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HomeMy WebLinkAbout6686-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at .~.v~..~.e.~.. ~.~.~.~. ............... Street Map No..~.e.~.~. ~.~lock No ........... Lot No, .'t.(~ ..... .S.o.~.~.h.o.~... ~.,~ ? ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ,~.~.e.. ~, 19. ?3. pursuant to which Building Permit No....6.6.~.~ dated ........... ~f~e.. 2.~..., 19~3., was issued, and conforms to all o£ the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P.r~v.~e. ~r~. ~'a~i.~y..~Ling ..................................... The certificate is issued to .~/.o.h~t. ?.,..G. 9~.~y. .... ~e~. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ...~.,..R., ............................ UNDERWRITERS CERTIFICATE No.. ~o.e.~.~$~g .................................. HOUSE NUMBER ... ~.~.0. ....... Street ...~Z~. ]:iaY. ........................... Building InspectOr FOE~ NO. ~, TOWN OF SOUTHOLD BUILDING DEPARTA4ENT 'TOWN CLERK'S OFFICE SOUTH'OLD, N:. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6686 Z Permission is hereby granted to: ...... ......... at premises locoted a~ ............ ~...~ .................. ...~.-?.L:!-..~....~...-~.. ......... ,~.~-.~.-..~.. ...................................... LOT t ~ur,uan~ ,o oppl~o~o, da~ed .................... L...~....~..U..~!.~..., ~.., ond o~pro,ed Building Inspector. Fee ........................ Building Inspector ~M ~0. 6 TOWN OF SOUTHOLD B.ildi~g Depa,tment Tow. Clerks Office ~ou~hold, N~ Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of wate~ supply and sewerage dispasal--($-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 plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming u~ses, or buildings and "pre-existing" 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 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 3. Copy of certificate of occupancy $1.00 $5.00 Dote .~. ............................................. New Building .................... Old or Pre-existing Building ............ ~. .........Vacant Land ............................ · 6'~/ ~'~' ,~7'/-~ocp /7 . ./../?. .............. Loco,,on Of Praper,y .......... ....... Z ......... ........................................... ... ..... Owner Or ~ners Of Properly ..0....~ ........... ;...~....~.~Z ........ .~ .................................................................. Subdivision ................................................................ Lo, No. A~.~L. Block No ............. House No.:.~.~.~. Permit No. ~.~.~.~..Z~.. Date Of Permit ~.:.~,=~...Applicant ~.H.~L.,~...~.~.,~.~...;~ ................. Health Dept. Approval .......... ~.~.~ ....................... Labor ~pt. Approval ........ ~.:.~.....~.... ................. U.d.rw,i~.,~ Zpp,o~.~ .............................................. Pmo,,~., .o.~d App,o~.m .... .~.:.(~.= ....................... Request For Tempm=~ Ce~ificote ........................................ Final Ce~ificate ..........~ ............................ Fee Submitted $ .~.~. ......................... able c~es and regulations. Construction on above described building and per, it meets ~[ applic . ...... ......................................... . Sworn to before me this .......... ( ..... day of ......................................... (stamp or seal)l~ ' L~ ~ I~OIF. M NO. 1 TOWN OF SOUTHOLD BUILDING DEPAIITMENT TOWN CLERK'S OFFIGE SOU?HOLD, N, Y. roved ............... ~'~~ ~' Pemlt ~ ~ ~ ~ 7 ,~pp ..................... ~4.~ 1 .... ' No ................................ ;.... Disopproved o/c .............~ ....... ~ Applicofion No ................... ~ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT ................ . ,,..7.3. .... INSTRUCTIONS 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. 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 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 Per~t. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the aJJplicant. Such permit shall be kept on 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 u~t]l 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 Permit 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, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder; Name ,f....%4.. ~.t'..~..~ .................... ~.~.,~.~.i.......~ ........., ................ If appli°caft~sn:rco°:p:rr:~i,;;n~re ~ff';~l~":~'t~:'/iz~'f~~ ......................................................................... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ...[ ........... ~.. I,~t No..L..~..~ ......................... Street and N u m be r .f'~..~..~ .~.~.... ~. ~.._.._i. [..?[..."~... 1 ......... O Municipality 2. State existing use and occupancy ~mi~s and~ intended use and occupancy of proposed construction: a. Existing use and occupancy .~[7~-~,~~..~ ................................................................. b. Intended use and occupancy ~...~.,~ ............................................................ ~tl n ~ Alter ti n 3. Nature of work (check which applicable): New Building ....................... Add' 'o ..................... a o ............... Repair Removal Demolition ...... Other Work Co~ ...~j~) ¢(~ (Description) 4. Estimated ......................................... 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 ....£~ ............ C~// 7. Dimensions,~,/of existing structures, if any: Front ...~.O,/ ...... Rear ....q~.~C~. .............. Depth ....~/~..~ ................... Height ....f..~....:.../~. ........................................ Number of Stories ...... ~ ........................ ~ .......................... Dimensions of same structure with alterations or additions: Front ...~.~. ............. Rear ..... .~.o~.(~... ......................... Depth ....~...?.~. ............................... Height ....... .v........w. ...................... Number of Stories ....~..,..~,~k~: .................. 8. Dimensions of entire new construction: Front ......................... Rear ............................ Depth ................................. Height ................................................. Number of Stories ......................................................................................... 9. Size of lot: Front ...[.~....~.. ........................ Rear .....(...O.....~.. .......................... Depth .../...~.....(~. .................................... Height .................................................... Number of Stories ...................... ~ ........................................................... 10. Date of Purchase ..(~..Lqx~.t.... Name of Former Owner 11. Zone or usa district in wflich premises are situated ...., ...................................................................... 12. Does proposed construction Violate any zoning law, ordinance or regulatmn..~...~ ..................................................... 13. Will lot be regreded ..... ~.~ ....... ,~ ....... .~.Wi[lexcessf[l,lberemoved frompremisas: [ ]Yes [ ] No Name of Owner of premises 14. ~] ~ (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 sat-back 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. [00 COUNTY OF ................................. .Z .................. ) ~U0J'J ~' "P ~-0~/,-~'~' ~ing duly sworn; de~s and sa~{~hat he is the appli~nt above named. (Na~ of individ~ si~ing con~act ) He is the ' O~ ~ ~.~..,-- .............................................................................................................................. ( Con~ctor, a~nt, coyote o/~cer, etc.} of said owner or owners, and is duly authorized to ~dorm or ha~ ~Hor~d ~e ~id work and to make and file this application; ~at all statements contained in this application are true to t~ ~st of his knowl~ ~d ~lief; and that t~ w~k will ~ ~orm~ in the ~n~r set forth in the appli~tion filed therewith. ........................... ~....dav of ................................ --~..~:r~'~leT;~ ............. ~ [) ~ ~ -- -- ~ .....................