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HomeMy WebLinkAbout8819-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y, Certificate Of Occupancy No..Z. ~. 3..2.3.7. ......... Date ..... F..e.b.v.u.a..ry..2.5. ............... 19 .8.5. THIS CERTIFIES that the building .... g.c.c.e.s..s .o.v.y.. g.a.v.a, g .e ......................... Location of Property ... ia...Q, Ia ...... bl/.S., g.&I.N. 3.0AD. ........................ 9.~.~.E.N. ~-.. House No. Street Hamlet County Tax Map No, 1000 Section , l $ ......... Block .... ~ .......... Lot ,., ~ ............. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... h g g.u.~. ~. ?.6. ..... ,197.6.. pursuant to which Building Permit No..8 ~?.9. g. ............... dated ..... ~. u..g.u.~. ~...2 .6 ............. 197.6.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ....... ~.c.q e..s b.q~. ~. ~.a.r?..a g.e.. ..................................................... The certificate is issued to Louis Demarest ..................... k ................... of the aforesaid building. Suffolk County Department of Healtt~ Approval ......... .~./fi. ....... I ..................... UNDERWRITERS CERTIFICATE NO ................. .I.I.N./.A. ............................. Bmlding Inspector ~ev. 1/81 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTFfOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8819 Z Date August 26 19 76 Permission is hereby granted to: ..~.m.~J.m..~.~.~s.t .................................... ................... 0~.~ .............................................. to Build new p.,rivate garax.e. ........ ...................... ~.~ ........ ._ ....... )..~ ..:-;..:_ .................. : ............................................... .~ ............... · ..... . ......................... ........ :.::........... ...... pu~Ua~t to a lication'dat~ Fee $.14..~.~...t.. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This apphcation must be filled in typewriter OR ink, and submitted in duplicate 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, 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. Commercia[ buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a cert~hcate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operty 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 buddings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tmn required to prepare a certificate. C. Fees: 1. Cert~hcate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Buildin§ ............. Old or Pre-existing Building ~ .......... Vacant Land ............. Loc at,on of Property ......................... .._~.. ~-.~.. ~'~..~.~./.~/~ ......... ~.~ 0 ~ner or Owners of Property ~~-~_z...,'~.'. ~~¢_~--~-~..< ................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ $15.00 Date .......................... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ~.~ ...................... Labor Dept. Approval ........................ Underwriters Approval .................... Plannin§ Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... ~..~ .~..7~. .................. on above described buil~jt mebt~}~~es and regulations. Construction ........ lrOH, M ~0o ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s application must be completely filled ~n by typewriter or tn ink and submitted in triplicate to the J~uildin, Inspector, 'with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buddings on premmes, relationship to adjoining premises or public streets o areas, and giwng a detaded description of layout ofproperty must be drawn on the diagram which ~s part of th~s application c. The work covered by this apphcat~on may not be commenced before issuance of Building Permit. d. Upon approval of this apphcation, the Building Inspector will issue a Bu~tdmg Permtt to the apphcant Such permi 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 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 applicable Laws, Ordinances o Regulahons, for the construction of buildings, additions or alterahons, or for removal or demolmon, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t, admit authorized inspectors on premises and it~ buildings for necessary inspections. (S~gnature of applicant, or name, if a corporation) (Address of applicant) State whether apphcant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ...................................... ..... .............................................................................................. Name of owner of premises ....... :~2J..;2 ..... m~.!1:..'~7. ..... ~ ..................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's L,cense No ...... .0.!{~.1.~ ................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's L,cense No .............................................. Location of land on which proposed work wdl be done. Map No ' .....:~: .......................... Lot No.....:~... ................ Street and Number ~.t..'.k'.:..:.: ........ ~.M/..:....':;..~.~.....~;.9.'.~.t~ ......... ..~.~.g.~..~.~. .................................................................. Municipality State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ..?.:.:~.]...'..z..i.]~ .......................................... , ................................................... b Intended use and occupancy 3 Nature of work (check which apphcable). New Building .X.'Y~ ...... Addition .............. Alteration ....... Repau .................. Removal ............. Demalmor ............. Other Work ......................................... (Description) 4 Estimcted Cost ..................... ~;~'(~0'""e' .... Fee . ~©o(~[0o be prod on fihng th~s apphcat~on) 5 If dwelhng, number of dwelling un,ts ....... B't"~ ......... Number of dwelhng un,ts on each floor ..................... If garage, number of cars .......................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ...................... 7 D~mens~ons of ex~stmg structures, ff any' Front ...................... Rear ................................Depth ................ Hmght ........................ Number of Stones ...................................................................................................... D~mens~ons of same structure with alterations or additions Front ................................... Rear .................. Depth .............................. Height .................. Number of Stories ............................. 8 Du'nens~oas of entire new construction' Front ....... .~;"~ ......... ............. Rear ........-'~.(6,~ ............... Depth ' .... LeO ........ Height ................. Number of Stories .................................................. 9 S~ze of lot Front ..~.?c~.~. .................................. Rear .................................... Depth ............................. 10 Date of Purchase .................................................... Name of Former Owner ........................................................ 11 Zone or use d~str~ct m which premises are situated . 12 Does proposed construction violate any zoning law, ordinance or regulation: ........ ~ ......................................... 13 Wdl lot be regraded ....... ~.~ ............. Will excess fill be removed from premises' ( ) Yes ( ) No 14 Name of Owner of premises ...... r.O,~,, ........ ................. ~,....~,+~ ....... ............. Address ............. ~..,~ ............ 2 Phone No ....................... Name of Arch,tect ............................................. Address ................................ Phone No ....................... Name of Contractor .................. ,,.-r~ ......................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and &stmctly all braidings, whether ex~sting or proposed, and md~cote all set-back &mens~ons from propcrty hnes Gwe street and block number or descr~pt,on according to deed, and show street names and in&cate whether inter~or or corner lot STA-J'E OF NEW YORK, I.S S COUNTY OF ...... sign~~''~,,~ contracf) being duly sworn, deposes and says that he ~s the apphcanl (Name o~ individual above named He ~s the ............................ [ ...... 4.T:,...t.:.t,~.~¢'..~.~ ...................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and file this application; that all statements canto,ned m th~s apphcat~on are true to the best of h~s knowledge and behef; and thor the work w~ll be performed m the manner set fomh in the apphcat~on filed therewith Sworn to before me th~s ............... ~.. day of ................ :,t'~- ............, 19-~6 Notary Pubhc, . ............. ~!~:~L.~,,].}r. ..................... County ~ ,'- 83~9~3 S~/fol~ Cou~ (Signature of applicQnt) '