HomeMy WebLinkAbout6180-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
THIS CERTIFIES that the building located at ...Bay. &vee ................ Street
Map No .... ~ ...... Block No...XX ...... Lot No.. C~lteho~ae .....................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .......... Apl*~.-~- .21.., 19.73. pursuant to which Building Permit No...6180Z
dated .......... Apl'iX .2t..., 19.73, 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 .. Aooes~J'. agl~dia ..................................................
~'~e certificate is issued to ..... I, awl, a~loS. Malta .................................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .BR ...............................
UNDERWRITERS CERTIFICATE No...1~ ........................................
HOUSE NUMBER ...... .~9~.. · Street ...... ~rml31k. Lane ........................
FORM NO. ~
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)
N? 6180 Z
Permission is hereby granted to:
pursuant to application dated ................................ ./...2 ....... 19 . and approved by the
Building Inspector.
Fee $ ........................
Building Inspector
FORM NO. S
TOWN OF SOUTHOLD
Building Depodrment
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 Beard of Fire UnderwrJters.
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. Swom 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
New Building .................... Old or Pre-existing Building ........ ~ ............... Vacant lend ............................
Location Of Property ......... (~...~.../~....~.~.~,~. ......... .~..~..~..~J~.~.~.~-~ ....... ..~'....~. ....................................
Owner Or Owners Of Property ~.~..(~.~;'~..~,~....~...~.~./.~..Z..~....~.~./~./.~....~,..../~...~L.~.
Subdivision ................................................................ Lot No. ............ Block No .......... ;.. House No .............
Permit No.~./..~..~...?~... Date Of Permit~..~.~.7.~...Applioant ..................................................................
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ....................................
Construction on above described building anodeS, it meets all applicabl~~.L.,~
Sworn to_~pefore me this
...,~..~...~...~day of ...... ~......~.........~...~....~....~.... (stamp or seal)
~ ~ Iron'tut NO, 1
/ ~ IUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
..... .......
Approved ................. ~( ........... ~.~......, 1:,..;.~.. Pemit No ..............
Disapproved a/c ......................... ~ .....................
APPLICATION FOR BUILDING PERMIT
:i ' INSTRUCTIONS ~/~
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector wit[z-
3 sets of plans, accurate plot plan to scale. Fee according to schedule. ~
b. Plot plan showing location of let. and of buildings on premises, relationship-to adjoining premises or public streets or areas, an~l~
giving a detailed description of layout of property must be drawn on 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 o1~
the premises available for impection throughout the work.
e. No I~ilding ~he~l be oceugied or used in Whole or in part for any purpose whatever until a Ce.rtificate 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 Zone
Ordinance of the Tflwn of Southoldj Suffolk County, New York, end otbe[ applicable Laws, Ordinances or Regulations, for the construction of
buildings, edditionJfor, elterationa,.or for removal or de~m01ition, a~ herein described. The applicant agrees to comply with all al~liceble laws,
ordinances, buildi~fg oq~oq~, houslng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or name, if · ~moration)
(Address of applicant)
State what, her applicant is owner, lesme, agent, architect, engineer, general contractor, electrician, plumber or builder.
'. ............... , ...............................................................................................................
·
Name of owner of premises .......................... .%b/.(~'..~ .....................................................................................................
If applicant is a corporate, signature of dUi~/authorized officer.
Builder', Licen,e No .................................... , .....................
Plumber's kicenr~ ~qo .........................................................
El~triCian's ticen~l~No .....................................................
Other Trade's L
!
1. I.~°~tion o* lend on w_hich ~.opo~d work will be done. Ma~ No ................... .~. ...................... Cot No .........................
Street and Number ..~..~..~....'....~...~ .............. , ....................... .C~~-g..~. ......
· Municipality
2. State ex. Sating use and occupancy of preS,sepia.nd0i~t.ended use and occupancy of proposed construction:
e, Existing use and occupancy ................................ ..~ .......... ~7......)/.. ..................................................................
b. end o upencv ....................................... .....................................................
3. Natum~f work (check which apl31icable): New Building ....................... Addition ..................... Altera{ion.....; .........
Repair ............... a' .......Removal ......................... Demolition ........................ Other Work.._[~:..~.....C=v~. .............
~ (Description)
4. Estimated Cost ...... /3,L~.~. ............................. 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, commemial or mixed occuoancy~, specify nature and extent of each type of usa .....................................
7. Dimensions of existing structures, if any: Front .....................Rear .................... :::... Del)th ...................................
Height ........................................................... Number of Stories............ ........................................... ......... ..... .... ..
Dimensions of same structure with alterations or additions: Front .............. ; ........... Rear .........................................
Depth ............................................. Height ......................................... Number of Stories .....................
8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth .................................
Height ................................................. Number of Stories .........................................................................................
9. Size of lot: Front ................. , .................... Rear .......................................... Depth ..................................................
.... Name of Former Owner ........................
10. Date of Pumhase .................................
1 1. Zone or usa district in which premises are situated ...................................................................
12. ' Does 13roposad constructi6n:vibi~ite any zoning law, ordinance or regulation: ........ ..1~..~ .............................................
13. Will lot be regraded .................................... Will excess fill be removed from premises: [ ] Yes . _[~] No '
14. Name of Owner of premises ........... .q~Ji{~.TT_.....~.. ............... ..-i~%j..~. ...........
(Address) (Phone No.)
Name of Architect ......................................................................................
· (Address) . (Phone I~1o. )
Name of Contractor ..~.r~...~.[~=~.~..~ .~. .~A<~....~.~..~.....~Y~.~-~. ................. ,~,c~.;:.....~..(~....~....,~.. ......
(Address) (Phone No.)
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and
property lines. Give street and block number or description according to deed,
er interior or corner lot.
dimensions from
indicate wheth-
STATE OF NEW YORK,
COUNTY OF ...... , ...~ .~...~-~. ~,~. ,~_ ................ )
............ ;' ............. ~'~'~;7~'~;;~ .................... ~ing dul~ swor~, deposes and says that he is the applicant above named.
· He is the .............................. '
of said owner or owners, and is duly authorized to ~rform or have performed the said work and to make and file this application; ~at all
statements contained in this application are true to t~ ~st.of his knowledge and ~lief; and that the work will ~ ~rform~ in the ~n~r
set forth in the application filed therewith. ' ' ~l L~E ~K .
(SJ~m~ of eppEce~t) ..........................
lrOB~ NO. ~
TOWN OF sOUrHOLD
Building Depa,tment
Town C:ledm Office
Southold, H. ¥. 11971
APPLIC:ATION FOR CERTIFICATE OF OCCUPAHCY
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:
!. 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 fram Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, a certificate of Code compliance fram 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 aH property lines, streets, buildings and unusual natural
or topographic features.
2. Swam 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
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 ~ccupancy $1.00
New Building .................... Old or Pre*existing Building ............~.. .............. Vacant Land ............................
Location Of Property ............................. ~.7....~..~.. ......... ~;.~..~..C./3.(~.~.~'."~'~'""""'{"~'~'' ...................
O ner Or O,n,rs Of P "7 .....
Subdivision .............................................. ._...~..,,,i...Lot No ............. Block No ............. House No .............
/ 1~_
,.
Perm., No. Date Of Permit/....~'./.~7~eT.r.~'~pphcont .... · ...............................
Health Dept. Approval .~ ................................. Labor Dept. Approval ................................................
Underwriters Approval .......... .~ .................................. Planning Board Approval .... ..~....'. ............................
Request For Temporary Certificate ........................................ Final Certificate '/
Fee Submitted $ ....................................
above described building ~ meets all applicabl~.~J~l~d )~g~
Construction on
Applicant ~... ~,..- .~,.....~~ ...............
Sworn to,before me this
..Z...~....~..... day of ....... ~.. ~......./..~....Z...-~.. (stamp or seal)
Notary Pub,it ..... ~..~ County _
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
....................... ,
Approved ............................ : ........... , 19 ........ 'Pemit No ...........
^pplicotion No ........ .~.~..~...~.,..., .......
Disapproved a/c ............................................................................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Dote / .
........................... ~.~....~ ./..~......, 19.....; ......
--I
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
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 property must be drawn on diagram which is part of this application.
c. The work cbvered 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 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 Bui ding Zone--
Ordinance of the Town of Southold, Suffo[h 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.~L
ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for npcessary inspections.
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................................................. .....................................................................................................
,_%- /
Name of owner of premises ........... f,,~Y.Z~..../~.(~...~,.,~L: ...........(...... ....... /.,4~...~.....,'......~%.. .....................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which oroposed work will be done. Map No.: .................... Lot No ..............................................
Street and Number .......... ~..~..~. ................ (~'.~....'~.. ..~...~......O.....~..
~ ~ /Municipmity
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .... ...................... ..~...~..'-~.~....~..~...~C .~... ............................................................
b. Intended use and occupancy .......................................................................................................................
3.~ I~latur~ of work (check which apphcable). New Bufld,ng ....................... Add~tmn ..................... Alteratmn...,~........
epalr ......................... Removal ......................... Demolition ........................ Other Work ....................................
~. (Description)
4. Estimated Cost
(to be paid on filing this application)
5. If dwelling, number of dwelling units .................Number of dwellirig units on each floor ........ : ................................
If garage be of ca
,num r rs ................................................................
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 ...................... f...~ .................. Number of Stories ............/. ........... ' .....................................................
Dimensions of same structure with alterations or additions: Front .......................... Rear .........................................
Depth ............. :, .............................. Height ..' ................. ~ ............. ; ....... Number of Stories ........................................
8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth .................................
Height ................................................. Number of Stories .........................................................................................
9. Size of lot: Front ....~.~....~...~.:...('~..~.. ....... Rear ......... .?~..../..~....~......'~ ...... Depth ......... ...'~.....~...~.,...~.~. ..............
Height ............................... v ................... Number of Stories .............. ~ ..................................................... = ................
10. Date of Purchase ..~......./..~.~...~.. Name of Former OwnerJJ~.~........~.....~.~,~......~......~..~'-e/~
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 ....... ~..~'/u- .......... ,.... Will excess fill be removed from I:)remises: [] Yes
[At'No
14. Name of Owner of premises .~..~J .~/../i~.~.(~*~..../....6~...~../.~..~.......~....0...~.C..(3.0..~..~....~'.~ ......... 7..~..~.'...'~..~.J....~...~'./..
· (Phone No.)
(Address)
Name of Architect .....................................................................................................................................................
(Address) (Phone No.)
Name of Contractor ..~. ........................................ : .....................................................................................................
(Address) (Phone No.)
' PlOT,DIAGRAM
Locate clearly and distinctly all buildings; ~vhether existing or proposed, and indicate all set-beck dimensions from
property lines. Give street and block number or des~.~iption according to deed, and show street names and indicate wheth-
er interior or corner lot.
STATE OF NEW YOR__K, ~__ _ , ) ~
COUNTY_OF .......... ............. ) .
...... ~.~.~.~.~~~.~ ........... ~ing duly sworn, de~,s and says that he is~ ,,nt above named.
{Name of indivi~si~g con~act} '
.................. ........................................................................................................................................................ .........
( Cont~ctor, a~nt, coyote o~cer, etc.)
of said owner or owners, and is duly authorized to ~Horm or have ~rfor~d t~ ~id work and to make and file this appli~tion; ~at all
s~tements contained in this appli~tion are true to t~ ~st of his knoWled~ and ~lief; a~ that the work will ~ ~or~ in the ~nner
~t forth in the application fil~ t~ ~
............................... L.~;-...~..a~...,a.~ ....... ~....]19 .............
..................