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HomeMy WebLinkAbout8913-zNO. $ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No.Z.~.~'. 9~ ....... Date ............. THIS CERTIFIES that the building located at . .Yll~.age. ~n~ ............ Street Map No..gX ......... Block No...×x ...... Lot Noxx~..Orient.. 21.Y, .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Oc~ .. 13-, 19.~.~. pursuant to which Building Permit No. ~.9~Z.. dated ............ Qc.'.t...~.~..., 1~$.., 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 .Pr~.v.a$o..o.~q~. f~$1y..cl~]..J, ing. w~.th, a~ttl.o~ ...................... The certificate is issued to .]~4igh~. Hor.~ ....... Ow~qer ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~. ,R, ............................... UNDERWRITERS CERTIFICATE No..pending ................................... HOUSE NUMBER ..... 7Y0. ..... Street....V:~llaga .Laae ...... 0~ia~t ........... ............ ........ FOBa~ NO. 6 TOWN OF SOUTHOLD 0 Building Department Town Clerks Office Sou~hold, 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; far 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 dispasal--(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. 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 New Building ....... Addition ~.. Old or Pre-existing Building ........... ~,Vacant Land. . . Location Of Property .....~...~....~... ................................. ..~..~ .~......,..-..~....~. Owner Or Owners Of Property ........ ~r./m¢._~ ......... z../~,-r....~..;,.~.. .................................................. Subdivision .... ~ ........................................................... Lot No ............. --~'"~__ ///-~ ,,~BIock No ............. House_No ............. Permit No...~..~..'../..~.....~... Date Of Permit ./..~).l/3l.?..~..AppJicant .~~...~.,.~~ ..... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temparary,~C~e~tificate ........................................ Final Certificate ......~ ........................... Fee Submitted $ ..~. ............................ Construction on above described building and permit meets all applicable codes and regulations. App,ieont ...................... Sworn to before me this ~/~'" NOTAffY PUBLIC, St~te of New Te~m ~xpires Marc~ 30. 19 FO~M NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL File No ................................................................. Dote ..................................... , 19 ....... PLEASE TAKE NO~.~- t~x~'o~,ap~[~jflnd,~Jated .................................................... , 19 ........ fo~ t~tru~/~ ........... :=~ ..................'~ i/ at~ pr~ses located at .................................... ...................................................................... Street Block Lot is d isapp r~4~ ~'~_ e fo~O~ ~o~ds ~O"/~C~ ~ L FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Finat 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate. 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 $5.00 Date ...~..i .!~..,.!~.~..©. ........ New Building ............. Old or Pre-existing Building v/ Vacant Land Location of Property ~ .O..O...~. 6. [.,.~%~. ,~.~..~,: .~.~. ~;. .............................. ~...~-'~S-.~.?,t- ~!',~/~ House No. Street Hamlet Owner or Owners of Property . ~.~.l~.~; ..... : . . .~..~. ~. .................................... County Tax Map No. 1000 Section ~.. ........... Block . I ............. Lot .J~. ............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant ........... ....................... Health Dept. Approval ........................ 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 applicable codes and regulations. App,icant ............................. Disapproved a/c .............~=..;;.;:.~ ............................ ~:..~;;;.~. ............ ~....~.:~ __,-- .~_~,,~ ..... ........................... ..................... APPLICATION FOR BUILDING PERMIT Date ............................................... , 10 ............ TOWN OF SOUTHOLD BUILDING DE.P,.A RTMENT · row. omc SOUTHOLD, App,eat,on ] 9..?.~. Permit ..~.. ~ cT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 or 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 ifsuance 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 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 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 alteratlons, or for removal or demolition, as herein described. The applicant agrees to comply with all applicabl.e laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises, and in buildings for necessary inspections. (Sight, re of applicant, or name, if a corporation) (Address of applicant) State whether ~pplicant is owner, lessee, agent/ architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .................. i ........... ......i .............. i ...................................... 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...~..Z.Z.~ ........... ii ........ Other Trade's License No ............................................... Location of land on which oroposed, work will be done. Map No.: ........................................Lot No ......................... Number ~.~ ~ -~'.~ Street and ............................................................................................. ........ State existing use and occupancy of premises and intended use and oCcupancy of proposed construction: o. Exisiting use and occupancy ..... .~...~.! ............................................................................................................ b. Intended use and occupancy ~ * '3 Nnture of work (check which applicable): New Building' · ................. Addition .............................. Repair. ................. Removal .................. Demolitior: .................... Other Work ................................................... ~/~.g) (Description) ,egO~ 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 existigg~ structures, if any: Fron~ .......~..~.. .............. Rear ...~..~.. ..................... Depth ..~[. ............ Height .,....'~:....~..~ .......... Number of Stories ........ ].....~.. ............................................................................................. additions: Front .... ..Q..?..../.....~ ............. Rear Dimensions of same structure withalleratJons~or ............................ Depth ...... ~...~...~..../. .............. Height ...... ...'~'....~.. ............. Number of Stories ..... ./....~ ............... 8. Dimensions of entire new construction: Front Height ...../..~. .......... Number of Stories ...... ~. ........................................................................................................... 9. Size of lot: Front .... .,~-~...'~..../ ......................................... Rear ...... .~...~....~ ......................... Depth ..../.....~:T....~'/...~ ............. 10, Date of PurcHase .................. i...:: ................................ Name 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 prem!ses: (~') Yes ( ) No ]~. j' ome o, Owner of premises .......... ~ ............................. Address .......'7..~ .......... rnone ~-~o ....................... Name of Architect ............................. ~,~_~.~,, ............... Address ................................ Phone No ....................... ix~ome of Contractor . .~..~....~....~.,..~..~ ............ Address .~...~ ........ Phone No.'?...~..~..':..~..("/,..?:/ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propr:rty lines. Give street and block number or description ~ccordJng to deed, and show street names and indicate ~vbether interior or corner lot ?T.&'FE OF NEW ?ORIQ t c ¢ coL~,~'r¥ o6 ..5.~...~..6~.z../z ......... f ..... ................. .?...~.../~.....~. ....... ...~..~....~...~.fi/,...~...Q~.. ............................... being duly sworn, deposes and s~ys that he is the opplic~r,, (Nome of individual signing contract) above named. Fie is the (Contractor, agent, corporate officer, etc.) oF s~id owner or owners, and is duly authorized to perform or have performed the said work and to make and file this opplication; that all statements contained in this opplicction are true to the best of bis knowledge and belieF; tk, o~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this .. ....... [.~'~.~.../~ day of ............... ~.~..~ ................... , 19.Z~. ~ ~ , Notary PuNic .................... :~:d:C :.~ .......... Coun~ .:L..~:.....~~LQ~ .................. ~ ~ q / ~ [ (Signature of applicant) '-- //' ' // FLOYD F. KING, J~ ~ ~ otaw Public State of New York , No. 52-7267800 SuffoJk County Term Expiros Mrrch 30, 197~