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HomeMy WebLinkAbout10073-zTOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Ot~ice Southold, N. Y. Certificate Of Occupancy No. ~./4.9.8. ..... Date .... APril.. ~1.0 ............. , 197.~. THIS CERTIFIES that the building located at . ~.50. ~/.esland .Rl~,cl ....... Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .De. cembel~....~./~ .... , 19..?8 pursuant to which Building Permit No. dated . .December.....~/4 ..... , 19.78., 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 .......... Acce~;~.o~y. ,~lldtng ...(.Detachec% .(;~'~® ) ................. The certificate is issued to ....... E%,erat'l:. & A'I ~.~ .5w®n~lon ...................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ................. .N.~R ............... UNDERWRITERS CERTIFICATE No .......................... .N../~. HOUSE NUMBER ....~.~.0 ....... Street ........ .W.e.s.~..~..d..R.o..~l.. ................... .............................................. s. . .¥or.k. Building Inspector 1000-059 TOW~,I OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK, AUTHORIZED) Permission is hereby granted to: ~/~ . ..,: ...... ~_~ ....' .~Z:..~.: .......... ~t premises ,a~ted at ~....~/_~...~~..~~;...~- .............................................................................'. ~ .............. '~'-' ................... Building Inspector. ui din~." Inspector FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall 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. Finat 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of peoperty showing all property lines, 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. C. Fees: 1. 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 Date...~../L~. >~.. .......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. House No. Street Ham/et Owner or Owners of Property ~/~,~.~:?-?~ ~.~/c~: ~E~s~ County*ax Map No. ~000 Section .. P.~..f. ..... B~ock ..... ~ ........ Lot-~.. ~(~. ~. ~.4. Subdivision ................................. Map No ............... Lot No ............... Permit No. /~...~.'.~. Date of Permit .......... Applicant..~..(~..~...~-~...~.-~.. -.~. ~./~..~../~..~. · .~,. · Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and~,mit meets al~cable codes and regulations. ,,pproYed ..~....'..'S': ............. , ,¢(.:: Permit No. I..~O.Z~....~..·..~'~ ~ ~ ~~;;~ i~ ~)isopproYed a/c .......... ..:.:.'::.-.............----~- ................. ./:? ................. = ................. ~% ? ¢ ........................................................................... ...¥ ....... ............... 75 //x (B~il~n~' Tn;petter) APPLICATION FOR SUILDING PERMIT ',~te ....~:...../..~. ................. , ,~.~..L INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building nspector, w th 3 sere of plans, accurate plot plan to scale. Fee according to schedule. . ,, b Plat plan showing ocation of lot and of bui d rigs on premises, rel~tio~n~ship to. adjoining premises or. .p.ubhc st..reets or areas, and giving a dotal ed description of ayaut ofproperty must be drawn on the o agrom which is port aT this appncat on. 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 far inspection throughout the work· e. No building shall be occupied or used in whole ar in part far any purpose whatever until a Certificate of Occupancy 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 the Building Zone Ordinance af the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances or ..... f removal or demolition, as herein described· Ragu at OhS, for the construction of bu,ldmgs, addmans or a, terat~ons, or or The applicant agrees to comply with al opp icab e aws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings far necessary inspections// ~ (Address of applicant) S ,' .... , ........ ~ .,-h;tnrt ~n~ine~r aenera contractor, electrician, plumber or build~. ........................ O.ta/.&/g~ .................... . ..................................................................................................... Name of owner af premises ........ ~ .................. ............................................. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officerP Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License Ne....~.,~O.~---- .~..~-.~'..4-.O-/~]J ........ ' ~Y ~/~1 Location of land on which proposed work will be done. Mop No.:~i~0i~,.~:~Lot No. g6.g~.~..- ...... ............................................... ...... State existing use ~nd occupancy af premises and in~ended use and occupancy of proposed const~ction: a, ~isiting use and =cupancy ...... ~,~,..-~~ .......... ~'"~-': ................................ ~. ,.,~.~ed.,~ =~ o=~.:, ........ ~.~-~...'...:~.::~~ .............................. 3. Ncture.of ~o/k (check which applicable): New Building ..... ~ ........ Addition .................. AlteraHen Repair .................. Removal ..................Demolitior~ .................... Other ~'ork ................................ (Description) 4. ...... : .... ........................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................Number of dwelling units on each flor ........................... If garage, number of ~rs ....... ~ ............................................................................................................................... 6. If business, commercial or mJx~ occupancy, speci~ 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 add;tions. Front .................................... Rear ........................... ' ' e f S~or es ............................... Dimensions of entire new construction: Front .......... ~ ...................... ~ear ............................ ~ ....................... 8. ~t ~ ~ N=;~hr ~ .... Number of Stores C ...................................................................................................... lQ. ga~e oF Purchase .... ~.t....~.[Z ..................... Name or former ~ner .~..~~.~ ..... ~/ ~. /~ 1 1. Zone or use district in which premises are situated ........... ~ .................................................................................... 12. Does proposed, construction violate any zoning law, ordlna~ce or regulation: ...~: ........................................... 13. Will lot be regroded .,,,~, ................ Will excess fill be removed from premises: (~ Yes ( ) i ~ ~4~ n ................................ .............. ...... .... Name of Architec~ ......................................... v .................... ddress ................................ Phone No N~me of Contractor ............................................................ Address ................................ Phon No PLOT D~AG~M ' .' Lac~te ¢leoriy and distinctly all buildings, whether existing or proposed, and indicate ~11 set,ok dimensions fror ~rope~y lines. Give street and block number or descriot[on ~ccording to de~, and show street names and ind[cot whether in~erior or corner lot. COUN.TY, OF,. ,.~.._~...~./.(,~- ........9~''~ . ~ .. ................... ~..~.~.~'.~..:'.~.:.~~...: ....... :.. be,n~j duly swam, dea~ses% and soys that he is the applica (Name of indiv~'~ual/signing controcf) He is the ................................. --~..~ (Contractor, agent, c6rporotb officer, etc.) af said owner or owners, end is duly authorized to per~or'm~or ho.ve.-~.erformed the said work (:nd to rr~ke and this application; that ~ll stctements contained in this apptic.~-tion ore true to the best of his knowledge ~nd belief; thor the work. will be performed in the m~nner set fo~h in the ~pplic~tion filed therewith. Swam to before me this , ~ ~, ~ ~ ............. ....