The URL can be used to link to this page

Home My WebLink About9320-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .... .~..~-"~ ......... Street ~p~o ..... .~. . , ~,o~No.. ~ .... ,.o, ~o. . * .... :~~':~. . .~. !/.'. conforms substantially to the Application for Building Permit heretofore filed in this office ( ~ dated ..... fr~. ~../ , 19.7 ~. pursuant to which Building Permit No..~.~ dated ...~/~'. (~..~'L'~....~I...., 19..~.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is The certifiC~ i; i;;~e~ ~' '~i~.~. ~f. ~/~.~.. (owner, lessee or ~t~nant) o£ the aforesaid building. Sl~ffolk County Department of Health Approval ~..'..~.'. .............................. UNDERWRITERS CERTIFICATE No ..... ff..~./..Z~. ......................... HOUSE NUMBER....~.~2.?...~.. Street .~...~..q~.-.~ .... FOll~ NO. ~ TO~N OF SOGTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS pERM~IT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) 9320 Z Permission is hereby granted to: ~ '. approved by the ~ Building I n.:Etor / ~' ~_~... Bui, lding Inspector. Fee $...~R'~..~.. ......... FOnM NO. ~ TOWN OF SOUTHOLD 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 d~sposal--(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 19§7), Non-conforming uses, or buddings 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 buddings 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 dwelhng or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ....... ~.......~......(..~ .. ~.Z ..... New Building ....... , ............ Old or Pre-ex, isting Building ............................ Vacant ~ ............................ Location Of Property ....... ..~.~.~.~~.......~.....~.. ...... ,; ......... ..~...~~~..~... ............... C)w,ner Or Owners Of Property ..~..Z~./Z..~.~.~.........~...~.'~.~:......~.~..~.~.....J.......Z... ............... Subdivision .................. ~ ..................................... Lot No.....~ .... Block No..~>... .....House No~V~ ? <j -- Permit No..,~.'..~,...'2...0...~..'. Date Of Permit Z./..~-/Z.~.Applican, .... ~.~~.~ ......... Health Dept. Approval ..... .~,.'...[...~.. .......................... Labor Dept. Approval .......... ,~,,':i..,,~,,.T. ....................... fV'- I'~--- Planning ..~..~' Underwriters Approval .............................................. Board Approval ....................................... Request For Temporary Certificate ........................................ Final Certificate Fe~. Submitted $ ~ ............ Construction on above described building and p,ermit meets all al;~icabJe codes and regulations. Applicant .././?/~~...~~...~ ............... ~ ...................... Sworn to before me this , .......... ~.... day of ~...[. ,~.,~.-Z ........... (stamp or FOI~,,M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....... Disapproved ~ ............................... APPLICATION FOR BUILDING PERMIT ~ \ I INSTRUCTIONS Date ..... ~ ..... ...~....~..., 19...~....~.. This apphcation must be completely filled ,n by typewriter or Jn ink and submitted in triplicate to the Buildir 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 ~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio, 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 apphcant. Such perm shall be kept on the premises available for inspection throughout the work. e Ne 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 th 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 herein describe, The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and ~ admit aulhorized inspectors on premises and in buildings for necessary inspections. ...................... (Signature of o~me, ~~;~;'~] (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde If apphcant 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 No ............................................... ~. Locot~on of land on which pro. posed w. or, k willie done. Mop, No .............. ~o/'gNo . ..~.. .............. Street and Number .......... Z~ ....... ~'"~'"'Municipality Sa tateEx~iiiit,n n; u~e aah? o~Uppaanr ~Cyy..~'.. ~~' / .~ ei..~;;.,,..~ .~ .~..~ .~i.~ .~ .~ .~ .~ ~...~'...~ r..~ .~ ~. i.~d...~ ~.~ .i'. i.~;'.;.~ .~i ............ b. Intended use and occupancy ................... ~.~ ......... .......~.......~~....~.~ .................................. / 3 Nature of work (check whfch apphcable) New Building . ......~.. ..... Addition ................ Alteration ............. Repmr ................ Removal .............. Demoht~or ..... Other Work ............................................... ~ (Description) 4. Esthnated Cost ......................................................... Fee ..... (to be paid on filing th~s application) 5. If dwelhng, number of dwelhng un;ts ....................... Number of dwelhng un,ts on each floor ........................... If garage, number of cars ...................................................................................................................................... 6 If business, commercial or re;xed occupancy, specify nature and extent of each type of use .......................... 7 D~rnensions of exmt,ng structures, ~f any' Front ........................Rear ................................ Depth ................... Height ........................ Number of Stones ............................................................................................................ D~rr.ens~ons of same structure with alterat;ons or additions. Front ................................... Rear ....................... Depth ............................. Height ........................ Number of Stones ................................ 8 D~rnens,ons of ent,re new construction: Front ........ /..?. ................... Rear ....... t..~ ................. Depth ./...~. ................. Height ................... Number of Stories ............................. ~ ....................... 9. S~ze of lot. Front ................................................ Rear .......................................... Depth .............................. 10. Dote of Purchase ...................................................... Name of Former Owner ....................................................... 11. Zore or use district in which premises are situated . ~.?..~.....~ .......................................................... 12 Doe,~ proposed construction violate any zoning law, ordinance or regulation ......... ~ .................................... 13 WHI lot be regraded ...........~ ..... Will excess fill be removed from pr~ses:,( ) Yes 14 Name of Owner of premises .~..(~.1~.....~...~ddress..t ~ ~~ .... Phon~ No Nar'ne of Architect ..................... ~/'Address ................................ Phone No ...................... N~e of Contractor ......... ~ ............ Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and dmtmctly all butld~ngs, whether ex~st~ng or proposed, and indicate all set-back dimensions fron property hnes G~ve street and block number or description according to deed, and show street names and indicat~ ~vhether interior or corner lot COUNTY ~'-'~k~rf'~"C4' "~ f ~'a ............. ~~~.~ ....... being duly sworn, deposes and soys that he ~s the apphcar (Name~f indiwdual signing contracf) He ~s the .......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and this application; that all statement contained ~n thru apphcot~on are true to the best of his knowledge and belief; an that the ¥1ork will be performed.~ he manner set forth in the application filed therewith Sworn to I~lor~ me th s" Notary Publ,c,. ........... 't"~,~' ~.~. County ...... T...¥.~'..~;~~..'.~:...: ......... ~ ....... ~,,,~ 7~' t~ ~- (Signatu4Ze of applicant)