HomeMy WebLinkAbout5654-z~0~ NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. Z.~gg ...... Date ........... Dec. ... 1.h-. ......., lg. 7~
THIS CERTIFIES that the building located at .. Llttl®. Peaoa~c. 2ay. ~kl Street
Map No. Nassau .Po~ ~1o1~o ........... Lot No. 2~ .... .C. UtCh~g~le...N. ,.Y.,. ......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........ Dec. · .. 2. ....., 19. -71 pursuant to which Building Permit No..~7~.
dated ........ Deg.. ~ ........ , 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 .Pl'i.vate. o~e. family. .dwe2.1i~g .Wit&. &~ldl~iQ~ ......................
The certificate is issued to ...I~,~1~1g*1~;t;t ....... ~e2 ...........................
(owner, lessee or tenant)
of the aforesaid building.
SuffoLk County Department of Health Approval ... ~.o.R, ............................
UNDERWRITERS CERTIFICATE No..peac~$iag ...................................
HOUSE NUMBER ...122fl ...... Street .. l~.t~].~ .PeP~:~t$. ]~aT. A~ad ............
Building Insp?tor
TOWN OF $OUTHOI~D
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PER~tT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF TIdE WORK ,~UTHORIZED) ;
N? 565 Z
Permission is hereby granted to:
......... ~...C~:.~ ....................... ; ..................
........... ~he~ ....... ~,X, ........... ~ ..................
to .... ~. ~.. ,~:~.. ~l~,~.e~..e~.. ~ ~l~r~.: ~:~ ..........................................................
at premises located at .,.j~O~..~.....~J.~J~,~.,~-t,..~.J'~j} ...... ~! ..........................................................
............................................ ~Lt~:Le..~c~z~c..i~t..~, ...... .:.1~,....~,..¢~teho~ae ..........
pursuan¢ to application dated ................................ ]~.....~j...j~ 19 ........ , and approved by the
.Building Inspector.
Fee $.....~,.00- .........
~ Building Insp~i~tor
FORM NO. S
TOWN OF $OUTHOLD
Building Deportment
Town Clerks Office
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
Inspector 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
installations, 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-ex'st'nB '
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 in-
formation required to prepare a certificate.
C. Fees: 1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
pete .~.C, ...... /.~..,../.~2~...
New Building ................ Addition ...... · .~....... Old or Pre-existing Building ................ Vacant Land ..............
Perm,, No .......... ..... Date Of ...............
Health Dept. Approval ....~'~/'.~ ..................... Labor Dept. Approval ................................................
.... ........ ........................................
Underwriters
Approval
Request For Temporary Certificate~ // ........................................ Finol Certificate .... ~ ............................
Fee Submitted $ .~.,.~2. ...................
Construction on above described building ar~.permit meets all applicable codes and regulations.
Applicant ~.~...~~]. ......... ~"..~.~(~..~
Sworn to before me ~is /"~/~ 2(
........ /....~. day of ...~.~..~.~.~..~ ............. (stamp or seal) ~ ~
Nota~ Publi~ .................................... County ~ ~,
6O
/
/
TOWN OF SO TsO'o
BUILDING DE'ART~EHT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ................. .t..,). .................. , 19;..t. .... Pemit No ...................................
Disapproved a/c .................
...................... ~' (Building Insp~or)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Application No .................................
-
a. This application must be.completely filled in by typewrite( or in ink and submitted in duplicate to the Building
Inspectori
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 ofproperty must be drawn on the diagram which is pert 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 g
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, ordi nanees, building code, housing code, and regulations.
(Signature 'df applicant, or name, if a corporation)
................. ..~....~...O.... "(',~,~'~' "~'"'i~ddress appl cant) U ..............
State whether applicant is owner, lessee, ag~~ngineer, general contractor, electrician, plumber or builder.
Name of owner of premises ...................................................................................................................
If applicc~t is a corpora~.e~ signature of duly authorized officer.
· (N~/me and title of corporate officer) '7-~ ~:~
Location of land on which proposed ~o,r,~, will be done. Map No.: ....... ./..~.~. ........................ . Lot No......~...~...~.. ...........
,, Er .~t__.~ j/'~ ~'...~T....'.~....~..-t~...~...~.. ~....~.. ~.. .................... '
Street and p~umDe .................................. ~ ................ Mur~i~Jpality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b. Intended use and occupancy .~ ............ ~ ............ i .................................................................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alt tion .................
Repair .................. Remaval .................. Demolitior .................. Other Work (Describe) ........................................
4. Estimated Cost ~000 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 ............................
~r nt ;LC J~/~
7. Dimensions of existing structures, if any: r o ............................ Rear ................................ Depth ....................
Height /8~ Number of Stories /
Dimensions of same structure with alterations or additions: Front ............ .?.~ .................. Rear ....... ~ ................
Depth .......... .z/.~. .................. Height .............. L.¥.. ........ Number of Stories ......... /. ......................
8. Dimensions of entire new construction: Front ............. (..~. ................... Rear ........ Z:./. ............... Depth ......z...~. ..............
Height ......... {'..~.. ..... Number of Stories ......................................................................................................................
9. Size of lot: Front ........... .~..o.~ ......... Rear ...... ..~.~...Z~... .................. Depth ........ ./..3..-~...~.
10. Date of Purchase ........................................................ Name of Former Owner
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 Owner of premises .,~,~,~.../~...'. .q...~. ............... Address ............. : ............ ~ ................. none No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ...~. ........................ ./~..q~....~.~. ........ Address ...~..~?....C~o4' ~.~ ~.~ ~c Phone
C'~ ~ /~J~/..e. cs J~, / ¢ ~ .............................. No...7..;~.~.,..:~.~../..~..
PLOt DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
,vhether interior or corner lot.
STATE OF N EW.....YO_~(_. t~ ~
COUN
...................... · .'-~...~ ........ ~ .................................... being duly sworn, d~oses and says t~t he is the applicant
(Name of i~dividuat signing application)
above named. He is the ~O~
(Contractor, agar, co~orate 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 t~e to the best of his knowledge and belief; and
thor the work will be performed in the manner set fo~h in the opplicati~~ filed therewith.
Sworn to before me this ~ , 19.~.~ ~ '~
.............. ............................................
oto. ........................................................... Coupe .......................... .............................