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HomeMy WebLinkAbout5950-zFOBM NO. ~ TOWN OF SOUTHOLD BUH,BING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ~/S. Bay. Ave. ( Sku~. I~). Street Map No.. ~ ........ Block No .....XX... Lot No...X~ ....~t~Ch0~tte.. ~.~, ...... co~or~ subst~ti~ly to ~e AppHca~on for B~l~g Pemit heretofore filed ~ thi~ office dat~ ...........~Y..~ .... , 19.. 7~ p~su~t to wMch B~ding Pe~t No... dat~ ....... ~...~.~ ......, 19.7.~, was issued, ~d co~orms to ~1 of ~e req~e men~ of the applicable pro,ions of the law. The occup~cy for which ~s ce~ica~ issued is.. P~$V~$~. ,,~.~.~ .P?~.. ~?~?~..~..~. ~.?~.~ ............. The ce~icate is issued to .. 2~.ber~..R~rk.1~.~. )~:lfe ......... ~er~. .............. (owner. lessee or ten,t) of ~e ~oresmd b~l~g. S~olk Co~ty Dep~tment of He~ Approv~ .~..~ ~ .............................. ~DER~I~RS CERTIFICA~ No... ~..~ ........ :~...~...~77~ .......... HOUSE ~MBER ...... .~7~... S~eet ...... $~. SYn. (Sk~. ~ ) .............. ' ' Building InspectorI · 0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 5950 Z Permission is hereby granted to: ~..~..~....~.....~.~...~..~..S,..s'...e. .................................. .... ~&~..A~e .......................................................... to .. ,T~,e.t~,Z3,.. #.V.l,,~m~,~..1~ ~.oZ,..~...~.e.~..e ............................................................................... at premises located at ....... L~n..~.~-Q.t[;....~.~..Qe...~..&..~.~.I~JL~.~.~I[I ....................................................... ........................................ I~,....~...~.~. .............. .c..~.t,.e~l~,~..... ~ .,~ ,, ........................................... pursuant to application dated .......................... ,~-~'. ...... ..~ ............ , 19.~.'.~..., and approved by the Building Inspector. Fee $.~ .~. ~'~1' ........... Building Inspector FORM NO. 6 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, anti unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(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. S. 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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 New Building ................ Addition .1~..~..~. ....... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~.~.~..~..~..~.~./~.~...~..~.~...~...'~..~...~...~.~..~.~...~...~...~..~.~../~..;~. .~.: ............................................ Owner Or Owners Of Property . ./..~..~..~.~...~..^.....~....~...~......~...~..f./..~.....~..:...~.'~....~ ................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No..."~'....~...~..~.. ...... Date Of Permit ..~..~'.~./~,~-....Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ....: ............................... Construction on above described building and pe~it meets all ap~:able codes and regulations. Applicant .......... ../. ~....~...'....~. _~.~.....:::.: ............................................... Sworn to before me this .... day of ........ ~_, ~ ~'~ Nofo~ Public, 51ae of New York (stomp or se°l) .... C ~ ! ' ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOLFTHOLD,~ N. Y. Examined ...~.~.~......~/ ............ 19,..~.... · ^pPlication No....~.~.. .......... 7 ........ ....... ..... ........................ 4. ............... . ......................... ...... .......... APPLICATION FOR BUILDING PERMIT Date ........... ~.. Jl~. ...................... , 19.~.~ ....... INSTRUCTIONS a. This application must be COmpletely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, wi 3 sets of plans, accurate plot plan to scale. Fee :according ko scbedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, ancl~ giving a detailed description of ;layout of property must be drawn on diagramL which is pert of this application. c. The work covered by thij'applicatJon may not be commenced before issuance of Building Permit. d. Upon alN3rovel of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept ory the premises availablp for inspection throughout the work.. . e. No building shall, be occupied or used in whole Or m 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 Zohe Ordinance of the T'0Wri 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, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) . JL~.e.....Cttt~..il'.~Z. .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...Jl. eb~z.~..J.,..J~J~.lrJ.a..&..~£= .................................................................................... If applicant is a corporate, signature of duly authorized officer, y ..................... ii~'~'M;;';,;',~"~i:,i~;';i'~;;;-~;;';,;~'~' ;~i~'~';i ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ao Existing use and occupancy ..... g~..J~ll~,~..JJll~.~[3i~ ................................................................................. · . , ' ........... ~: (Description) o/" g0~Z,f,O~ IR~gL'oGud., T1'-~1 11ned. ~wtmm.t~ ~ool 4. Estimated Cost ..... JlL~,,P4)D. ........................... Fee ..jl3,~..OG..:. ....... .:.....:: ...... : ......... : ......... : ................................. ' Ito ne paia on Tiling this application/ 5. If thralling, number of dwelling units ................. Number of dwelling units on each floor ......... , ............................... If garage, number of ' ' · 6. If business, commercial or mixed occupancy. specify nature andextent 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 ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ..................... ; ................................................................... 9. 'Size of lot: Front :~,t,~,~;~£~t~ ................ Rear ..~9..~Aa~ .................... Depth .J49..£e~ .............................. Height .................................................... Number of Stories ...................................................................................... 10. Date of Purchase .,l~.ga...JJ~...3,~.~ ...... Name of Former Owner .~ll~a],~.~...(Jl~ll~4l~tr, e..~l;l~a~t~ .......... 11. Zone or use district in which premises are situated u ,u 12. Does proposed construction violate any zoning law, ordinance or regulation: ....Ta~. .............................................. 13. Will lot be regraded -,,~LI. .......................... W(llexcassfillberemovedfrom premises: ~] Yes [ ] No 14. Name of Owner of premises ...,~O~I3~L.JL~..,9~:[I..~t,...It"~"~ ....... ~lllr..&~&.,..; .......... .~.~m~fiJtJg. ............... (Addr~#iatt~ehoJle ~ :Ii .~'. (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) f n or Ado.3,.~h ;B~'ol'l;olb&oh u&tn Rd. oho Name o Co tract .................................................................... ~l,.~t: ...... JL'R....~.~..~A~t. ....... ~/~lr~.~ ............... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildlnp, whether existing or proposed, and indicate all set-back dimensions from property lines. Give ~reet and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. Bee at;t;aehed, p:ha STATE OF NEW YORK, COUNTY-' t / , / ,~' ) ur .................. ., ............................... ;..) .......................................................................................................... being d~ly sworn, deposes end says that he is the applicant above named. · {Name of individual signing contract} . ~. . . He sth, ,~..1: ~/ /../..~. ' /' (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work end to male;and file this application; that ell. statements contained in this application ere true to the hast ofjl~Tl~in~.wl~j~[er~lm$ helief; ~Jhd that the work will be performed in the manner set forth in the application filed there~ith~)~,. N~ow Public, State of New .................................... /.day of ...................................... C~m~i~jloSgE~i/~:,/~rch 30, 19/_L-~ /'J Notary Public,/,~s~.~,~,.. ,....~,~....~..~,,..,~nty . ........ ;...; ....... ;,/....~..,4,...,~.~..~ .................................