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HomeMy WebLinkAbout6582-zFOR~ ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z..6.~0 ..... Date .......... l)s¢ .1~. ......... , lS.?.b THIS CERTIFIES that the building located at Makn Rob, ri & O~¢ha~.d .... Street Map No. ~ ....... Block No..~. ....... Lot No. ~ .... Y.~.~st M.~..~o.~.~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .. M.a~r ?~. , 1973.. pursuant to which Building Permit No6582Z... dated ..... Ma~... 21. , 19 7.3., 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 p~.~vate, tw.o .f~m~,ly ~ .W~!!~r~g. w.l.~.h, ad.ditlon ................... The certificate is issued to J.a.~.es. ~ogera ....... O~m~ar ...................... (owner, lessee or tenant) of the aforesaid b,,ilding. Suffolk County Department of Health Approval ~.*.~..~ ............. UNDERWRITERS CERTIFICATE No. p.~.l~.~:~. ~ ................................... HOUSE NUMBER 8200.. Street ~in Road ....... 6i~t' '6i.~ii~dl' '~ ...................... .... Building Inspector FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH*OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 6582 Z D~t~/'. .......................... ~ ..........2-1..C...., 19...~/.~ I~ermission is hereby granted to: · J~s--.itoge~-s ................................................. .......... ~e.s~..~-~-/~n. .................................... to .~B~lt~..~.~cl~l./.t&en..&..mak~..e.l.te.~a~en...o~..em~[~t~..2...£am..~t~.g ............. ct premises located ~at ...6/~..~.-~c~.....~....~.a....Old,...O~etm~t..I,a ................................ ........................................... .~a.~...~a.~£o~ ............................................................... '. ......................... pursuant to application dated ........................... ~t ......... .~ ....... , 19.~/.~.., and approved by the Building Inspector. Fee $.].~..t...O~.. ........... FORI~ NO. 6 TOWN OF $OUTItOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicahon must be filled m typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the fotlowing; for new buildings or new use: 1. Final survey of property with accurate Iocahon of all buildings, property lines, streets, and unusual natural or topographic features. 2 Final approval of Health Dept of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of F~re Underwnters 4. Commercial buildings, Industrial buildings, Multiple Residences and s~milar buildings and installations, a cerhficate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B For existing buildings (prior to April 1957), Non-conforming uses, or buddings and "pre-exist~ng" land uses' l. 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 Dote 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 ..K ............ Old or Pre-existing Building ................ Vacant Land .............. ~/ ~ Location Of Property ..... ........... ,¢'~.9. .......... .............. x ...... .¢Z,.s.~..~. ........ ..c-....;...A,I..¥.....Z4.~..3..? ............ Owner Or Owners Of Property ..... .~..~.~.....~....~..~.r:..'n...../~.'....~71m.~r.,~..~.~. ................................................... Subdivismon ................................................................ Lot No ............. Block No ............. House No ........... Permit No ................... Date Of Permit .... ,,..,...,..~.,..Applicant ~~ ..~.~ ...................... Health Dept Approval ..... ..i,....~,..-~. ......................... o or ~ App v ! ............................................. ! Request For Temporary Certificate ........................................ Final Certificate ......... ~..._... .............. Fee Submitted $ ...O~.....~.. ......................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ......................................................................................................... Sworn to before me this ...... day (stamp or seal) BUILDING DEPARTMENT TOWN £LERK'S OFFICE 9rd ^pplication Disapproved a/c APPLICATI°N FOR BUILDING PERMIT ~ Y-.a7 ~ 19...73k'R.~........ Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate t° the Building Inspector, 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, ~ giving a detailed description Of IWout of property must be drawn on diagram which is pert of this application. c. The wo~k covered by this application may not be commenced before issuance of Building Permit. d. Upon ~pproval of' this application, the Building. Inspector will issue a Building Permit to the applicant. Such permit.shall be kept~b~ 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 Ce.rtificate of Occupancy shall have I~een granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permit porsuent to the Building Zone Ordinenee of the Town of Southold, surfak County, New York, and.o~her applicable Law~, Ordinaries or R~ulations, for the ~e~t~ of buildings, ~ldltiom or alterations, o~ for removal or demolition, as herein described. The applicant agrees to comply with all alR~lmlble't~ ordin~ncal, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for neca~ery inspectlonL Janes Rogers (Signature of applicant, or name, if s corporation) Stat Aarton (Address of applicant) State whether applicant Is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owner - b~{~lder Name of owner of premises ...,,T.~RS...~.~aZ'.8 ................................................................................................................. 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 License No ................................................... 1. Location of land on which proposed work will be done. Map No ......... ~ .............................. Lot No.~ ................. Street and Number ..... .I~.I~.....[.~D....~..~.~,~.....&...~,~.~.....~,~....O.3~.~'.~,..~I, ....... ~Jg,~L~.....J~..J. D3~ ............................. ~o~ 0 0 ~"" Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... .2..,..~...a~......~.~...]:..:~...~. ............................................................................................. b. Intended use and occupancy ........... ,S~,[~J~...9~J,[b,.~,dI~..~;..B~.~B~&.~O/3, ...................................................... ~ 3. Nature of work (check which applicable): New Building ...................... Addit.on ..._~_~_.?.~. ........ Alteration.....,b/h%.. Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... (Description) 4. Estimated Cost ........8....0~......_,+ ......................... Fee ...... ~,~.QQ ................................................................................ (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 occuoan~/, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Deoth ................................... 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 ....12. ................ Rear .......... ].~: .............. Depth ....... .!..2. ..................... Height ................................................. Number of Stories ....la[o .............................................................................. 9. Size of lot: Front ...................................... Rear .......................................... Depth .................................................. 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11., Zone or usa district in which premises are situated ......... ~,....~,~a~ ............................................................................ 12. ~ Does proposed construction violate any zoning law, ordinance or regulation: ....... .11o. ............................................... 13. Will lot be regradecl_zzo, ............................. Will excess fill be removed from premises: [ ]' Yes [ ] No 14. Name of Owner of premises ,T~.~..es Ro~ers (Address) (Phone No.) Name of Arch tact ................................................................. (Address) (Phone No.) Name of Contractor .............,~tA~9 ............................................................................. ~ ............................................. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all sat-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior o~ corner lot. 8e~ f~le~ Plan STATE OF NEW YORK, ) COUNTYOF .................. ~.1~.~.~... ................ ) ~ ........................ ~B~te"eL.~aQ~~.]~.~ ................................................. being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) He is the ................................................ ~Z~ m hlL~L~cl~ .................................... (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 therew[th.