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HomeMy WebLinkAbout6573-zFOILM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . Sm~,m.m.l.t.D. ~75.v.,. ........... Street Map No.g. aP~; ~.$~1~1.. Block No .......... Lot No. part .~...Sq......P~..~.ti.~.u. ek.. ~.Y.: confor~s substantially to the Application for Building Permit heretofore filed in this office dated ..... M.~y....]5... , 19 7.3.. pursuant to which Building Permit No. dated ........ 1~..~y .....i ~ .., 19.?.3., 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 Pl~i,ra.~. p.n.~...f.a.m.i.~y .d.w.~.~.in. g ................................... The certificate is issued to p?t.el' .Kat.o.~ ........ . .(~..?.~ .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~1 oR, ............. UNDERWRITERS CERTIFICATE No. .p.~..1~..i.~.g .................................. HOUSE NUMBER ....li..2.0. ..... Street .... ~Am..,,.i.~...D.r.i.v..~ ....................... Building Inspector TOWN OF SOGTHOLD 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? 6573 Z Permission is hereby granted to: ...... ~_.~.~ .......... ~.,....~.~ at premises located at .............................................. ~..~.../~.]..../~/..../....'~'.. ........ .~...~..J...~...~..~ ....................... ............................................................................. ~.~.~.~.z.~.c~ ............................................... ...... ~..~...~.~ ....... ~........~....~..~ ...... ~.~.~....~..~.z.~ ............................ pursuant to application dated ....................................... ~...~......~.~'//]9......7.?, and approved by the Building Inspector. Fee $ ....../,, ,~.,..~.. Building Inspector FO]gM 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 ~n duplicate to the Building Inspector with the follow.ng; 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 F~nal approval of Health Dept of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installahon from Board of Fire Underwriters. 4. Commercial buddings, Industrial buildings, Mulhple Residences and similar buildings and installations, a certificate of Code compliance from the Architect ar Engineer responsible for the budding. 5. Submit Planning Board approval of completed site plan requirements where applicable B. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of property showing all property hnes, 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-exist~ng dwelling or land use $5.00 3. Copy of certifmate of occupancy $1.00 Date ...... New Building .................... Old or Pre-exishng Building ....... ~ ............... Vacant Land ........................... Location Of Property ..'~.'..~....aO....r~r)...!....~T......[~, .~..~.~;~.,...j..~F-~..~/71~...-~...~-...I...~..~. ........................................ Owner Or Owners Of Property ..~..~."~-r;(~. ...... .~....~...~...,T~.. ................................................................................ Subdivision ~, ...... ,~.~,a.~. ............................. Lot ~'~ No..~..[O.... Block No ............. House No...,........ Permit No ......~...~...7....~....~:.. Date Of Permit ..J...~'......~.....7'.~..Applicant ......~...~....~/~....~.....~...(-~. ~.~..~. ........................ Hea,th Oept. ^pprova, .............. ................. Labor pt. ^pprova, .............. ....................... Underwriters Approval .............................................. Planning Board A~proval /V ~ Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ k ~ Construction on above described building and permit meets all applicable codes and regulations. Applicant¢. .....~..~ ................................................ Sworn to before me this ~'~'~:;~ ,,X.o Nutary Public .................................... CoUnty (stamp or seal)~~ c~.~ (Building Inspector) APPLICATION FOR BUILDIHG PERMIT INSTRUCTIONS ~i a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Impec~o. r, witt~ 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 prmnisas or public stree~ or areas, giving s detailed description of layout of property must be drawn on diagram which is part of this application. ¢. 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 iNue a Building Permit to the applicant. Such permit,shell be kept on the premises available for inspaetion throughout the work. J~ e. No building shall be occupied or uasd in Whole or in part for any purpose whatever until a Ge.rt ficate of Oegupenny ~hall have gsant~d by the Building Inspactor. ' L APPLICATION IS HEREBY MADE to the Building Department for the i#uanca of a Building Permit pureuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinancas'ot ReguiMiom, for ~fle oonKrugtion of buildings, additions or elteratiom, o~ for removal or demolition, as herein described. The applicant agree~ to comply with alt IppJJqable laWS, ordinances, building code, housing code, end regulations, and to admit authorized inspectors on premises and in bullding~ for necelmFV Jmipacflom. (Signature of applicant, or name, it a corporationl (Addre~ 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. (Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's L cense No .................................. J 1. Location of land on which proposed work will be done. Map No ..................... '. ........................ Lot No ...................... Street Rnd Number ...--,~..~.~//~.,/~..../~)~L.~..~...~ ......... .~J~..~'./..~.~..¢~.~ ............................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ao 3. Nature of work (check which ~pli~:al~e~:'N~v Building ....... ' '"ti J · - ................ ~oo~ on ..................... Alteration ........ ; ...... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... ................. (Description) (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 occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..:. ...... [ ........ Rear ..... .~....o~. ............... Depth ......... ~. ....................... Height ........................................................... Number of Stories ........ ~-~.~.~,~, ',~,....,./',~, ,~,~/~, Dimensions of same structure with alterations or additions: Front ......~,,,e~., ........... Rear ..... ~ .............................. Depth ....L,~....¥. ............................. Height ......................................... Number'of Stories ...... ../. ............................... 8. Dimensions of entire new construction: Front ..... .~,¥.~.~...*. ...... Rear ....Z.~/...~....~..?. ......... Depth ... ¢~.....~.C/,..~~. ............. Height ................· ......................... ....... Number of Stories .....~. ..................................... ............................................ 9. Size of lot: Front ...................................... Rear .................. ~..:...]. ................ Depth 10, Data 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: ..... Z~.~. ............................................... 13. Will lot be regrae~ed _.~. ......... ~....,..~ ....... Will excess fill bfi. removed fron] premises: [.],Yes _ ~ No ...... . ........................ (Address) -(Phone No.) Name of Architect ........................................................... (Phone No.i ._ _ ................................ '-'"'"":"::'"' '2"_" ....... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. GLve street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK. ) COUNTY OF ......... 2LL...o... ,~/]Vame o]~indiVi~u~ sibling contract) ...... being duly swo~.., {~?oses and says that he is the applicant above named. He is the ' '- [ C~nt~¢tor, ~ent, co'~'~';'e"~;~;' :';'t;. ") .................................... of asaid owner or owners, and is duly authorized to perf6rm or have performed the said work and to make and file this application; thet all statements contained in this application are true to the best of his knowledge and belief; an~l tbet the work will be performed in the manner set forth in the application filed th~ewlth. ) , Notar~ Public .......... ~allli~:~.~.u.fJ.°,?...C,°~u.n~ty-~.~. ~ County ~-~---~-~ ~-~ ~ ................