HomeMy WebLinkAbout8550-zFOi~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPAHTMENT
Town Clerk's Office
Southold, N. Y.
Certificnte Of Occupnncy
THIS CERTIFIES that the building located at l~orth Sea Dr C~ Horton La
............................ Street
Map No. ~ ........ Block No...XAC. ....... Lot No, .x~.. .....8.q.u.i;.h. qZ..d, t~,~,
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ........... &p.z'.~.~,. ~.0.., 19. ?.6. pursuant to which Building Permit No..8..~.~.0.~.
dated ......... A.p.r..~.~,..~..0 .... , 19.7.6. ., 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 . .P.r.~.v..a.~.e..o..n.e..S..a. ~.k~.]:y..' ~.~,e.l.~.~.ng..~.~.~..h. ,a.d.d. ~.~.~.o.~ ......................
The certificate is issued to ...~.h.o.~..~..A.n.n...K.e.Z..2,~,. .... . .O~Tx..e.~. .......................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .1/,R~ ..............................
UNDERWRITERS CERTIFICATE No. ~,*.~.* ........................................
HOUSE NUMBER ..... .8300 .... Street .... Hor.t,or~. Le~ ......... .~.o.u.t..h?.~:d. ........
No. 8550 Z
;>ermission is hereby grant~'d to:
TOWN OF~:
BUILDING
TOWN
SOUTHOLD, N~ Y**
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE I~RE~
COMPLETION OF THE WORK AUTHORIZED)~'
FOI~I NO. 6
TOWN OF SOUTHOLD
, Building Department
Town Clerks Office
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
Inspector with the following; for new buildings or new use:
1. Fino~ survey of property with accurate location of oil buildings, property lines, streets, and
unusual natural or topographic features.
2. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal).
3. ,~pproval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, o certificate of Code compliance from the Architect or Engineer responsible
the building.
~. 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"
I~nd uses:
]. ~ccurQte su~ey.of property showing ~11 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 pe~inent
formation required to prepare ~ certificate.
C. Fees: 1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existi~ dwelling or land use $5.00
3. Copy of certificate of ~cu~ncy $1.00
.....
New Bqilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
..... .......................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
~'"':'~"t[/, / .......
Underwriters Approvo, .......... ~..:.].~ ....................... Plonning B~rd Approvo, ........ ~..,'.[.~ .................
Request For Temporory Ce~ificote ........................................ Fin~l Certificote ........... ~...
Fee Submitted $ ~
Construction on above described building and permit meets all applicable codes and regulations.
A Ippicant ..................................................... ~_~V-~. ~ ...... --..Z~~..
IPOI~M NO, J
TOWN OF S(~UTNOLD
BUILDING DEPARTMIENT
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y,
Exam:ned .... o. ..........
~proved .............. :.~ .......... ~..~ ...... , 19~.. Permit No...~:..~.~ ........
..........
^pp.cotio. ...........
APPLICATION FOR BUILDING PERMIT
Date ...~....~...?...g ......
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 lot and of buildings on premises, relationship to adjoining premises or public streets or
areas, end giving a detailed descripti6n of layout ofproperty must be drawn on the diagram which is part of this application.
c. The work covered by this opp!ication may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issue a Buitding P~rmit 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 o Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New 'fork, 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 regulotions, and to
admit authorized inspectors on premises and in buildings for necessary .insp.~ ections.
......
(Signature of.applicon ,~r name, i/~ a corpora'~6n)
(Address of applicant)~,~.~o
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .......... ~ ...........................................................
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 ...... ~ ..............................
Other Trade's License No ...............................................
1. Location of land on which p/'c~osefLv/Jork TJI[ be done. ttMap No.: ................... r~...-~.>-.....,..- L9t No ....... /{ ................
Street and Number ....... ./L..~.~.~....~R.~:;.¥~ ........................... :. ............ ~ .~...../. .................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
o. Exisiting use and occupancy .............. :~..../~..~..~-t¢..~ ......................................
b. Intended use and occupancy .............................................................................. ~ .......~/ ~ .........
3. Nature of work (check which applicable): New Building'. ................. Addition .....~ ......... Alteration ................
Repa r ...............Rergoval .......... Demolitio~ .................... Other Work ...................................................
¢~ 1l,~' ~ 0'O (Description) '
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 ............ I ...............
If garage, number of cars ................... .J,~..~...~..~ ......................................................................... ~ .................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, if any: Front .........;~9..'. .......... Rear ......... ,~.~.[ ............... Depth ......~..~..'. .....
Height ........................ Number of Stories .............I. ..................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories
8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................
Height .................... Number of Stories .....................................................................................................................
9. Size of lot: Front .................. ;...~.......... ...................... Rear ............ :..,,..~..- .............. Depth..
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
1 1. 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 premises: ( ) Yes (~) No
14. Name of Owner of premises .................................................... Address ................................ Phone No .......................
Name of Architect .............................................................. Address ................................ Phone No .......................
Name of Contractor ............................................................ Address ................................ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all 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 lot.
LJ
she. J 3x/ L_
STATE OF NEW YORK, IS S
COUNTY OF ....... ~tZ£~'oZc~ ....... f ·
.................... ?Z}'ZO~,D,~..~..,J,....Ee,-L.'I ~ .................................. being duly sworn, deposes and soys that he is the applicom
(Name of individual signing contract)
above named.
He is the ................................................... 0.!tfJ&~;~. ..................................................................................................................
(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
thor the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
........... 3.0..t~... day of ............................... ~,~"J,.~., 19.~.~... ? ~ ~ ~ ~.~
Notary Pub,c,. ................................ Co,n,,, ......
(Signature of applicant)/ /~'