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HomeMy WebLinkAbout7008-zNO. 4 TOWN OF SOUTHOLb BUILDING DEPARTMENT Town Clerk's office Southola, N. ¥. Certificate Of Occupancy No. Z~819 Date Mal~ 11 ., 19. Map ~¢o.~ .... ·: .... B,ockNo .... ~ .... LotNo...=.'..~.~?...~?~Y ..... conforms substantially to the Application for Building Permit heretofore filed in this office aatea ........ ~97..2~..., 19~3.. pursuant to which Building Permit No. dated ......... [';~PY...~P .... , 197~. ,, was issued, a~d conforms to all of the require- ments of the appH¢able provisions of the law. The occqpancy for which this certificate is i!y d on'' issued is Privat~'.~one f~ we- ling wi~ ~duiti ~' to Frank McDonald The certificate is issued ....................................................... (qwner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N.~.R ~.~ .............................. U~OSHWHIrSHS dSH~l~C~rS So...~B~ .... ~ ............................. HOUSE NUMBER $60 Street Island ~iew Lane TOWN OF $OUTHOLD BUILDING ~ DEPARTMEN'I~ TOWN CLERK'S OFFIGE' SOUTHOLD, N. Y. BUILD, lNG PERMIT (THIS PERMIT MUST BE KEPT/ON THE PREMISI~S UNTIL FULL COMPLETION OF THE WORK ~THORIZED) Dote Building Inspector. Fee $.....; ...... ,. .......... FORM N'O. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE O1~ OCCUPANCY InstructiOns A. This application must be filled in typewriter OR ink, and s~bmitted in DUPLICATE to the Building Inspector with the following; for new buildings or new Gse: 1. Final survey of property with accurate location of all ¢.buiidings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and dew, erode 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 plarj 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 ail 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 Date ................................................ New Building ................ Addition ................ Old or Pre-existing BUilding ................ Vacant Land .............. Subdivision ................................................................ Lot No ............. Block.No ............. House No //~" '~ Permit No '~ ©O~'~ Date Of Permit .................... pp ..., ........................................................... Health Dept. Approval ............................................ Labor Dept ....................... Underwriters Approval ................. ............... Planning Bo,~rd Approval ..... ,......'.,..~. ..................... Request For Temporary Certificate ........................................ Final. Certificate .......................................... Fee Submitted $ .... : ..................... Construction on above c~escribed building and permit.meets all applicable codes and regulations. Sworn to before me this Notary Public .................................... County Approved Disapproved a/c '~'i ........................ Date..~..~.. ~......~...~... ....................... , FORM NO. 1 TOWN OF SOuTHOLD '7~ 'BUILDING DEPARTMENT- ToWN C:LERK'S OFFIGE SOUTHOLD, N. Y. 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 pu~ ¢ streets or areas, and giving o detaile~ description of layout ofproperty must be drawn on the diagram which is part of thi~ ¢lpplication. 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 progress of 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 Perr~it 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, ordi nantes, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ...~...~ ......... ~..~......~....r~...~ ....................................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot N .c~.. . . Street and Number ~.~..~A..D .~.~e~ J.~i,/e~ ~----~1~...,~...~...~. .~' ...... ~:~'~; ..... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... J....~.'l~..~.~..'~ ....... ~¢___,,.~..).~...~.. .................................................................. b. Intended use and occupancy ~)1 ~' ~.~. ' · 3. Nature of work (check which applicable): New Building .................. Addition................../ Alteration .................. Repair .............. '~i Removal ..................Demolition .................. Other Work (Describe) ........................................ 4. Es ma ed Cost ............................................................ Fee ./..~ ..................................................................................... (to be paid on filing this application) S. 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 ................................ 8. Dimensions of entire new construction: Front .....~....~.! ........................ Rear ..... ...~:....~..'. ............. Depth ...]....~..'. ............. Height ......~.~. ......... Number of Stories ..../. ............................................ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 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. Name of Owner of premises .~......o~..~..~.~...l~ .~.....i..Addross ..,.~...(~J~.~...~...-~... .................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No. .................... Name of Contractor .................................................... Address ............................................ PhoneNo ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-hock 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. STATE OF I~EV~.OJL"~ ,~,/~ J~ ¢ COUN~ Of ~ ...... ..................................... dbly ~om, d~es and says t~t he is the applicant (Name of individual signing application) , above named He s the ~ .......................................................... (~ntm~or, agar, co~rate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e p~o~ed the ~id work and to ~ke and file this application; that all statements contained in this applic~ion am t~ ~ the ~st of his ~owledge and belief; and ~at the work will ~ peffo~ed in the manner set fo~h in the ~lic~i~ fil~ therewith. Swam to ~fore me this ........... ......... o, .............. , ........ JUDI TH T. BOKE~ Nota~ Public, Stale of New York No. 52-0344963 Suffolk C~n~/ Commis~io~ ~pJre* March 30, 19~