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HomeMy WebLinkAbout7878-zTOWN OF $OUTHOLD BlJlT,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy TttIS CERTIFIES that the bu~dlng located at .... ~/es~; .D~. &Leettm.D~... Street Map No....~ ........ Block No .... ~ .....Lot No... ~ .....~.tA9~...N. pi[.,. ...... conforms substantially to the Application for Buildi,~g Permit heretofore ~ed in thi~ office dated ..............~Y...2.., 19.~.~. pursuant to which Building Permit No. dated .............i~..ay.....2.., 19.7~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this cerlificate is ~sued is ...................................... Private one fail[ dw~llSn~ w~th a .............................. addition. . The ceriificato is issued to..E.I~..s.t;..$.e.ll.~.d.e.l' ....... .0~.e.~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Depari~ent of Heaith Approval .N....R: ............................... UNDERWRITERS CERTIFICATE No..N. ?.R.. ....................................... HOUSE NUMBER ..... I~0 ....... Street .. l~eat. 91'. ............................... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P]~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 7878 Z Date ....................... ~.~r .......... ,'~ ............... 19. r].~... Permission is hereby granted to: ................ .~ ......~ ~..z:..t...o..n.. ..................................... at ~remises located at ...... ~,~.~..D.:~!~'e ........ £~..,...I.^Z.~3D, ttt:;,.~.,~ .................................................... ......................................................... So.~.tho!d .................................................................................. pursuant to application dated ........................;:~.y .......... ~. ............. , 19.~.~ .... and approved by the Building Inspector. Fee $ ..... I.~,i~ ....... I~OB, M NO, 6 TOWN OF SOUTHOLD , Building Depo~tment 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 ,n 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 hnes, streets, aha unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage d,sposal--(S-9 form or equal) 3. Approval of electrical installation from Board of Fire Underwr,ters 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code comphance 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 end 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 .;...~ ......... OkLor Pre-existing Byriljding .....~:..,,Vocant Land .............. Loc a ti on Of Property ../~.. ..... /LJ~.....//~(.~,~ ~........~..~.~.~..(.- .~./~.... .................................... Subdivision ............................................... .~ .............. LotN.~:~..~No ........ ..... Ho.~ ......... ~ Permit No .qk/~.~.....~... Date,rr~Of Permit/~2~.~.,/~.~pplicont "'~'"~Z~'~'¢'""* '~"/~-'~'"~"~"~'-- ,~'~ Hca,th ,,pt. ^pprova, ...... ~...'...X.. ......................... ~bor ~pt. Approvo, ............... ~,,,:.~,~ ................. Underwr,ters Approval ........ .~....'..:~..~.. ........................ Planning Board Approval ....... ..~....L.~ .................. Request For Temporary Certificate ........................................ Fincd Certificate .......................................... Fee Submitted $~..'.~... ......................... Construction on above described building ond,perrr~i_t meets all applic~oble, code,i and regulations. ...................................... ........ :~. day of ...................... .Z..~.'~ ~ota~, ~ub,,c ~~~ cou.~ (stamp or seal)' TOWN OF SOUTHOLD -- BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. ............................. ................... APP,ICATIO. BU,L.'.G P.RMIT / Date./x.r.t.~.//-//4 ........ ~ ................ 19.Z~J INSTRUCTIONS a This apphcatlon must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi, Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule· b Plot pJan showing location of lot and of buddings on premises, relahonsh~p to adlommg premises or pubhc streets, areas, and g~ving a detaded description of layout of property must be drawn on the d~agram which ~s part of this applicatio c. The work covered by this appiication may not be commenced before issuance of Building Permit. d Upon approval of this apphcat~on, the Budding Inspector wdl ~ssue a Building Permit to the apphcant Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to tt Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances. Regulahons, for the construction of buildings, additions or aJterat~ons, or for removal or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, buil&ng code, housing code, and regulations, and admit authorized inspectors on premises and in. buildings for necessary inspections. (Signature of applicant, or name, if a corporation) .............. ..................................... (Address of applicant) St t ' h t.l~er appiicar~s o~,~er,,les~r,~e, agent, architect, engineer, general contractor, electrician, plumber or buildc ...... .............................................................................................................................. Name of owner of premises ............. ..~T...~.Z~..~.....~....... ~...~.~.~.~.....~..~. .............................................. If applicant is a corporate, s~gnature of duly authorized off,cer. (Name and title of co/~.orate officer) Budders L,cense No ..... ..~..~..~.. ......... ....~......~... ............. Plumber's License No ................................................. Electrician's License No ............................................ Other Trade's L~cense No ............................................... Location of land on wh,ch proposed work will be done Map No ..... .~/.~ . ~...~/.Z.~. ...... Lot No ~.~.~.~.,~.~7~,~ Street and Number ............. ...... ............. ,-~.~,~.?~-.£4~. ............. ...~...~,/ ........ Municipality State existing use and occupancy of premises and re'ended use and occupancy of proposed construction' o Exisltlng use and occupancy ....................... ..~....~,./..~',,'~..~. ...... ~~./~...~; ........................................ use and occupancy ................................... .~'~...~.. ...... ~ J ~(/....~.....~...~"" ............................... b. Intended 'ute of work (check which applicable) New Building ................ Addition .................. Alteration ...~ ....... _r- Repair .................. Removal .................. Demoht~on .................Other Work ................................................ (Description) 4. Estimated Cost ........................................................... Fee ..Z.?.--..':.~....~.. ................................................................. (to be prod on filing th~s apphcat~on) 5. If dwelhng, number of dwelhng umts ....... ~ ...Number of dwelling un,ts on each floor ..... . ..................... If garage, number of cars ........................................................................................................................................ 6 If business, commerc,al or m~xed occupancy, specify nature and extent of each type of use ......................... 7. Dimensions of ex~st,ng structures, if any: Front ............................ Rear ................................ Depth ................... Height ........................ Number of Stones ....................................................................................................... D~mensions of same structure with alterations or addmons: Front ................................... Rear ......................... Depth ................................ Hmght ............................ Number of Stones .............................. 8. Dimensions of enhre new construction' Front ................................. Rear ............................ Depth ...................... Height .................. Number of Stories ...................................................................................... ;.....;;...;; .... 9 S,ze of lot. Front ................. ./.,.~....~...~. ................. Rear ............ ./..~"'.'~..~.?..~. ......... Depth .~('.'~74..'./...~.. ....... 10. Dote of Purchase .,~.4W.~. ...... ~.DZ./¢./~...J./...~'..?../...Name of Former Owner~../."~./~f~/2~'....~..(.'.'J~.~../.~Zg ...... 11. Zone or use district m which premises ore s~tuated ...................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation ................. ~4'.~ ............................. 13 W, II lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises~Z-~.Z~'.4~5"'~...~..~/~4~--'..~.~-~.,. Address .~..~..~...~....~..~. ...... Phone No. Name of Architect ..................................................... Address ................................ Phone No ...................... Name of Contractor .................................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all build,rigs, whether existing or proposed, and md,cate all set-back d~mens~ons fron property lines. Give street and block number or descriphon according to deed, and show street names and indicat: whether inter,or or corner lot ....... ' ..................... /xf~/.~f'~.L....V..4~..~ ........................................... being duly sworn, deposes and says that he is the apphcan~ (Namel~f individual signing~q~ntracf) (~bove named. ~. '0 He ,s the ......................................... ............................................................ of sa~d owner or owners, and is duly authorized to perform or hove performed the sa~d work and to ~ke and fil' th~s opphcat~on; that all statements contained m this apphcation are true to the best of his knowledge and behef; that the work will be performed in the manner set fo~h in the application filed therewith Swam to be~me th,~ ................... >~ day of ..., ........... Coun~ · ............................ ..........................