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HomeMy WebLinkAbout9876-z~OI~M ~0. & TOWN OF SOUTHOLD BUiI,BING DEPARTMENT Town Clerk's Office Southold, iN. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .. 1350 "Lupron' 'Pt; ....... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...I~tay. · .2/* ........... , 19.. 7.Spursuant to which Building Permit No .... 9(976 dated ...Nay..~ugus~c .. ~ ..... , 19. ~8, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .... Priva~ce· 0ne. F~mlly' 'Dwettirrg-with 'Deo'k 'Additlo~ ............. The certificate is issued to ............ ~0~.e. Rh..E~.qu~.r. ol ........................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ............ N/R ..................... UNDERWRITERS CERTIFICATE No ..................... .1)l/.l~ .................... HOUSE NUMBER . . 1350 ...... Street ....... .; ~tpton 'Pt;' 'Rd~' ~ '~ .............. / ttituck Building Inspector FOILM NO. ~ OWN OF SOUTHC~D~ BUILDING 'DEPARTMENy~'~ TOWN GLERK'S OFFICE SOuTHOLD, N~'Y. BUILDING__ .~.. PERMIT ~' ~(THIS PERMIT-M~UST BI~;',,K:EI~ ON THE PREM SES UNTIL FUI~L COMPLETION OF THE ~0RK~AI. jTHORIZED) N? 9876 Z Dote Permission is hereby granted tO: [0 at r pursuant to applicatiOh~ ~ated, ~.i~ ...... Building Inspector. · ee $..~...~,........, ..... i~Ol~M NO. 6 TOWN OF $OUTHOLD , Building Depo~tment 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 DUPLICATE to the Building Inspector with the following; for new buildings or new use: I. 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 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 as to use, occupancy and condition of buildings. 3. Date af any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o 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 '/'l'"~' 1''~''~/_..~../~! New Building ................ Addition ................ Old or Pre-existlog Buil~ting · ............... Vacant [and .............. Location Of Property ....... ~..~ ........ L~'-"-~ .................. ~ ...... ~ ...... v... ................ , .............................................. Owner Or Owners Of .~.,... ~ ......................................... ,~,,.~ .................................... Subdivision .................................................... ~...., ...... Lot No ............. B,l,~ck No. ....... .~... House No ............. Permit No..,~....~.~..J~.~. Date Of Permit ~..//..~.lZZ.Applicant ~/A/'~..~..T~7/.~/,~.~....~.~....~..~:~- ........ Health Dept. Approval ..... ../~/.././...~.. ............ .~.:.' ....... Labor Dept. Approval ....... ~../..,~ ....................... Underwriters Approval .............................................. a n ng Board Approval Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building a~permit/fl~eet~X~,~p~pli~qble~foad~ and regulations. ........... Sworn to before me this V ' V/ / ................ day of ............................................ (stamp or seal) ~ · ~ leO~M NO. 1 TOWN OF SOUTSOLD BUILDING DEPARTMENT ,/~ · TOWN CLERK'S OFFICE ~.~ ~ ~OUTHOLD, N. Y. Examined , ~2~ ~' , igX.. '~ ~ Application No..,..~....1..~7/ .............. ......... ....................................... .......... AFPLICATION FOR BUILDING PERMIT °ate .................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or. 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 o7 areas, and giving a detailed description of layout ofproperty must be drown 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 port for 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 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 ir~ buildings for necessary inspections. (Signature of applicant, or name, if (3 corporation) (Address of applicant) State whether applicent is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ~ ~.:.~..~ .~?.., ~..~.:......~. ~x.... J.~:-.: ~. ~.: .~L .o:.~%:. ....... g.: :/... u :::.:,:.~L-.~.~::.,....*.- ;:.~.,.. ~..: .~..= :..:(.;.: .~;.~.:. :: ~..:. :: ................................ Nome of owner of premises ....................... ; ......................................................................................................................... If applicant is a corporate, signature of duly authorized officer. ........................................................................................(Name and title of corporate officer) /~c~ Builder's License No ................. P:;~.~ ........................... Plumber's License No ................................................. Electrician's License No .......... ~?;../~.~,~....~. ............... Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .... /~....~,.~-~.: ................. ~ ............................................... ~,~.~.'.,.....* ........... ~-.--~ ......................... Mbnicipali~ 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 ...... ~~ .......... ~.~......~l Z t,~ ...... 3. Nature of ~'ork (check which applicable): New Building, Addition ~' erafidn ...... : ...... Repair .................. Removal .................. Demolitior ..................... Other Work ................................... :: ........... ,... (Description) 4. Estimated Cost ........ J..0..(J..~'.....(2.,~ ................................ I-ee ..~....~... ............................................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ............................ Number of dwelling units on Each floor ............................ If geroge, number of oars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify,nature and extent of each typ~ of use ..:; ........................ 7. Dimensions of existing structures, if any: Front ......... .~....~? ............. Rear ......... ~.'. ................Depth .... '..~...~...~. ....... Height ...... ~.~......~,~. .... Number of Stones , ..~ ...................................................................................................... Dimensions of same structure with alterations or additions: Front ........... :~.~...~.L ................ Rear ......... -~Lg.t. ............ .............. : ............. Number of Stories ....¢~ ........................ Depth ........ ..~..~ .................. Height ~' , G' . 8. Dimensions of entire new construction: Front ....... ~ .......... · ............... P, ear ......................... Depth ........................ Height ....... ~..~ ......... Number of Stories .......................................... ~ .......................................................................... 9. Size of lot: Front ..................... /..~.~,.~ ........................ Rear ...............~.~..,,O..~ ................ Depth ..... ..z~.~.~!.J.~..~..~ .......... 10. Date of Purchase .................. ...................................... Nome of Former Owner ........................................................ 1 1. Zone or use district in which premises ore situated ............... .~..~.~.!.~..~..(c:.~:t~J..~..~.~: ................................................. O 12. Does proposed construction violate any zoning law, ordinance or regulation', ........ ~ ........................................... 13. Will lot be regraded . ........ ..~.~ ...........Will excess fill be removed from premises: ( ) Yes ( 14, Name of Owner of premises ...;-.¥~..~..~...P...~......~.,~,C.¢.~.~..~...~....~..,. Address .~.o.:..o..~...--.. ....... Phone No. Name of Architect .............................................................. Address ................................Phone No ....................... ............ .~. ............................................ Address ...................... Name of Contractor 4,~'~+~ ~ 7~'~'~''~ /,O~b ...~..~.~...~../'~...~9.~.r.~9.¥)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 lot. STATE OF NEW YORK,, , ~ S S COUNTY OF ............... r'...:..-...:.....~ ' ................ M...;.,4,.L:..::~ ....... ....... ~ ...................... : ......... ..:..::::.'..,..being duly sworn, deposes and says that he is the applicanl (Name of individual signing contracf) above nome~J. 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 ail statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before ~,this ,, .......... : ............. of ........... ..................... , /~ ]~ ~ . ~ (Signature-of applicant) .%.