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HomeMy WebLinkAbout6585-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No..2~.'3.Q ..... Date .......... ~.el~;...1.0 ....... , 19.7.3. THIS CERTIFIES that the building located at ....~.~.e..n~...g.o..t~..~ ........... Street Map No~0~.© . . Block No .......... Lot No..~.~. ..... .C~..~.~.h.o.g~..e....N.,.~? ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... l~.~y...]7. , 19 73 pursuant to which Building Permit No. ~8~.~. dated ........ t.~y.. 24 , 19 ?~, was issued, and conforms to all of the require- -'~' ~,..~'~rnents of the applicable provisions of the law, The occupancy for which this certificate is issued is .. P~.:~va~e~. Ae~cessox7 ~uild~r~. (B.~orag~) ..................... The certificate is issued to .H.a?.o~.d....&.. E.mr~.. . .K~.o.~..e? .....O~r~..e.~.$ ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval N,R, ............... UNDERWRITERS CERTIFICATE No....~...R.,. ..................................... HOUSE NUMBER . .7..0~. ......... Street . .~.~.e.V:~..~.o..u~..~. .......................... ....... ~i~g' i~sp;~t'o~z' 'CT ....... FORM NO. 2 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) Ne 6585 Z Permission is hereby granted to: :~:~o3,~..~. ~':m,~,,...,K~.o~r. ................................. ..... ~-..,-]g.l. we, d.-_.Ave ......................................... ....... ~ &~..~m,:. L~3,..e. ............................................... to .....B~..~ :t~.. i~,~w...t~%.Xra ~.e.. mc c.e s.s o rS.. h~ ~ ~d _~. _~ g, ................................................................ nt premises located et .... ~(~t,...1.% ............ ~.~EJ.~a.-~.~l~-~'- .................................................................. ...................................... ~J,l~X~'g..~O.~.t .............. .Cutcho~ue ............................................................ pursuunt to opplicution doted ..........................M.~,~ ....... :~,.....1.~., 19.~.3..., ond upproved by the Building Inspector. Fee $.~O.~,gO ........... FOBM NO. 6 TOWN OF SOUTHOLD Bullding Delm~tment 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 Budding 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 dlsposal--(S-9 form or equal). 3. Approval of electrical ~nstallat~on from Board of Fire Underwnters. 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 (prmr to April 1957), Non-conforming uses, or buildings and "pre-ex~stmg" 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 inspectton 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 3. Copy of certificate of occupancy $1.00 $5.00 Date .... ...... (..f..2...>.. New Building ~ Old or Pre-existing Building Vacant Land Lccation Of Property ..... G.~...,....~.... ..................... E~~~ ................................. Owner Or Owners Of Property ..... I.,~..,C~..~.. ...... ..~...~~...~..~ ................................................. Subdivision .....~..~..~....~. ............................................ Lot No .....~..I ..... Block No ............. House No...~...O.... Permit No ...~..~.'~....~......~ate Of Permit ..~4,...~......~. Applicant ........ .~...~ .................................. Health Dept. Approval /V ~ (x(_. Labor Dept. Approval .......... ~ ................................. Underwriters Approval .......... !~..:....../~.. ...................... Planning Board Approval ...... ..~...l.~. ......................... Request For Temporary Certificate ........................................ Final Certificate .......... ~ .................. Fee Submitted $ . .~......,~... ...................... Construction on above described building and [oI~mlt.~,~eets ,c~~e codes and regulations. op,cant .............................................................. Sworn to before me this ............. /.~day of ....... ~.......~.....?...?..,~" (stamp or seal)//~ Notary Public .................................... County / t I FOR~f NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Di,~pprov~l ~/c ............................................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS / Applicotion No ............................ a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with~, 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict 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 of property must be drawn on 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 Building Permit to the applicant. Such permit,she be kept 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 Certificate of Occupancy shall have granted by the Building Inspector. ' ~,~ APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, SuffoJk 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, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (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 ................................................ ,;~.. ......... ~..~'~....,~. ......................................................... If applicant is a corporate, signature of duly authorized officer. IName 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.....~-.....~....O. ............................ Lot No....../.! ............ Street and Number ..............~...0...~.....~..~..~.~.......~....~.~ ...... C.O..~..V.4.........~.... ..................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. E×isting use and occupancy ............. .~. .................................................................................................................... b. Intended use and occupancy ..... /~:~`~i~~F~`~/~~ ............................. 3. N~*re of work (check which applicable): New Building ....,,,~,,. ............. Addition ..................... ¢ Repair Remo al Demolitio Othe Wok ................ v ........... n ........................ r r ....... ~ (Description) 4. Estimated Cost .......... .~.~. ............................ Fee ...... ~....0. ..................................................................................... (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.........................O ..................................................................... . ........... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ...... .0. ............. Rear ........... ~ ............ Depth Height . . . Number of Stories ............................................................................. Dimensions of same structure with alterations or additions: Front .......................... Rear ......................................... Depth ................... He ght . Number of Stor es ............ 8. Dimensions of entire new cqnstruction: Front ....~.~ ................. Rear ...... ~...~. ................ Depth .....~.. .......................... Height ....../~..~.~..~ .~...~...t. ................ Number of Stor es ................ 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. Will lot be regraded ~__ ~.~£~ ....... ~ ............... Will excess fill be removed, from premises: [ ] Yes [ ] No 14. Name of Owner of premises ~`~?~[~-Z~/~ ........................................................ (Address) (Phone No.) Name of Architect ................... ..~.~..~.~.~ ..................................................................................................................... (Address) (Phone No.) Name of Contractor ........ .~,~.{/..~.~......./...~'......./~....~.~.. .............................................................................................. (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. ~'/£ £ /~r'~/f~v~ ~6e ~>',~ STATEOF N~O~~ ) COUNTY OF .............................................. ) ............. ~. ~?,..0. ....................... ~'- ~ ...A~...; ,~,. ........................................ being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract) (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.