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Home My WebLink About9119-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy 19.~.~. THIS CERTIFIES that the building ................................................ o ~ ......... . .m~.:~.~.. ~.~..< ............. ~4~. :~.~ .~..~.. ~.. Location of Property . ~/...? ~.. House No. Street Ham/et County Tax Map No. 1000 Section ... (.~...~....Block ....... ~ ..... Lot .4 ~ ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .~..0., 19... pursuant to which Building Permit No ...................... dated ............ .)~.. !2..4.5 ..... 197~.., 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 ......... /7.:,.,~,~ - ~',~.r. ~.,~..¢....~.4~.....~/....~.~.~. ~,:~.~.<.. ~ .~.4~ ..... ,.. The certificate is issued to ................. "[o'~n'o'r,~"~t~J ...................... of the aforesaid building. Suffolk County Department of Health Approval . .~.4'~. ......................... UNDERWRITERS CERTIFICATE NO. A~',t~ Building Inspector Rev 4/79 l~O/g~ NO. ~ TOWN OF SOUTNOLD 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) 9119 Z Permission is hereby granted to: · . : .................. <..~.~...~..~....~ ....... ~ .................. o, pre~,se, ,o~ot~d o, ....... ~/..~.....~:... .~....~~~l ........................... ' ..... ...~:~...~............-~ .. . ~,,s,o~, ,o o~,ico,,on ~o,ed ........... ~..~.5 ............. .,,.Z...(. ond a~proYed by the Building Inspector. ~ee ,../.~T...~ ..... Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hell Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor 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 installa- tions, 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: I. Accurate survey of peoperty showing alt property tines, streets, buildings and unusual natural or topographic featu res. 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. 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 Date .................. ~ ........ t New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property House No, Street Ham/et Owner or Owners of Property ..... ]-{'~. ,/~, .... ~.? County Tax Map No. 1000 Section / 0 ~)~_ Block ~ Lot. ~ Y. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. [ Date of Permit .Applicant Health Dept. Approval ........................ Labor Dept, Approvel ........................ Underwriters Approval ~/A- .Planning Board Approval Request for Temporary Certifi)coate ....................... Final Certificate ....................... Fee Submitted $ ....... ~"') .................. Construction on above described building and~/~meets all a~p~, e co~es and regulations. A ppl,cant.. ~i...~ .~.,~~ ....................... 7 TOWN OF SOUTHOLD ~ ~ BUILDING DEPARTMENT ~ TOWN (~LERK'$ OFFICE SOUTHOLD, N. Y. Examined '~~ ~.S ~Z 7 Application No..~.LL,~.. ................. ~ proved ................, ..... ......... ~sopproved ~,c ..... ~~....~.=.'.~...~.~.~.. ...... ~ ............. ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~. INSTRUCTIONS a. This application must be completely filled in by typewriter ol~ in ink and submitted in triplicate to the BuJlding~ Inspector, with 3 sere 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 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 permi~'~ 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 o Certificate of Occupancy~J~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 ~ 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 a~.mit authorized inspectors on premises and in buildings for necessary inspections. ........ ~,...,..%....:~.¥.~.,.:.~:c~..,...~..,. .............. ~ (Signature of applicant, or nome, if a corporation) x ................................ iX;~i;';;'Z'~T';'~;ii;;;;~'z' ......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......... ~..f ............................................................................................. If applicant is a corporate, sianotare of duly authorized officer. (Name and title of ~orporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trode's License No .............. ..~...~. ........................... 1. Location of land on which proposed wgrk will be~ d~ne. M~ap ,Noi ................ ~..~,.~.:£.~..~.-..~ ......... ;_,Lo~.No~ ........................ Street and Number ................... ":...~...¢~.~...~i ...... ~J:,,.~:.~.c.~.~ ........................................................ Municipality 2. State existing use and occupancy of premises ond~n?¢tq;(Jed~u~e an~)c.c~i~(~y'~f~r~posed construction: Exisiting use and occupancy ................................................................................................................................ 'ntendeduseandaccuponcy w~,z~ ~r'&,/~.~ ~.~.~. ............................ -q 13. Nature of work (check which a~')icable): New Building'. .................. ../..T. ........... Alteration ................ Repair .................. Removal .................. Demolit~on.........~ ........ Other Work ..................................................... ~ ~-- (Description) Estimated Cost .............. ~ ......................................... Fee .......................................................................................... (to be paid on filing this application) If dwelling, number oF dwelling units ............................ Number of dweiling units on each floor ............................ If garage, number of c~rs ...................................................................................................................................... If business, commercial or mixed occupa~cy, spect[y nature and extent of each type of use ............................ Dimensions ~f existing structures, i{ any: Fror,t ............................ Rear ................................Depth .................... Height ........................ Number of Stories ............................................................................................................... Dimensions of some structure with ahemtions or additions: Front .................................... Rear ............................ Depth ................................Height ............................Nu~-nber of Stories ................................ ~imensions o{ entire new construction: ~ront .......... ~ .................. Reor ........~.~..~ .......... Depth ....... ~ ......... Height .................... ~umber of Stories ............................................................................................................... Size o{ lot: [font ................... [l.~. .......................... I~er~r. ........ ~.J.~ ...................... ~epth .~.~.~ .................... ~ate o~ Purchose ........................................................Name of Former Owner ........................................................ Zone or ~se Bistrict in which promises ore situated ..................................................................................................... Does proposed construction violate any zoning iow, ordinance or regulation: ........................................................ Will lot be regraded ................. ~.....,... Will excess}ill be removed from premiseg: ( ) Yes ( ) No Nome of Architect ............................... ~ ......................... Address ................................Phone No ....................... Nome of ctor ~ Address PLO]' DIAGRAM Locate clearty propert lines. Give whether fferior or distinctly all buildings, and block number or according to deed, and S'I-A'I E OF NEW YORK,. COUNTY OF ..,~.>,1;~,1,1¢, ............. f~'~ ~'~I~I ..................... ~.~,-~...~.~.~.~.~ .................................. being daly sworn, deposes and says that he is the applican~ (Name of individual signing contract) above n~med. He is the .................... .~9.~g.~.~.~g~...~...~ ............................................................................................. (Coatractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to ~ke and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in tho applicoti~ filed therewith. Sworn to before me this Notary Public, . ........................ ~ AF~ ~E~LLE~