Loading...
HomeMy WebLinkAbout7887-zFORM NO. 4 TOWN OF SOUTHOLI) BUILDING DEPARTMENT Town Clerk's Of[ice Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . ~ager~ Land~x~g. Raad ..... Street Map No..~ ....... Block No. ~ ...... Lot No, ~ .. ~t~d.. ~Y, ......... co~orms substantially to the Application for B~l~ng Permit heretofore filed ~ this office dated ............. Ma~.. %., 19 .~. p~su~t to which B~ld~g Pemit No. dated ......... ~Y .... ~ ...., 19.~%., was issued, ~d confoms to ~ of the req,~r, ments of the applicable pro~sio~ of the law. The occup~cy for which tMs ce~fficate is issued is . .~r~..q~9. ~ .~Y~.~g. K~ ~. ~$9~. (~9~) ......... ~e c~icate is issued to . .~P. Pg~P .~. ~. P~P.... ~Q~ ........ (owner, lessee or t~t) o~ the Moresaid b~d~g. S~o~ Co~ty Dep~ent of He~th Approv~ . .~ '~.~ ............................. ~DERWRI~RS CERTIFICATE No...~2~.* ...................................... HOUSE ~ER .... ~ ...... Street .. ~g~. h~.~g. ~P~ ................. B~ding Inspector I~ORI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to.'/q/~ ..Z././~.~./....O.. ...... .~/..~,~...~Z2..~..Z ............ ~.~..z..~...O~.~.. ........ ~.~q~... ...... ,-o . . . ~.~ .,~. .,~_. . . ~ ~ . c ~ . . . ,~.~. ~. z ~ ~. ~ ~. . . . . . z .~/. _ ~. . ~ ~ ~ ~z ~ ............. .......... ~,~_~. ...... o.~.~. ...... ~.zu~.....~-,~,~.z~...~~~ ........... ~.~u~n, ,o ~,,c~,,o~ ~,~ ..... ~~.~...~ ............. Bu]ldin~ Inspector. FORM NO. 6 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 typewnter OR ink, and submitted ,n DUPLICATE to the Building Inspector with the following; for new buddings or new use: l. Final survey of property with accurate location of all buildings, property lines, streets, aha unusual natural or topographic features 2 Final appraval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical ,nstallahon from Board of Fire Underwriters. 4. Commercial buddings, Industrial buddings, Mulhple Residences and similar buildings and installations, a cerhfmate of Co'de comphance from the Architect ar Engineer respons,ble for the building. 5. Submit Planning Board oppraval of completed s~te plan requirements where applicable. B. Far existing buildings (prior to April 1957), Non-confarming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or prev,ous owner as to use, occupancy and condition of buildings 3. Date of any housing code or safety inspection of bu:ldings or premises, or other pertinent in- formation required to prepare a certificote. C. Fees: 1. Certificate of occupancy $5.00 2. Certificote 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 .............. Location Of Property ........ ~.:.~..~.........~...~....~...~.~.~.~. ......... ~I~J./~'...~.L...~.~...~... ....................... ~..i..[~.. ............ Owner Or Owners Of Property~/.'.~.~[~...~...~¢//~-~... ' ...................................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............ Permit No ..~..~.~(.'7...Z. D ~'- ' ate Of Perm,t _/~_ ~.;.~-.J.t..?~'-pphcant .................................................................. Hea,th Dept. Approval ................ ................ Labor Approval .......... 6L.....4. ........................ Underwriters Approval ................... ..~.......~. ................. Planning Board Approval ....~......~.. ....................... Request For Temporary Certificate ........................................ Final Certificate ....... ~ ........................ Fee Submitted $ ..... .~..~.'~.~. ....................... Construction on above described building and permit Lr~eets_..all applicable codes and regulations. Applicant ........................................ Sworn to'he, fore me this . ................ day of ~.~.;~ .................................. (stamp or seal) Notary Public..: ............. L~.-~ ............... County Approved FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19..([... Permit No ...../...~..~.......~.....~ .... Dm~pproved a/c ........................................... '7~ ......................................... / g p APPLICATION FOR BUILDIN~ PERMIT .......... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin~ 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, relationship to adioming premises or pubhc streets areas, and giving a detailed descriphon of layout of property must be drawn on the diagram which is part of this apphcation c. The work covered by this apphcation may not be commenced before ~ssuance of Budding Permit. d. Upon approval of this application, the Building Inspector wdl issue a Budding Permit to the applicant. Such permh 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 Occupanm, 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 BuHdmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regular,ohs, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto described The apphcant agrees to comply w~th all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and ir~ buildings for necessary inspections. ....... pp , , p ' ....... (Address of applicon) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 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 .......... ~ .................... Lot No ....~ ................. Street ond umber ....... .... ........... Municipality State existing use and occupancy of premises and intend.........~ed use.and__ ~-'),~', ~°cc~tpancy of proposed construction' a Exisit,ng use and occupancy ........ .~..~...~../..:..~..X..~.....~........4~....../~......~....~...~.../. ~ ........................ ..... o intendea use and occupancy .................................................................................................. 3. Nature of work (check which applicable). New Budding ................. Addmon .-~.~.~..¢~... Alteration ......... Repmr .................Removal ............. Demolmor, ............... Other Work ............................................. ~ ~ (Description) 4 Estirnated Cost /"'~-o'~O ~ .Fee ..-./...~......-~... .......................................................... (to be pa:d on fdmg th:s appltcat:on) 5 If dwelling, number of dwelling units .......................... Number of dwelhng umts 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 ....~......~.....:. ..... , 7 ..... : .............................................................. He,ght ~.C-.,/...'f:.~......--.. Number of Stones .......................... D~mens~ons of saree structure with alterahons or addmons Front ......... ~..~., ................. Rear ...<~...C..J...: ........ Depth ...~..~..~.~... Height " Number of Storms ............... -'-. 8 D,menslons of ant, re new construct,on: Front ...... ~. ....................... Rear ..... ~ ................. Depth ...J.~:~ ...... Height .....:: ............ Number of Stories ..............~.tt~. ~,.-- ......... 9 S~ze of lot' Front ....... ~.~..J C~ .................................. Rear ........I..~.~.~ .................. Depth. J..~.-~.O,.~ ......... 10. Date of Purchase .......... F:~Z/~r....(..~...72-, ........ Name o~f Former Owner ..~)./c&.,~)...~.~,).,1~.j ........ 11. Zone or use d~stnct m which premises are s~tuated ........ /...-~ ................................................................... 12 Does proposed construchon wolate any zoning law, ordinance or regulation: ..... /i~).~.,) ....................................... 13 Will lot be regraded ..... ~ O. ......... Wdl excess fill be removed from premises. ( ) Yes (~--g No 14. Nome of Owner of prem,ses/:~/'~.6i .-~/:~..~D~.l.(.~Address~;~.l./~.6~.4;~ ..... Phone Name of Architect ....... -. ..... = ................... Address ................................ Phone No ...................... Name of Contractor ............................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~sting or proposed, and mdmate all set-back dimensions fror~ property hnes G~ve street and block number or descnpbon according to deed, and show street names and indicab whether interior or corner lot STATE OF NEW v-~DRK, ~ S S ............................ ...... being (Name of indlwdual signing contract) above named He ~s the ............. ~.~.~ ............................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and this application; that all statements contained m th~s apphcat~on are true to the best of his knowledge and belief; tha~ the work will be performed ~n the manner set fo~h m the opphcation filed therewith. Sworn to before me thru .... ~.~.. day of .:~~~ ............. , 19Z~ Nota~ Pubhc, ..~ ........... Coun~ ./~.~....~~~ .............................. ~ ~ _~ ~ (S~gnature of applicant) NOTaRy ~UBLIC Sf~ ' ~ ~ ....