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HomeMy WebLinkAbout5982-zFOB,~ NO. 4 TOWN OF SOUTHOLD BU'B',I'HNC:;. DEpARTM~,NT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No. Z9~/7~ Date Jan 30 19. 7~ THIS CERTIFIES that the building located at ...0.a~....D..r.~.v.e...(.A.~.e..) ....... Street Map No..G.o.o.s.e....~.y.. E~lot~k No ........... Lot No..~2. ~.~,2.~.2.-.2..~. .... S. 9.u.t.h. 9.1.d...N. :Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ .J.%kly...3 ..... , 197.2.. pursuant to which Building Permit No. ~982Z.. dated .......... J..u.ly. .... .3..., 19.7.2.., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private one family dwelling with an addition The certificate is issued to . .Mr..~...~.a..J.e.r.Q$~..B. :..L.e.w.i.~ ..... .Of, Ln...e.r.s. .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ?..' ~.' ............................. UNDERWRITERS CERTIFICATE No.P.e.n.d.i..n.g ..................................... HOUSE NUMBER ...8~.~. ........ Street ...0.~...A.v..e..(.D..r.~.v.e. ). ...................... Building Inspector FOEM 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? 5982 Z Permission is hereby granted to: .......... YaL.~..tt~....~.er.o~e..Le~ ................ ............ ~ .......... lt;,--~,~ ...~;,.-.; ~ ..... ............................................ ~.~_~ ...... a~t.~ .................................................... .................... ~., .~ :'.~, .................... .~ ................................................... (~/.~ --.7 ..... .;ff ...................... .' ............. pursuant to opplication doted ................... ~l~:.]r. ......... -~.. .............. , 19...~-...., end opproved by the Building Inspector. Fee $..1.~..~... ........... jBuilding Inspector( FOP~I NO. 6 TOWN OF SOUTHOLD Building Department 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 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 $5.00/~ 3. Copy of certificate of occupancy $1.00 New Building ................ Addition...~......~.,.... Old or Pre-existing Buildin~a~..~...~:ii"V~;~;"~':'~;'"['[ ......... Location Of Property ..... ~.......~...~ .................... ~ ....... ..~....,,..k.~..,. ........ Owner Or Ownersf) '-- ~,,-,k" ' ,~ ~ __ _,,~ :~t~'Of Property .~~...ff.~....~ ,. ....... ....... Permit No....~..~...Z .~...~/...~.. Date ~O~f Per m it l~.3..~,pp lica nt ...... .~...../~.,.~.. .................................... Health Dept. Approval ...~.J%. ........... Labor Dept Approva~ ~. f.~ ~ .. Underwriters Approval ..... f.~...~....'~..../~'......~.. .................. Planning Board Approval .... ../~.....!...'~.. ................. ~ ~euS~mFi~e ~esm.~ o.~..a. [~.~ i. [ii ~ t. ~. ;;;;;; .................................. Final Certificate ......~ ................. Construction on above described building anc~rmit meets oll~licabl~s and. regulations. App. ica nt~..~....,~4¢~,ruff,~...... Z~....~ ........ ~...~ ........................ Sworn to before me ,t,his ~ ,,~--~ ~z,.~ -r-v- ........ '.~..~). day of .~~ ......' ........ .~ .... (stamp or Notary Public .................................... County Approved ........................................ , 19 ........ Pemit No. ~ ~' ~' ~ TOWN OF SOUTHOLD ( 1-.93 - 7 ~/ ~~ ~/~' ~ T~ ~/~/41 BUILDING DEPARTMEN~x, /~,/<,/..., ~ ~ c. e. TOWN CLERK'S OFFICE ~ - /~ ) ~UTHOLD, N.Y. ~ Disapproved o ~ .T.'.; ................................ _ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS oTe ............................. /.. ................. ; a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, witht~ 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, anc~ 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 appl~nt, or name, if a corporation) ........................... State whether applicant is owner, lesseb ~t~/a~c,.hlt~t, engineer, general contractor, electrician, plumber or builder. .......................................................................m~ n n~u n nm' ~ ~. Y ~ IL'"-~"-''': .................. "~.-~C' O~'f 5'~" ............ "- ................... ~ ['~-~J/'t~/' ....................................................... Ne.._ ~f ~..ner _f ,.re,,,ises .......................................... ~ ................................................................................................... If applicant is a corporate, signature of duly authorized officer. ..................... , ..................... 1. Location of land on which proposeddi~i.J[,-li~done. I~ap No.: ...~.: ........................... Lo No ............. Street and Number ..... .E...~..~.~":...~ .~.....~..i!...V'...~ ............... ~..C/....~.[3..)....~...(...J. ..................................... Municipality 2. State existing use and occupancy of,,o, remises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ '1'[ ....................... '~,~7/~,~ ' '5 "~.~' ~Y '" '_'" "~'~; '::" ,";; ....................................... b. Intended use and occupancy ................................... ~ .............................................................. 3. Nature of work (check which applicable): New Building .............. , ........ Addition ..................... Alteration ....... Repair .......................... Removal ......................... Demolition ........................ Other Work .................................... ..... '~"~"~"?~'""~'~"'"-- ........... /,~ ~a~13aid on filing th's applicat'on) I Description) 4, Estimated Cost Fee ............. ,~,.~, ....................... ; ............ ;i ...................................... 5. If dwelling, number of dwelling units .................Number of dwelling units on each floor ......................................... If garage, number of cars ..................... .~...~]....L.. .............................. ~ ................................. .; ......................................... 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 ....; ...................................................... 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 St~e~. ..................,,~,,,,~,,, ............................... .,~;,,.~ ........................ g. Size of lot: Front ...................................... Rear ....................... ~epth .......... ,.~ ............................... ~ ..... Date of Purchase ..................................... Name of Former Owner ..... ...~....c~.........b~....~........~.~.....~ 10. 11. Zone or use district in Which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, or~inan.ce or regu[0tion: ............................................................ 13. Willl°tbemgraded~ ...... ~ .................. ........... Willexcessl(lltl.,b~;)ed~.n~from promises:~.. t~[ ] Yes [ ] No 14. Name of Owner of promises ................................................................................ ~..~.. .......................................... (Address} (Phone No.) Name of Architect .................. ......................................................................................... ................. ~ ~ ~ ! (Address)~'- ~ ~, (phneo ~N'O.) Name of Contractor ................'~..:..]'~.~....J~.~..~I..I../~Z ........... i~,~i~.~.,_,~.a2...~...fT..~.~..J..).ss~/~ (Phone No.) PLOT DIAGRAM . .L°Cat6 clearly and distinctlve~l-bui dings, whether existing or proposed, and indicate all set-back dimensions from property li0es. G~ve street and bloc~(~~pt~on according to deed, and show street names and ~nd~cate wheth- ·~ ~er interior'or ? corner : lot. STATE OF NEW Y~.~I~ K.,~/~ ~ ~.... ) ....... ................ V' .......................................................................................................... ~ing duly sworn, de~s and says that he is the appli~nt above named. He is the ....................................... ~ ............................................................................. (~n~ctor, a~nt, coyote of~cer, etc.) of said owner or owners, and is duly authorized to ~Horm or have ~rformed the said work and to make and file this application; that all statemen~ contained in this application are true to t~ ~s~ of his knowled~ and ~lief; and that the work will ~ ~ormed in the ~nner ~t f0rth in the applicati°n filed ther~ ~ ,~ .............................. ......... ............ / o aW Public ................................................. ; .................... ~unW ..... (.../ .......................................................... ; ....................................