HomeMy WebLinkAbout7612-zNO. &
TOWN OF SOUTHOLD
BUiI.DINC. DEPART~mIT
Town Clerk', Office
$outhold, N. Y.
Certificate Of Occupancy
No. Z621.8 ...... Date ..............De~.. 2 ....... ,19.7!*.
THIS CERTIFIES that the building located at .~..~.~..4.w..a.~.~.~.. &..~ .t.~... Street
Map No. lq~SS. P.t. Pr~ock No ...........Lot No, .. 18.8 ..... Cutohogu~ .... N,~,...
conforms substantially to the Application for Building Permit heretofore fried in this office
dated ............Lt.. 30., 19. ~ pursuant to which Building Permit No. ?~xl~2Z..
dated .... ...... .0~..t. .... iQ.., 19.~.., was issued, and conforms to all of the require-
merits of ithe applicable provisions of the law. The occupancy for which thi.~ certificate is
mu~ ~;.. ?.rl.v~,..one. f.~.m, llr. t~;~l~s .wit~. a~ .$!.~.~o~. ................
The c~icate is issued to ~,. J.o..]~t~sch ..... .~m~. ................
(owner, lessee or tenant )
of the aforesaid building.
Su~lk County Department of Health Approval N,R, ...............................
UNDERWRITERS CERTIFICATE No. p~dtJag ....................................
HOUSE NUMBER .... .6.6.~ ...... Street..BXg~.d,~.e~:#~.$ ...........................
~ Wuneweta
Buildin~ Inspector
pO~t~ NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7612 Z
Permission is hereby granted to:
....... ~..3~ ............ ~...~.~.#. ......................
at premises located at .~..~...l~li...~..~ ....... ~41,~$J.113~..~;~3.~..]:~1~.]l .....................................................
.................................. .qr~t ..~.t.~ r~ ..& ..l/m~m.m.. ~.~ ......... ~mlmlm .............................
pursuant to application dated ....................... ~.~.~ ....... ~(~ ............. , 19~t...., and approved by the
Building In~:tor.
Examined . ~ .......
...... ...7 r z.-.
Approved
........................................ " , 19 rmit No .......................
Disapproved a/c ...~~..._.._._~.......................... .........
APPLICATION FOR BUILDING PERMIT
TOWN OF SOUTHOLD /~/~,~ ~/~,~ ~r /~- - ~
BUILDING DEPARTMENT ~-~--~.~._ ~// . ~,~ ~ ~"~ ~
~OUTHOLD, N.Y. ~,_. .................... ~'/~-.--- .~
INSTRUCTIONS
This application must be completely filled in by typewriter oe in ink and submitted in triplicate to the Building~~'~
Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on prem see, re at onsh p to adjoining premises or public stree~
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which Js part of this applicahon.~.
c. The work covered by this application may not be commenced before issuance of Bui d ng Perm t
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 Bui d ng Permit pursuant to the
BR~i_l.d.i_n,g.._Z__on~e_?.r,dinance' oft. he T,o.wn .of. Sout~ho, l,cl.: Suffolk .County, New .York, and other applicable Laws, Ordinances or.~
~u u,un=, Tot me construction o? Duualngs, aaairions or alterations, or for removal or demolition, as herein described
The applicant agrees to comply with all applicab e laws, ordinances, building code, housing code, and regulations, and t
admit authorized inspectors on premises and in buildings for necessary inspections.
..... ~(~.~.....~....~...: ~'-7..,,z~ ....
(Signature of opp~icant, or n~me, ,f o co~r~i~n~ ......
.... ~....../.. ...... ~...~,~.....~.~.~..c..~'~~
(Address of applic;;~tj ........
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........................... ~..o.~.~.~..~-~. ..........................................................................................................................................
Nome of owner of premises .....~....~'...~ ....... ~....~.~..~... .....................................
Electrician's License No .............................................
Other Trade's License No ...............................................
Location of land on which proposed work will be done. Map No.: ./~.I~.."~.~Q~.~.--'~. Lot No...../~. ..........
Street and Number ....... .~...l~....,~/.~d..~..1~,/.ll~'~.l~ ...... ..~.~ ....................................... ~l~.~.(~..~t~ ..........
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy . ,,.~J~i.&t~L~{ ~ .~
~ ' .~ .................. ~~' ..............................................................
b. Intended use and occupancy ........... ~..'~...~.£~ ..................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No .....................................................
Plumber's License No .................................................
31 'Nature of work (check which applicable): New Building.. ................. Addition ....~ ........ AIteration'.....i.....' ......
Repair .................. Removal .................. Demolition .................... Other Work .,..= ................................................
//,G~ ~,_.~_.~ (Description).
4.
Estimated
Cost
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 ............................
7. Dimensions of existing structures, if any: Front ........... L..~. .......... Rear ........... J..~. ............... Depth ........ .~...(~...i.
Height ....... .J..'~- .......... Number of Stories .............~l ...................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................ ~
8. Dimensions of entire new construction: Front ............. ~....~, ................ Rear ............ L...~...I. ...... Depth ...... L...~. ..........
Height j ~.~t
.................... Number of Stories ............... .~ ....................................................................................................
9. Size of lot: Front ......... ,.~...~.~. .............................. Rear ......... ---- '.~..C~...'~.; ............... Depth ..... 9...~...! ...............
10~ Date of Purchase ..............; ......................................... Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .....................................................................................................
11). Does proposed construction violate any zoning law, ordinance or regulation: ............................. ~...C) ..............
13. Will lot be regraded .........7~...C3 ......... Will excess fill be removed from premises: ( ) Yes {~ No
· ~al~ol ~ ~ ......................
14. Name of Owner of premises ..... ,.;,.,...L~'~ ............ ~ ..~ddress ................................ Phone No.
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor .'~r~-~-.~:~.~..~..~..~-4~--, Address ................................ Phone No...~.~..~..~..L.~...~<:~
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 NEW YORK,
COUNTY OF ...~,,~,~....~ ............ ..:~'~'"" ~ .,._---~ ,
........................ .~..~.~.~..~. ..................... )~gr ~/../~(Z/,/~eing duly sworn, deposes and says that he is the applicant
(Name of individual signing contrac~
above named.
He is the .............................................. /....~--~-.- ............................................
(Contrectot, 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
th~m' the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
.......... ...... ................
Notary Public,. ................ ~/~. - .~. ............. County .......... ~~.....~ ..,~[. ~~. · · ........
(Signature of applicant)
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
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 $§.00
2. Certificate of occupancy on pre-existing dwelling or land use $§.00
3. Copy of certificate of occupancy SL00
Date ..........
New Building ................ Addition ~ Old or Pre-existing Building ................ Vacant Land
Location Of Property ...~...O,..~......~.../.~.~.......~..../~...~...~.........~..~.. .~'~..~.~.. ..................
Owner Or Owners Of Property .... ,~.~ .~....../~....~.~.... ..~:/. ~.,~f,/~....~./.. ..............................................
Subdivision ................................................................ Lot No../..~i~.... Block No ............. House No .............
Permit No...~J..~....~.. Date Of Permit ..~.~j~...~../;~...Applicant ~./f~../.~Z..x/~...~..~ .............
Health Dept. Approval ............. /~.//.~.. .................... Labor Dept. Approve .... .~./..~.. ............................
Underwriters Approve . ..'~../~. ......... Plann ng Board Approve ....... .~.../.~.. .........................
Request For Temporary Certificate X/Z) Final Certificate .~.~..~..
Fee Submitted $ ....~.,..~..O.. ............
Construction on above described building and permit meets all applicable codes and regulations.
Sworn to before me
........... · ..~.. day of :~.~.._ .~. ~.~... ~.
Notary Public ............. ~~. ?County
(stamp or seal)
Z
TOWN OF'
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