HomeMy WebLinkAbout7888-zNO. 4
TOWN OF SOUTHOLD
BUll.DING DEPARTMI~IT
Town Clerk% Office
$outhold, N. Y.
Certificate Of Occupancy
No. E?2.~J!~ ...... Date ..............Oct .... 1~ ..... ,19..76
THIS CERTIFIES that the building located at ...Vlc.t.~r~..D.~, ............ Street
Map No. xx ......... Block No... x~ .....Lot No.. ~x .... S~uf~old ................
conforms substantially to the Application for Building Permit heretofore filed in *.h~ office
dated .............. .E.a.y...~., 19.?~[. pursuant to which Building Permit No..~8~.~_
dated ...........l~e.~..~ ..... , 19. ?.~, was issued, end conforms to all o! the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . Pr. ivat~ .o~e..£am~y .~l~nE. ~tth. a~¢e6.$o~y, c%e~k ...............
The certificate is issued to . .. ~.d.v..~!~..~..H..e.l.e. xl..F,.o.e.r~$g ..... .~q"..~m .................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval .lq ,t/ ................................
UNDERWRITERS CERTIFICATE No. 1.,' ,~.. ................................ ~ .......
HOUSE NUMBER ..... ~.7.~ ..... Street....V. ictar, ia. ~:c .........................
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 7888 Z
Permission is hereby granted to:
, ..11e3.en..&.ll~w~&. ltoe~ i~ .......................
............ ~.i,¢~.to.l'.ie....D.~ ................. fl~u.tholcL..
to .. ~.~],t ..i~...~.~.e ~.~Qi'.~...4 e.~ ..................................................................................................
at premises l~ated at -.~-..-.~o~g.-D~*6 ............... (.R~--.H~$ .................................
............................................................ Sa~o[d ...... ~ ~.~. .................................................................
pumuafit to application dat~ ........................ ~ .............. ~ ....... , 19...~, and approv~ by the
Building Inspector.
Fee $...~ .........
FO~M 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 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 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 s~te 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, 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
formation required to prepare a certificate.
C. Fees: I. 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 ..............
Location Of Property .... ~...~/.~.~...~...~.~...~------- '~ .......... ..~..~...~.~ ................................................
Owner Or Owners Of Property ..... ~~...~...~..~.....~...~~ ........................................
Subdivision ................................................ '1'"~' ......... Lot No ............. Block No ............. House No ...........
Permit No..~..~..(~.~.....?.. Date Of Permit ...~.~'~.~. ...... Applicant ./.~-~.~....[~t.....[.'~.~.~. .......................
Health Dept. Approval ............................................ Labor Dept. Approval ...............................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Fin~ Certificate .........................................
Fee Submitted $ ...... ,.~..~ ...................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant .... ~'-'-~.. ~.~¢.~....~'~< .~..¢..~..~.¥.. · .~. · . .' ........................... ~; ............................
........ !. ,~.... dayo~ ........ ~.~ ......... r ................. (stamp or seal~,'~~e
Notary Publ,c ............... County /~-'_ _ ~ ~1'--,
Approved ..................... ./.! ........ '..~......,
l~O~ NO. !
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
..........
19 ........ ermit No.
Application No...?...~....~...~ .........
Disapproved a/c ~...~....~..........._:~_....-----~
APPLICATION FOR BUILDING PERMIT
Date ....... ...~.......~... .................. 19...~..~.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildinc
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 adjoining premises or pubhc streets oi
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 Budding Permit.
d Upon approval of this apphcation, the Building Inspector wdl ~ssue a Building Permit to the applicant. 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 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 th[
Building 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 with all applicable laws, ordinances, building code, housing code, and regulations, and t,
admit authorized inspectors on premises and in buildings for necessary inspections.
' ( 'g pp' , or name, ij~ a corporation)
..........
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder
Name of owner of premises ......------.'.~..~.~.~.....~ ........~'--..~..'.~.~ ...... ~~.~....[
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 ...............................................
1 Location of land on which proposed wgrk w~Jl be done /Vk~p No ........ ,~.... ~--~....~.. Lot No.. :....~ ..............
Street and Number ....~..~.~.......~...~..?...¥...4C~....~.~....~....~.'''- '-~-- -~ - ' ' ............. ' ' ~'~'~ ...................... '. .............
Municipality
2 State ex~sting use and occupancy of p,l:~ises an~intended use and occupancy of proposed construction'
b Intended use and occupancy ................. :.'. .............. ' - // ~.~'...~.. · ·...~.........~.... ...............................................
3. Nature of work (check which apphcable) New Building ............ Addition .................. Alteration .
Repa,r ................Removal .................Demollt,or ............. Other Work,..~..<~.~... ~....~..~.(_.z-~....~ ..
4 Estimated Cost .~,/,z/~. ~,u ............ Fee ..[ ~.. ~ (Description)
(to be pa~d on filing th~s application)
5 If dwelling, number of dwelhng units ................ Number of dwelhng umts on each floor .....................
If garage, number of cars .............................................................................................................................
6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ..........................
7 D~mens~ons of ex~stmg structures, if any: Front ...................... Rear ................................ Depth ....................
Height ....................... Number of Stones .....................................................................................................
D~mensJons of same structure with alterations or addmons. Front ................................... Rear .......................
Depth ............................... Height ........................ Number of Stories ..........................
8 D~mens~ons of entzre new construction' Front .................................... Rear ........................... Depth ...................
Height .................. Number of Stones ............................................................................................
9 S~ze of lot. Front ................................................... Rear .................................. Depth ..............................
10. Date of Purchase .................................................... Name of Former Owner .......................................................
11 Zone or use district m which premises are s~tuated ................................................................................
12 Does proposed construction violate any zoning law, ordinance or regulation' . ......................................................
13 WHI lot be regraded ....................... WHI excess fill be removed from premzses' ( ) Yes ( ) No
14 Name of Owner of premises .................................................. Address ................................ Phone No ......................
Name of Architect ...................... Address ................................ Phone No ......................
Name of Contractor ........................................... Address ................................ Phone No ......................
PLOT DIAGRAM
Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensmns fron
property hnes G~ve street and block number or descnphon according to deed, and show street names and ind~cot:
whether interior or corner lot
CoN
STATE OF NEW.. ,~.OR.~:. ~S S
....... ..... .,~., .~....-~...~.~,...,-~..,~.~¢,...~rZ~.....~../..u..~.~.z..r.~.. be,ng duly sworn, deposes ond soys thot he ,s the opplic~n
(Name of ~nd~vldual s~gnmg contract)
above named
He ,s the ............................................... ~.~.~ .........................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and ,s duly authorized to ~erform or have performed the sa~d work and to make and fd
this application, that all statements contmned m th,s apphcat~on are true to the best of h~s knowledge and belief;
that the work will be performed m the manner set fo~h m the apphcat~on fried therewith.
Sworn to before me th~s
........ ~ .... day of ~.~Z~~~~ ............. , 19~-~~~~~~
Noto~ Public, ..~~---- ........... Coun~ ...~...~;.~ ~ ............. ~ ~:.-..~.;~. z.~_::....Z. ?.....1.,gno ot appl,cont) ~ ............
NOtAry PUBLIC, Sfafe of New Yo~k
No. 52-4522026 . Suffolk
O0~is~o. Expires Marc~ 30, 19 .......