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HomeMy WebLinkAbout8400-zFO~ NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occup.ncy No. Z.?~.~.~. ...... Date ........ 0~.~;...~.0. ....... , 19..7~ THIS CERTIFIES that the building located at . .N/8 .bla~ .Roact ......... Street Map No... ea ....... Block No. .. xx... Lot No.. ~ .... ~X~tahogu~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... :. . Ma~.. ~l , lg. ~6 pursuant to which Building Permit No...~OOZ dated ...... ~1~.. 2., 1956., 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 ameessaxKz building. ,-..shop &. ~torage ........................ The certificate is issued to . .8.id__.~9~r ~e~]~e.....o~.u~e~ ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval I~,R, .................... UNDERWRITERS CERTIFICATE No..][~06~ ................................. HOUSE NUMBER 21~92~ ..... Street .. Maim. t:[oa4 .... gu$,~h~go~ .............. FORI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 8400 Z Permission is hereby granted to: ~.~z..,~..~.. ..................................................... Fo...Jl~..~aw..a~eas~J...I~o~'a~..&.I~...~a~ ................................................. ............................................................................................ :.:.: .................. : ........................................... p..ursuant to application dated ~uil,ding 'Inspector. FOR~ NO. $ TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUFANCY instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Bu,lding 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 F,re Underwriters 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a cerhficate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-ex~sting" land uses: 1. Accurate survey of property showing all property hnes, 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 inspechon 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 .... .0..o...¢. g..b..e...z' ...2..0..,....~. ~o.~...~.. ..... New Building ..........~. ..... Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ~.a~.~-~3~..~.~.~..~.~t~.~q.~.~3`~'~[.`~(~ ...... ~,1.c)..35 ....................................... Owner Or Owners Of Property .~.~..d:..~..e..~.....~.,e..e...b..e. ........................................................................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ........... Permit No ..8..L['...0..©. .......... Date Of Permit ..]~..2..~..'~.~...Applicant ...~.~,~f~...~.ft.~.~.f~ .................................. Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval ...~.~..O..?...O.~..Zl.. ........................... Planning Board Approval ........................................ Request For Temporary Certificate ....................................... FinaJ Certihcate ......................................... Fee Submitted $ ~. :. . .0. .0. ........................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this Applicant ................................................................ ~~,..~...~.,~ ...... ~:i:~PP~:cy' ....~~-C°f .~...Z.~...;~ (stamp or ,e~~~ oc'f/ ' ~ OF SOUTHOLD BUILDING DEFARTMIHT TOWN CLERK'S OFFICE SOU'THOU), N. Y. APPLICATION FOR BUILDING PERMIT ~3te illL~h INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ir~k 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 areas, and giving a detailed description of layout ofpraperty 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 o 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 pursu.a, nt 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. .......... .~..A..GeMz~.l...Centrzmto~. ......................................................................................................................... Name of owner of premises .~,~[dZtll~..~d~ll~l~ ............................................. ~ ........................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No...~[..~..~J~l.t~l~,~l[..~l~g~,.~e Plumber's License No ................................................. Electrician's License No. ~lmm4..[1.e~t'~Z'~Lg Other Trade's License No ............................................... ~ .A Location of land on which proposed work will be d~one. ~ap N/~: --~..../.-~.~ ............. Lot No{ ........................ Street and Number ...J~..~lg~j~ .................. ~ .......................... . ..................................... I Municipality State existing use and occupancy of pr,~e~sy~'ln~end~use.~/,.~u ~ ~ . . .. and occupancy of proposed! constl~lction:.' b. Intended use and occupancy ..~JU~..~I..~'JgI~3~I~JI ...... ............................................................................ {.! ....... 3. Nature of work (check which apphcable) New Building .... X ..........Addmon ............... Alteration Repair ................ Removal .............. Demohttor~ ................. Other Work ................................................. (Description) 4. Estimated Cost ....~..~.,..0..0...0.~.0...0. .............................. Fee ;~]5,.0.O ............................................................... (to be pa,d on filing th~s application) 5. If dwelling, number of dwelling units ................ Number of dwelhng umts on each floor ....................... If garage, number of cars ......................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of useS~o.~l..&..~!l:;o~.~ 7 Dimensions of ex~stmg structures, if any' Front .................... Rear .............................. Depth ................... Height ........................ Number of Stones .......... D~mensions of same structure with alterations or addmons. Front ................................... Rear ..................... Depth ............................... Height ....................... Number of Stones ............................. 8 D~mensions of entire new construction' Front ...... .¢~0.* ..................... Rear .... .~0.! ................. Depth ...... 2..(~.~. ........ Height .... .~./~: ........Number of Stories ....... .].. ................................................... 9. $~ze of lot' Front ....... :1.'~.~.° .............................. Rear ......... &.~.~?. .................... Depth ....... 2.8~'..*. ............. 10. Dote of Purchase .... .1:.~.~ ................................. N~me of Former Owner W~..1 fz:.ed..Be, ehe ....................... 1 1 Zone or use district in which premises are s~tuated .]~tl~.~l. elBl~ ................................................................. 12 Does proposed construction wolate any zomng law, oral,nonce or regular,on: ..~.O ............................................... 13 W,II lot be regraded .... ~ .............. Will excess fill be removed from premises' ( ) Yes (][) No 14. Name of Owner of prem,ses~.~cl, ne.~r..~,..~l~.el:~e .............. Address ¢¢tl.t¢~c~g~e .......... Phone Name of Architect ...................... Address ................................Phone No ..................... Name of Contractor ..~id~,.~y..~le.e.b~. ................... Address .~.~.~..¢.~.9.g~..e. .......... Phone No. PLOT DIAGRAM locate clearly and d,stmctly all bu,ld,ngs, whether ex,sting or proposed, and ,nd,cate all set-back d~menslons flor property lines G,ve street end block number or descnpt,on according to deed, and show street names and ,nd[cat whether interior or corner lot STATE OF NEW Y~I<X' ~ .~./ I¢ COUNTY OF ~f¢ S ............................................................................................ being duly sworn, deposes and says th4;t he ~s the opphc~ (Nome of individual s~gning contract) ~bove homed He ~s the ............................................................................................................................................................ (Contractor, agent, corporete of E~cer, otc ) of s~d owner or owners, ond is duly authonzed to perEorm or h~ve performed the s~d work ~nd to moke and fi this opphcation; that a~J statements contained in this apphcchon are true to the best of h~s knowledge and behef; tha~ the work will be performed ,n the manner set fo~h in the apphcat,on filed therew,th Sworn to befo~ me th~s ~ ............... ...... -- ................ ..................... Nota~ Pubhc, Stale of New Yo~ No 52-02449~ Suffolk Cou~ CommJ~imn ~pires March 30~