Loading...
HomeMy WebLinkAbout9371-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. ,. Z.922.~.... Date ... Se~'cemher,,, 22 ........ ,19..?8 THIS CERTIFIES that the ~cated at . .8.'t~.0.. N.e~ Suffolk Rd,. ~ ~Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... l~y .... 2~ ..... , 19. Z~ pursuant to which ~ilding Femit No..9]Z~.Z. dated ...... ~y .... 2~ ......, 19..~, was issued, and conforms to ~1 of the requke- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued is ...... ~iva~e .Sw~tn~ .POo~ w~th. ~ce. ........................... The certificate is issued to ....... Jo~. ~,..C~On .................................. of the aforesaid b~lding. Suffolk County Dep~ment of Health Approval ............. N~R ................... UNDERWRITERS CERTIFICATE No ..... N5~2977 ....... ~t..~. ~977 ....... HOUSE NUMBER..8~ ....... Street .......... N~ ~fgolk. Roa~ ............. ................................................ g~*~.~. ~ .............. Building Inspector (THIS PERMIT MUST BE KEPT ON TNE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9371 Z Permission is hereby granted to: ..~L~.b~.~....~.~.~ .................................................. ....... .~.~..fi~.~ ..~...£~Z .~.. ~.t ............ ~..ew 8~tffo]~ to ......................................................... ~stal! new private sw~.~g p.o...o.!...V..~.~.tL...t~.~.~.e.,~....&' .~.q.e..~.~...s..o..~y..s .......... l~ow Suffolk pursuant to application dated . ~...~...2~ ....... , 19....~.~, and approved by the ";'~-? Building Inspector. FOltM ~0. 6 TOWN OF $OUTHOLD Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This opptication must be filled in typewriter aP, ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: l. Final survey of property with accurate location of (311 buildings, property lines, streets, end 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 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 applicabte. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" lend 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 os to use, occupancy and condition of buildings. 3. Dote 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 3. Copy of certificate of occupancy $1.00 New Building....J......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ......... ~ .......................... ~ · Owner Or Owners Of Property ........... ~.~.~...,.~..'..-,., ~'~-~:~-'J? ...................................................... SuLdivision . . . Lot No .... B ack NO-- ....---~.. House No ..... ii' ......... : .................................................. '"?'/- ...... Permit [No...d-~.~.~ 7.(...~_.Date Of Permit 7../...~...~/...~ .~. Appl cent ..,'~.~Z~.....~...~.~...~'~..~... ................... Health Dept. Approval .......... ~../..~.(~: ................. Labor Dept. Approval ........... ..,~../~ .................... Underwriters Approval ~ ................................. P annng Board Approval ...J~'.~.~.... .................. Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $.~.. .................................. Construction on above described building and permit meets all applicable codes end regulations. Applicant .~.. ........... ~.~,.4 ....... dc.c.~... ........................... Swocr?~. before me JOB # ~ ADDRESS TOWNSHIP ~ -~ PHONES ~ SIZE [~I LTER LOCATION I IC~.~L L~C~TI©N SI GHA~S: O~ERS: LINER SHAPE' T~E UNDERWRITERS : '~ ~ ' ,,THE.NEW YORK BOARD OF ; h~ ~ BUREAU OF ~LEcTRICITY ~. , 8S JOHN STREET, NEW YORK. NEW YORK,'~038 onl~ the deetr~cal equipment ~ described below a~ ~ntroduc~ bY t~ eppt~o~t ~med on . ~$chaPd J. Cron, J~c~on 5~.s Cot. o~.~e~ i~thefollowi~glqcatio,t; ~ B~b~cnt ~J lst~'l. __J 2rtd FLoutStde '~ TOWN Sou'r"O .D BUILDING DEPARTMENT ~" / .~ ..........'~;~'~ ~UTHOLD, N.Y. ~~-- ~/A~licotion No Examined ............. Disapproved a/c ................................ ~ ...............~'~. (Buildin~ Insp~tor) PERMIT APPLICATION FOR BUILDING ....... I~STRHCTIO~S ~. ~his opplic~tion must bo completel~ fill~d in b~ typewritor o~ in ink ~nd submitted in triplicote to the Buildino~ Inspector, with 3 ~t~ o~ plans, ~ccur~to plot plan to ~1~. F~, ~ccordino to schedule. b. ~lot plon showin~ Iocotion. of lot ond o{ buildinos on pr~mises, relotionship to ~djoinin~ premises or public streots oreos, ond Oivln~ o detoil~ doscription of Ioyout ofprope~ must be dr~wn on tho di~or~m which 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 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 Ce~ificate 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 the~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constru~ian of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building c~e, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for n~essa~ in~ections. ........... z.~.~:~..,..~.~..x.~..~..~.. ....................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................ ~....~.;~...~. ........................................................................................................................................... .~) ~; ~,~ ,~ f;,~ ~ ~, . ............................................... Name of owner of premises ......... : ................. ~ .............. ;....¢ ............................................. If applicant is 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 1. Location of land on which prop_osed work will be done. Map No.: ......... i .............................. Lot No..iX:;: ................. Street and Number ......~..,-.x.~....~.~.t......~.....~.~......~¢f....¢. ........ ~.~¢c...~.~....'..~. ............................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ........ .?,../'.~.?;:..~..?../.'~..~. ......................................................................................... b. Intended use and occupancy ./~.......~,.,¢~././~...~...~.....,:....¥....~...F~.;.~.~r~.~ ............... ~. ....... ~'~'..~.~,;.~. '.~..'~, .............. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior. .................... Other Work ................................................ ~... · (Description) 4. Estimated Cost .......... ..~....0...o..?.. ................................... 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 each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................................... Rear ............................ Depth ........................ Pleight .................... Number of Stories ....................................... ~ ............................................................................. 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Address ................................ Phone No Name of Architect .............................................................. Address ................................ Phone No Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from proporty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW,~YORK, ~ S S COUNTY OF ..~..~ .~..~'.~..~.(:....~ ' .........................~..~...~....~?....~.,'.......~....:....~z..~...~?.,..~.. ........................ being duly sworn, deposes and says that~he is the applicam (Name of individual signing contract) above named. ~He is the ...................... ~..~.~.~.~ .................................................................................................................................... (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 tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to.b~ore me this .... ~..-m~.~ day of ..~. ....................................... , /- · .................. ........................... RICHARD J. CRON ~otaty publle in the State of ~. ~ ~o. ~-5~1~0- Su~[olk County ~7 Comi~ion ~xplres Mar. 30,