The URL can be used to link to this page

Home My WebLink About7818-zFOILM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the b,~ilding located at . ~e~O0~ .~ ....... Street co,orEs subst~tially to ~e Application ~or Building Permit heretofore ~fled in this office dated ........ Ap~X.. ~1.] 19.?~. pursuan~ to which Building Pe~it ~o.~0~... dated .. Ap~ ...%1, 19~., was issued, ~d con~orms to ~ og the req~ merits o~ the applicable provisions o~ the law. The occup~cy ~or w~ch this ce~ificate ~ (owner, lessee or ten,t) of the ~oresMd buil~g. S~olk County Department of HeMth Approval . N.*~ ~ ............................. UNDERWRITERS CERTIFICATE NoNE$J~ .... ~C..3.~.. ~.~ .................. Build~g Inspector FOI~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N: Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7818 Z Dote ................. A~',tJ,.. ...... 1.'t ............... , '~9...?Y. Permission is hereby granted to: ~..o...~.....~ ...~:~z g~.e..~....u..o..~.~ ............................... to .... ~.l~...an..~d~i.t~n..on...e.~.Cln~..d~.elllng ............................................................ at premises located a~ ...~q~...l~....~lL~lg~OCL...~ .................................................................... .......................................................... ~.~r.~.].w.o.~cL.T0.rJ.~.~...&..W.~.~LaLcL~.. ~a ....... .L~ar. el. ....... pursuant to application dated .................... ~a.l~....-.~.~. .................. , 19..~..~.., and approved by the Building Inspector. Fee $..1 .~.s,:.0.. ,0. .......... FORM NO. ~; TOWN ~ $O~THOLD , Building Department Town Clerks Office $outhold, N. Y. 11971 // D APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be fdled in typewriter OR ~nk, and submitted in DUPLICATE to the Building Inspector w,th the following; for new buildings or new use: 1. Final survey af property with accurate location of all buddings, property lines, streets, aha 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 buddings, Industrial buddings, 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 alt property lines, streets, buddings 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-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 o te .... ......... New B~dding ....~.... ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..................................................................................................................................... Owner Or Owners Of Property ....... .3.~.)::1...~. ...... ~ ......... ~..o.~.~ ................................................................. Subdivision ................................................................ Lot No.../~-~ ..... Block No ............. House Pe~it No..Z~Z~..~.... Date Of Permit ..~...~plicant ........ .J.~....~:....~.~ .................. Health Dept. Approval ............................................ Labor Dept. Approval ............................................... Underwriters Approval .............................................. Planning Board Approval ..... 7 ...................... Request For Temporary Certificate ........................................ FinoJ Certificate ......................................... Fee Submitted $ ~ ~ ................ day of ............................................ Notary Public .................................... County ,THE ',NEW, YORK BOARD OF O~y tAe et~tr~cal equipment ~ ~q~ ~ a~ ~ntr~uc~ b~ t~ appllcant'~mea on't~ a~ app~g~tlon ~u~r ~E tA~ ' :, m-' ti - ,' , mi , m ' ' :~' 'dl ,l-I :i1-~11¢tI:,: h'J: ",, :'k;: . FIXTURE- ' - ' ' ' l ' FIXTURES ; ' ' J ' RANGEs, COOKING DECKS il,I ,OVENS DISH WASHERS EXHAOST' FANS OUT.TS rECEPTACLES SWITCHES I~OE~CE~ FLUOeE~ENT ~Y ' ~T ' [ W ~f. K,W ~f ' KW ~r [ W, ~T' ' ' ' " ' II :,~ ' , ¢ l: , _,:: 1,1: ~, , ' i '- 7_ 5'. ...... :. _' ;, l, DRYERS FURNACE MOTORS - ~TURE A~UANCE F/EDERS SPKIALREC'PT TIMECLOCKS i "BELL UNIT HEATERS I MULTI-OUTLET ~t [,W ~t ~e. ~ ~ .,;~p , ~T NO &w G ~ ~P : ~r ~Ps TRANS. ~T H P ND. OF FEET IMETER ' i' NO oF CC C~D, :~7 A w O" ,;~_; , NO ~ HI~6 &w G HO.~HEUT~L$' ' '? w G"t ,_:,1~ _~ _ :t - . - :: - -. - :~ ,-, ~ ,I--: ~f -:t ~ 1' ' i ' , ' ~ _ : -: _' ~ _ ~ ,, ' : I[ -h~ I - Ill:- l--hi:q[ This ce~ificate must not be~altered in any manner; return to the office of,the Board If incorrect. Inspectors may be Sale'tit:ed by their ~ ~tials., NOTE- LOT NO'5 SHOVVI"I P..EFEI;2.. '-f~"MAP OF' P!,,AP OF' ~ ~.:"~'~-~ -'~"~'-~-'-~{~,:~F~ ~ ~'~'- ..... ~ ~ ~-~ FO~M NO. 1 TOWN OF SOUTHOL" /'Z~ BUILDIHG DEPARTMENT TOWN CLERK'S OFFICE . 7 . · ~mmed ,..~.~.~L ................... 19 ........ Apphc~hon No ................................. ;:/approved a/c%.~;~ '~ ....... ~' .................. ~' ........ ~ ................................................ ........................ (Buildin~ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s 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 Iocahon of lot and of buildings on premises, reJahonshlp to adjoining premises or public streets or areas, and giwng a detailed descriphon of layout ofproperty must be drawn on the d~agram which is part of this application. c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Braiding Permit to the applicant Such permit shall be kept on the premises available for inspection throughout the work. e No braiding shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuon~ to thc Braiding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in buildings for necessary inspections. (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Owner Name of owner of premises ........ ,,T..o,~,g,..~..~..,~.~.g~JZ.~.~..,~ql~. ................................ If applicant ~s 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 ,,...~a..z~..?..]:~.o.o...d: ........... Lot No....'i..~.. .............. Street and Number ..... .~...a....~-'~...,e..~.o...o.~...D..~.....~,....~..o..,o.~.$.~.~...~..D.~ .......... ~.e~.~.~ ............................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Exisitmg use and occupancy .... ..d..~..e...]:..]r..J:..rt..~ ....................... same with a~tached garage & breeze~ay b. Intended use and occupancy ......................................................................................................................... 3. Nature of work (check whichT. licable): New Building.. ................... ~ ........... Alteration .~.. .............. Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost .................... ~).(~)..+,~ ...................... Fee ~.~.e...(~... .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .i3~--e .................... Number of dwelling units on each floor ............................ If garage, number af cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each t~pe of use ............................ 7. Dimensions of existing structures, if any: Front ..~ ...................... Rear .....,~.~. ..................... Depth ...~.~. ........... Height ........................ Number of Stories ..... .~...~..O.. .................................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~.~. ......................... Rear ..2~. ..................... Depth ..~ .................. Height .................... Number of Stories ...O..~..e. ............................................................................................................. 9. Size of lot: Front ...... .1.2:~.&.....~.0.. ......................... Rear ............ .1.~.~..~,..2~. ........ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ....".A."...Ats~ .............................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ...... ~.~ .......................................... 13. Will lot be regraded ...... ~r.e.a ............... Will excess fill be removed from premises: ( ) Yes ( ~ No 14. Name of Owner of premises ....~..9~l~..~....~l~[~'.e..~..,l~g&~l Address ..~.}~.e,~, ............... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ....... ~...a~...? ............................................ 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. see attached survey STATE OF NEW YORK, [c c COUNTY OF....~IL~C~.~ ........... ~"~ ........................ ~ToJ~I~.,I?~O~i~ .................................................. being duly sworn, deposes and says that he is the opplicam (Name of individual signing contract~ above named. He is the ............................. ~V'~e~'. ..... .bGi.'l.~.e~'. ............................................................................................................... (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 in the manner set forth in the application filed therewith. Swam to before me this of .......... .............. , \ n Notary P,~ublic, . ................. ~~/~',~..: ....... Coun~ ...~........~....(S~ig.~.~;l~ii:;;~.). ............................. ~ I~OTARY PUBLrC. St~ ~ of ~l~w York