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HomeMy WebLinkAbout7562-zNO. 4 TOWN OF SOUTHOLD BUT~.nlNC DEPARTMENT Town Clerk% ONice Southelcl, N. Y. Certificate Of Occupancy THIS CERTIFIES that the bugdlng located at .. E~. 8% ................. Street Map No. ~ ......... BI~ No.. ~ ..... ~t No... ~ .... ~$~.. ~t~p ......... co~o~ subsidy ~ ~e App~ca~on for B~g P~it he~fo~ ~ ~ ~J~ o~ dat~ ............ Sep~ · .~., 19.~. p~t ~ w~ B~ P~t No. ~.. dat~ .......... ~ept...~..., 1~.., was ~u~, ~d eo~o~ ~ ~ of ~e ~ men~ of ~e app~eable pro~io~ of ~e law. ~e ~p~ for wM~ ~hl, ~ca~ ~ ~u~ ~ .~vAte..~e. f~ .d~ll~g. ~. a~$~ ...................... ~e ce~ica~ ~ ~u~ ~ . .J~..~F~... ~OF ............................. (o~er, le~ or ~n~t) of ~e ~or~d ~g. S~o~ Co~ Dep~ent of He~ Approv~ N~R~ ................................ ~~I~RS CERT~ICA~ No..$~ ....................................... HOUSE ~ ...~ ......... S~t. ~. $~ ................................ B'~ Ins~r ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7562 Z Date ........................ ~e~t .......... ~6 ........ 19r/~... Permission is hereby granted to: ~e~.~..~et.~a...~g~-....:..q~n...~*~r.~ ........... .................... ~£e~ ............................................. to .h~...~..~u~lt~c~..~..~xiat~g...~wl~lli~ ............................................................... ct premises located at ..~,..~...g....~.~. .......................................................................................................... pursuant to application dated .......................~/~p,~....~ ............. , 1~.~..,.., and approved by the Building Inspector. Fee 'I~.5.~.G0 ............. TOWN. OF SOUTHOLD Bu;IdJng Deportment 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 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 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), Nomconforming 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 ....~..~ :.....~...... ~.~ ~.~. .... New Building ................ Addition.. .............. Old or Pre-existin, Qg Bqilding ................ Vacant Land .............. .............. ........................................................ Location Of Property Owner Or Owners Of Property ..... ./~:.~..:.......~.......~..~ Subdivision .... .......................................................... Lot No ............ . BJqck No ............. ~ouse No ............. PermtNo ~7~Z~' Date Of Permit .~/~ /' A licant~ ........ ~-~'~ .................... 7~'~y~7~...' PP ..... ~..~ ........... ./.../t:..: ....................... U Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporory Certificate ........................................ Finol Certificote ......................................... Fee Submitted $ ....~....~ .......................... Construction on above described building and perm)~ meets all applic,able codes and regulations. Sworn to before me this , u ....... c~....~.., day of ..... '"~'"~'"~'"('?'"'~'~'!" (stamp or seal) Notary Public ......~"/7/~.. County ~ '~-- '~ ~! · Approved ........................................ , FOV, M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No..Z~..~...~.....~ ......... Application l'~o ................................. ~ Disapproved a/c .~ ........................................... ~ APPLICATION FOR BUILDING PERMIT ~ Date ........ ...... ............ , INSTRUCTIONS '~, o. 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. Lq 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 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 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. (Signature of applicant, or name, if a corporation) ........ ............. ................ (Address of applicant) Stale whether applicant is owner, lessee, qgent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... .~ ...... ,4~Z-..~~... ....................................................................................... if applicant is a corporate, signature of duly authorized officer. (~Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... "~ A--' Location of land on which pro,os,ed work w. ill be done. J~cp No.; ....~ ............... /........~ .......... Lot No. Z...~. ................. Street and Number ............ /.~...~ ............ .............................................................. (] (/- Municipality State existing use and occupancy of premises and in}ended use and occupancy of proposed construction: occupancy ......~~~ ................ ... .................................................................... Exisiting b. Intended use and occupancy ....... --'~ ~.E~....~.d~.~...r~.....~..¢....~~~' I/ 3. Nature of work (check which applicable): New Building .................. Addition ......~.... ........ Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Estimated Cost ~ ............ Fee ...... Z.~....~.-~..~.~ ...... ~ ........................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specie'/ nature and extent of e~ch type of use .............. ;., ............ 7. Dimensions of existing structures, if any: Front ..... ~:~ ................ Rear ......... '/.~.'....~.. ............ Depth .....~.~.. .......... Height ....~9.~..i ........... Number of Stories ....... ~ ............................................. .! ...................................... ?.....~; ....... Dimensions of same structure with alteration~ or additions: Front ......... .~.....'~.. .................. Rear ..... ./.~...'"..~' ........... De th ~D r Height .......~.....~.. .............. Number of Stories ..... ~ ....................... Height ...../...~. ......... Number of Stories ......... ~'... ........................................................................................................ 9. Size of lot: Front ........... /.....-~..~..'~.. ................................ Rear ......... /......2~. ....................... Depth ......,~....~...-~..~... ........... 10. Date of Purchase ........................................................ 1 1. Zone or use district in which premises are situated ....~.~. .~44.. ............................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ..... .~.~ ........................................... 13. Will at be regraded' . ......... /...~.O .......... ~Vill excess fill be removed from premises: ( ) Yes ( ~"~No 14. Name of Owner of premises ................. Address. ..~...~.'. .......... Phone No.-J~..~.~...'T....~...~....~' .................. Address ......... ; .......... ,, .......... Phone No ....................... Name of Architect '"'~i ........ ~' Address~i~..~ Phone No.~.~..:~.~.././.. Name of Contractor .. ....~..,-. ................................... PLOT DIAGRAM 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 whether interior or corner lot. STATE OF N E'~, I~ IS c_ COUNT, . _ ........ (N~ 6f 4ndividu~ig~mg contracf) a'bow~ named. He is the ~~ . · , (Contractor, ~gent, corporate officer, etc.) of said owner or owners, Qnd is duly authorized to perform or hove performed the s~id work and to make ~nd file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thQt the work will be performed in the manner set forth in the ~pplication filed therewith. .......... , , .................. .... .................... ............................. .