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HomeMy WebLinkAbout9892-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Occupnncy No....Z.9.~.0./!..... Date .... .J..aD.u.a..r~r..' .2~. .......... , 19..7.9 THIS CERTIFIES that the building located at .. 97.8.0.. 8.o.U~.d..A.v..e ........ ~tm~e~x Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .. Augu~.t. 3 .......... , 19.7.~. pursuant to which Building Permit No... 9~9.~ dated . Augurer. 9 .......... 19 ]~.., was issued, and conforms to sll of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... ,Ic.~.ov ~o~z. Ferm. Building ........................................ The certificate is issued to ..... ~h~:~vt.~e .D£~];er~ ............................ (owner, ~.~t ) of the aforesaid building. Suffolk County Department of Health Approval ............ .N./.R. .................... UNDERWRITERS CERTIFICATE No. N/It HOUSE NUMBER ... ?:~:~? ...... Street Sound Ave Mattituck, N.Y. ...... .................... Building Inspector Couuty Tax Nomber 1000-122 -2-2l~ FOENI NO. 2 TOWN OF SOUTI~OLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIt' MUST'BE ' KEPT ON THE PREMISing,UNTIL FULL~ / COMPLETION OF THE WORK AU?HORIZED) N? 9892 Z Date Permission is hereby granted to: ,remises located pursuant to application dated Building Inmector. Fee $. . FORM NO, 6 TOWN OF SOUTHOLD Building Depm~ment Town Clerks Office Southold, N. ¥o 11971 APPMGATION FOR C:ERTiFIC:ATE OF OCGUPANCY instructions This application must be filled in typewriter OR ink, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of oil buildings, in triplicate to the Building 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 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 certif cate of occupancy $1.00 ~ "~' ~ · Date ....... '.t..~..~..t [.~ ........................... New Building ..... .~ ......... OId_%lc~°r Pre-ex~ting~ ,~/~ ~'/A'~] ~jBuilding ........................... : Va.cc~nt L~ond ............................ Location Of Property ............ ~.~,~ ........... ;~"~'~'~'~':';'~'~)"~"~""~;~"~'~'?"~"~'~"~'~'1'" '~'"'"[ Subdivision ................................................ ~...., .......... Lot No ......... .;}; Block No ............. House .~o...i ......... Permit No...!i~:~.:~f~ Date Of P,e:,mit .:.~:l.~,.l.~....Applicant ,..~.~'J~.~.l~.~,~.....'~..: Request For Tempora~.:Certificate ........................................ Final Certificate .... i~ ................................ Fee Submitted $ ....... :~.'.'i ....................... Construction on above described building and pe~n~ t~ .meets all pppl, icable codes end regulations. Applicant ...... ,Lv<~,~,/X ~, ...... w ......... ;..;.~.~. .................................... (stamp or seal) Sworn to before m~q this ................. ........ - TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No.~-~ ~- ;--./....~.."7,/.C~- .............. APPLICATION FOR BUILDING PERMIT Date ............. ~.~..(~.....~.. ................. INSTRUCTIONS a. This application must be completely filled in by typewriter off 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 oF 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 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 in buildings for necessa~)lspections. (Signature of applicant, or name, if a corporation) ., ........... ........ ...... (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, epgineer, general contractor, electrician, plumber or builder. ........... .............................................................................. applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ........... ..~....~.~'..~:.....~.. ..................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which ~roposed work ~vill~ be done. McLo No.: .................. ,.....~ .............. Lot No ......................... Street and Number ...... :~.~S.....~.~u....t.,.,.",......l...,.y..,m.,~.,.~.~,__ .......... .................................................... ~ f Municipali~ State existing use and occupancy of premi~and intended use ~nd occupancy of proposed constr~tiom b. Intended use and occupancy .......................~ .~..~..,~....~.~....~-...,~'~r..~ 3. Nature of work (check which applicable): New Building....~)~. Addition .......................... Alteration ............ : .... Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) 4. Estimated Cost '~-000" Fee .......... J.0..~.. ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..~...~..~. ......... Number of dwelling units on each floor .....~Z.. .................... If garage, number of cars ....................... -4...~..g. ............................................................................................................. 6. If business, commercial or mixed occupancy, specify 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 additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number~,,, of Stories ................................ Height g].:~....~.~.-~..~... Number of Stories ................. ~ ............................................................................................ 9. Size of lot: Front ......... ~ _., ..~/~'i'"'~'~. ............................... Rear .......... :.~...~'. ............. ~?~[~. m [_~ ...... Depth .................. ~, ............ 10. Date of Purchase ......... L~G~'..'.I.~o. ............................. Name of Former Owner .~£~(~.T.U/~£....V~l~.l.t~.e...~. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed constrvction violate any zoning law, ordinance or regulation: ..... .~.~'?. ............................................ 13. Will lot be regraded ..~.~....~f~.~,~..~f.~.~lWillll ,~excess fill be removed fror~premis(ts: (^/I )' Yes,~-. ( ) No 14. Name of Owner of premises ....~.~..[0'.~...).~.....~,~}~.{.~tSh'~4Address ...%l~lt~.~[~.~....i~.~'h~n~tNo. '2~1[.....~.~... Name of Architect ........... , ....................... a. ........................ Address ................................ Phon~No ......... ; ............. Nome of Contractor '......k..I.~4~.~,...~.~.~[ ........... Address 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. COUNTY O~ .it~(~'~.~..,~._.k.~....i...~~''~ ................... .~'.L.I~..(~..~.~(,:~.~.~....6~. ............................. being duly sworn, deposes and says that he is the applicon, (Name of individual signing contract) above named. ~ [ ~ 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 all statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performe~ in the manner set fo~h in the applicatio~jled therewith. Sworn ~o before me this ~ .~ / ] ........ ............ ........................ No cw .............. ............... ................ ...................... /~.~ ~ ~ ~ ..~ ~gnmure or appucanu NOT~Y FU;LIC SM,o ~ J~e~J~ Qt, ali{~ L ,~t. ,~ ~,~arch 30~ l~,~,[,k .~LIE~VEY~D FOE CHAIZL©TTE DiClCEEI26ON