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HomeMy WebLinkAbout9051-zTOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, H. Y. 11971 APPLIGATION FOR GERTIFIGATE OF OCGUPANCY 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 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 Date ...~i ......................................... New Building ................ Addition ...... ~.... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~..~...~.. .... ~..(/..~...~...~.. ..~... ~--/..,.................Z~.~C-~.C ..................................... Owner Or Owners Of Property ...~,../~..~.~..~.. .~...w~.:....~-~... ~.~.~.... . Subdivision t ................ ~ ............................ Lot No. ~.../.:..., Block No ............. House No ............. Permit No..~...~...~..Z..~..... Date Of Permit ..~../.~...~/.~..~..Applicant ,...~.~.~..~......~.~..~..,S: .................... Health Dept. Approval ....... i~ .................................. Laoor Dept. Approval ................................................ Underwr.ers ^pprovol .... ............... Pbn. .g Board Approval ....... .................. Eequest For Tempora~ Ce~ificate ......................................... Fin~ Ce~ificate ......... ~ .................... Fee ~bmitted $ ....~ ........................... Construction on above described building and permit meet~all applicable._, codes and regu ations A licant/ ~tw__~..~......~ Sworn to before me this ~ / ......... ~ ..... day or ............................................ [stamp or sem~ ~ , :,q~'H~ NEWi YORK` BOARD OF;FiRE: LINIDERwRiTERs' THIS CERTIFIES THAT-" only ~h e eJe~trical'~qulpmcnr ~ described below and introduced by ~he appllc~[ nan{ed on the above appl~c~ti~ ~u~er in t~ premises of ~ John:F. Troyan, Jr. ~.Elizabeth A, 650 Cardinal Dr~ve, Mattituck, L.I. RXTU~E SwITChEs' 'RANGES' ' OVENS EXHAUS% FANS ~- OUTLETS B.J. Electric Co., _ . Box 17, Stillwater.'Avenue, ' - -: ~r~A~ aaa^taR Cutchogue, b.I.. 11955 'I Lic.505E ,. ~//J Y Th $ ce t f cote must not be altered in any manner; return to the office of the Board if incorrect, Insoectors may be idenfifieo--by t})~'~r credentials. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEIJK'S OFFICE SOUTHOLD, N. Y. Application No ....... ..~.....~....~. ,/.. .......... Approved ~/~ ~ 7y ~6 5~{ ~ ........................................ , 19 ........ Permit No ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 Jot 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 diag?am 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 hove 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 bu Idings, add tions or alterations, or for remora or demo ition, as herein described The applicant agrees to comply w th all appl cable laws, ordinances, budding code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. ............... ........... (Address of aplSlicant) State wheth~/~plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ..~...¢~..~z.../..~....~'..~.~'..~....~...~?.. ..~......~...,'~../.~.~.-.~.~/.~... ,~../~'.:..../...~.C~./. ~ ................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporat~ officer) Plumbers bcense No .............. Electrician's License No ......... .~..~..~. ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New Building,. ................. Addition ........ ~. Alteration ............ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... ~/,~ ~,~ ~, ~, . (Description) 4. Estimated Cost ..... z..~ ................................................ tee .......................................................................................... (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 af each ~pe of use ............................ 7. Dimensions af existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ De~th ................................ Height ............................ Number af Stories ................................ 8. Dimensions-- of entire new constr~ction: Front ..~..~...;.~..~'" ............. Rear ...... ~..:.:,.::.... Depth ~..~.'~ Height ...~.....~. ...... Number of Stones ...... ~ ......................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ........................................................ 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 pr~es: ( ) ~es ( ) No 14. Name of Owner of premises ..... .~.~:~.~c~.~...e.~.s.. Addre~ .~~ .......... Phone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~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. SI-ATE OF NEW Y~OJ~I<,,-/' x"/ ~ c S COUN'r¥ · .............. fj~/~..-:z...~..~..~....~.~....,F~f.....~T...; .................. being duly sworn, deposes and says that he is the applicam (Name of in~ividuab4'igning 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 and file this application; that all 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~/c...~.to be!~/re me this ,~_~/ ~- ......... ..... day of ......../~' '~ -~' ..........~..-.~..~..~....~..~/. ...... , 19 ........ ?'~2 ..~_... j~ ~.~// j....._...~ ~'~-~' '__~[.~ Notary Public,. ................................................... County ...................~;.....-.....-.....;...,....;~ .-;'/:.: ...(,:.....]. ................. ~_/~lgnature or applicant) ~/ 55 0 --~ Lot 54 Lot SURVEY FOR WILLIAM WOLFMULLER LOT NO. 54, "MATTITUCK MATTITUCK TOWN OF' SOUTHOLD SUFF. CO., N.Y. SCALE: I"= 40' APR. 27, 1967 INEZ WOLFMULLER ESTATES" GUARANTEED TO-' SOUTHOLD SAVINGS BANK THE TITLE GUARANTEE CO. PROFESSTONA4_ ENC~I~EER * AND LAND SURVEYOR, N.Y.S.LIC.NO. 12 B45 RIVERHEAD, N.Y. 246.~7' NOTE: · = MONUMENT / ,"/ ," / / / ,'" I ' / ,' / /~unifip~ily/- State existi(~g us~ and/occupanCy of r nd intended~use/land occ panc, y of r~posed/cor)~truct' : ~/ L/ ~ '' / : ~ ..................