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HomeMy WebLinkAbout5750-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sou~old, N. Y. Certificate Of Occupancy No..g .~..8.8 ...... Date ......... ~.e.t~;.e~.b.q .z'. ~.6. t,,.' 19.73. THIS CERTIFIr_~ that the building located at. 0a~J~g:on. Ro~d ......... Street Map No. Naaaau.l~.,. Block No.. XX ...... Lot No ....39~.. l~asau conforms substantially to the Application/or Building Permit heretofore filed in this office dated ........Feb:L~lal'~..L~.b lg..~.2 ptttsuant to which Building Permit No... ~.~0~ dated ........~ia~.eh. Lft .... , lg.22., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy ~ued is ... Private..one. fe~l~..dw~ltnll ..................................... The certificate is issued to . .ldt~Tt~. ~t*.~l~,d~). .................................... (owner, lessee or tenant ) of the aforesaid build!rig. Suffolk County Department of Health Approval ...~.t.~ .............................. UNDERWRITERS CERTIFICATE NO..i~TT.~.~.~ ......... : ............................... ttOUSE NU~aEg...~.0~ ....... Street .... .~..r..~.. g.~.O.n...aO..~.. ........................... ........................................ W&a~e.a...~. ~. fi'ut;armgae ................ .... Buildin§ Inspector FORM 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? 5750 Z Permission is hereby granted to: at premises located at ........~t,..~9~[....JJll~llll~..J~t,..J;~jljI ............................................................ pursuaffc to application dated ....................... J~ll,:lj4~ ....... %(a. ............ , 19..~ll~eL, and approved by the Building Inspector. PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT CE~SPOCL C ,~$ i', :CTION CELLAR C~NSTRUCTION OTHER TOWN OF $OUTHOLD 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 occupancv $5.00 2. Certificate of occupancv on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Dote ................................................ New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ....................................................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit ~ ''~''~ ~' . ~/'z~-'~)/ . ....(~..~...~....~......~...~...,~...-.~...~...: ............................ No .../~... .............. Date Of Permit ........... ~......App ,cant Health Dept. Approval ............................................ Labor Dept. Approval .......... ~ ..................................... Underwriters Approva~ ......................................... Planning Board Approval ........---~. ............................... Request For Temporary Certificate .............. ~ ......................... Final Certificate ..~. ................................... Fee Submitted $ .................................... Construction on above described building and gerroit meets all applicable codes and regulations. Applicont ......~.z~.....~.........~.~ .~,~ ..~..~. ........................................... Sworn to,before me this / Notary Publi~:...~ County ,, BARBARA M. HAURUS ..................................... ~.., 19 ........ Pemit No ..................................... · - Disapproved .a/c ....... ~ ~ TOWN OF SOUT. OLD BUILDING DEPARTMENT ' ' ToWN CLERK'S oFFICE '~/~'/'~/~"~'/~' ~' $~THOLD, N. Y. ....... Application No ................................. APPLICATION FOR BUILDING PERMIT Date ~eb 2bt 19....~.2. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. 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 ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenaed 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 progress of the work. e. No building shall be occupied or used Jn 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or 4 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. (Signature of applicant, or name, if a corporation) .......... C.ug~-hogu.~ .................................................................. ~/.~.~ ~ ~ ~L ~: ~ ~ ~'~'1 (Address of applicant, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~o~'¢~,...~.~'&.p~ ....................................................................................................... If applicant is a corporate, signature of duly authorized officer. --7---0~ ~- ~, ~ (Name and title of corporate officer) 1.L~ation of land on which pr~osed work will be done. Map No.: ....... .~.~.fi.,...~ ............. Lot No; .~.~ ............... Street and Number ..... O~.~.g~..~. ......... ~s~..P~..~ob~e ...... ; .......................................... ~unicipad~ 2. State existing use and ~cupanay of premises and intended use and ~cupancy of prepaid construction: a. ~isiting ~e a~ ~cupancy ....... ~.~.~ ...................................................................................................... b. Intended use and ~cu~ncy ............ ~.~..~.~...~...~.~ ................................................................. 3. Nature of work (check which applicable): New Building .................. Addition ...~...~.3r~... Alteratipn ................. '., Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ..........~..~.~).(~..-+. .................................. Fee ....I~.,~.QO. ........................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... 0~ .............. 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 .................... 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 ......... 2{) ............ : ......... Rear ............ ;~6 ........... Depth ......... .1..~ .......... Height .................... Number of Stories ..4)z>,e ............................................................................................................ 9. Size of lot: Front ...... ~..2..Q .............. Rear ............ .1..~..~.. ................ Depth .....2..~..Q../...~...1.~7. ...... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated"..~..!!....~.,~,.s..t;;. .................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... .~ ............................................. 13. Name of Owner of premises ~.....~eD::i.~.O ............... Address ........ .C.~.c...~..o.~..~..e. ............... Phone N~i~..v...-.~i~. ;~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...J.~..M~,~Z31S ........................... Address .......... C.u~,~hG~t~e ............Phone No..~.~..~...~..~..~...~..~ PLOT DIAGRAM Locate 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 whether Interior or comer lot. see plan attached STATE OF NE-'~/YORK, COUNTY OF ~.~.fmlk ............... ................. ;'~; .......... yY";~;~'~tT"~eI.%l.~C[8'"; ........... ~ ................. being duly sworn, deposes and says that he is the applicant t~ame at ina~waual s~gmng applicotion~ above named. He is the ............................................. .C..g,~.~.~.~{~.~.Q~. ................................................................................... (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 statements 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. Swam to before me this · ................... 2~- day o~/~..._........~.e~.r.~,....., 19..~.~,~. L ~.. //'~. //~,,. ~/.,. ~,. · /~1~'~-~ L/ ~-'~ n_ .~· ~- IN TUT.~I It.I· .................... ~..Y-:.:-.../-/-~~ ....................... No. 52-4040975 ()uallfied in Suffolk County 'l'entl Expires March 30~ 19~ /02.0