The URL can be used to link to this page

Home My WebLink About9377-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....g.O 37.~.~. ....... Date ........... .g:.u. ~...s.~. ~ .2 ........... 19.8. ~. THIS CERTIFIES that the building .... a.d..d.i.~.5, o..~.. .................................. Location of Property .. ~ ¢~.0. .............. .~.i?.e.. ¢.~.e.e...~.d.. .......... ' ...... House No. Street Hamlet County Tax Map No. ]000 Section ..... 9.~. ....Block ....... .'1 ....... Lot ..... .2.0 .......... Subdivision .... I~lg~.~lg..~.~ .r~. $ ............. Filed Map No...q ~. 79..Lot No .... ~.~...&. ~.~.. conforms substantially to the Application for Building Permit heretofore fried in this office dated ...... ~TL~L~..~q. ........ 19 .~.7. pursuant to which Building Permit No ..... 9.~.7. ?.7' ........... dated ....... ~TLI~.. 25 ............. 19 2.~.. , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Addition (deck & storage) on existing dwelling. The certificate is issued to ........... g2t~;IONX. ~Z.O. ................................. of the aforesaid building. Suffolk County Department of Health Approval ................ ~g. ...................... UNDERWRITERS CERTIFICATE NO ...................... ~/.~ ........................ Building Inspector Rw. 1/81 BUILDING (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL F~LL COMPLETION OF THE WORK AUTHORIZED) N? 9377 Z Permission is hereby granted to: ¢~.,e.,~,, .,O.~.~,~m~,$.....~Zq.,...~he~y....~ ~.~o ....... at premises located at 1~:~.,.~..~.~..~ .~Q~.~ .,. M~....~..' .~,~ ..~..~.-.:~.i ] ..................................................... .C.~ .~J~g~t.e .1~.,.~.,....: ............ :-. ................................................... pursuant to application dated ......................... ~.!~.....~JL ............. 19...?..~., and approved by the Building Inspector, Fee $ ........................ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southo]d, N.Y. 11~71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Building Inspec- tar with the following; for new buildings or new usa: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topograohic 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 building~ and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. B. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings asd "pre-existing" land uses: 1. Accurate survey of peoperty showing all 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 informa- tion required to prepare a certificate. ~ C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land usa $5.00 3. Copy of certificate of occupancy $1.00 .~/. Date ..... ~ .. g New Building ........... Old or Pre-existing Buildin (X) ........ =/Vacant Land ........... ~am/et Health Oe~. Approwl ........................ L~bor Dept. ~pprowl ...................... ~.. Und~riters Reques~ for T~m~or~ry Fee Submitted S.. ~.~.~.~ .......... Construction on above described building and permitters all app~cabl~odes and regulations. ... f zYo - ':' ' ....................... Approved FO~ I¢0. 1 TOWN'0F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19.Z.~. 19..~./...~ Permit No....~...~.~....:.~....~...~ .... Application No...~...a.../....~. .............. iq Disapproved a/c ............................................................................................ APPLICATION FOR BUILDINJ~'PERMIT INSTRUCTIONS a. This 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 location of lot and of buildings on premises, relationship to adjoining premises or public streets o~ areas, and giving o detailed description of layout of property 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 Building Permit. n~ d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit n~ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used Jn whole or in port 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 pursuant to the ~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or 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 to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or nome, if a corporation) ......... ............................... %~ddress of applicant) State whether applicant is owner lessee agent, architect, engineer, general contractor, e ectr c on, plumber or builder ....................................................................... ...-. ............................................................ '--,-~/.~..,~..,' ~....' -~ -- Name of owner of premises .(,~ .............. .'~. ~. If applicant is o corporate, signature of duly authoFiz~d'officer. (Name and title of corporate officer) Builder's License No .......... ..~..~....../...;L....~.~....../~.. ........ Plumber's License No ................................................. /OOD-- Electrician's License No ............................................. Other Trade's License No ............................................... ]. Location of land on which proposed work will be done. Map No.: . .. ~Y.~ ................ Lot No.....':;; .................. Street and Number ..... ~]0 Mdnicipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exislting use and occupancy ...~¢~.~%-:~;.~.M.~..~w.....t~...~ ........................................................ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Altergtlon ................ Repair .................. Removal .................. Demolitior ..................... Other Work .(~¢~.~....~...~..~..~?.~ ~ ~ (Description) 4. Estimated Cost ...:~..~..~...o...~ .......................................... Fee J ~' (to be paid on filing this gpplication) 5. If dwelling, number of dwelling units .......... ~.--.. .............. Number of dwelling 6nits 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 ...Z....~. ........... Height .....~ .............. Number of Stories ...................... 2~ ...................................................................................... Dimensions of same structure with alterations or additions: Front -- Rear ....~.. ..................... Depth -- Height .................. :7. ....... Number of Stories 8. Dimensions of entire new construction: Front ...................'T ................ Rear ....... ~ .................. Depth ........................ Height .......... ~ ........ Number of Stories .........~. ........................................................................................................... 9. Size of lot: Front ......... ........................................ Rear ............ ............................ Depth ..~'~...~..'~...~ ....... 10. Date of Purchase .......... ~..~..~....O. .............................. Name o~ Former Owner ....~z.. ................................................. 11. Zone or use district in which premises are situated ....... /~..~:z,u~q,,,~,~lq~m~....~ ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ...lO, dm'.......-.. ...................................... 13. Will lot be regraded . ........ ~.~ ................ Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ........ Address .............. I Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractork,,.,~<..{.J[/...(~-z)..~Lm~w.~ .................. Address ~...~.. hone 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. STATE OF NEW YORK, cou NTk¥~ ~ .............................. ~- ~.~ ........... ' ... ..'3,~,~L~ ................................. being duly sworn, deposes and says that he is the applicant (Ndme of individual signing contracf) 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 stetements 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. Sworn to before me this ........................ day of ............................................ , 19 ........ ~ /fi,. T~ /'/%') j? Notary Public,. ................................................... County ........ ~~....~~~ ............................ (Signature of applicant)