HomeMy WebLinkAbout7134-zll'ql~M NO. 4
TOWN OF SOUTHOLD
BIm~DING DEPARTS~NT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No. 1,6.686 ...... Date ............~,ep.tl.. ~. ...... ,19.?~.
THIS CERTIFIES that the building located at .~4~ .Lan~ ............. Street
Map No. Bter~.:Ll~g..H~oc.~ No ........... Lot No. $6 ..... Or~e/tpO~.~;.. ~B.,Y., ........
conforms substantially to the Application for Building Permit heretofore ~ed in tht~ office
dated .............. Jal~..21, 19~. pursuant to which Building Permit No. 713~-..
dated ...........Mai,.. 2~..., 19.~t%., 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..l~ivat~, on~. family..dvelLling, vi.th, an .addition .................
The certificate is issued to. All'r~ .T~l~ls. ...... .t~r ..........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Departmant of Health Approval . .~....B.. ..............................
UNDERWRITERS CERTIFICATE No. 1t~.~.~.~ ...................................
HOUSE NU-~ER ..... ~i ..... Street ....... .Z~.d.~. S..~.~.., .....................
..............................................
Building Inspector
FORM NO. 9
TOWN OF SOUTHOLD
BUILDING DEPAIITMENT
TOWN CLERK'S OFFIC~
SOUTHOLD, N~ Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7134
Date ....................... ~'F~ib....2 ~. .......... , 19.~1~.
Permission is hereby granted to:
......... ~.~'~..~.~...~ ..............................................
at premises located at ..l,~tv.... ,~ .............. ~l~i.i. ll~...H~mw~ .............~ ........................ ~ .....................
.............................. I~n~;I.l~..~e .......... 0~e~r~o~t ....... ~v.~., .....................................................
pursuant to application dated ....................... ~.-~:a~l.-..-~.l;....-, 19...~1.., and approved by the
Building Inspector.
Fee $.1.~.a~ ............
FOB, M NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFI¢!
SOUTHOLD, N. Y.
Application No ..............................
Approved ,,, ,I ~ ~.
........................................ , 19.. Permit No..7../......~.....~....~...
Disapproved a/ ................ ........ ..................................
' APPLI~~IT
/--
oo, ..... ................ .
INSTRUCTIONS
a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildin
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
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which Js 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, t~e 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 Occupanc
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY /V~ADE 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.
(Signora're of applicant, or name, if 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 .~..~...~/-,~.....~ .....................................................................
If~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 ............................................... F c/'~ 0 ~ /~
Location of land on whi,~os/e~/w.o~rk will ~,~d/o,n~, h~ap ~o,~~,.x ..... Lot No .........................
Street and Number ..~(~...~ ........ _~..~.~.5,~,~.xw~r ..............................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisitlng use and occupancy .....~~,~ .......................................................................................
b. Intended use and occupancy ~~'~..~'~(7 ............................................................................................
3. Nature of work (check which applicable): New Building .................. Addition i....~ ..... Alteration ..................
Repair .................. Removal .................. Demolition .................... Other Work ................................................ ....
(Description)
4. Estimated Cost ~ ~z~--/.,,~..2...~¢.~..Z.~.~.. ................... Fee ..../:.~ ................................................................................
.......... (to be paid on filing this application)
5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ................. r' .........
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 ............................................................................................................ 7'"
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 .....~../. ......... Number of Stories ../.. .................................................................................................................
9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................
]0. Date of Purchase ........................................................ Name of Former Owner ........................................................
1 1. Zone or use district in which premises are situated .....................................................................................................
]2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
13. Will lot be regraded~· ........................... Will excess fill be removed from premises: ( ) Yes (~'~No
14. Name of Owner of premises .................................................... Address ................................ Phone No .......................
Name of Architect ............................................................. Address ......................... · ...... Phone No.
Name of Contractor .,,.~~i~.S. ............. Address,,,~ .~.~.....('.. ,~..~....~..:.. Phone No. '.~.'.'~..'~'.~.'.'~.'~.'.~
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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.
I10. ~
STATE OF NEWYORI~ /! ~cS
COUNTY OF ....z>~%~-~ ~'
............ ~ ..................................................................................../! being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract0
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 rn~ke and file
this application; that ali 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 therewith.
Sworn to before me this
........................ day of ............................................ ,19 ........ ~J~/,-'Y~t 1)~¢ ~,~
Notary Public, . ............................ County ....................... .._T..C%~_,~i.~nature; .......................... v ..... of app cant)' ..................................
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
~outhold0 N.Y. 11B71
APPLICATI~3N FOR CEP, TIFICA'IPE OF OCCUPAN~
In~l~ru;tions
A, This application must be filled in typewriter OR ink, and submitte~to the Building Inspec-
tor with the following; for new buildings or new use:
1, Final survey of property with accurate location of all buildings, property lines, ~raet% and unusual
natural or topographic features. ,
2. Final approval of Health Dept. of water s~pply and sewerage disposal--{$-B form or equal}.
3. Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa,
6OHS, 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 end "pre-existing"
land uses:
1. Accurate survey of peoperty showing all property lines, s~reets, buildings and unusual natural or
topographic features. .
2. Sworn statement ct owner or previou~ owner as to use, occupancy and condition of buildings.
3. Date ct any housing code or safety inspection of buildings or premises, or other pertinent informa-
tion required to prepare a certificate.
C. Fees:'
1. Certificate of occupancy $5.00 /
2. Certificate of occupancy on pre-existing dwelling/ land
.. 3. Copy of cart f cate of occupancy $1.00 .
New Building . ...~....
use --Pre-gxi=ting C.0. $15.00
Vacan: land C.0. $ 5.00
Date. June 17, 1986
Old or Pre-existing Building 4~ Vacant Land
of Property La'ndinq LaD.e' Greenport
Location .............................................. ........-.-. .. · ...
.~_ Hou~ Nm Street Ham/et
Owner or Owners of Property Estate .o.~ Louise Timmins
043 Block 9~ Lo 016
C~n~ Tax Map No. 1000 Section .............. ~ ..... ~ ....... t ................
Subdivision ................................. Filed Map No ........ Lot No .....
,-m,,.o. ..................................
Undm~vriters Approval ' Planning Board Approval '
Request for Temporary Certificate ..................... Final Certificate .......................
Constr~ction on above described building and permit m~eetJ~l~Lapplicable~'..odes and regulations.
,,, ppi t... ............
~ ' C~[~ ~ Wi~liam H. PrK~e, Jrt., Attorney/Agent
Re~. lO-lO-Ti
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
Southoid, 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 19.57), 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. 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
3. Copy of certificate of occupancy $1.00
Date ...9Z%~./.2~. ............................
New Building ................ Addition ..~ ........... Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property .......... ..~..~..e..~]:...z..n.~....~...~..~...e.~.t..~.J:~....~....~...e..~...~..~..e..e...~.1~..~..~..~z..~§.~..~.~ ....
Owner Or Owners Of Property ........ ~,~,,¢'~.~.ct,..~.,i,I~/)J,~,S .............................................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No ........ ~.l...~.~+....ZDate Of Permit~.../..~...~./..?..~.....Applicant ~~A~e~U:~-~:~~
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ~
Fee Submitted $ ....~:...0..0. .......................
Construction on above described building and perm~t)~r, .meets_ alibi aop~/~/e~' ~'^ codes and regulations.
Applicant .............. ..-~..~......~~ ................................................
GEORGia'RS, BUILD~, INC.
Sworn to before me this ~~~~
Notary Public ....~c~..~.... County
u//
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