HomeMy WebLinkAbout6772-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
No. Z8938 ...... Date . Februa. r~r. · 2~ ............ , 1978.
THIS CERTIFIES that the building located at ~ ~.~. ~ra.t.o.o. ka. ~.o.$.d .... Street
Map No ............. Block No ........... Lot No ..................................
conforms substantially to the Application for Building Pemit heretofore filed in this office
dated .. Aug~ls~ .... 2 ...... , 19.73. pursuant to which Building Permit No..6.772.~..
dated .. Au~tls~; .... 2 ....... , 1973.., 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 ...... Accessol'.y .Bu~ld:h~ ............................................
The certificate is issued to .... J. ohn. & .Nancy. t{amllf~on ..........................
(owner,
of the aforesaid building.
Suffolk County Department of Health Approval ..... N~R ............................
UNDERWRITERS CERTIFICATE No .............. N~.. ...........................
HOUSE NUMBER ... ~.~ ...... Street ..... Ear~ato~ka. P, oad ...................
........................................... ~attituck ~. I~Y .....................
.... .
Building Inspector
FORM NO. 6
TOWN OF SOUTHOLD
Building Depmtment
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 triplicate 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 water supply and sewerage 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.
5. 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 "pm-existing"
land uses:
1. Accurate survey o~ 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
ate .......... ......
Notary Public .................................... County
(stamp or seal)
New Building .................... Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property .......... /..~..~.,~.. ........ ~....~....~......~....~......~...~...O/C'./~.. .......... ..~'...~..~.....z~.. .......................................
Owner Or Owners Of Property ....... .?.~.,H..~.. ....... ?.. ......... ..~/..~....~..~..~.~. ........... ..~....~..!.v.!../.c....-~...~.../~.. .........................
Subdivision ................................................................ Lot No ............. Block No ............. House No.../..?.....~'..
Permit No ...... ..~...-./...7...~....-~Date Of Permit ..../~...~....~../.?..7.?Applicant ..................................................................
Health Dept. Approval ................... ; ....... ~ ................ Labor Dept. Approval ...............................................
Underwriters Approval .............................................. Planning Board Approval ....... ..~...\ ........ .~ ................
Request For Temporary Certificate ........................................ Final Certificate ~'
Fee Submitted $ ..................................
Construction on above described building~nd j~rmi/~,~e/s all ap~ble codes and regulations.
Apphcant ...: ..............................................
Sworn to before me this ~/~'~c:~u~% ~ c~Jr~
................ day of ............................................
TOWN OF $OUTHOLD
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)
6772 Z
Permission is hereby granted to:
.,,e,,.c,...~,,s~,~,, ...........................................
to ..... ~..Z~..~.e.~..~.e..q..e.~.~........t...o.~.g.e....~)~ ..........................................................................
at premises located at ....l~lt~f/~g4llll~..&..~..~ ................................................................
pursuant to application dated ................... ~ .........~ ................. , 19~,~..., and approved by the
Building Inspector.
Fee $ .%0~.00. ...........
TOWN OF SOUTHOLD ~f/~"~'
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
~UTH~D, N. Y.
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
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 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 work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall hove been granted by the Building Inspector.
APPLICATION IS HEREBY /VlADE 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
"egulotions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
~ applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
~'..~aothorized inspectors on premises and in buildings for necessa_ry inspections.
........
............................... ...............................
State whether applicant is owner, lessee, lent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of rem see ~j~''' ~"3' '~ ~ '~- '~ e~_ _ ~~.~ ..... .~;~
p ............ ,...:.....= ................................................
If applicant is o corporate, signature of duly authorized officer.
(Nome and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .................................................
Electrician's License No .............................................
Other Trade's License No ...............................................
]. Location of land on which proposed work will be done. Ma~',lo.: ...................................... 'Lot No ...............
Street and Number ~...~..~...~,,.~.....~.. ...... ~~'~-~,..~.,.~.,.,.~,.~~.i.iiiiiii__~________
Municipa-[ity
2. State existing use and occupancy of prefl~s_~,o.a~nd intended~---c ~ use and occupancy of proposed construction:
a. Exisiting use and occupancy .......... ~_(~)'~7 ................................................................................
'""""-'7"
Repair ............. .;.~.~,,l~emoval .................. Demolition .................... Other Work ~.~.......~...;
~/~,~ ~ . /~ ~ , (Description)
4. 'Estimated Cost .......... ./....e....~.....,:~...x. ................................ Fee ....~.....~.. .............................................. i ....................... i ....
: (to be paid on filing th!s. application)
5. If dwe.!ling, number of dwelling units ............................ Number of dwelling units on each f!ogr ............................
If garage, number-bf cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use
7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ....................
Height ........................ Number of Stories ...............................................................................................................
D~mens~ons of same structure w~th alteratmns or eddmons. Front .................................... Rear ....../...~.. ...............
Depth ................................ Height ........ ~ ................ Number of Stories ................................
8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................
Height .................... Number of Stories .....................................................................................................................
9. Size of lot: Front ........................................................ Rear .......................................... Depth....~ .........................
10. Date of Purchase .......... ,~.....?..~....?. ............................ Name of Former Owner ........... ~.?=.~...7~....7.... ...............
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.regrdded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No
14. Name of Owner of premises .................................................... Address ................................ Phone No .......................
Nome 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-bock dimensions from
property lines. Give street and block number or description occardlng to deed, and show street names and indicate
whether interior or corner lot.
COUNTY .
..................................................................................... ~ ........... being duly sworn, deposes and says that he is the opplicam
(Name of individual'signing'contract~
above named/
He is the .................................................................................................................................................................................
(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
thaz the work will be performed in the manner set forth in the application filed therewith.,
Sworn to before/me this II ,,-, -~ /' ~ /
........... /'
~ ~/ (Signature of applicant)
JUDITH T. BOKEN
Notary Public, State of New York
No. 52 ~0344963 Suffolk County.~,..~..=.~
TITLE NO, 8008-00591
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NOTE:
· = MONUMENT
SURVEY FOR
EDNA TONNESEN
TOWN OF S
SUFF. CO.,
R~'~;£ CO.
NO. 80- 124