The URL can be used to link to this page

Home My WebLink About8914-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z73.7.5 ...... Date ... NW~embe3~. 1 ? ............ , 19.~6. THIS CERTIFIES that the building located at~].~. ~t;,. ~,. I.~..: ........ Street (~o~h ~evRoad) ~ient Map No.. ~ ........ Block No, ~ ........ Lot No, . .~ ............................. conforms subs~antially to the Application for Building Permit heretofore filed in this office dated . . .~etoher. ~ ....... , 19~6.. p~suant to which Bui]dlng Permit No. 89~2.. dated ...0ct0~r. ~ ....... , 19~., was issued, and conforms to ~ of the require- ments of the applicable provisions of the law. The occup~cy for which thi~ certificate is issued is . A~d. P~. g~ .g~rAg9'. ~P. ~ri:~. ~! .f~$!Y. ~ell~g ...... The certificate is issued to .~0B. ~.t .H6g.~ ....................................... (owner, ~t) of the aforesaid building. Suffolk County Department of Health Approval .!~/~ ............................... uNv w rrEas CSaTI CAT .............. HOUSE NUMBER..?~ ......... Street PY.~ .~g,..~l.i..~O~.h .~l~.~O~ ........ B~lding Inspector TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, 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-D 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 awner 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 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 B~ilding ................ Addition ...~ ...... (Did ar Pre-existing Building ........ Vacant/and ............ Locot,o. of Property " Subdivision ................................................................ Lot No ............. Block No ............. House No ............. PermitDate Of Permit/. 6.gg Applicant ......... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate Fee Submitted $ .................................... Construction on above described building and permit meets all opplicab~ codes and regulations. ............... ~f ....... '~ ...... ~'~" ~' ' ~' ~';'~"~' ~'~Z: .................. ~'~"'~"~"' Sworn to before me this ................ day of ........ .................................... .................................... No~o~ Public I Examined ..................... ,~-./., ........ , Approved .............. !~. ....... :.~... ......... , ,ow. o, BUILDING DEPARTMENT ...... ;> c / · ~9 Permit No ..................................... Disapproved a/c ............. ............................. c B ......................... 'APPLICATION FOR BUILDING PERMIT Dote ., ,9 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 Iot and of buildings on premises, relationship to adjoining premises or public streets o7 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 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 alterations, or for removal or demolition, as herein-described. The applicant agrees to comply with all app icab' e aws, ordinances, bui ding code, housing code, and regulations, and to admit authorized inspect6rs on premises' and in buildings for necessary inspections. (Sian~ure(S'g re of applicant, or name, if a corporation) ,(Address of o?pli~ant) State whether opplicdnt is owner, lessee, agent, architect, engineer, general co~tractor, electrician, plumber or builder. Name of owner of premises .......~..<~/~.......~.~.....:......~,~ /z ~-, ;! ........................ 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 Lice~qse No. /~....~.....~...../.'~'... ....................... Other Trode's License No ............................................... Location of land on which proposed _work will be done._Mop No.: ........................................ Lot No ......................... Street end Number ...~.....?...~....~.....'~.. ............................................................ .'..~..~ ......... Municipality State existing use and occupancy of promises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ......~.,~.: ................................................................................................................ b. Intended use and occupancy .,..~,! ............................................................................................................... 3 Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration .............. Repair .................. Removal .................. Demolitior. ................... Other Work '"~"~~i~'fi~'i'(Desc .......... ~ 7~ Fee 4. Estimated Cost ........ ~ ............................................................................................................................................ (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: Froot ...... ~.~....~... Rear ....... ~ ........ ~ .........Depth ...~.~ ......... Height .,..'~..~...~...: ...... Number of Stories ....... ~. ................ ~ ...................................................................................... Dimensions of same structure with alterations or additions: Front .... ~.....~ ............... Rear Depth ........ ~Z..( ............. Height ........ ~..~ ........... Number of Stories ...... J ........................ 8. Dimensions of entire new construction: Front ~ ~ I / ~ / ................. Height ......... ~ ........ Number of Stories .................................................................................................... 9. Size of lot: Front ...... ~.~..~ ................................... Rear ...... Z..~..~..( ................. Depth ...~..~..~ ........... 10. Date of Purchase ..........: ............ ................................. N~,of~ ~ Former Owner ........................................................ 11. Zone or u~e dmtnct m which premmes are s~tuated ....~ ................................................................................. 12 Does proposed construction violate any zoning law, ordinance or regulation: ...~ ..................................... 13. Will lot be regraded .......~.... Will excess fill be removed from premises: (~) Yes ( ) N~ i4. Name of Owner of prem,ses ~.~f..~ .................. Address .~~ ...... Phon~ No Name of'Architect .......................................................... Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from propcrty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Io~. %-ATE OF NEW YORK, I c ¢ COUN'F¥ OF ..~'.~ .~..~77,.¢...~.~. ........ ................... .~.~,.~. ...... ~..~,~.~.~.~ ............................ , being duly sworn, deposes and says that he is the ~pplicanl ~ (Name of individual signing contracf) ~bove named, ~ i, ~ ........................................... ~.~.(.~Ld ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have peFfbrmed the said work and to make ~nd file ~his application; that ail statements contained in this application are true to the best of his knowledge and belief; tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this .......... ~Z.~... day of ........ :.: .......... ~:.~ .............. , 19..~ /~ , ~/~ .~ '"~ ~ / ~ FLOYD F. KING, J~ ...... ~ '(Signature of applicant) c~- ~///~¢ Nota~PuBli~ Stato of New york ~ ~ ~ No. 52-7267800 Suffolk Coun~ Term ~xpires M~rch ~0,