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HomeMy WebLinkAbout9014-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk% Office Southold, N, Y. Certificate Of Occupancy No. Z9096 Date July 5 19 78 THIS CERTIFIES that the building located at ...2.8~...~..e.~.~..R .o.a.d....~/.~... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Dec.ember...20.., 19.7~. pursuant to which Building Permit No .... .9.0.~./*.Z 'dated ..... Dee.ember...20 .... , 197~.., 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 ... BEDR0,0M. ADDITION.T0..ONE., ST.0.R¥..C0.T.T, .AG,E....AND...A.C..C.E~..S..0.R,Y.,..~,. ~ING SEE BELOW * The certificate is issued to ........ H....M~l~'S.h$~!l..Fl~'O.s.t ............................ (owner, of the aforesaid building. Suffolk County Department of Health Approval ............ N/R ..................... UNDERWRITERS CERTIFICATE No ..... .P.e.n..d.i.n.g ............................... HOUSE NUMBER ....... 285 .... Street .... .W.e.s.$..R.o.a..d ....................... ............................................ j~u. tchogt~, e ~ N....Y/. . ' :, ' ....... y_'i~ '£ ................ ~- Bmlding Inspector * ,NO,T~ This Certificate covers a one story cottage and a one and one half story accessory seasonal cottage built prior to April 23, 1957. Buildings conform substantially to requirements for Living ~nits. I~OBM NO. 2 TOWN OF $0UTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 90~ Z Permission is hereby granted to: x1~ .............. ~....~..,.....,.~.:...,.....~,~vu,~ 4 ~o...~L.o.~......©..~0.~zk~--...~ ....... '~""":':f""P~'~'I ............. ....................................... ":': ............... ': ................... i ........................ :'":"':::::::': ....... :'; ........... at premises located at ...?.~.~ .......... ..~..?.~..~.....~.,~..~.~,.."~'"'~"~": ....... '/"'"'~ ........ n'..~..;.d ....... ...................... .:..~.....~:,.~. ............ ~:~~ .................................... Building Inspector. pursuant to application dated .....................~....~ ........~ ..... 192.~., and approved by the ? FORM NO. S TOWN OF $OUTHOL~ , 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 disposals(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, occupcncy and condition of buildings. 3. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o 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 Z/..~.~./ New Building ................ Additi or Pre-existing Building ................ Vacant Lend .............. oca, o Of Property ...... .~.,...~....../.~.,~'~.~....~,'~ ............... ....... ..-~.~.v.~..~7..g'.,~.'~.~ ................. .~..... .z///,,~ ,.~ × Owner Or Owners Of Praper,y ............... .'..,..=~.,.,.~.,~,~.,~/....../....~'~....'.. .......................... Subdivision .................. :.o........~---~. .................................. Lot No......~.. I~lock No..[....'.'[[... House / ...... ..................... ...... ....................... ...~.~/.'...~.~ .................. .... Underwriters Approval .~.. ........................................... Planning Bo~rd Approva~ ~7~.., Request For Temporary Certificate ........................................ Fin~ Certificet* ....................................... '... Fee Submitted $ .~..~...~ ...................... Construction on above described building and permit meets all applicabl~,,codes And regulGtions. ^pp,,cont .................................. Sworn to before me this ................ day of ............................................ (stomp or seal Notary Public .................................... County ~ ~//~ .~ ~ '~ Examined ............ ~ ................... , Approved ~ ~ ~D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Permit No ..................................... TOWNOFSOUTHOLD ~ ~ ~ Disapproved a/c .................................................................. ~~ Date 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 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 applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature 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. ... .......................................................... owner of fetuses ' If applicant is a corporate, signature of duly authorized officer. (Name and title of c,~rporate officer) Builder's License No. Y~ ~?-'~ ~3 Plumber's License No ................................................. Electrician's License No ...... ../~......~...?.J. ......... ~..'Z.~.. Other Trade's License No ............................................... 1. Location of land on whi.c,h pDoposedrw9rk will be done. Map No.: ........................................ Lot No ...... % ............... Number ~'.~..'~ ..~/.4 .~...'-~' ~.~. L~O .~.~..~., (~¢'--) ..'~..~.~,,J~ 0 ~ ~L~ Street and ......................................................................................... L ................................. Municipality 2. State existing use and occupancy of~)~j)m:~nd infended use and occupancy of proposed construction: o. Exisiting use and occupancy "'"'~:"~"'~;:":'-7~":'~"~ b ntended use and eccuponcy ..................... ~. ~' . ............ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... ~ ~-, (Description) 4. Estimated Cost ......................... ' ....................... Fee .................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ C~ ........ 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 ................................ ....... Rear ...... /..~ ................. Depth ~ ....... 8. Dimensions of entire new construction: Front / .~..'~.., ............. ~ ................. Height .................... Number of Stories ............... ~ ..................................................................................... 9. Size of 1at: Front ....... ~/.~ ....................................... Rear ....~...~ ........................... Depth ......°~7....~..~.~....~.. .......... 10. Date of Purchase ........................................................Name ~f Eorr~r Owner ........................................................ ]2. i , n ulotion: ................. ~ .............................. 13. Will lot be regraded . ........ ../~(......~.. ......... Will excess fill be removed from p.r~mis~: ~ ) Yes ( ) No · .~.. o-~,~....~...~..:~ r ~...~..4 Phone 14. Name of Owner of premises .... . ..~... ........... Add ess ...................... '..~.... No ....................... Name of Architect ......................./~ ~..~..~._~.;..; ................. Address ................................Phone No ....................... Name of Contractor ..... (,~)...~-.....~..~ ................... Address ................................Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate oil 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 L-Ilo STATE OF NE~t~,YO)~J~, ,~ ~ c c COUNTY OF~~ ......... f~'~ · ,,--m ,~ ...................... ~/~:_~~..~ ............ being duly sworn, deposes and says that he is the applicam (Name~f in~idual signing contract) 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 ~nd file this application; that all statements contained in this application are true to the best of his knowledge and belief; and th, ar the work will be performed in the manner set fo~h in the application filed therewith. Sworn to ~f~e me this ~)0~ ~ ~ Nota~ Pub c, . .............................. Coun~ ....................................................................................... (Signature of applicant)