The URL can be used to link to this page

Home My WebLink About8551-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Yo Certificate Of Occupancy No. Z7.2~].]. ...... Date .............. ~P.~.~... ~ ....., 19.7..~. THIS CERTIFIES that the building located at .14ox:ton. La. 6. ~ort~..3e8~. D~treet Map No. 342 ......... Block No ..... ~;~ .... Lot No, .. ~ ,.. D.o.v,~.h.e.~.c]...~.~.Y.: ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... ~)~p;~... ~,019.~.~.. pursuant to which Building Permit No. dated .......... A!~r~-J- .... ~.0., 19.7.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which thi~ certificate is issued is . .P..r.~.v.q .~..qn. 9..~:q~> .~Y..d.V.e.~.~.~.n.g.y.~.~.~..a~.t.~F.a.~.~o..n ................... The certificate is issued to ...'t~. rarfl~ .~lagenbr.e~er. ...... ~.v~er ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval K,i{o ............................... UNDERWRITERS CERTIFICATE No..~l.i{ ........................................ HOUSE NUMBER .. ~5~0 ....... Street ... ~Iv. rton..~.ane .......................... FO~M NO, ~ TOWN BUILDING TOWN SOUTi~OLD, N~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) 'N°. 8551 Permission iS hereby granted to: D~te FOI~M NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office $outhold, 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-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-existincj dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 / New BHilding ................ Addition v/ Old or Pre-existing Building Vacant Land Location Of Property ../?....~..~,7-tPA/ ...... ../~,/~ .4/./~T~' ....... ~ ../~..(~. .... Owner Or Owners Of Property ,,,~..~..~...f~...../(~.. ...... .,~,~,....,,~)......~?..~..~...~...,,~,;..~...~.., .~..~.,/~,/, ..................... Subdivision .............................. ,..--~.. .............. , ............. Lot No....,,.--~..... Block No. ~ ......... House No..ZTZ... ....... Permit No ........... .~..-(.o~... Date Of Permit ................... Applicant '/~..,.~...../~..,~..,/.C<,. ....... ,eo,th Oept. Approva~ .......... 'H'"~ ....................... Labor Oe,~. Approva, ......... fl...t~ .............................. I~- Underwriters Approval ........... .ff..i!~ ....................... Planning Board Approval Request For Temporary Certificate ........................................ Fined Certificate ........ Fee Submitted $ ...~..... ............................. Construction on above described building and permit meets all,applicable codes and regulations, Sworn to be,ore me this ................ ~o~ o, ...~._~.Z~. ............... (~,o~ or ~o~ t t ~ 0 Nora. Public ........ ~~.. Coun~ FO~ NO, [ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~rov~ .................. '.~:.~ ....... ~.C)., 19.2~.. Permit ~o. ~; ........................... App~ullun Nu .................. & ............ '~. INSTRUCTIONS Date ................................................ , 19 ............ 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 m areas, and giving o detailed description of layout ofproperty must be drawn on the diagram which is port 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 0th'e~ applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or ~or 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. 0w~er Name of owner of premises ...~.~..~...~...!~.,,et.~.e..~.~.~...e.~.e.~. .............................................. i ............................................. )f 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 ............................................... Location of land on which proposed work will be done, Map No.: ........................................ Lot No ......................... Street and Number ............. .~...o..~.~g..~.....~..e..~.e....~..~..~....~..~.~t~.~...~.l~....~;L~.Y.~. ................. .~..9..~..~}.t..o,~..~. ..................... Municipality State existing use and occupancy of premises and intended use and Occupancy of proposed construction: 0u%~&e chewer a. Exisiting use and occupancy ................................................................................................................................ Inco~or~in~ o~e~.~e aho~er ~n~o hardee b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building.. ................. Addition .....~ ........Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................ .... (Description) 4. Estimated Cost ...... .~.5.0.f}.,.0,0. .................................... Fee ../..~':~ ........................................................................ (to be paid on filing this application) 5. It- dwelling, number of dwelling units ....... ..~..O...~.?, ........... Number of dwelling units on each floor ..~.O,..~..G. ................. If garage, number af cars ............................................................................................................................................. 6. If business, commercial or mixed accupancy, specify nature and extent of each type of use ............................ 7. Dimensions af existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories One 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 ..................................................................................................................... 109~.~ize of lot: Front ..... ,,...:~ ........ .~...~..0.....~.~.,. ................. Rear ..... .~...~..0.....~.~..~. .................... Depth ~...~'..4:.....~.~.*...1 ............ ......... Name of Former Owner ~ate of 11. Zone or use district in which pr~mises'%- ore situated ..... .~...0.?....~.~..0..~..~.. ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ..~9. ......................... ~ ....................... 13. Will lot be regraded . ........ ,.~..O. .............. Will excess fill be removed from premises: ( ) Yes' f . F ntc W, W gen'o e me ou'bhold ,. 76 -9213 14*. Nome of Owner o premises .................................................... l~Address ................................ wnone mo ....................... None Nome of Architect .............................................................. Address ................................ Phon~ No ....................... 0wne I~' Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from properly lines. Give street and block number or description according to deed, and show street names and indicate ~bether interior or corner lot. ~:~,, STATE OF'i'NEWf YORK, [ c c COUNTY OF .......... B~,:~RO'~.~..... f'~'~ ................................(Name ~idu~si~~;~ " ~ .......... being duly sworn, deposes and says th*t he is the: ~bove nome& He is the (Contractor, o~porote officor, of said owner or owners, ~nd is duly ~uthor~zed to por~orm or hovo por~ormed tho said work ~nd to moko ond file this oppHcation; thor oll stotemonts contoined in this .pplicetion oro true to the best of his knowlod~e and belie~i ~nd tho~ the work will be porformed in the m~nner set {o~h in the ~pplicat[on fllod thorow[th. Sworn to bo{oro mo this ......... ~h ...... day of ...................... A~'~ .........., ]9'""76 ~ / / ~ No~a~ Public,. .................... :...~,.~.,, ..........CounW ~..Z~...~¢.....~~~' ...................... ~ (Signature of a~cant)