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HomeMy WebLinkAbout6816-zFOR, M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnle Of Occupnncy No. Z.~20 .... Date ............ Sept .... ~ ...... , 19. THIS CERTIFIES that the building located at ~/S' 14~ddle .I~1. {OP~?-) .... Street Map No..~ ......... Block No .... ~ .... Lot No. ~X.. ~tcl~gu~...No¥., ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Aug...23..., 19.. ?.~ pursuant to which Building Permit No..6816~. dated ............ AUg..2~. ·., 19. ~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 . Private..one. famil~ .dwalling ....................................... The certificate is issued to .. Philip. A.. Brown...ow~e2 ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... .N.R, ........................... UNDERWRITERS CERTIFICATE No..N,Ro ...................................... HOUSE NUMBER .26~00 ....... Street ..... 14id~lle..Boa4..(-¢1~) ............... · . ........... ~OKM NO. ~ 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? 6816 Z Permission is hereby granted to: ~h ~.]:i~ ... · .~ t,~,,e~ ................................................ ..... ~ho§ue ..................................................... to ~.~,,~..;l,.6....~.~..~.~[.~.~;k~v,,..~ .,e:~.a ~;;L~g:..~l~e.~ ~ ................................................................ at premises located at ....~/.q..ldJ. cldle...~.oacl.....{,O~Z~...--....F,~......~l'.~[g~...~ ......................... ........................................... .c...u..t;~.~.o. ~.e.....~..,~.: ................................................................................. pursuant to application dated ................. l.tlg .......... ~ ................. , 19.~..~..., and approved by the Building Inspector. Fee $.1 ~.~).Q ........... lrOl~M NO. 1 " TowN Oi~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, Approved ........................................ , ..... Pemit No ...... . ............................... Application No ........ ......................... Disapproved a/c .................................................. ~ ....... .~ · APPLICATION I~OR BUILDING PERMIT q% Date .. ' "'"'v"", 19 ... ./ ~ ~ INSTRUCTIONS ~. 3; This-applicetion mu~ be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector witl~ 3 sets of plans, accurate plot plan to scale. Fee according to schedule. %v 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 Permit. ~ %]J d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern'i~,shall 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 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, Suffo/k County, New York, and other applicable Lows, 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 ragulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature or'applicant, or name, if a corporation) - r.., . ............................ " State whethei ap~i~¢ent is owner, lessee, agent, architect, engineer, g~neral con~raator, ele~rieian, plumb~ or builder. ...... ~ ..................... '~"'~ ......... ~2'~-;'T' J','_l'-"""-'"'""c~'~"~ ...~ ....... --.....m, ................................................... ~ ........ , ........... Name of owner of premises ....................~...~-...~L~~ ........................... i ........................................ If applicant is a corporate, signature of duly authorized officer. .................. i' 'i ~1'~ '~'~'fi"~ J~'l~ '~J' ~ ~'1~';~'{~' ~¥iJ~i ..................... Builder's License No ........................ ~ ............................. Plumber s L~cense No ...................................... Electr can'$ L cense No .......... ~ .......... .~._~ ~. Other Trade's License No .................. ~ ............................ 1. Location of land on which proposed_work will be de,ne. Map No .............................. /~...~ ...... Lot FIo ......................... C, k, - Street and Number ......... ~ ..................................... ~ ............................. . .~.A~~ ............ ; Munieipa!ity 2. State existing use and occupancy of premised use and occupancy of proposed const ~r~ction: a. Existing use and occupancy .............. ..~..~:T-_f~..../~..... ~. _ ~. .......................................................................... b. Intended use and occupancy ............................... .'..~-.'..~ ............................................................ ~... .................. .1~ -- Repair ..*;..v-~'" ...... ~...., Remo~{al ~ ................... ~,.. I~mol~tion ,: ....... ~""'i' ....... Other V~o~k'~-~ °" -~-- '~ .~.., ,_,~,~.~ .......... 4. Estimated Cost .................. ..'~...~...~-.: .-O...o. ........... Fee ........................... t ..................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... [ .......... Number of dwelling units on each floor . . . '~ ............... cars ..................................................................... If garage, number of -~ ........................... 6. If business, commercial or mixed occuoancy, specify nature and extent of each type of use ........ ~ ....................... 7. Dimensions of existing structures, if any: Front .....................Rear ........................... Depth ......'~.. ........................... Height ........................ .......~........... ........ Number of Stories ............ ..-: .............................................................. Dimensions of same structure with a terations or ad~ditions: Front ............. ~ ......... Rear .................. ~ .................... Depth.......... ..... ... ............. .....~-..... .... Height ............... ,~ ....................... ,. Number of Stories ....-=. .................................. 8. Dimensions of entire new construction: Front ..... ~.[,L.-7 ............ Rear ........... .T~.. ............. Depth .........~.. ...................... Height .............. ..~.. - . Number of Stor es .. , ......'~. ................................ e .................... ,..... ..... ................. ~ " ~ t.l 9. Size of lot: Front ........... ~..~..~.: ....... '; ........ Rear ............ 1.~.~ ........... ~ ......... D,~epth ....~...~.. ..... ~ ...... ..~...~. .......... 10. Date of Purchase ......... ~..~,c..~4.~...¥.~..~.... Name of Form~)Owner ¥..~,,~...~ ....................... 11. Zone or use district ~n which premises are situated .......... ~ .............. ~: ............ .~'v~'-:~,',~.~ ..................... 12. Does proposed construction violate any zoning )aw, ordinance or regulation:-...~....~..~...~:~ ............ 'i3. W ot be re~radedof Owner- of. ..... , ..-~.....~.~,/~ ~,J, ~r~ [~J~/_ ~JJL~t-X~O~J7--'' ~Will~xce[~ fill be remove~l, from premises: [, Y]~t,Y--fl.~--l~ [ ] No ..:..~.~..~ b 14. Name pram,sas ........ ..~..~k~,u~,~..~..~:?..:...~,~./~....~-.~..~....~.~l. - Naeme of Archit~t ............. ~V~ ....................................................................... ,: ........ .:;~..~ij~o.~.~-~i~,,....---~, · (Address) Name of Contractor ............ ...~.~..~..~.i:...: ............... . · - · - (Phone No.) Locate olear)¥ and distinctly all buildi~ property lines. Give street and er interior or corner )ot. ~ PLOT to deed, and indicate all set-back dimensions from show street names and indicate wheth- STATE OF NEW YORK, SS ...................................................... .......................................................................................................... ~eing duly sworn, deposes a~d says ~a~e is the appli~nt abo~ na~d. fName o[ in~*~id~l ~i~ing connect) .................................................................................................................................................................................... ( Cont~ctor, egent, coyote o[~cer, etc.) of said owner or owners, and is duly authorized to ~r~rm or have ~rfor~d t~ said work and to make and file this appli~tion; ~at all statements contained in this application are true to the best of his knowl~¢' and ~lief; and that the work will be ~dormed in the set forth in the application filed therewith. .......... ........................................... TOWN OF $OUTHOLD Building Delmr~ment Town Clerics Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. Final approval of Health Dept. of water supply and sewerage disposal--($-9 form or equal). Approval of electrical installation from Board of Fire Underwriters. 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 "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 $5.00 3. Copy of certificate of occupancy $1.00 // Date ........... .°.. J....-c~......l...)...~. .............. New Building .................... Old or~,~. ~ ~,,~ ~ (~ g, ~ ' (~ Pre-.existing, B~ildiqg ............................ V~aca, nt Land ..... n ..................... Location Of Property .....~'...~..~...~.:...~....~..~...~...'~..~..~._.':.....~.....~.~(~T~J~.~'-~., Subdivision ............................................................... ~;tp ::a ..................... ~.....:.:: .... Permit No. ..~..~..L..(0.~ Date Of Permit ...~..l..~l.~. nt .... ...~...~..~.; .......... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ....................................... ? Request For Temporary Certificate ........................................ Fina~ Certificate .......................................... Fee Submitted $ ......~..i:..~.,©. .................. Construction on above described building and p~jt~?~t: ?JI ~jol,,~ c~;s_.and regulotions. App Ii ca nt ............... }.......'~..~.~......~......¥..~. ~.~....~... ................................. Sworn to~fore me this / -- ~ ~/~ ..... ~. day of ......... ~7......[~'[ (stamp or seal, ~2 r~~