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HomeMy WebLinkAbout6624-zFOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.. Z~786 ..... Date ........ Feb .. 7. ..... , 19 THIS CERTIFIES that the building located at .]29... gapt ]~;$.d.d..~..l' ..... Street Map No..C, ap.g Kidd Block No ........ Lot No. .~29.. · l~ttl~;Ug~ I;.,Y. .... conforms subst~tially to the Application for Building Pe~it heretofore filed in this office dated .... g.~e .~ .., 19..7~ pursuant to which Building Permit No. dated ... g~a.. ].. , 19 7~, was issued, and conforms to all of the req~re- ments of the applicable pro~sions of the law. The occupancy for which this certificate is issued is .~ri~ate. accesaory, building (storage] ....................... The certificate is issued to .Ewa ~tonopo%~es. .. ~er ........... (owner, lessee or tenant) of the ~oresaid building. S~olk County Department of Health Approval N~R, ................ UNDERWRITERS CERTIFICATE No. .N.,R, ....................... HOUSE NUMBER 16~ - .. Street ..... Cap-t .K~dd Dr ................ Zena Rd Building Inspector[ FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6624 Z Date ......................... ~11t~ .......... ~ ......... , 19.r/.].. Permission is hereby granted to: ......... ~..v..a.........at..~..o..n...qp. ~..o..s. ............................. .............. N~;~ok ............................................ ~o ...b...q$.~..c;~.~..n.~.~..~.$.~.~`.~.m~c.¢.~.a~.y...L.~.~.a~.&..~sg~)..~~~ ~:a ~ ......................... at premises located at ...,L~¢ ..... ~.~) ......... ~l~-~I~..t{.:i~it-.-~s~-~e~ .................................................. ....................................... ~a~t-...Ki-~ld...D. tv, e ......... ~{~t;.t t~ct,~.-.-.l+~.~ .~ ....................................... ............................ .~LLIle ..... .~ ............ 19~..~ ..... and approved by the pursuant to application dated Building Inspector. Fee $~..~. ~.~.Q ............ Building Inspe~tdr FOI~IVI ~0. 6 TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicahon must be filled tn typewriter OR ink, and submitted tn DUPLICATE to the Building Inspector w~th the following, for new buildings or new use: 1. Final survey of property with accurate locahon of all buildings, property lines, streets, aha unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage d~sposal--(S-9 form or equal). 3.Approval of electrical installation from Board of F~re Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buddings and mstallahons, a certificate of Code comphance 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 buddings and "pre-existing" land uses' 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of bu,ldmgs or premises, or other pertinent in- formation required to prepare a certificate C. Fees: 1. Certif,cate of occupan '~ '~ 2. Certificate of occupancy"on--~xisting dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date . ....~.... Z ..~...Z .¥. · .................. New Building ................ Addition .....~ .... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..~.~.~' .~./~...C'./~. ............................................................................................... Owner Or Owners Of Property ...c.~..~'...,z ......~c~<...~... '.~..-.~...~..r...n-.:....~.~¢~. ............................................... Subdivision ................................................................ Lot No../.~."~...~.... Block No ............. House No../.'..~...~, Permit No i~...~Z..~....~'.'..'.~.. Date Of Permit .~Z~.T~.~....Applicant ~..//.~....~...~.'~..~.~/~..~..~...~...~...~..,,~. ................ Health Dept. Approval ...... :~ .............................. Labor Dept. Approval ............................................... Underwriters Approval ............ ~ .............................. Planning Board Approval Request For Temporary Cerhficate ........................................ Final Certificate ..~ ................................. Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this ~ ~L*¢-~'~'"~ ~'~' ~ '-~ ' ~ ~, ~ '~ .... o~ New Yot~ No 52-0344963 Suffolk Caun~ Comrn,ss~on Exptres March ' L ~ L ' INSTRUCTIONS ~ ~ ' ' ~ ~ a Th s app cation must be completely filled in by ~Pewrite¢ or in inl~ and submitted in triplicate to the Building Inspector, wit~ 3 sets of plans accurate plot plan to scale. Fee according to schedule. , b. Plot plan show ng ocat on of ot and of buildings on premises relationsh p to. a~ljoi~ing praises or public streets or areas and giving a detailed description of layout of property must he drawn on diagram v~ich is part~°f thi~ ap'J~tication. c. The work covered by this application may not be commence~.~ ,b4~.o~re.~ssuanCe oJ Building Permit. ~ d. Upon approval of this application, the Building Inspector wi~'issue a Building Permit to the applicant. Such permit.shall he kd~t the premises available for inspection throughout the work. e. No building shell he occupied or used in whole or,in part~fo~ any purpese wherever 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 Ordinance of the Town of Southold Suffotk 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 ~des~rib~, The applicant agrees to comply with ell applicable lav~ ordinancas, building code, h~using code, and regulations, and to admit authoHzedlnspectors on premises and in buildings for necessary inspect ohs. (Signature of applican% or nai~l~ 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 .......... ........ ~r...~..:..IK~..!...~,.m. ....... ~. ........................................................................ If epplicant is a corporete, signeture of duly euthorized officer. (Name and title of corporate officer) ~%~ Builder's License No ......................................................... i*~ Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ....................................................... 1. Location of lend on Which proposed work will be done. Map No ...... ,/..~....~.....~... ..................... Lot No....~...Kl~.~.........~ Street and Number .~.~.p~......'.C~.~....~..e~.~.....d~g'^ ........... ~'.~..~...~...~.~..~4f~ .......................................... / ~, 6 0 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use end occupancy ............. ~....~,....d~'..~.~..~.~.~.. ..................................................................................... b. Intended use and occupancy ............... ~..~.~.g~ ........ ~.~a~J~,~'.~,:.!: ................... : .................................................... 3. Nature of work (check which applicable): New Building ....................... Addmtlon ..................... Alteration .............. · Repair .......... Removal ..................... Demolition ........................ Other Work ....~.~,....~f'~,~... ................... (Description) 4. Estimated Cost ~,~)O0 ~ . 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 occuoancy, specify nature and extent of e_ach.type of use ...................... ~ .............. · ! 0~' . . 7. Dimensions of existing structures, if any: Front ....... ~..~; ...... Rear ........ .~..~. ........... Depth ....... Z....., .............. Height. ....... .... ..... ....... ........... .. .... Number of Stories ...................... ~.. ................................................... Dimensions of same structure with alterations or additions: Front .......................... Rear ......................... : ............... Depth ............................................. Height ......................................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... ~..~. ........... Rear ........ ~..~..../. ......... Depth ....... .~...~..../. ................ Height ............. Z../- ............................. Number of Stories .................. /.. .................................................................... Size of lot: Front ........~...~.,.../. ................. Rear ............ .~..~....~...~ .............. Depth ...,.....~....~... ................................. 9.10. Date of Purchase ..... ,~.~/.......~/././.~...~.. Name of Former Owner ..~...,..~.M~IL~.~ ~ ....... . .~.f........~.../.......~.f[~./Z .......... 11. Zone or use district in which premises are situated .................................................................. ; .................. ;; .............. 12. Does proposed construction~vi,~jate any zoning law, ordinance or regulation: ..................... ;; ................ ~ ................ 13. Will lot be regreded ~.,~ ......... :~ ...... Will excess fill be remo_ved f~rom pre. rn, ises: [~] .Yes 14. Name of Owner of premises ~...~...~'~I/~ltl~..~...~....4..-~.....'.-~.~..~.-.-~;'~".~"',~ear"~"i~h~x'x"w'°' (Address) Name of Architect ....~..~..~.../~....~.....=~-.-.5[-~;..-Z~-:-~ .~/....~....x/.~t-.~.~..~..(~'~i;~'~;~ .................................................................. (Phone No.) Name of ContraCtor*,-4~...~-~..m-...°'¢''('''': ............................. [~')' ................................... i~ No.)' ' PLOT DIAG RAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-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. qT' STATE OF NEW YORK, COUNTY OF ...~..~..~.~...~..~,X.~ .......................................................................................... : ............... being duly sworn, deposes and says that he is the applicant above named. (Name of individual signing contract/ , He is the ...................... .(~....L~.,~..~..~ ................................................................................................................................................................... (Contractor, agent, corporate offfcer, 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 tberewlth. ~ T.~R~ ~ £L~ ~ ~ JI(~TAEY~,...~.-- pUBLiC, Stat~d.~s~0f Nev,~,.v o~ ~ ..-.-~ ..~,, day of .......... ..~. .............. .N~..~2: ...~. ........ ........ · ............................