The URL can be used to link to this page

Home My WebLink About5960-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..~t~...~.. ...... Date ............. Sopt ..... 19.., 19. THIS CERTIFIES that the building located at ~o].der~ .La ................. Street Map NON,. Gold~,a.. Block No ........... Lot No. 19 .&. l~t20' · ' 8e~thold. · .I~,~. · conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ,~le. 20.., 19 .?2. pursuant to which Building Permit No.. dated ........... ,Tt~e.. ~1..., 19.72, 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 . l~.$vate .o~e..f.a~.l.y .dwelling ....................................... The certificate is issued toMro. H, .Xell,y ....... 0~xer ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .NolO., ............................. UNDERWRITERS CERTIFICATE No... ][ .be~6~0 ...................................... HOUSE NUMBER....I~2~ ...... Street...Gel.den. Lane ................................. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P, ERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 596O z Permission is hereby granted to: ~ ,..,~'Cm~a3,3.. JL~C.....~, ..l, e3~. ................ to ..~..&l~.~.l.t,~e]~..~..~.~im.,~is~g..~e2Xtx~ ............................................................. at premises located at .........~{~;...1.9..&..~....~...~1.~.~ ......................... : ................................. .................................................. O~].,41J. ....... ~ ....... J,o~'l~bo.:l.& .................................................... pursuant to application dated ................................ ~2,111~.....~0....., 19...~{~, and approved by the Building Inspector. Fee $....~.ff.e.O0 ......... Building Inspector- FO~M NO. ~ TOWN OF $OUTHOLD Building Delm~fment Town Cierks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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 disposal--(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 3. Copy of certificate of occupancy $1.00 $5.00 I ....... New Building .~ld or Pre-existing Building .............. x ........... Vacant Land ............................ Locat,on Of Property ....~~.....~ ..... ~.....~..... .......... Owner Or Owners Of Property ....~...,../~. Permit No...~.~..~..~....~.....ZDate Of Permit ~/,~../,/.~....'~Applicant . .~..~'.~ Health Dept. Approval ........./~..:....~.. .......................... Labor Dept. Approval ..............~...~....~... ...................... Underwriters Approval .... .~.....~..~..~.~....0. .................... Planning Board Approval ...... .~....:.~ ..................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ '-~ ~ Construction on above described building {~ .pe//~n~ i t ~11 app ' ~ ~_~e~ Sworn to before me this x/ / ~ ~ [~ ( .......... ~.~. day of ....... ~.....~.~ ~ / (stamp or seal) ~y public, Sta~e of Hew York ~a~ ~2-0344963 Suffolk County~ ~i~lon Exp~es March 30, J" 5o" Exomined .... ~..,,~..L ......... , Approved t~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........Pemit No ............... Applicotion No... ~,~..Z..~.....~., ............ Disapproved a/c ............................................................................................ .......................... .......................... APPLICATION FOR BUILDING PERMIT Do~....~._.~ ........ ~ ............ , 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. Pict 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 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 been 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, 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 ~omoration) (Address of applicant) If applica~ is a ~orp~te, siflna~ of ~ ~t~rized officer. 1. Location of ,and on which,prgposed work wil. J be done. Mag N.o.: ~...../'./..i.~.....~.. ............................... Lot No('. ~'~.~...~.~ Street and Number ...~..~.~,....~........~......~..~...~........~......~..~......: .......... ,,ff..~..~..T...~.~.~.,..~... Municipality / 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Ex st ng use and occupancy ................. ~ ...... ~~Z ............................................... // // b. Intended use and occupancy .................................................................................................................................. ~. N JAiteration.' 3. Nat~lre of v;ork (check which applicable): New Building ....................... Addition ..................... i ............. Repair ............. ...,~ ...... Remove ..... Demo, Jjtion ........................ Other Work .................................... (~/ ~ ~ ~ /...~' ~ (Description) 4, Estimated CostZ~..,'JF...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, commercial or mixed occupancy, specify nature and extent of each Wpe 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 ......................................... Stories ........................................ Depth ............................................. Height ......................................... Number of 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height .......... ~.~ ................................. N~mber of Stories . / ............. 9. Size of lot: Front ............ ~,.~.. .................... Rear ....... ~..J, ............................ r~nth ~'o, ~*,,~/?~, f~'/ ~ ~...~., 10. Date of Purchase ..................................... Name of Former Owner ....... , .................................................................... 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 ~.~3~.. Wj41/ex~ fill be removed from premises: [~j~Yes [ ] No 14. Name of Owner of premises .~..~....,~.,.~_,.._.... ......................................... ................ ..... (Address) (Phone No.) Name of Architect .....,~ ......... x~ .....,~ ........................................................................................................... Name of Contrac __ ,~.~.~.... ..... ................ ....... ............ ~/ PEOT DIAGRAM Eocate 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. .......................................................................................................... being duly sworn, deposes and says that he is the applicant above named. ( N~me o.f ~ndh,Jdual ~J~nJn~ conUac t ) lie is the ................................................................................................................................................................................................................. {Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly a~J~Jgl~iz~dB~(~rform or have perfo/rn~ed the said work and to make and file this application; that all statements contained in this appliJ~ffionPabe¢~r~f~o'j~ be~t pf his knowled(~ and belief; and that the work will be performed in the manner set forth in the application file~J~efSe~)j~.4963 Su~iCot'~e~ouZ~ ............... ......... . .ot, ry ...... ; ........ ................. (Signature of applicant) 1/