The URL can be used to link to this page

Home My WebLink About7446-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. ¥. Certificate Of Occupancy No. Z6.0.2~ ...... Date ........... JulY;..29 ........ , 19. THIS CERTIFIES that the building located at . No~th. Road..to. Barrier.. Street Map No...x~x ........ Block No. ~ ....... Lot No. ~ . ~p.u.t.~.lg.l.d.... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .J.u..ly...2.9., 19.7.~. pursuant to which Building Permit dated ......... .J.tl, l.y....2.~ .... , 19 ?..~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .... P~.~V~.~ .a.c.c~p.ry...s.~.o.r.a. g~...b.~.i. 1..d.~..~.g ........................... The certificate is issued to . .J. Osepit. Po.~ox'Bki ..... Owla$~ .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ~.o.~,. ........................... UNDERWRITERS CERTIFICATE No...~y.R., ...................................... HOUSE NUMBER .............. Street .......................................... FOF,~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMI:~IT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (-CHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 7446 Z Permission is hereby granted to: 1~ & ~s Jo~.~.h Pot~o~skX ~.~.~.~...a. ....................................... , to build new accessory s~oragetbu~ld!ng pursuant to application dated ........................... .~..,,~..~ ......... ~...:., 19.~...,, and approved by the Building Inspector. Fee $. .1. . .0. ,,.0. . .0. ........... Building Inspector FORM NO. 6 TOWFI OF SOUTHOLD Building Department Town Clerks Office Souehold, Fl. Y. 11971 APPLICATIOFi 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), Nan-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 ........ .~.l.z.~ ........ ~..... ~..~.17~... New Building ..~....~... ....... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... ~./...~....~.~..o..z?.~.lq:....~.~..o...~..c]:...~.o....~..~.,-,(.~.e..~ .......... ~..o..~.~.o.~.~ ..................................... Owner Or Owners Of Property .... ~.o..s...e.~g.~,...~..o..t;...q.z'..~.3.': .............................................................................. Subdivision ........ ~ ................................................... Lot No...~..~.. ...... Block No.....~..~.~.. House No ............. Permit No..~.~.~ ........ Date Of Permit ~.../.~.~./..~..L.F....Applicant ..... ~..O..8.~.g.~...~.~..O.~.O.~.8.~ ......................... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ 1~' .~. ~ .~q. Underwriters Approval ................ ~. ............................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate 3:* Fee Submitted $ ~.t..0..©. ........................... Construction on above describedAppl cantbUilding~andf~'~c-'permit mee~,all,/"),~ ~A 'applicable co?s and regulations. Sworn to before me this ........... 2.~ day of ....~tZ].~ ........ 'J..c).~.~.t~ ............. (stamp or seal) Notary Public .......~.~.~.. ~..o. ~.~. ............ County TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Approved 19.~...~ Permit No. 2~..f[!.~...?;....-~. ....... '(~uilding Inspector) ~/ 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 plat 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 areas, and giving a detailed description of layout ofproperty must be drown on the diagram which is port of this opplication.~ 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 o Building Permit to the applicant. Such permitJ 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New. York, and other app cab e Laws, Ordinances 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 admit authorized inspectors on premises and in buildings for necessary inspections. ......... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~.....~:...~ ............................................................................................... 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 ............................................... X 1. Location of land on which proposed work will be done. Map No.: ..........................4..........~... Street and Number~ .... J~.y..~.¢~,....l!~j~d.,. ~m~.'t~.~ld,, ~.,..~.,~ ....... .I.).~'/./. .................................... J ~/~3~.~ Municipality State existing use and occupancy of prem~'e~ and intended use and occul~ancy of proposed construction: a Exisiting use and occupancy ....:.~.~...g.ejP...l~°:......e~.~/~,~P.~J ........ ~.zT~. ............................................................. b. Intended use and occupancy ..... .~...'~.P.I~.fJ~P,....~....9.~)Wt.J~.~.¢#.~.....t. ....................................................................... 3. Nature of work (check which applicable): New Building' ...~... ........... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... o~.-~ (Description) 4. Estimated Cost ...... .~..~-~.,,.'~.~.~ .................................. Fee .../....0......~..~...."i~i ............................................................... (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 ............................ Rear ................................ Depth .................... 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 ...I.O.~. ........................... Rear .../..~). .................... Depth ..~. ................... Height .....~..~ .......... Number of Stories ...~.#.~' .......................................................................................................... 9. Size of lot: Front .......... /.~...~..:..0~.. ................................ Rear ........ L~.~..:~../ ...................... Depth ..... !.~'..~.r.¢).~ ............. 10. Date of Purchase ......... ............................. Name of Former OwnerC, II~.~'...~.:...T'¥/~.. ........................... ! I. Zone or use district in which premises ere situated .'J~l~l~.~./..b.l .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~.e ................................................. 13. Will lot be regraded. .......... /~.e ............ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .d.l~<;~k..,,J..~.~.¢~(( ................... Address ~.,,~,~:B:.I~),~I~..~..,. Phone No.7~,~..'.~,~.1.9. .... Name of Architect ................. !~l.~.~..9. .................................. Address ................................ Phone No ....................... Nome of Contractor ................ ~.~.~ ..................................... Address ................................ Phone No ....................... 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. STA-I-E OF NEW~OJ~¢,~ ~/~ ! ¢ c COUNTY ~.~.... I TM ................................................................................................ being duly sworn, deposes and says that he is the epp[icam (Name of individual signing contrqcf) above named. He is the ................................................................................................................................................................................. (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 tha~ the work will be performed in the manner set fo~h in the application flied therewith. Sworn t~e this ....... ~ ~~..~....~.~f~n~ ................................................................................................. (Signature of applicant)