HomeMy WebLinkAbout8158-zNO. 4
TOWBI OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, BI. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at . ]~1~.. ~.o..n.d. :~ .~..~ .......... Street
Map No~. i .1.1..O~...P.tl.,.. Block No ........... Lot No ....... [i..O!$t..h.O..1~....N.,.Y.: ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............. i.~g .. 2.$., 19 .~.~. pursuant to which Building Permit No..8.! .~.8.Z..
dated ......... Allg.. 2i ..... , 19.?~., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy fo~ which this certificate is
issued is
The certificate is issued to .~.0.~..8~..& ..... .~., .e.~. ................................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .I~.~.: .............................
UNDERWRITERS CERTIFICATE No. N. :.I~.,.
HOUSE NUMBER ..... ~.9~.. .....Street Bttdd Pond
Buildifig Inspector
FO~I~i NO. $
TOWN OF SOUTHOLD
, 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.
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 end 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
........... ........
New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Locatio. of Propert ....... .........................................
OW er Or Owners Of Property ......... dZ~.~'~z...~..:.......~.~.~,,..~ ...........................................................
Subdivision ................................................................ Lq[LNg, ..~,,~i.... Block No .............. ~ouse
No,.~..,.Q
Po rmit No....~..../.~r~.'~..~.-~ate Of Permit/~....~.~..~./.~pplicant-(.~/~:~.~,....~...~. ~....~.. ~..d~..:..~ ..........
Heath Dept. Approval ................................... -. ........ Labor Dept.~p'proval ........ ~ .........................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Ce~ificate ........................................ Final Certificate ~
Fee Submitted $ '~ '~ ..........................................
Construction on above described building and permit meets all applicable codes and regulations.
App cant o....~.'~..~x~c-....~..'.:..,C~...~,,~:..~ ...................................
Sworn to before me t~fi~ ~'~ (~
o,
............... Y ' /~" "~"1 (stamp or seal~
BUILDIH~ D~PAtTMENT
TOWN CLERK'S OPIqC~
IOUI'HOM), ~ Y.
BUILDINg ~RMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
8158 Z
Permission is hereby granted to:
.......................................................
................. ~(~dae;L6,.... ~.,.g ~. ............................
at premises located .at ..L~t..~ ....... ~/,J,~W...Pc'~l.Ii~Sttl~e .............................................................
..................................................... lJud4 .,P. oncl... ~,o~d,. '. ....... ',i. ou,t, hc~d,.... ~.. :/.,. ..............................
AI~ Pl . . 19.?..~..., ond'appr~ed by the
pursuant to application, dated ........................................ ~ ............. ,
Building Inspector.
Fee $..1,0~(X). ..........
eulldtng 'i'~,~pecfor i
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
~OUTHOLD, N. Y,
Application No......~.. ,/...~...~.... ..........
Disapproved a/c ...................
APPLICATION FOR BUILDING PERMIT ~
/I
........ ................. ....
Date
INSTRUCTIONSL/
o. This opplication must be completely filled in by typewriter or.in ink ond submitted in triplicate to the Building
Inspector, with 3 ~ete 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 drown 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 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.
licant)
State whether applicant Js owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome °f °wner °f Premises ~d~~o icer. '
If applicant is a corporate, ff
(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 ,ro,~o~e~d,. -,-~,^ /,~ ~-- t~,_ _ ~ ~_ ~,w°rk' will be ctone/'~Aap No.~--/,'~'.~./.?..~....' ..... Lot No .........................
Street and Number ......... ~D.....~....~.....~'..._/....~....~.~:~. ...............................................................
Municipality
2. State existing use and occupancy of ~;~ ~nt~e~_ended use and occupancy of proposed construction:
a. Exisiting use and occupancy ...... ..~t:~r......~m..~..:.:=..:....~ ......... ._. ....... ~ ........................................................... , ......
b Intended use and occuponcy ................................ ~ :.~.; .................... ....
\
3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................
Repair .................. Removal .................. Demolition .................... Other Work ...~.~..~-~ ...........................
[Description) '
4. ~timated Cost ......... ..~...YZ....~. ...................................... Fee ....I...~.. ..............................................................................
(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 ............................ Numbey of Stories ................................
8. Dimension~,o~ntire new construction: Front .............. ..~....~.......~...... Rear ........ ~-c~../~...~.....~. Depth ...... ?'...~...?.....~'-.
Height ...~../}"~...,.. Number of Stor~es.,,., ......................................... ~ ........... : ............................................. ~ ...............
9. Size of lot:~ '~ror~t ........................................................ Rear .......................................... Depth ................................
]0. Date of Purchase ........................................................ Name of Former Owner ........................................................
1 l. Zone or use district in which premises are situated .....................................................................................................
]2. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) 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 setJoacl~ 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.~,OR[f.~_.. ~ ~ . ~ S 5
COUNTY OF ..~,~J,~."tZ~'.~L~'....~' '
............... ~..~..j~ ............. ~.[~ .................. being duly sworn, deposes and says t~t he is the applicon,
(Name of i~ividual signing contr~
above name.
He is the ........................................... O...~..~..~.~.. ..........................................................................................................
(Contractor, a~ent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and fife
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 fo~h in the application filed therewith.
SWorn/to before me this
...... ............... ..................... ,'
..................... .......... ........ : ............... .......................
No. 52-8125850, Suffolk
Term ExDiresMarch 30