HomeMy WebLinkAbout9877-zFOI~M NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificate Of Occupancy
No .... Z9.1/4/4... Date . A~. .... .1 .............. , 19.7.8.
THIS CERTIFIES that the building located at .. ~30...~fa.~.a.s.s.q..S.t.,. ...... Street
Map No ............. Block No ........... Lot No ..................................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated .. May... 2.4. ........... , 19.7.8. pursuant to which Building Permit No. 9B.7.~.Z..
dated .. Angus.t... 3 .......... , 19.7.8., 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 ~ .... P. ri.vate. One. Family. DwelliNg .wl~h .D~c~ .~. $.~q .r.age., .S.h.e.d., .A.d.d:ition
The certificate is issued to ....... Edw~.d. F~k ...................................
(owner,~
of the aforesaid building.
Suffolk County Department of Health Approval ........... N/.R .....................
UNDERWRITERS CERTIFICATE No ..................... N./.R. ....................
HOUSE NUMBER..910 ......... Street .... ~ ~.a.~$$.o..~.t.r.e.e..t .................
......................................... .~./..~.o.~ .b.p.~.d.,..N.e./o.~.k. ............
.
Building Inspector
TOWN OF'SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOI:D, H.~Y.
BUILDING PERMIT '~
~(THIS PERMIT MUST" BE' 'KEPT ON THE P~,EMIsES UNTIL FULL
COMPJJJ~TION OF THE W~0RK AUTHORIZED)
N.° 9877 Z Date
permission is hereby granted to'.'
to
at premises
Building IhSP~ctor.
Fee I
FO~ NO. 6
TOWN OF SOUTHOLD
Building Department
Town Clerks Office
Southold, N. ¥. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
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:
]. Final survey of property with accurate location of oil 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, o 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 o~ 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
formation 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 '2/~.~ l '~' ·
Date .......... ~. ................................
New Building ..... ~..... ........ Old or Pre-existing Building ............................ Vacant Land ............................
Location Of Property .....................................................~ ................ e ..............................
Owner Or Owners Of Property ...(..~...~. ......~.~.....~..(.~.~.~ ...... .E/. .......... ..~. .......................................................
Subdivision ................................................................ Lot No ............. Block No ............. House No .............
Permit No..~.ZT~...... Date Of Permit~..//Z~.....Appllcant .(¢~.~:~T~...~...~....,...~..,~"..~..!.~,.~.. ........ 1.~.~ ......
Health Dept. Approval ......... ..X~..../..~ ................... Labor Dept. Approval ....... ,..'~.../.../,.,.~. .........................
Underwriters Approval ~. ............................................. Planning Bc~rd Approval ...~..//~-~.. ....................
Request For Temporary Certificate ........................................ Final Certificate ..........................................
Fee Submitted $ ....................................
Construction on above described building a/permi~eet//~'~,~bl~c~ and regul~ti~s.
Applic~~~ ;.~'....~: ................... ~
Sworn to before me this / ~ c~ / / ~
~ota~ Pu~ ~f * **Count, (stomp or seG,)~ J'~ ~ ' r
FOBM NO. ~
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Disopproved a/c ...................... ~. ....................................................
................................................. ;;T~.~ .......................... ' ....................
(Building Inspector)
Application No,-~,~,~,,~,Z,~Z. ..........
APPLICATION FOR BUILDING PERMIT
Date .................
INSTRUCTIONS
a. This application must be completely filled in by typewriter o~ 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 or
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part 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 part 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 o 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 in buildings for necessary inspections.
(Signature of applicant, or name, if a corporation)
./. ......... .... .< ....
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, g~eneral contractor, e_l_e~c.t.r_[c~ia~n, plumber or builder.
................................................... ......................................................... i
Nome of owner of premises ../..~..~;.~'. ....... .~i...~...~.~..~.~. ........ ..~....~.(.~.~. ...........................................................
i 7'-"-J" (~";~'r~ title ~-~l~,~-~a'~e officer) Builder's License No.
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 .~...O.,,~.,,,~,,,c,?,,~,,~,~,,:,,~,,. ...... ,,~,,,c~,,,,~. ................. ~,~,~,..~.~.. .............
"~/~ ~ / Municipali~
State existing use and occupancy of pre~i~ps~~ ~/.~an~igfended use an.d occup~f propo~d construction:
3.' Nat~'re of work (check which applicable): New Building'. ................. Addition ..... Alteration , .......... .~.., ,.
Repair .................. Removal .................. Demolition .................... Other Work ................................................ ....
~'/ D ~ (Description)
4. Estimated Cost ...........~....c~?... ........................................ Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......... ..~.~... .............. Number of dwelling units on each floor .......... .,~2,. ..............
If garage, number of cars ............................... , .............................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each~ type o use ............................
7. Dimensions of existing structures, if any: Front ...?_?. ............ : .... Rear .......?.,, ...................... Depth ..~...~. .........
· /z/' / --
kmght ........................ Number of Stones .......................................... ~ .......................................................... > ...........
Dimensions of same structure with alterations or additions: Front ...... '~....3..~.....x. ................ Rear ...... ..~....~.. ..............
n~,~*~ Heiaht · ~2/ Number ofxStories ....... ; ...... ;. .......... ' ,
8. sions of entire new const ction: Front _,.,,/,,?.,..~ .... ~.. ..... Rear ..../...~.. ...... .(....~,...i~.. Depth .../..~. ..........
Height .q,......~.t...e. 4. Number of Stories ............
9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................
10. Date of Purchase ........................................................ Name gf Former Owner ............................................ ' ............
11. Zone or use district in which premises are situated ......'ZZ...~.: .................. /..~...~....~.: .........................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: 'TT;.......~.......~......~.. ............................
13. Will lot be regraded ' '~""~'""L~ ............ Will excess fill be removed from~oremises:,( ) Yes
14. Name of Owner of premises ...~.'~,~..~.~'~.......x~..?...,~....~....,~.. ....... Address .~.).fl..~.~..~...~.~..~.~.~..z.. Phone No. 2(...J~.. .............
Name of Architect ...................................... ~ ....................... Address ......~;;;. ................. Phone No ..... '......-'-'T ...........
Name of Contractor (~.~...~,/~,...../.~...~.<...~.?.....~....../.~.C~.:. Address ~..4~t..~.......~.......~. ......... Phone No ....................... ~.~..5...~.
PLOT DIAGRAM
Locate clearly and distinctly oil 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,
r
STATE OF NEW YORK,
COUNTY OF ................................ ~'~
~?,.8.~.....,~.......~(...i..~.~.~.'~......r~...'~..~ ................ being duly sworn, deposes and says that he is the applicam
"(Name of individual signing contract)
above named. ~
He is the ...... -- ~ --~'-- ~~G=~.~.~...~....~~....~,~ ............................................................
(Contractor,~ --agent, corporate officer, etc.)
of said owner or owners, and is du]y authorized to perform or have performed the said work and to make and file
this application; that aH statements contained in this application are true to the best of his knowledge and belief; and
tha~ the work will be performed in the manner set fo~h in the application filed therewith.
Sworn to before me this ,x --~ //
................ day of ............................................ , 19.~'h
Noto~ Public, . ................................. :; ................ Cou~~~,) ' ' · .......
........... ~ .............................. ti .................................. :_Il
sand ~ grovel
coarse
sand
v~ater
( vacan t)
HIAWATHA'S
;¢.84°~
4rlea=26,795 sq f~
H/zl/ard /-Z Sch/lling
(vacant)
~ TH
REVISED.
NEAREST WATER MAIN- 3000't
0: PIPE
ANGELO AccARDo &
dOAN ACCARDO
SOUTHO~D
,,.w~,, $OUTHOLD
~FFO[..K COIJN ~ Y,
YOUNG
' ' ' r ': ' ': ' DI--ISIONOFV CHICAGO
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