The URL can be used to link to this page

Home My WebLink About6270-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z5268 ....... Date ............. JuJ.y... L~0 .... , 19.7~. THIS CERTIFIES that the building located at W/$ .Eob~.~t · Ro~d .......... Street Map No. Fova~Aers..~sl~ll0~l~% ........... Lot No....~.18. &.~.1.9....~.O~tho.~4 ..... :.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ No~ .... 29., 19.7.~. pursuant to which Building Permit No. 6270Z.. dated ........ ~.o.'~ ..... ~9 .... , 1~2.., 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 .. ?r.~.v..a.t.e..o.l.~.e..~..a~..$.~X .~..wg.~.~$~.g ...................................... The certificate is issued to . .~r..&..PV$..~'.~]~...6~..~.~.~.a ..... .0~...~?.~. ................ of the aforesaid building. Suffolk County Department of Health Approval (owner, lessee or tenant) h,R, ............................... UNDERWRITERS CERTIFICATE No.pOl~.~g ......................................... HOUSE NUMBER..2200 .Street, I-Iob&~; ~O&~ Building Inspector FORM NO. 2 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) 6270 Z ~...c~..e~be~ X~ 72 Date ........................................................ 19 ........ Permission is hereby granted to: Ro t It att ..A~..C. Arthu~ Olella & ~iI'e $outhold Build an addition on existing dwelling _L. ots ]11~ & 11~. F.o....u~..ders Bstates at premises ~ocate~ at ....................................................................................................................... W/$ Hobart Roa5 So~thold N.Y. pursuant to application dated ........................N.O.v..e..~.~...e..r........~..9.1.., I9..Z2.., and approved by the Building Inspector. Building Inspector FOEM NO. ~ TOWbi OF Building Department To~n Cledm Office Southold, bi. Y. 11971 APPMCATION FOR CERTIFICATE OF OCCUPANGY Instructions 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: 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 dispcsal--(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 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 3. Copy of certificate of occupancy $1.00 $5.00,/. Date ~. ......... l....l...~'....I..~...... ~. ...... New Building .................... Old or Pre-existing Building ..~..... ............ Vacant Land ............................ Location Of Property ...~.~..~....././.....¢~.....~...~./...~........~..C>..~...,-~/.~...~..S~......~...,~'.~...'~.. ........ Owner Or Owners Of Pro-~rt'' Permit No....~....?..J.e.,~Dote of Permit .~.~...~.?'..V.'[AJ~pplicont ~.,,~.~..~...~/_~. ~.. ..................................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....~,.',,~....,~, .................. Sworn to before me this / ..... · ~ '"03'...'~ ~day~.~f · · ,,,~, ,, ~,~ ' ........ ,~.-~.,,~,.,~ ........... ' (stamp/ or seal) ~/~ ~ ~ ' ~ c~ . /f)~, Nota~ Public ~.~~ Coun~ TERRI ~ ~T~Y ~UBLIC, S~te ol New Yo~ FOaM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~.....~......c(. ...... , 19..~.....~' Approved ............. .~.[. ......... :..(. .......... , 19..:.~.... Pemit No ..... ..'~.....~...~..~... Disapp ro~',~l a/c ......~.......~_..~ ........ ........................ ............ .............. : ......... (Building., Inspector) / 7/ q- Application No....~....~....~...c,2. ............ ~ ~'~c~ //~_~.~ APPLICATION FOR BUILDING PERMIT ................ ................. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wit~ 3 sets of plans, accurate plot pien 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 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 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 be~n 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, Suffo[l~ 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, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inslaeCtions. (Signature of applicant, or rC~e, if a corporation) ....... ................. (Address of applicarl~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; Name of owner of prem scs ~ - ~ If applica,~6is a corporate signature of duly authorized officer. (Name and title of~q~porate officer) 1. Location of land on which prpposed work will be done. Map No.: ~.~ Lot No .............................................. Street and Number ......... ..~.~/~....../.~.~...../....~.....%...~. ................................................................................... o~,~,~ O C~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: use and occupancy '"'~'~~~"~','-"~"'x~. _,- ' ~/ /~, ............................................................................. a. Existing occupancy ~/........~.......~.....~..~-" ......................................................... b. Intended use and 10. 11. 12. 13. 14. Natu;e of work (check which applicable): New Building ....................... Addition ..... ~..... Alteratron.....:.-. ....... Repair ...................... ... Removal ....... ................. . Demolition.......... ...... ........ Other Work .................................... (Description) F~timated Cost ....~....~........~. ........................... Fee ................................................................................................. (to be paid on filing this application) If dwelling, number of dwelling units ..../.. .......... Number of dwelling units on each floor ......................................... If garage, number of cars .............................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................................... Dimensions of existing structures, if any: Front., ...................Rear ........................... Depth ................................... Height ......................................................... Number of Stoie .~....~....{~ Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ............................................ . Height..... .... .................... ............ Number of Stories ........................................ Dimensions of entire new construction: Front ......... /..~ ......... Rear ........ ;~T..~. ............. Depth ................................. Height ................................................. Number of Stories ........ ~. .............................................................................. Size of lot: Front ..... Rear ..... Depth .................................................. Height ................................................ Number of Stories Date of Purchase ..................................... Name of Former Owner ............................................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposad construction violate any zoning law, ordinance or regulation: ........................................................... Will lot be regraded ..~..5. ........................ W[U exoe~ fill .bo mmo~d from premisas: [ ] Yes [~ No Name of Owner of prem / sas ............ ........ (Address) (Phone No.) Name of Architect ..................................................................................................................... J~'~;{~"l~'~; ................ // - - *~ {Address) . J ( .) of Contracto~; . . . · ~ ~ ' ~ 7~/ -- ~ Name ~ ~ ~ (Phone No.)..~.., PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-back dimensions from property lines. Give sl[reet and block number or description according to deed, and show street name~and indicate wheth- er interior or corner Io~t. ~ (Name o/itl '~t'~'~7) .................... being duly sworn, deposes and says that he is the applicant above named. · ( Fie is the .~...~.~.~.~ .ii. ................................................. : ............................................................................................. (Contractor, agent, 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. TERRI LEE ELAK ..~ NOTARY pUSLIC, State of New York No. 52- ' ~5 , ......................... o, ....... ------- NotaryPublic, .~ ................... ~ ........ County .... ..G~....~~.,...~ .~.......~..~ ........................................... (Signature of applicant )