HomeMy WebLinkAbout3733-zFOi~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No...~..~.f.!...:~. .....
Date ....................................... .]..~.)~.~.4, 19 ........
THIS CERTIfieS th~ the b~ffdi~9 ~ted ~t ...................................................................... Stree~
- i ~- ~'
~ ~...e:..~E.~ ...... ~,~ ~. ~ ......... ~ ..... ~. .........................................................
conforms substantially to the Application for B.ujJ,ding Permit heretofore filed in this off~ia~.)~a, tedy
.................................................................. , 19 ....... pursuant to which Building Permit No .................
dated /7z ~"c.. 1~. Z 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 ........
.D.. ~,/: /../::..L(>.L~: .................. I....!? ?' : ',. I"
................................. t~:~w/'r, '"¢'"':,:4":): ....... Z"':~'"~"::: ....................
The certificate is issued to ....................................................................................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEFAltTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
Permission is hereby granted to:
.............. ~4e~,~e~...~.'a.~L~4~.~..e~,.~.O, ,~;~em~ ~
tO
at premises located at ....;[O-t,.....],.~ ....... ~l~:f/,~O~ ..........................................................................
.................... ~!eeel~oe~...Z,~e ............... Se~*~e;[~ ............................................ -....: .....................
pursuan¢ to oppli~:atJon dated ................................... ~¢-e .......~,....., 196~...., and approved by the
Buildin~ Inspector.
,Fee $...~.1~ .........
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 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
natu raj or topographic featu res.
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 peoperty 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 or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date .... ~ ......
New Building ............. Old or Pre-existing Building . ~ ........ ~VaAant Land . ............
Location of Property ......... .~...'~... ~.~. · .~. } . ~ ~)~ ....................
Owner or Owners of pHr:;S;rtA;'.....~..~.~ .'~ .~..,~,,~:r:~.~_~A ~. ~ ~& ~a~, ~'~
County Tax MapNo. 1000 Section ..':~.~ ..... Block ...X.~ ........ Lot...~..
Permit No ........... Date of Permit .......... Applicant ...- ...............................
Health Dept, Approval ........................ Labor Dept, Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ................. /':~al Certificate ..~ ..................
Fee Submitted $.. l .~ .~. ..................... / / / ~-- ~tl~
Construction on above described building and permi~ e~ts I///~licable~de~ and regulation. '~P
Applicant..~.-~..~~ .... ;.. ~.~.....,'~".~
,.,.,o.,a.,a , RY FLANNER OLSE;.I
P. O. Box 38
J ain Road
Uattitu&, L. I., N.Y.
S-9
SCHD
TO WHOM IT MAY
at
SUFFOLK
CONCERN:
The sewage
COUNTY DEPARTMENT
Date
Bldg.
OF HEALTH
October 7, 1968
Permit No.
disposal facilities for a structure located
So, th Side Beachwood Lane on Moose Creek (Give deed location)
So~,t~wood Estates~ So~tho].d
have been inspected by this department and found to be satisfactory.
District Engineer
District Engineer
FOI~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ........................................ , 19 ........ Permit No .................................
D~sapproved c/c .......... :.~.~ ....... ./ ........ ::~,.~...,: .................... ,.~ ............................
................................... ....................
(Building Inspector)
Application No .............................
APPLICATION 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 lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout of propertymust 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 o 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)
/I ~
.... .......... ....... .......
(Address of applicant)
State whether applicant Js owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...................................... ..............................................................................................................................
Name of owner of prem,ses ........... ~..~.~....~.Z ....................... ~..~.~ ........................ ~ ............. ~. ...........................
If applicant is a corporate~sig~u~ duly authorized officer.
.........
(Na~e ~nd titl~o~corpot
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:
o. Existing use and occupancy ...................... ~..~.~.~..'~ ....................................................................................
b. Intended use and occupancy ...... ~.~.....~-~.~X/.~.~. ......... ~..H~..~.~.~...{J)L~. ................................................
3. Nature of work (check which applicable): New Building ...... ~ Addition .................. Alteration ....... : ..........
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
4. Estimated Cost ............. ~..~ ............ : ............................ Fee .........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelHng units ........ .,O../~/.~.. ......... Number of dwelling units on each floor ...... ~./.~/...~.~,. .........
If garage, number of cars ................,~..k~C.~ ...............................................................................................................
6. If business, 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 .............. T..ZZ....~ ....... Number of Stories ........................................
8. Dimensions of entire new construction: Front ......... ~.~..~.'..~ ....... Rear ......... ~.~...O....~- ....... Depth .....~...z:./.. ............
Height ......... ,~.. .......... Number of Stories ......... .~2r~..~:.~. .......
' ..... ..............
9. Size of lot: Front ....... ~..Z.:...~../..... Rear ..... ./...~.....~.. ....... Depth
10. Dote of Purchase ......... ~...~..c.'..~..../..~.~...~.. ................. Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............. /.~..~ .................................
13. Name of Owner of premises /?~/~j/~.~..~./~./~.......Address~..?.:~..`~../.~.~.....~..~..I.~.°.~.~/'~. Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor .~.O. 7~..J..~...¢./~...J~...u.(6/~./t/~..Cq}~ddress ..}J(#J.J:.~...~...Jv/~./.~.u..~.~..... Phone No,~.2~.: ..~/..~..~.,
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions from
property lines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner Jot.
f. F oo c e
STATE OF NEW ~0~, ~ i ~ S S
cOUN~ OF .~ ......... [ ' '
...... ~~ .............................. being duly sworn deposes and says that he is the applican~
abow~ named. He is the .~...~..~r.~.....z..f.....r ........ ~.n~.:...~.....~..~:; ............................................ .
~ ~ (Contractor, ~e~ corporat~ officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
th s app icat on; that a 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~eJ~r~me this / ~
Qu:~}:;'~d in Suf[o~k County
FO~ NO. !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y,
Approved ........................................ , 19 ........ Permit No .................................
Disapproved a/c .............................................. - ~'~¢~--~:¢~, ~P~)
...................... i'l~'~'i'l'~i'~' ' i ~ ll~'~ ~ ' ~ ~.i ................................
APPLICATION 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 lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, and giving a detailed description of layout of propertymust 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 hove been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
....................................... ..............................................................................................................................
Nome of owner of premises .............. ~(,.I~J,[.O,.f~./..°.,....',~..:....~.fY.l~.......'~.~.~.e.~.,,...Z-~.; ........ ~..,~...~l,..,~,,. ...................................
If applicant is/a corporal, dgg~ature of duly authorized officer.
...................
· (~-4a~e ana' p '
1. Location of land on which proposed work will be done, Mop No: .......... ~,./..,~../. ..................... Lot No: ...~..~,.~.. .........
Street and Number ..J~...~.(~..Y.~..~,~.J,~. ...... ~./~..¢[.~, ............ ,.~.P..q..[.,.(l,.~'f,¢.6/,). ....... ~.,~.., .............................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Existing use and occupancy ..................... ~//.~..C,.Z{...~.,: .........................................................................................
b. Intended use and occupancy ........... ~.~/..~....../~.~./.¢Z../?.,~... ...... ~..~..(.'../~.~¢~..J.(~..~.~.~.. ..............................................
3. Nature of work (check which applicable): New Building ...... ~ ..... Addition .................. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
f' -~ e ~ ~.~ .
4. Estimated Cost ............ ./...)...~/2~. ........ ~. .................... F e .............. ~ ...: ..................................................................
(to be paid on filing this application)
5. If dwe[li'ng, number of dwelling units ..... ~.~.~ ............ Number of dwelling units on each floor ..... ~..~Z.¢~ ..........
If garage, number of cars ................~M~.O ................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each Wpe of use
7. Dimensions o~ existing structures, if any: Front ........... := ............ Rear ....... ~; ................. Depth ........~ ...................
Height .............. '~; ............ Number of Stories ............................ ~ .................................................................................
Dimensions of same structure with alterations or additions: Front ........ ;T;::~ .................. Rear ..................... , ...........
Depth ............. cz'. ............................................ Height '~ Number of Stories ..... ~ ..............................
8. Dimensions of entire new construction: Front ...... ~.~...~ .......... Rear ....... ~ ..............Depth ....~...~..[... ...........
Height ...... .~...~ ............ Number of Stories ........ ~..~L~ ..........
9. Size of lot: Front ..... ~.~..'...~/. ........ Rear ..... /.~.~.:.~ .... Depth ...~.~...~ ...............
10. Date of Purchase ........ ~..~.~....~.~.~. ................ Name of Former ~ner ........................................................
1 1. Zone or use district in which premises are situated .................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~..~ ......................................
13. Name of ~ner of premises ~.*~..:~.~..?~.~;5:~.~..Address ~.9...~.~... ~ ....... ~..~a...(~. Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ~;~:ZEN.~.~..~.v.l.6.~.~]~..~g~Address .~[.~Z~J...~.~...~(8~ Phone
PLOT DIAGRA~
Locate clearly ~nd distinctly ~11 buildings, whether existing or proposed, ~nd indicate ~11 set-b~ck dimensions from
property lines. Give street ~nd block numbers or description ~cco~di~g to deed, ~nd ~how street n~mes ~nd indicate
whether interior or corner lot.
0
STATE OF NEWIYOJ~,K.// ~ ~ c
COUNTY OF~~ ......... ~ a'~'
~~ ................................. being duly sworn deposes and says that he is the applicant
................'~f~' ?'~ ~N'~me of indi~~g~ ~pplic~ ~~ ~
,,. ......................................... - .........
. .........................
of said owner or owners, and is duly authorized to perform o~ 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 ~hat the work wil be performed in the manner set forth in the application filed therewith.
Sworn ~fore ~: tho~ ~ ............ 1~ .~~~/' / - ' /~"
.......................... . . ......... ........................................ .