The URL can be used to link to this page

Home My WebLink About9427-zNO. 4 TOWN OF SOUTHOLD BUT[,nING DEPARTME~ Town Clerk's O~ice Southold, lq. Y. Cerlificete Of Occupency conforms substantially to the Application ~or Building Permit heretofore filed in this office dated ...........[~. f,-~..~..~.., 19.~]. pursuant to which Buildins Permit No~.~..~?...~-- dated .......----~,~<~L... ?.--ti..., 1'9 ? ~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which _this certificate is (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~. ~. ~.../~..7.~ ................ UNDERWRITERS CERTIFICATE No..~...,~..~..3-..~..~'..7. ..... .~..~..~. ~.../.~.7.~ .... HOUSE NUMBER ..'~. ~..[.~. ..... Street...~...~.../..,-c~......~...~.. Building Inspect4r sOUTHOLD: BUILDING D~PARTMENT 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? 9427 Z Permission is hereby granted to: ..... ~'""*~'~'~**-*/'T';~ .... F~:~-~.,, pursuant to application dated ................................................ ] ..... ..Y.~,,., and approved by,the Building Inspector, ~ee ,......~.7....~. FORM NO. 6 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 ali buildings, property lines, streets, and unusual natura1 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 os 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: 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 $I.00 ........... New Building ....... .~...... ..... Old ar Pre-existing Building ............................ Vacant land ............................ Location Of Property ~/`~~6~~;~z~~/~~.~s~?~`~ Owner Or Owners Of rope.y .................................................... Subdivision ................................................................ Lot No ............. Block No ............. House Permit No.~.'.~.,~..~...Z.. Date Of Permit Z/'~.~.~'?~/...(~..~..Applicant . ~.~.(~..~..~(.~..~...~'../~.~.~./~.-A;./.Jk/.~'.; ........... Health Dept. Approval ~.J~F_~..~...i..~..~...o~ ............... Labor Dept. Approval ............................................... Underwriters Approval .~/.~.~:..~...~,..J..~,.'~..2 .............. Planning Board Approval ....... ..~../..~. ........................ Request For Temporary Certificate ........................................ Final Certificate ...~.,; ............................. Fee Submitted $ ..... ~,~......'~.~: ................... Construction on above described building.anti,permit meets all applicable c,o~es and regulations. Applicant .~-.~..~..... ~.;......: ........................... / ? Sworn to before me th~ L~:..:......L..~...~(.../ .... (~t.~p o~ s,.I) , Nota~ Public ...~;... :~ County ~:- ~ (''~ ' " THE NEW YORK ,BOARD OF FIRE UNDERWRITERS, cms ' , "' ', ' ' BUREAU OF' ELECTRICITY , ,, i:' ' 85 JOHN STREET, NEW YORk, NEW YORK 10038 ' z~,,,~ lqovemb&: l~77 ~ . t~ eb~trical equipn~e~t as ~scribed below and i~trodrzced by the applicant natned o~ the abo~ applied[ion number i~ the premises of ~ ~EECEPTACLESI SWITCHES I ' F;XTUEES ' I' RANGES ICOO~I.~DECKS 0~ENS '~;;H~ASH;R5 EXHAUST F'AN5 ~ ~ ' BELL' ~UNITHEATERS JMULT OUTLE~ DIMMERS ' SERVCE DSCONNECT ' NO O~I ........ " ' ' S ' E ....... R ~ V ~ ' I~ ~ ' ' ' i-G.F.C.I, .:' . . . - , . . 1-Smoke DetectO: '.- . :' ... 760 Long C:eek Drive · $outhold, LoI. 11971 Lico#657-E ' GENEI~A[ MANAG~E~R ~t y manner; return to the office at the Board if incorrect. Inspecfors may be ~a~.tifi~a ~h;~; credentials ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Examined .................... ., ,~% ,'~,..?, ,~..~.., Approved .................... ~/t¢.:o~.,., 19.:~..~. Permit No ..................................... Disapproved a/c ....... ~ ................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote ....................... ¢.7..?. . ..... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 or ore6s, and giving a detailed description of layout ofproperty must be drawn.on the diagram which is port 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 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 Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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 i~ buildings for necessary inspections. (Signature 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 of premises ....~..~...-~.~.~...~ ...... ...~.....~...~...~-...~..,..: ........................................................................................ If ,aoplic~nt is a corporate, signatur~ez~r,.of, duly~zed officer. (Name and title of corporrd'te officer) Builder's License No ..... .~,.,,?, ........................................ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which~roposed work will be done. Map No.: ................ ;,....'......~ .......... Lot No .................... Street and Number .~.~,/Z_~ ~..~.//'t' ..~.Z*~'/~/~.../~.. ~..~...~,..?...~.. ~. ~./f~..?.~.~,~/ J~. 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 ..... ~..g,j.~...~...~.,~x.~..Y......../~....~...J,~/,,..~/lJ.~.~;. ................................................... 3. Nature of work (check which applicable): New Building.. ....... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................... c/ /~ (Description) 4. Estimated Cost .......................................... i ...... Fee -~ .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~ ................ Number of dweIling units on each floor .. ,~."T../...~..'(.-..~....~....~''' If garage, number of cars .........../.......c,.....~..~ ................................................................................................................ 6. if business, commercial or mixed occupono/, 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 ............................ N~)mber of Stories ................................ 8. Dimensions of entire new construction: Front '~.-'~. ..................... Rear ....~...~.. ............... Depth Height j..~.. ........ Number c)f Stories ...~..,.,~..~..g..~. ......................... ; ............................................. ; ........................ 9. Size of I'~':' '~r~nt ......Z.~.~...:.. ............... Rear .../.,,,~ ............. Depth ~..~.../. , ............... C - 10. Dote of Purchase ,..Z.c~...~..~.. ............................ Name of Former Owner ....~-? ............. ~ ......................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ,~...0. ............................................ 13. Will lot be regraded ....... ~(2 .............. Will excess fill be removed from premises: ( ) Yes 0~) No Add ress .~..~.!~.~ .~...G..~. ~-~F~c~.~.&I.-~ N o. z~..~ 7..-,~,~ ,,.'?.-~...'.~.., 14. Name of Owner of premises'~.~,-~.~......~...°...~..!~..~.. ............... Phone Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor .E~..~...~k~).,~ .~..~..).~. ~..~I.~....JU.~..~.... Address ~.~.~...~..,..~.t~. ........ Phone No.'~.~..~-~..~....~...~.. 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 STATE OF NEW YORK, [cc ...../__ ~ ,,'~,~,~ ~'"'--~~u~'~z"~'~:;'~ac') be ,g duly sworn, deposes and says that he is the applicam above nemed. 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 ore true to the best of his knowledge and belief; and thaz the work will be performed in the manner set fo~h in the application filed therewith. me this ........................ day of ............................................ , 19 ....... ._ Nota~ Public, . ................................................... Coun~ ~~~,...~;:..-.~ ............................... L~gnature o~ o~lJcant) TO~VN CLERK'S OFFICE SOUTHOLD, N.Y. /~/ ........................................................... ....... ........ ............... z.~.....~...,..~.~.~..~....:...~ -~ ~ ~ ~ v (Bui~aing ~tor) ~ ~.~ ~ u' ~ ~ ~:~: This opplicoti~ must be completely fill~ in by ~ewriter o~ in ink and s~mi~ in triplicote to the Bui~i~ ~tor, with 3 ~ts of plens, ~ccurate plot plon to ~ole. Fee occording to sch~ule. ~ .. b. P~ot plan ~ing I~otion of lot ond of buildings on premises, relotionship to ~joining premises or public struts m ~ ~s, ond giving a detoiled de~ription of I~yout ofpr~e~ must be drown on th~ diogram which is ~ of this opplicoti~. ~ c. ~e work covered by t~ ~licotion moy n~ be commenced before issuence of Building Permit. d. Upon opprovol of this opplicoti~, t~e Building Ins~tor will issue o Building Permit to me opplicont. Such ~r~it~ s~ell be kept on the premisesawilable for inaction thr~gh~t the work. :~ e. No building sholl be ~cupi~ or u~ in whole or in pa~ for ony pu~ose whotever until ~ Ce~ificate of ~cu~ncy · s~oll hove ~en granted by the Building Insp~tor. ~ ~PPLICATIO~ 15 HEREBY ~DE to t~e Building D~o~ment for ~e issuance of a Building Permit pu~uont to the ~ Building Zone Ordinonce of the Town of Southold, Suffolk County, New York, ond other opplic~le ~ws, Ordi~nces or ~ Regulations, for t~e construction of buildings, edditions or alterations, or for ~m~ol or de~lition, es heroin d~rib~. The opplicont ogrees to comply with all oppliceble lows, ordinances, build ng c~, hous ~ c~e, ~ ~ulotians, and to 'odmit outhorized inspecto~ ~ premises and in buildings ~r n~es~ i~tlons. ~ ..~ .............................. ~.~ ......................................................... ~ ~$~~p~~me4 ~mtion) ~ ...~;.;.~...~....~.x~;~~7..~r~ ........... State-whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... ~ ..... ~ ........................................................................ f>~ ~ ~ T,,~. · ........... If applicant is a corporate, signature of duly authorized officer. Builder's License No ..... L,~,,~' ....................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number .... . ..................................................... ~:..~ ............... , ........... 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 ....~.~.~v..~......~j~ ..........~ ............. ~ ...... t-...u ........ '_ .................................................... 3. Nature of work (check which applicable): New Building :'~i;f' .... Addition .................. Alteration .....: Repair .................. Removal .................. Demolition .................... Other Work -~ ~ ~ (Description) 4. Estimated Cost ....... .~.,~..~ ................................ Fee ........... .................. 5. If dwelling, number of dwelling units ....... ~ ......... ...... Number of dwelling units on each floor .... If garage, number of cars ~ ~t, ~, : 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 ..... ~'tt~ ............. Depth ...,~j'...~. S Heightze of ........ at ~rc~nt~'~'/'"' Number of~ Stories ........... /, .)"'~'~l~'~1~*/, _ , ............................................................................. . ~ ]'..*~ ...... 9. ' : ' .................................................../~aJ Kear '"'~_~l~ ........................... Depth :..~,~4jjl~.~ ............ 10. Dote of Purchase ..~-1.~g1.',~_.__~.,.¢~ ...................................... Nome of Form~r Owner C'~'~'~,?'~:',"~'".'""~' 11. Zone or use district i~' w'hlch premises are situated ..................................................... i ....................................... ii. ..... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... ~ .......................................... !3, Will lot be regraded,~.: .......~ ............Will excess fill be removed from premises: ( ) Yes (~ No 14. Name of Qwner of premises'.~ijj~....~,~.~'~.~ ............. Address ~ljl~t~.l~jjlj~hone No. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..Z?t.. .................................................... Address ~'~.*~4$, J;~.,~,*~, l~e, ..,~iv{;:t~O ...... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-beck dimensions from property lines. Give street and block number or description according t° deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, lc c COUNTY OF ................................ ~ '"'" ............ ~.~~ ...... ~,~.,.: .................. being duly sworn, deposes and says that he is the applicant ~o-'t~i~rg~a I ~ ~ojJ~roct) above named. He is the ......................... '~!~'~'~'lt--'~ '{' 1~"'":" '~ ................................................................................................................ ~tractot, a~ent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 t0 before me th~s ~otorv Public, .................................................... Countv ...:~..~::~ ............................ ~ - (g~g~of opp~ant) t 0 F' ~> ?_ .¸ 0 't- // ,i LNOTIFY BUILDING DEPARTMENT AT lED INSPECTIONS: ~. BEFORE BACI~FILLING FOUNDA- 5. ALL CONSTRUCTION MUST ~EET 'i il