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HomeMy WebLinkAbout9298-z]FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certi[icete Occupency No..Z~.7.'l.'l ...... Date .......... J~,~s...'10 .... , 19. THIS CERTIFIES that the building located at . .~.~e~.Od. Ro..a~ .......... Street Map No. ~ ......... Block No. ,X~.. ..... Lot No, ~ ..... Oatcho~e .............. conforms substantially to the Application for Building Permit heretofore filed in this office 9298Z dated .... J':'~9 . 'lO .... , 19..?? pursuant to which Building Permit No..9.299.z dated ...... .J.u~..o.. J.O., 19. ?.7, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is 1~..I'.i.'Va. te. O.D..e ?..a~.t.~y .d..w.e.t.l.~.~..~..w.~.~.h., .addttig.~..&. fe.n..~.t~..~ ........... The certificate is issued to Thos & Sandra l~gg~[~L~ owners (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ..N"R* ............................ U D ,RWRIT ,RS C ,RTXFICAT , No. .................................. HOUSE NUMBER ....~.~ .. Street ...... p~..~.e.w.o.p.d..R.o..a.d. .... .~.u.~.c..h.o..~.9 ..... Building l~nspec~q~ FOE]~ NO. ~ TO~N 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) 9 98 Z Permission is hereby granted to: at premises located at ~,~nl3,~,d..}~i~l....: ....... ~..; .......... ' .................... ~....; ....................... ~....~ ........... ; ................................ · , ............ ;,.:,,;..~...~a'~ ....... iI.,.I,. ..................................................................... .......... ~,,:,..:,..~.'-.; ~..~'.....~..:,; ................. ~,..L..~....~,.:'. ........... ~ .:..,.~. ...... .~: ............................ : .................................... ................. .:,,;,:.,~..~:.,~.:~.:.?..0. ............ , 19~...., and approved by the pursuant to. ,application. dated Building Inspector. "/ ......... Building Inspector / ., ~ FOR~ NO. a TOWN OF SOUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation 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 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 .nstallations, 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: ]. 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 · Rte .... ......................... New BHiiding ................ Addition ***.~** .......... Old or Pre-existing Building ................ Vacant Land · ..... · ................................. Owner Or Owners Of Property~~..~....~'.......~....~k.~.=.~...~.l~.~. ~ ........................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. ~..~...~....?..~ Date Of Permit ........... Applicant .!.~.t .............. Health Dept. Approval ......... .J~....~.. .......................... Labor Dept. Approval .......... (~-....~. .............................. Underwriters Approval ........ .~....~. ......................... Planning Board Approval .... ~.....~.. .......................... Request For Temporary CeKtificate ........................ Fee Submitted $ .~./'~..',~-..~....C~.~.~1~ ~~r~~ ~ '~ ~.~ Construction on above described building and pe~ me~~/~lisbl~e ~~ regulations. Applicant ....~.~~~ . .~,~,~. ·. _,~ ................... - , ., Sworn.to before me t~ C\ __ · .... ./Z~., .... day of ..~....~ ............. ....~~'~.,~ [ ~amp or sas:g) , Notary Public ..... .-~.~:~'/'/~Z4...Z,.~ ~o.un~',, No 52-0830410 Quahfled m Suffolk County Term Exp~re~ March 30, 19~ ! June 9, 1977 Southold Building Department Town Hall Main Road Southold, New York 11971 Attention: Re: Mr-. ,T.er. ry Thomas A. & Sandra J. Higgins ~.i.n.ew.~..od .%o.a~, Cu%chogu.e.,....N.e~. york Dear Mr. Terry: In accordance with my conversation of today, I enclose copy of survey of property, dated September 21, 1973. We have reason to believe that an addition to the rear of the dwelling was made subsequent to 1973. Riverhead Savings Bank is placing a mortgage on this property, and if at all possible, we would like to have a Certificate of Occupancy for the addition. Thanking you for your cooperation, we are, Ver~ truly ~yours, CRUsE~ & HILLS GnC:jb Enc. TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Disapprov~.~ .................................................................. ate ...... /0 . INSTRUCTIONS ~7 ................................. a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi, Inspector, with, 3 sets o. f~.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, areas, and giving a deta,led description of layout ofpraperty must be drawn on the diagram which is part of th~s applicatio c. The wore covered by th~s apphcation 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 apphcant. Such perm 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 Occupan, 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 t} Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto describe The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on pre~ises~and in buildings for necessary inspections. .... ........ ;e of applica~;"~r name~"~"~"co~'j]~i~'"~ ........... Addr;;'s ;f apphc ' D' .......................... State whether applicant is owner, lessee, agent, a~ect, engineer, general contractor, electrician, plumber or builde Name of owner of premises .......... ~...~~..~..:~,'.. ..... J......~'~ .................. ;;;..;;;;;;;;. If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............~ .......... Plumber's L~cense No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ - Location of land on which prpl~secLwork will be done. Map J~....6..-.....-. ........... ..-7T..~_ot No ...... ..~ Street and Number ......... ~...~.~..~..~..~...~.. ......................... ~~ ............. v Municipality 2 State existing use and occupancy of I~,~mises and intended use and occupancy of proposed construction' a Exisihng use and occupancy .... ~ ......................................................................................... b. Intended use and occupancy ................ ' ,.~.~ .............. ' / J7....~.......~~ .......................................................