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HomeMy WebLinkAbout8162-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g.1.1.8..3.8 .......... Date ...... P:.u..~.u.s.t:, ,9 ................. , 19,8.3. THIS CERTIFIES that the building . g.c.q e..s .~.o.r. ~/ .................................... Location of Property . .3..9.5 ................ .T.v.a.c.k...~.v.e.n..u.e ............ .qq~. 9.h.o.~u.? ..... House No. Street Ham/et County Tax Map No. 100O Section ... ! .3 .7 ...... Block . .0.1. ........... Lot ...0. 1. .9 ........... Subdivision...lq.: .S....~ .a.n.d.,...S¢.c....2. ........ Filed Map No..1.2..8.0...Lot No...7.1..&.. 5.2 .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~u. g.u.s.t: . .2.2 ...... , 19.7.5. pursuant to which Building Permit No..8..1 .6.2..g. ............. dated ..... g.u.g..u.s?;..2.2. ............. 19 .7.5., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... an accessory .bt~5.~.d.~: The certificate is issued to ELLEN MENZER MUBDOCK {owner, les~ or't~rrant~ of the aforesaid building. Suffolk County Department of Health Approval ..... ~/.~ ................................. UNDERWRITERS CERTIFICATE NO ............. N/.~. ................................. Building Inspector Rev. 1/81 TO, MN OF SOUTHOi.~ BUILDING DEPARTMENT TOWN CLEItK'S OFFICE SOUTHOLD, N~ ¥. BUILDING PERMIT ~HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8162 Z Date .................. &l~-.... ~.~ ..................... , 19..~.~.. Permission is hereby granted to: ~LLe~..~,uz~,~ ................................................. ................ · ~eek...&~e .......................................... to ....T~u~c~..n~..~a c~e~ s ~...s~c, er~ ge..~ t~ ................................................................. at premises located at .~Lo~s..4t ............ l~,~-,tlaet~.....8,~b ................................................................. ........................................................ · ~r&o$..&ve ......... Cu.t,e ~e~e ................................................... pursuant to application dated ....................... A1~.....2~, ............... , 19..~.~., and approved by the Building Inspector. Fee $ilI.~Q ............ / ' Bui~dtng Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor with the following; for new buildings or new use: 1. Final survev 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 installa- tions, 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. For existing buildings (prior to April 1957), Nomconforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion required to prepare a certificate, C. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling land use 3/~-/ $5.00 3. Copy of certificate of occupancy $ ,, ...... ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ~ .......... Location of Property .~ ................. ~ .~ · ]-~-, ....... Hou~ No. Street ....... County Tax Map No, 1000 Section . .~:~ ...... Block ~.~ ....... Lot .... ~,~). ~ .~ ....... Permit No. ~ ) G ~ ~ Date of Permit .~ .~ ~ ~.~Applica,t ... 0~M~'~?~. ,~; ~ ... Request for Tempor?y rt~ficate . , Final Certificate , . ~/ .... Fee Submitted $. ,~ ~/,.. ~ ..... Construction o~ above described bu,l~r~}t , ,, ,.. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. prov ........................................ . I,..2.f;erm,t ..... Disapproved ale .................... .................. INSTRUCTIONS o. This application must be completely filled in by typewriter at in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plat plan to scale. Fee according to schedule. b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets al 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 ~hall 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 shaJl 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 oil applicable laws, ~ces, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings [for necessary inspectior,~. /~ ................... : ........ ~] /.(Signatur, e of appli/ca~, e~am~(/'if a co~oratio~) '"7' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of cDrporote officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... -,/~ ~' // ,~ Location of land on which propose~?gk wi i b~ ~n~_Map N~.,:.~: ........ ~.[......: .......... ~ Lot ~9...., -- ~umcJpa~ 5ta~e existing use and occupancy of pre~s ~d intende8 use ~nd ~cupancy of pr~osed construction; 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolltio~: .................... Other Work ................................................ (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 e/ach type of use ....~,...,..~, .............. 7. Dimzio~2~f e~isting str~jmt~,~f ~:r Far°at ....... '~"~'T,,~'~"~" Rear ..... .~.~. .................... Depth ~...~.. ............. Haig ...... ~. ............. N b is .............. ~....ZS. ..................... , ........................................................... Dimensions of same structure with alterations or additions: Front ..... ....~../~... ....... Rear Depth ................................ Height ............................ Nu, mber of Stories~/' ............. ./ ................. g. Dimensions of entire new construction: Front .......... ~. ...................... Rear ..... .~.. .................. Depth ...~... ................. Height ...:~....~.. ...... Number of. Stories ......................................................... , ................................. .,...~....,~. ............. ,ze of ,at; ront ....... ................................. Rear ........... ................... .................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed constructi~r~ violate any zoning law, ordinance or regulation: ........................................................ Will lot be re. reded ~ Wd[ excess fill be re eyed fro rem~ses ) Yes 13. ' g · ........................... ' _ ' ~m ~rj~p ' ~: ( ( ) No 14. Name of Owner of premises ...,~,~...~. >~./..~....~'~....~...t~.)...~dres~ ~.,..~...~..~. ~.~, ........... Phon* No? ~.~...~ .~....~,.~.~.' Nome o~ Architect .............................................................. Address ................................ ~hon* No ....................... Nome of Contractor ............................................................ Address ................................ ~hone 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 ar description according to deed, and show street names and indicate whether interior or corner lot. COUNTY O~X~'/~Zm::..,..~,' x /Z ............... ~.;;.%.,.~.....,,:.~....~ ............~..bemg duly sworn, deposes and soys that he is the applicom '(Ng~ of individual signing contract) above named/'/ He is the ................................... ~~.~~ .......................................................................... ~/(Contractor~'gent,-' ~ ' 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 thls application; that oil statements contained in this appiic ~ are true to the best of his knowledge and belief; and '~ation filed therewi .