ OF NEW YORK, )S.S. cOUST OF .............. ) ...~f/.....~...~r..)~..~.~..)?.]./?.~....~..... ~ .A?..~..~. ..... being duly sworn, deposes and says that he is the appli- (Name of individual signing application) cant above named. He is the ................ ~.~w~...~.. (Oontractor, agent, oorporate officer, etc.) of said owner or owners, and is duly authorized to per/orm or have performed the said 'work and to make and file this application; that all statements oontalned in th is application are true to the bes~ 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 / day of ....... ................ . UFrdL.. .Count Notary Public, ................