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HomeMy WebLinkAbout6464-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy IVo..Z 067 ..... Date ............. April .... 9-. , 19.73 THIS CERTIFIES that the building located at . Sc~t~h. 'Ls.~' .............. Street Map No... a~xX ...... Block No .... :K;~...Lot No. · ~l~X.. · .l~a~; .l~t~'ioll conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Apt.il.. 9, 19'75' pursuant to which Building Permit No. dated ............ Ape'.il. · .9.., 19.73., 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..o~e.~aml~.iwe~ting ....................................... The certificate is issued to .Leopt~ld. S.terla ........ Omie~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .}t ~R.* ............................. UNDERWRITERS CERTIFICATE No. · . N.,.Ps* ; HOUSE NUMBER ............. Street ................................................. Building Inspector FOEI~ 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) N? 6~6~ Z Permission is hereby granted to: ~ ....~.¢,~......A./.~......~.q-~.~.o...z.~.....~.~.?.~:~. ................ .......... ~.~..o..~:.~ ................................................ Build an addition on existing dwe].]ing at premises located at ......~..~.~ .......... 8~..~..~...~.....~....~. ·~. ...................... : ..................................................... ........................................... ~:~.~.~.~.~ .....~.....~.~. ............ ~f!~.~.~..i~...~ ................................. pursuant to application dated OCt 17 19.~..., and approved by the Building Inspector. Fee $.?..?, .~. _ .O~.. ........... ......................... 'b'~ii~i/~"¥~'~'~'~'~ .......... '[ .......... FORM NO. 6 TOWN OF $OUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCGUFAN(:Y Instructions A. This application must be filled in typewriter OR ink, and sdbmitted in duplicate to the Building Inspector with the following; for new buildings or new us~e: 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 seweiage 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. §. Submit Planning Board approval of completed site plan 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 all property lines, ~treets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os 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. 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 ss.00, _ , ~ ! ~ ~ Dote ....~ ....... ~. ................. New Building .................... Old or Pre~existing Building ................ i ........... Vacant Land ............................ · ocoton of Property ............ KC...': ................... ...................................... Owner Or O~ners Of Property ................................... : .............................................................. Subd~wsmn ........... ~ ............................................... Lot No .......... ,. Blocl~o ..... .'~... House No ............. Permit No...~ate Of Permit ..~h~....~...~..~Applicant ..... .~.1....~....o?~ ................................ Hen th Dept. pp oval ......................................... abet D~pt. Approval .......... ~ ................................. Underwriters Approval .............. i: ................... Planning Boa~d Approval Request For Temporary Certificate ........................................ Final Certificate ........................... Fee Submitted $ , , Construction on above described building and R~rmj4qmeets all applicable.,c~des and regulations. Applicant ....................................... Sworn to before me this ' '2 ........... .?... day of .............. (.amp or Notary Public .................................... County FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ....... .......... Approved ................... t.! ....... ~( .......... , 19~..~.. Pemit No..,..............~ ~/~'~/~. ....... ............ Disapproved a/c ................. (Building/inspector) Application No. %..?....~., .~.. ................. APPLICATION FOR BUILDING PERMIT Date ........ ; .~ ......................... , 19.?...~ ..... INSTRUCTIONS o. 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 public streets or areas, and giving a 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 Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progi'ess 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 [S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, 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, ordlnance~building code, housing code, and regulations. i .... ....... ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ,6' ...... Name of owner of premises ........... ~3. ......................................................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done, Map No.: ~ 4 · ...~ .................................... Lot No ......................... ... ~.:~..~..~.~....L~..~..~:~'~' .: ............ :...~... ~.~ .s. :/..ZZ~/~ ~. ...................... Street and Number 6'~/~/'~ ~ ~ ?~zt/l~ ~-~ ~ i Municipal ty ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ......... .~.../v...~.....~./~.~.i.&-...~.....~.~?...¢~...¢.~,.~.l.*.6¢:.~ .......................................................... d' ~"7''c~ ~ ~, ,'*~'~[*'i /~ ~'c~ . b. Intended use and occupancy ........... .-/?...~......~..~. ......... ~....~......~, ............. ~ .... .~. ,,~./?..J~.,~. .............................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal Demolition .................. Other Work (Describe) ~ n 4. Estimated Cost ......................... ; .................................. Fee ............................................................................. ~ ........... (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 o:F existing structures, if any: Front .......... i.?. .............. Rear .............. .................. Depth ......~.'~'.: ......... Height Number of Stories : ''/ ~ Dimensions of same structure with alterations or additions: Front .......... '.~.?. .................... Rear Depth .......... ~/..~'. ................. Height ............................ Number of Stories .....,L:~ ................... 8. Dimensions of entire new construction: Front ....~.~; ............................ ~ear ....... ~..L~ .............. Depth ...... /.;~ ............. Height .................... Number of Stories ..................................................................................................................... .................................. ~,,~,,, ' ....... ;:,,K..~, 9. Size of lot: Front Rear .................................... Depth : 10. Date of Purchase ........................................................ Npme, ~f: .Farmer Owner, ........................................................ 11. Zone or use district in which premises are situated .... ~/~' ~ ' ¢'~ ~''~ .. , 12. ' ..... ~ i~ '~ ~ '~ Does pr~osed construction violate any zomn~ JOWl ordinance or regulation ........... : ................................................. 13. Name of Owner of premises ............... ~ ........................ Address ............................................ Phone No .................... 'r,~ .... ~ ," q' ~S~, ~ / ~ ~',~ A---- '* '~ ' Name of Architect .............,~f ...................................... adress ........................ ~;. ........ ~: ......... Phone No .................... .:/.' 4 F ' ' , - ' '" ~' '~ ~'1~ "~/' ~ "1'~'"'"<' :~' Phone No. /.~Z:L..:.~.~.2.~ Name of Contractor ,..: ........... ..................................... Address ......................... PLOT DIAG~M Locate clearly and distinctly all buildings, whether existing or proposed, ~nd indicate all sef-~ck dimensions fro~ prope~ lines, Give street and block number or description according to deed, and show street names and indicaf~ ~hether i~terior or ¢or~r lot, STATE OF NEW YORK, COUNTY OF ................................ ,( '~'~ ................................................................................................. being duly sworn, deposes and says that he is the applican~ (Name of individual signing application) above named. He is the .................. : ..................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~t authorized to perform or have performed the said work ahd to make and fil this application; that all statements cqntained in this application are true to the best of his knowledge and belief; an, that the work will be performed in the manner set forth in the appli~]afion filed therewith. Sworn to before me this / / Nota.¥ Public,. ........................................................... County-:/'z"~'~Zz"~:'"r'"'~'~~"m'~c, '"i's'i~.~;;'~i~'~'~T~;'~ ..................