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HomeMy WebLinkAbout6269-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office ' Southold, N. Y. Certificate Of Occupancy No. ~..5~9 ..... Date ........... ~Tu3.~ ....20 ...... , 19.73. THIS CERTIFIES that the building located at .W/a ]~O!~.~;. Ito~d ......... Street Map No..FoYers..~o~k No ........... Lot No..1 ~8..&. 1 .~.9. .... j~O~4...~...~., conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ]l~r... ~f}.., 19 .~.2.. pllrsuant to which Building Permit No.. dated ......... ~1.o.~ ..... 29..., 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 ... F~.$¥a.~.e..g&Ir&$e..(.~q~..e.s.s.o.~.~..B..~..[). ................................ The certificate is issued to . .lq~,..~..l~.?.~..g.~.$.h.~....6.~.e..1~.~. .... . .0~...e,.8 ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .N,R.o .............................. UNDERWRITERS CERTIFICATE No... I~.~R~ .......................................... HOUSE NUMBER..~..OQ ....... Street...~l..°b&.~...~..~..o~.~.. ............... ; ................. Building Inspector FORM NO. 2 TOWN OF SOUTHOLDi BUILDING DEPARTMENT TOWN CLERK'S OFF!Gl SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PAEMI~ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 6269 Z Dote . J.., ~ ' , 19..~. ............ ~: o~e~be~z· .......... ~.. Permission is hereby granted to: .......... ~o,~ .tA~ ......... ~.o¥. ............................... to ~3~i3~ .. ne -~.. p.~ £v.~/~e..~a~,~.~ ................................................................................................. ........................... ~ a.s..,~p~.r. ~v e & .. ~,~...,~i...A~ e a.~. s.) .......... : ........................................................... et premises located at .......... ~./¢J..~[~'bO,.'~...~a~ ....... .~O~-~..i,'j..~..&-..~-~.¢)..--.j?~?,L~,~.-.~,e:t{ts ................................................ -~o~;~).:L4 ............ ~.,.Y., ....................................................................... pursuant to application doted ......................J~C~' ............ ,~.g)..~ ...... , 19..~..., and approved by the Building Inspector. Fee Si.Q,, D.(] ............. ui ding ns~6ctor / TOWN OF SOUTHOLD Building Depo~tment Town Clerk~ Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions (~ ~ A. This application must be filled in typewriter OR ink, and su~bmitted int~' ~t~ o the Building Inspector with the foliowJng; for new buildings or new us~: 1. Final survey of property with accurate location of all ~uildings, 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 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, ~treets, buildings and unusual natural or topographic features. 2.Sworn statement of owner or previous owner as to use, oFcupancy 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 / . ,~ ~ Da,e ........ New Building .. Id or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..................................................................................................................................... Owner Or Owners Of ~r~perty/.~T.L~/~/~..~/.~.~.~.~.~..~:.~./--..~/.~..~:.~.~`..~).~..~/..~.~./~.~z'. ............................................. ,... Subdivisio~.~J)~.S:...~.~.~:~...., ........... .,..Lot No .......... ~.. Block No ..... : ....... House No ............. Permit No. ~.'~..~.~Dote ........ :¢ .... ......... ¢ ......................... Hoolth Dept. Approvol .................................. ~ ........ Lobor Dept. ~pprowl ................................................ Undorwriters Approvol .............................................. Plonnino Bo~d Approval ........................................ Request For T~om~ Ce~ific~te ........................................ Final C~rtific~to .......................................... . Fee Subm~tted-~ ~-~ .............................. Construction on above described building on, permit meets all al~plicabl?, codes and regulations. Applicant ..i.. .~ ................................... Sworn to before me this .... day of ............ (stamp o, sea, / TERRI LEE ELAK NGTA~Y PUBLIC, State of NeW York No 52-6168205 I~alJtie~ m Suftoi~ Coul~y Commissior~ Expires ~,~arch 30, [9 ~0~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned .... ............ ?,,/z z/? ~' Application No......~....~,~..(.i.~. .............. Disapproved a/c ............................................................................................ · r~/ , 2t ~ ./ I .... " f' ................... ~ilding 'lnspe[~ : " I ~STRUCTIONS a. This a~lication must be com~etel~ filled ia bg tV~ewriter or in ink and submitted in triplicate to the CuHdin~ ~ns~ector~ wi 3 sols of plans, accurate plot plan to scab. Joe according to schedule. b. Plot plan showin~ location o~ lot and of buildings on premises, relationshio to adjomin~ premises or ~ubhc streets or areas, ~iuin~ a detailod description of lagout of prooertg must be drawn on diagram which is part of this application. c. The work covered b~ this application ma~ not be commenced before issuance 6f BuilOin~ Permit. d. H~on approval of this application, the Buildin~ Inspector will issue a Building' Permit to the apolicant. Such permit shall be kept on tho premises auailable for inspection throu~hout the work. e. ~o b~ildin~ shall be occupied or used in whole or in ~art for an~ ~uroose what0uer until a Certificate of Occupancg shall have been flranted bg the Buildin~ Inspector. Date .......... .~....~..~.~-:'...~. .......... , , 9..~......)~Z. 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, Suffoik County, New York, and other apphcable Laws, Ordinances or Regulations, for tbe 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, hous~ ng code, and regulations, and to admit authorized inspectdrs on premises and in buildings for necessary inspections. (Signature of applicant, or nan~ff,~ a corporation) ..... ................ (Address of applicant~t State whether applicant is owner,)~ee,~a~gent, ar, c~.t. ect, engineer, general contractor, electrician, plumber or builder. ................... ...... ........................ ......................................................................... Name off'w/er of premises ~......¢.'L..~'...~....:..~..,~.~ ............................................ If applicarj~4~a corporate,~z~ignature, of duly authorized officer. <~N ........... ....................... (Name and title of ~7orate officer) ~. t-ocation of lana on wnicp p[o, posea wor~ will be~l~9 . p .: ~.~.~-." .............. "~ ....... ;' ..... :~/'"";;'"~z ........... Street and Number ...... ............................... _¢..,~r~.'.Y~....: ............ :: ................... o~-,~ o~ ' - Municipality 2. State existing use and occupancy of premises and intended use and occuPancy of proposed construction: a. Existing use and occupancy ................. b. Intended use and occupancy ..,~.....~..~.~.~.~*.....:,~/..~...~.,,f-~:,~., ...~:_,~.~. ....................................................... 3. - Nature of work (check which applicable): New Building /~ Addition Repair ......................... Removal ......................... Demolition ........................ Other Work .... 4. Estimated Cost ............................................... Fee ..we..,; ........................................................ (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 ...... 7. Dimensions of existing structures, if any: Front ..................... Rear ........................... Depth .... 10. Alterati,on .............. ( Descript on} Height ........................................................... Number of Stories ........................................................................... Dimensions of same structure with alterations or additions: Front .......................... Rear ......... Depth ............................................. Height ......................................... Number of Stories ........ Dimensions of entire new construction: Front ...... .'.~.....z~-. .......... Rear ............ .~...~. ...... Depth Height ........... ~.~. ................................. Number of Stories ...... ~/ Size of lot: Front ...................................... Rear .......................................... Depth ................. Height .................................................... Number of Stories ........................ 1 ............... 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. Will lot be regraded .... ..~...~. ........................ Will excess fill be removed from premises: [ ] Ye~ ~ !o 14. Name of Owner of premises .................................................................................... 'Z.~.Z~ ~ (Address) Phone No.) Name of Architect (Address) Phone No.) Name of Contractor/~7~..~. .L.~. 7 (v ~' B q D ........ Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, lines. Give street and block number or description according to deed, and show stree~,nam~ property er interior or corner lot. g contract) He is the being duly sworn, deposes and says that he ~ck dimen ;ions from and indic ~te wheth- applicant 3ove named. {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 fil this appli( that all .;tatements contained in this application are true to the best of his knowledge and belief; and that the work will in the mannea set forth in the application filed therewith. ~'ERRI LEE ELAK ~ I ,.~ ¢:7 x'/"~-~, /--//NOTARY PUBHC Stat~ of New Yor Notary Public, ~.,..~9.~,..~ ......... County .~-~'.'"'~";'""~N'~'"'"': .............................