Loading...
HomeMy WebLinkAbout7209-zNO. · TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificete Of Occupancy THIS CERTIFIES that the building located at ...~o~d. ~.t .............. Street Map No.. ~ ........ Block No .... ~ .... Lot No, ...Zk~x.....~.q¥...5~...f.O..1~... N.;Y.; ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............. Ajar.. 2,~ 19.O. pursuant to which Building Permit No...?.~)..~.Z. dated .......... AI~.. 2.6 ..... , 19..7~.., was issued, and conforms to all of the require- ments ~f the applicable provisions of the law. The occupancy for which this certificate is issued is .. PTlV&.~. &~.e.e ~ aO:e~'. ( ~.tO~'&ge..)..b~tld.~u~ ......................... The certificate is issued to ....]i.e..m~'. ~'..E. ;..Ba...y~..o.r ....... . .0~..e..r ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE No... N.°.R.; ..................................... HOUSE NUMBER . .i. ~.?~ ....... Street ..... .8??.o.n.d., S.t. .......................... TOrn4 a~ Se4KJ~OU) BUILDING ~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CC~APLETION OF THE WORK AUTHORIZED) lq.o 7209 Z Permission is hereby granted to: m ~lLl&..m.~eeeeee~..4et~e )..Im~bll~ .............................................................. at pmmlms located at ..... ~d~OGIId...8.'~ ............................................................................................... ............................................................. lll~..~lff-e~It: ........ loX. ............................................... ~,. pursuant to al:)pllc~iofl dated ...................... .&~.~. .......~ ......... , 19.~]~.., and approved I~ em Building Inspector, Fee $.:'1~3~00. ......... l~Olt~ ~/0. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Sou~old, N, Y. 11971 APPLIGATION FOR CERTIFICATE OF OCCUPANC:Y 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), 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. Swam 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-existing Building ................ Vacant Land .............. Location Of Property · ..... Owner Or Owners O~ Prope,~ ..... ~..~:C ........ ~.~.~ ................................................................. Su~vis~on .................... = ....................................... 'at No...-~ ......... B~ock No ....... -~ ..... Hou,,,o/..~.~.~ .... Permit No..?. ~ .0..?. ~ Date Of Permit .?.~..~./...Tl...Applicant Health Dept. Approval //t/?~ )~/_/~ , ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ......................: ................. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all ap~lioable codes and regulations. Sworn to before me(~l~ ................ day of~..7/..~/~ ...... ~ (statue TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........ .I Approved .................. '.! ......... Z!. ........ , 19. Permit No...,~..~ ............................ Disapproved a/c ....... ~ .................. ~..._..~ .......................................... .............................. ............ _ .................. 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 o~ 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 pa rt 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'x~ 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. -' ....... : ...... i .... ........ (Address o app icant~ / ! ~v~o State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................. ........................................................................................................................ Name of owner of premises ............. .¥'~..~ ................. .~..f~..~ .................................................................................... 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 ............................................... I. Location of land on wh ch proposed work w be done..~.=_Map No' /'~ L t o ~. Street and Number .....~...~.¢-~....~.....~........~....?..~..~..~.i.l ............. ii.iiiiiiiii~i~~.~.....iiiiiiiiiiiii .... //? '~'~nicipality .... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. Intended use e~eec-u~,,~......~.~..~.~ ...... ..~.....'~'..~...~...~....~......~...~/~..~. ...................................... 3. Nature of work (check which applicable): New Building ...... .'~. ....... Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~. (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 flor ........................... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed ~cupancy, speci~ nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... ~eight ........................ Numar of Stori~ ................................................................................................................. ~tmens~ons of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ (.~./. ................ Rear ............~..~..~ ......D~th ........ ~..~..~ ....... Height .~...~..*. ........ Number of Stories ................. ~ .................................................................................. 9. Size of lot: Front .................... S~ ............................... Rear .............. ~ ..................... Depth ........ (..Q .................. ~0. Date of Purchase .............]..~..~...~ ............................. Nome of Former Owner ....... ........... 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'regraded . ....... ~.~ ........... Will excess fill be removed from p~mises: ( ) Yes (~ No 14. ~ome of Owner of premises ~[:~.~.~...~..~.~ ................. Addre~.W .~.~.... Phone No ~.~ Name of Contractor .~ Address Ph--- ~.- PLOT DIAG~M Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oll set-~ck dimensions from prope~ lines. Give street and bilk number or description according to deed, and show street names and indicate whether interior or corner lot. " , COUNTY OF ...~...~ ......... ........ ~"~'~W~'Q~[~o~ ~ina~ ~ ................. being duly sworn, deposes and says that he is the applicant .... g ' g above nam~. He is the ............................0..~..~..~ ............................................................................................................................. (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 thor the work will be performed in the manner set forth in the application filed therewith..~ Sworn to~dabef°re me thiSof ~ jUmTH ~. ~o~u- -- [(Signature ~ applicant) ............................