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HomeMy WebLinkAbout8130-zFO~ NO. 4 TOWN OF SOUTHOLD BUrLnlNG DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z 73~,~ 0¢-~ ZA 7& ............ Date . '1'~','~ '~c;~b' ' ~'l£(J' ' ¥% ~/~" 19 .... THIS CERTIFIES that the building located at ............................ Street Map No ............. Block No ..........:Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed inf~this loffice- dated ................ ; ..... , 19.._.. pursuant to which Building Permit 1% ......... ,~to- 7 75 dated ....................... , 19 .... , was issued, and conforms t~ all of the reqllire- merits of the applicable provisions of the law. The occupancy for which t. hL~ ee~ificat~ is issued is ........................................................................ ~l~e cert~i~ate is is,~ued to ......................................... ~ .......... (o~er) levee or tm~xtt) of the ~oresaid btt~l~. ~.~.. Su~olk County Department of Health Approval .................................... UNDEE~'RI?ERS CER~I~ICA~ Bio ............................................. IZ,~/~D SOU~j) Vi~u~ HOUSE NUMBER .............. Street .......................................... ,got; T N o LI:~ N.Y. ............................................. .... Building Inspector FORlVl NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N; Y. BUILDING PERMIT (THIS PERMIT MUST 0E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8130 Z Permission is hereby granted to: 1t~ ~...g.~:~.~-~nr, ................................................... ........... ~o~t,l~.~ ................................ : ................ to ....~:~.b'~.. ~..~c ~.~ aa o~.y...bux.~o~i~$ .................................................................................... at premises located at ..~}4'.~0 .......... ~..-~/'~t~..~'V/a' ................................................................... ..................................... oaut,,hol~.....l~.,~., ............................................................... pursuant to application doted .........................~l,l,~ ....... )~ ............. , 19..~.~., and approved by the Building Inspector. Fee ¢..0..~..0.0. ............ TOWN OF SO~TNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....................................... 19.~..~Perm,t No.-~.../...-?...?....~.. Disapproved o/c ........................................................................ [Dunalng inspector) / APPLICATION FOR BUILDING PERMIT 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 o~ 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 Jn part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY /V~DE 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. (Address of State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ............................................................................................................................. Name of owner of premises ....~.~...~......J~...-. ...... ~.~./~..~. ,~,.,./~...~...,~... ................................................................ 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 pr,,,~osed work, will be done Map No · . .... ~. Lot No Street and Number ~'...~..~.r'~.~.c(.~'~'~.~./'~.~.~'/~.'~4~''~..~./~-~..~..~~~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................ b. I ntended use and occupancy .....S....a~"...~.../...J....~R".....~--~'... ....... ..~..~...~..~.. .................................................................. 3. Nature of work (check which applicable): New Building- ~' Addition Alteration Repair .................. Rem,,~,al .................. Demolition .................... Other Work .................................................... /~, 3~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 ............................ 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 ............................ N.u~ber of Stories .......... Dimensions ,~f entire new construction' Front L .~.. , Rear / ~1/"' Depth Z .~... Height ..,... .............. Number of Stories .................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Narr~ of Former Owner ........................................................ Zone or use district i.n._,w..hich p~e.mises are situated ... 11. Does proposed constru,,tion :orate any zoning law,'ordinance"or"regu,a~,on-'""" '"' "'"":"~'"'i .......... 13. Will lot be regraded ......... WilLexcess fill be removed from ............ .................................................................. 14. Name of Owner of premises ~..~...~.~....~.~../~/Address. ...~...~....~...~"' phone N;..~...~. Name of Architect ................................ .-~""',~,, 'b.~'~-,~,~/~/~ ...................... ,Address ........... ;?; .................. Phone No .........~? ........... Name of Contractor ...~..~...~... ...........'..~...?~..../~....~..L/..~..;..~...~. 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. STATE OF NEW_.__..~Y~O.RK,-- ~ ,~ ¢ ~ COUN,¥ ..... .......... ~....~.......~......~XJ~__/~..~.~[I~...~...--~' ............... being duly sworn, deposes and soys that he is the applicam (Name of individual signing contracf) 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 inthe manner set forth in the applicon filed there~with. Swo[~to~ore me this ~ --~ / / ..... ...... Notary ?bblic, . .................... ~ounty ..~~.~..'..:..; ........................... ! o ~,~ ~ / I // (Signature of~plicant) V ~'~" ' /// ~ NOTARY PUBLIC, State of NeW (/ (/ No. - l~OR~t NO. $ TOWN OF $OUTHOLD , 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. 5ama as subrnit~ted 8/7/75 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). N 3. Approval of electrical installation from Board of Fire Underwriters. N .A. 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 peffinent in- formation required to prepare a 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 $1.00 accessary ~te ..... .g.~.~.~.~...~.,....~.~.~ ~ .... Ne~Bqilding ...... ~ ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ....].~.~.~...N.O.~D.d~.$.~...~.~.e~.~.,....~.fl~.~b.o.~.~ .................................................... Owner Or ~ners Of Prope~y Rose C. Berrym~n Subdivision ......B'l'3O'"Z ............................................ Lot No ............. Block No ............. House No ............. Permit No....~....~.~.~.... Date Of Permit ~.~.~.~.~ ...... Applicant ..Jg.~O...~.~.~.O~.~0 ................................. Health Dept. Approval ................ ~.~.~., ................... ~bor ~pt. Approval ..... ~..~6.~ .................................. N .A. N .A Underwriters Approval .............................................. Planning B~rd Approval ............. ~ .......................... Request For Temporaw Ce~ificate............_..........................N .A. Fin~ Certificate .......................................... Fee Submitted $ .............. .5......0..0, ............. Construction on above described building and/permit/meets al~plicable codes and regulations. Applicant ....... ~.'~,~,,, ~~ ............................................. Sw~or~ to b~fore me this ~ ,' '~.~ay of~ ....... ~~....~:7 ~' (stamp or seal) Nota~ Public .. n~ ,, , 4~,+ ~ _~. 4..Zo ,.~? o<m, k%/.