Loading...
HomeMy WebLinkAbout9410-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at . E.,S.. ~econc1, .Bt .......... Street Map No... xx ....... Block No...xx ......Lot No. x~ · · · Neq~ .~u~f.f. olk .............. conforms substantially to the Application for Building Permit heretofore filed in t_hi~ office dated ..........Aug...1.7..., 19.7.7. pursuant to which Building Permit No..9~10~. dated ............. Au&..18.., 1977.., wes issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is..p~.~v.e.te..(~c.c.e.~ry.~..G~r.e~e .... (e~pr.o.v~..b.~..~..~pp.e.~:~e).. i .... The certificate is issued to . .JulY.us.. ~inez~l ..... Career .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...E,~, ............................ UNDERWRITERS CERTIFICATE No. ?. :~: ....................................... HOUSE NUMBER ..... 8.~0. ..... Street .. Second. atree~t ...... ]~e?~..~u££~lk ..... Building Tn.~pector ~ BUILD TOWn sOuYi BuILDiI~G ?FEk'HUT (THIS PERMIT MUST BE KEPT ON THE P]~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9410 Z Permission is hereby granted to: Oeo at premises located at .E,/,*...2rc..,a~Z~.f.e.t ................................. : ...................... ............................... ~,' e.~ ~u.~:z ~:],k. ......................... pursuant to application dated ............................... ,~,.'~.g.....:t.~ ......... 19..~.~.., and approved by the Building Inspector. Fee $~ .g. ~.(~.Q ............ ~0~,~1 NO. $ TOWN OF $OUTHOLD 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 triplicate 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 lines, streets, and 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 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 and 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 3. Copy of certificate of occupancy $1.00 $5.00 Da,e .................. New Building ~ar~.~.,~.,. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property .... ........... Owner Or ~ners Of Properly .~ .......... ~~,.~...'"...,.- ...................................... Subdivision ................................................................ Lot No ............. Black No ............. House No ............. Permit No..~/~.~ote Of Permit .~/~Applicont Health Dept. Approval .............. : ............................. Labor ~pt. Approval ............ ~[~.~. ........................ Underwriters Approval ..... ~...~ ............................... Planning Board Approval .... ~ ............... ~ ............ Request For Tempora~ Ce~ificate ........................................ Final Certificate .......................................... Su i, d $ ......... Construction on above described building and permit meets all ap. plicoble codes and regulations. App icant .~.....4~~...: ........... ~ ......................... - d 7 · Sworn to before me this ~/~'/ ' ~ / ......... 6.~.. day of ...... L./..?.: ......... ~..vf......./.. ....... (stamp Or seol)~r ~/~_ (~- ~,O Notary Public ......... unty - © FO~M NO, 1 TOW~ O~ $OUT~OL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~..3 19 ........ Application No....- ......... Examined ,~,m.~. .........., ~ ~ ? t~j.' ./...~ ............. Approved iii i~?.ilil ...~......., 19.~.?. Permit No..~.~..Z.~..~:;~ ...... Disapproved a/c (J~-~l ~ (~- q ~ t/~,. ~ .......... ................ ............ ............................................. ~ ~ ~ .......................... 'r '~' - " ~ ' XZ~ ~ ~ ~ ~ ~/~ ~Z (Building Inspector) L ~ ~T~ 7~~ ~,,LICATION FOR BUILDING PERMIT ~. This opplication must be completel~ fillod in by typowritor o~ in ink ond submittod in triplicoto to tho Buildino Inspector, with 3 set* of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship to adjoining premises or public streets o~ 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 Building Permit. d. Upon approval of this application, the Building Inspector wJlJ issue a Building Permit to the applicant. Such permit sha~l be kept on the premises available for inspection throughout the work· e. No building shah be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have bee~ 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 o~TM Regulations, for the construction of buildings, additions or a~terations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and to admit authorized inspectors on premises and in buildings for n~essary inspections. (Signatb'fe of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner or pr s ...~,-r,~. .................... ~.~;,~c.~r~-~,~-~ .................................................................................... If applicant is a corpora~ureof duly authorized officer. · ~'~itle of corpo~c~'~"~'""~'"'~'~:~'' o'~'¥fic~r) ........ Builder's License No ............~../.~ ................................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed, , b ,~,~ ,work will be done. Map No.: ............ ~ .................... Lot No...."../~.. ................. Street and Number ..... ,.~b.~.,,~,,~........../~.,~..._,~4-.¢¢~..~...' ......................................................... Municipality 2. State existing use and occujgoncy o( p~remlses and in.ended use and ogcupancy of proposed construction: :, .................................................... :.. property lines. Give street and block number or description according to deed, and show whether interior or corner lot. ~ature ~f work (check which applicable): New Building .~. ............. Addition .................. :AIt~rati'on .:...,'..L...~. .. Repair .................. Removal .................. Demolition .................... Other Work .................................................... / ~ ? (De.scription) 4. Estimated Cost ............c~.~..~-~...(2 ............................... 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 ........... '..Z,/. .................... Rear ....... /....~.. ............. Depth ..~.c;~ ............. Height ...~./. ........... Number of Stories ................................................................................................................... 9. Size of lot: Front ...... /.'.4~.,.Z ..................................... Rear ........ .~...~..~... ...................... Depth ..../~...~..'. ............. 10. [)ate of Purchase ........................................................ Name of Former Owner ........................................................ ! ~. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, 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 ....................... Name of Contractor ~.(-.~.~ Address ,~.~-~....~.~ Phone No.)..~...~Z .~.../.~. PLOT DIAGRAM ~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicat~ all set-back dimensions from street names and indicate STATE OF NEW YORK, IS S COUNI'Y OF ....... ~tl.~..~ .]~ ........ ~' ' ............................ · ~,~'~l'~¢,-b'Jilz. t~,1~.~ ................................ being duly sworn, deposes and says that he is the opplicanl (Name of individual signing contract) above named. He is the ..................... ~l~...~i,~..~¢)l~ir&~t,O~. .......................................................................................................... (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 oil statements contained in this application are true to the best of his knowledge and belief; and that the work wi[I be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... 3,~,.1~... day of ............ &~l~,~llll.t; ................. , 19.7.7-_ Notary Public,. ...................... .~u,J.j~l.~ ............ County ELIZ~B~H A~N N~ILL~ NOTARy PUBLIC. State ~o. 52'8~25~50, ~.~,~. New York (Signature of applicant)