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HomeMy WebLinkAbout6901-zFO~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..Z6068 ..... Date ..............Augurer. · 23.., 19.. THIS CERTIFIES that the building located at .Re2~on. Dr..ye .............Street Map No. R.e~Cla..~.O~l~ck No....~ .......Lot No..~6. :.~.7.; ~..8.,... $.o~..t.h..o.l.d....N...Y. conforms substantially to the Application for Building Permit heretofore filed in thi~ office dated ............0or. ·. -~., 19.7'~ pursuant to which Building Permit No. dated ............. .Oct.. ~ .., 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 ...Private. one. family, dwellins .wi.th .new .pr&~ate..Garage ........ The certificate is issued to . Willla~ .P4L~D ..... ~le~. ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . l~,R. .............................. UNDERWRITERS CERTIFICATE No.. ~el~d~ .................................. HOUSE NUMBER ...... ~87.~... · Street ...l~eydon. l)r. ive ......................... Building ~nspecmr ! FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COJ~PL~ION OF THE WORK AUTHORIZED) 6901 Z Permission is hereby granted to: t~_lJ.~m,.~a~q~ .................................................. ......... ~oathol~ ................................................. to ...~,~..~,~w...l~x'.;Lv.~... g~'ag.~. ........................................................................................... at premises located at ........~...~.~§...~..6.~J.~.~..~..8......~..e.~....~..t.~.~..'e.~.~.~.~..~.~.~.?..?.?.~ ............................... ................................... ~c~./~r~.v~ ............ Sauth~l~ ......... ~X~ ............................................. 'pursuant to application doted ................ ~ ......... ..O..c.~. ....... 3 ............ , 19....~.~., and approved by the Building Inspector. Fee $..~ .~..~.Q.Q ........... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s application must be filled ~n typewriter OR ink, and submitted in DUPLICATE to the Budding Inspector w~th the following, for new buildings or new use' 1. Final survey of property with accurate Iocahon of all buddings, 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 buddings, Industrial buildings, Multiple Residences and similar buildings and mstallahons, a cerhficate of Code comphonce from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable B For existing buddings (pnor to April 1957), Non-conforming uses, or buildings and 'pre-ex~sting" 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 (.~ ~ ~1 C-(~ Date .............................................. New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ......... ~...~.i~.~....~... ...... ..~...~....~....~....~....~.. ........... ~....~..../...~'.....~.. .............................................. Owner Or Owners Of Property ..................................... )'~,'"';:~""'t;'~' ............................................................ Subdivision '/'~ ........................................................... Lot No ............. Block No ............House No~..~....7'. '?.~ Permit No...~...~....0...[ .... Date Of Permit ..~...:~...~..T..z..~...t/Applicant ..... ..~..~....M..........~.......~...../~.....~..;. ..................... 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 permit me,ets all ap, plicable codes and regulations. t fore me L/ Sworn o be this '/,///'~/~ Nota~ Public ........... ...... ~County · FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~ SOUTHOLD, N. Y. Examined ...~...~... .................. , 19.2.~.... Approved ........................................ , 19 ........ Permit No ................................... Disapproved o/c .................. (Building~:~ector) Application No. ~,c,~ ~ ~.~_ APPLICATION FOR BUILDING PERMIT c:~.~ Dote ..................... .0.?...~..o..~...e..r........~...., 19...?.3....."3'~ INSTRUCTIONS ~ a. This application must be completely filled in by typewriter o~:in ink and submitted in triplicate to~the'l~uilding~, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to ~hed~uler ~ b. Plot plan showing Iocat on of lot and of buildings on premises, rel~Ho~nshi~5 t~djOining premises or Public streets o~ areas, and giving o 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 commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a E~'~l~li~g Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. ~ No building shall be occupied or gsed Jn whole or in pa rt for any purpose whatever until a Certificate of Occupancy have been granted by the Building Inspector. - (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, 5uffol.k, County, New York, and other applicable Laws, Ord nonces or Regulations, for the construction of buildings, additions or e~terations, or for removc~ m" d~ofiti0n/'cis herein c~scribed. The applicant agrees to comply with all applicable laws, ordinances, building code, hoJ,sing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ............. (Signature of applic~nt,~r name, if~corporafior~ ........ R.'..e~. d on ~ve outhold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pluml:~',.~.o~.'~'~ilder. · ....................................... O~.~' ............................ Name of owner of premises Willia~ Ra.m,p. If applicant is a corporate, signature of duly authorized officer. Other Trade's License No ............................................... "~F 1. Location of land on which proposed work will be done. Map No.: Re don Shores I ' ~ L%t ,NO. ..... ~ - ~, Drive ~.outhold ' Street and Number -.~e~(~..~ ................................................................................................................. ......... Municipality State existing use and occupancy of premises and intended use and occupancy of propo~e~l ~nstructJon: a. Exisiting use and occupancy .......................................................................... . ........................... y...? ................. b. Intended use and occupancy .... s~me ~ith ~ew ~ra~e ? Stor~e 3. Nature of work (check which applicable): New'Building ..~;Y..~ ........ Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cost ............. 2~g.Q0....,~+ ........................... Fee .....T,0~00. .................................. (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 .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ....~ Depth ................................ Height ............................ Number of Stories ............. i .................. ~ 8. D mens ons of ent re new construct on: Front . .~ ....... Rear ....,~0. .................. Depfl¥.....2..~.. ............... Height .................... Number of Stories ..... ~.~e ........................................................................... ! .................. ~ ........... 9..Size of Jot: Front ........................................................ Rear .......................................... Depth M./ ........................... 10.* Date of Purchase ........................................................ Name of Former Owner ........................r...i! ............................ 11. Zone or use district in which premises are situated ...... .~!A!!..~.S~; .............................................. ! ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..N~3 ...... ~ .......... ; ............................... ]3. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes i ( )' No _ f . Wi- liam Ramp ~ 14. Name of Owner o prem ses ....... :: ........................................... Address ................................ Phc)he No..~ .................... Name of Architect .............................................................. Address ................................ Phone NO ....................... Name of Contractor ...................s..~..~...e. ........................ ; ........ Address .............. ~ ................ Phone No ....................... PLOT DIAGRAM LOCate clearly and distinctly all buildings, whether exi,~ting or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. / STATE Of NE'W'~YO~;~. (SS ~ },e...~K~ COUNTY OF ...~..~.['~.O.....;L~.. ............ ~- · .................... i.~..~.~..1..~..8-...~...,~....m,~. .......................................... ,.,being duly sworn depos, e,s .c~3.d:,says that he is the applicam (Name of individual signing contract) above named. He is the ...................... .o....~...e...~. ............................................................................................................................................... (Contractor, agent, corpora~ affi~er,tetc.) of said owner or owners, and is duly authorized to perform or bav~ p_9.r, formed the said work and to make and file this application; that all statements contained in this apl~i~icat~n~[~e'Jr~6 to the best of h s knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................... · ~... day of .................. .o.?..~,o..b..e...~. ......... , 19.~... ~ ~'"'~( ig ature (~PliCa t)/-C~ ..~....~ Notary Public,. ................................................... County ......................... .....................~,_.._..n.......;..~...~. .............