HomeMy WebLinkAbout6161-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. ?-..l~l~lO .... Date ............. ltovo. ID ...... , 19.72
THIS CERTIFIES that the building located at 14.,0.1d,.-lt/S. t-slai~l-.¥1ow .L~ti~et
Map No.. xx ........ Block No. ~c ....... Lot No.. X.X... ~.oent.,.ol~t; .... }loY, .......
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............ (Io.l;..~.., 19.72. pursuant to which Building Permit No6161.Z. · ·
dated ............ .Ge.i;...5. ., 19.~.~., was issued, and conforms to all of the require-
ments of the applicable promsions of the law. The occupancy for which this certificate is
issued is ...P.r.i.v.a~;.e..g.arggo...(..A..c.c.e.~91'y. k~lll.dljag) ..........................
The certificate is issued to . .Arnold. Fsldmari .. · O~ner ............................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .I~,R.~ .............................
UNDERWRITERS CERTIFICATE No .... l'I,lt, .........................................
HOUSE NUMBER.I~-90 ........ Street..I slan,4 · ¥1e.,~ .Lane ............................
Building Inspector
TOWN OF SOUTHOLD
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)
6161 Z
Permission is hereby granted to:
to ..~,~4..~e~ ..p~l..~e..~lmee ...............................................................................................
at premises located at ..~)..~Jle~.....J~.~...~I~T.BIIt, .......................................................................
.......................... ge~r~M~...t~.. ~.. {l~f....Z-~.Zea~l.. ~e~...Z~ ............... e'~eeal~er~ .......................
pursuant to application dated ........................~ ............~ ......... , 19.~/'~..., and approved by the
Building Inspector.
Fee $.t Oe~) ...........
Building Insp~f~or
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
Southold, N. ¥. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instruction8
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector with the following; for new buildings or new use:
I. 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 dispasal--(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-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 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~. ~ ..~....~.Z.~..
3. Copy of certificate of occupancy $1.00
Permit No. ~//~..Z ~... Dote Of Permit ../.~./.~.~.?~pplicont ...~.~....~..~'/,~
Health Dept. Approval ............................................ Labor Dept. Approvol ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate .~... ..........................
Fee Submitted $ .~.,...~ ..........................
Construction on above described building and permit meets all applicable codes and regulations.
Sworn to before me this
............. ?. do.of ...~....(.~..~..~ .........
Notary Public '-~,~: ......-...%~LCounty
TERRI LEE ELAK
NOTARY PUBLIC, State of New York
1~o. bE 6]68295
FO~M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ....... ~......~.. ............. 19..?...~
' 19.?.,,~., Pemit No. ~ f~//'~
Approved .............. .? ........................ , ....................................
Disapproved a/c ...._._~......~ ~ ....... ~...."'"C~
.......................... ................................ '
APPLICATION FOR BUILDING PERMIT /~ '~
//1
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicste to the Building Inspector, witlT~
3 sets of plans, accurate plot plan to scale. Fee s¢¢ording to schedule.
b. Plot plan showing location of lot end of buildings on premises relationship to adjoining premises or public streets or ereas an(~
giving a detailed description of layout of property must be drawn on 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 Bud ng nspector will issue a Building Permit to the applicant. Such permit shall be kept on)-
the premises available for inspection throughout 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 bee
granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zen,
Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction (
buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws
ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessarv inspections
................
(SigJ~ature of applic?/nt, or name.~'a corporatioq)
(Address of applicant)
State wl~. t~h. er,/8~J, icant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buiJder~
If applicant is a corporate, signature of duly authorized officer.
..................... .....................
1. Location of land on whi,~ pro~o~d work, will b~done. Map N~..' ~Lot N~).(..,~.....~......,..~ ' '-"-~' ..~; ...............
Street ana ~umDer .~....~..v...t~....~...*~.....K.L.~....~:~.. ...................................................... .~:,,~rZ,%~,2~...~ .........................
~.O.h/ ~,~ ~- ~"~0 c::~.-~-,-~ ~ o~ ~ ~' Municipality
2. State existing use and ~)ccupancy of premises and intended use and occupancy of proposed construction:
Existing use and occupancy ....... ~,] ............. ~ ........................................................................................................
Intended use and occupancy ..~/~,~ ............. .~,,..~...,,~ .......................- ~f ' '~'~7~' '~ ...............
Repair ......................... Removal ......................... Der~'olition ........- ................ Other Work ....................................
(Description)
4. Estimated Cost ...c~.~.~'J'~ ............................ Fee ....... ~ .......................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ................. Number of dwelling units on each floor .........................................
If gara~, number of cars ........... ~; .............................................................................................................
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 ................. ~"/7' .................. Number/o~/Stories ...................... ~7' ............
8. Dimensions of entire new construction: Front ...... .~....~... ........ Rear ........... ~... ,.Z~. ...... Depth ........ ...~....v~.. .............
/
Height .......... ~ ............................... Number of Stories .........................................................................................
9. Size of lot: Front ../~.~.../. ........................ Rear ........... .~'..~...~...:. ................. Depth .~..,~..~
Height .................................................... Number of Stories ....................................... ,~ ................. ,~ ......................
10. Date of Purchase ........ 2..~...~..~.~...~.. ........ Nameof Former Ownerl~,C,,~..,.d.~t~-4;~
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation:~ ..............................................
13. Will lot be regraded 7~.......~,...--~i.. ex~s f~j~ removed from/pr~_ ,~ey [
14. Name of Owner of premises ...~~._..t~.~ ......... ~.~~4;::~., ..... .q ..~....~....~..."',-,-,-,-,-,-,-,~'.?~.-
(Address) (Phone No.)
Name of Architect ...........................................................................................................................................
. .~/..~ :~~~_~,~,ddress) (Pho e No.
Name of Contractor ................................ '" ,2~A~')' ............................ ([~'l~'e'~:i ...... 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 wheth-
er interior or corner lot. I / O' ¢~L
STATEOF NEW~;(:~, /"/,!. //
cOU.TY OF ................ ss
................................. ~ ......... ~~.~ ........ being
duly sworn, deposes and says that he is the applicant above named.
(Name of individuf.~ ing
(Contractor, agen t, 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
,;tatements 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, lr£RRI LiE [LA}(
~ ~--~ ~ NOTARY PUBLIC.No R2-~r,~9 ~State of
........................... ....................................
Notary Public, .~_~g ~~ ......... County ...~_~....._~_~~ .............................
(Si~ture of applicant)