HomeMy WebLinkAbout9904-zNO. ~.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
No...Z. 9.25.8. .... Date ..... 0o.t.o. ber...'~8 .......... , 19.7.8.
THIS CERTIFIES that the building located at 27.'[5. Nassau. P. oin.~ .Rd,... ~
Map No .... :~5~ ..... Block No ........... Lot No ....... .'10. ........................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated . .August...17 ........ , 19..78 pursuant to which Building Permit No .... 990/*Z
dated ...A.u../~.s.~ .... ?8 ........ , 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 is ........ .A.c.c.e.s..$9..r~.' .t~..t.~..d.t.n.g ..........................................
The certificate is issued to .......... M?.,..&..l~.~s.....R.t. qha. v.d' .W.a..~.1 ...................
( owner,:~:~g~ )
of the aforesaid building.
Suffolk County Department of Health Approval .......... N/R ......................
UNDERWRITERS CERTIFICATE No ................... .N./.R. ......................
HOUSE NUMBER ...2.7.~5 ....... Street ........ .N.a~.z~. P.o.l~. ~cl, ...............
.............................................. Cu.~chog~e,. N...Y .................
........ :.. -
Building Inspector
County Tax Map # 1000=104-13-8
FORM NO. ~
TOWN 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)
N? 990~ Z
Permission is hereby granted to:
..... "FZ~ "";:P'~;q;4'~'Z; ...........
FOBM NO. 6
TOWN OF SOUTHOLD
Building Deportment
Town Clerks Office
Southold, N. Y. 11971
APPLIGATION FOR CERTIFICATE OF OCCUFANG¥
Instructions ~
A. This application must be filled in typewriter OR ink, and submitted in ~to the Building
Inspector with the following; for new buildings or new use:
1. Final survey of property with accurate location of ail buildings, property lines, streets, and
unusual natur(~l 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 Cede 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-ex'st'ng'
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
3. Copy of certificate of occupancy $I.00
$5.00
Do,e .~..~....,../..~ .......... '/...' ....
uwner ur t.,~'ner~Aut ~'rop, rty ..-, .................................... ~ ............................... ~;~;';"~o .........
............ ..........................
Permit No..¢~.~..~te Of Permit ~..~.~..~.~:licant ~ .~.:. '~~: ........................
Health Dept, Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ..... ~ ......................
Request For Tempora~ Ce~ificate ........................................ Final Certificate ..........................................
.................
. . .-/~/~ U,~-. ..
................ day of ............................................ (stamp or seal)
Noto~ Public .................................... County ~<; ~ [' t~7~/
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined
........................................ , 19 ermit No .......................... : .....
Disapproved a/c ................. ~ .~....~ .~ .............................................
............
(Building Inspector)
No. ~* .
Application .......... ! .~... ................
APPLICATION FOR BUILDING PERMIT
Da,e t7- ,,
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 or
areas, and giving a detailed description of layout of property 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 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 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 cede, and regulations, and to
admit authorized inspectors on premises and in buildings for necessa~ .i.nspections, .
(Signature/of(~pli~J~or nome, if ~"~';';~'~';;'~i;~ ........
(Address of applicon) ...... ~ .....
State whether applicant is own~lessee, a,g. en~, orchitect, engineer, general contractor, electrician, plumber or builder.
................................................ .....................................
Name of owner of premises/'~J..~.~....'~....~l.../~....~..~, f'~ ~~ ..............................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ............~ .............................
Plumber's License No.
Electrician's License No .............................................
O her Trade s License No ............................................... , / /') ,
Municipality
State existing use and occupancy of premises and intended use and occu.p~ncy of
proposed
construction:
Exisiting
and
use
b. Intended use and occupancy ............ .~.~...~...~ .....................................................................
3. Nature of work (check which applicable): New Building .................. Addition ..~..... ........ Alteration ................
Repair .................. Removal .................. Demolition .................... Other Work ................................................ ...,
,..;.. ~_~ (Description)
4. Estimated Cost ~ .................... Fee ..... ,.,.......-~.~......./.
(to be paid on filing,~is applica~ron)
5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................
7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ...... 7..:./~... ..................... Rear....Z.:.~... ............. Depth .../..~,~.' ............
Height ./.~...I. .......... Number of Stories ........ L~..~.¢~.....~.,,Z'...~.. ............................................................................
9. Size of lot: Front ...... ~...~..~. ........................................ Reor/...~..~ .............................. Depth ....~....~..? ..............
10. Date of Purchase ...... :..~.....~.. ....................................... Namezc~Fer' ~e,r O~_~er .~.xL~....~..~ .........................
11. Zone or use district in which premises are situated ............. ~¢-,~.. ....... ~.~ ..........................................
12, Does proposed construction violate any zoning law, ordinance or regulation: ...... ..~.....~...; ......................................
13. Will lot be regraded . ...... ..../~.~, ............. Will excess fill be removed fram premises: ( ) Yes
14. Name of Owner of premises .....~'..~..~[~,,~¢~.......~...~ ....... Address .../~/...~...../...'/-,T.~./.:. ........ Phone No .......................
Name of Architect .................. : ......................................... Address ............................. Phone No .......................
Nome of Contractor ..~'.~'~.i..y~.: ..................... Address ~]~.... Phone No..~..~...~
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
......................... ~~....~...~eing duly sworn, deposes end soys thclt he is the opplieam
(Nome of individual signin!~'ontj/~cf)
above named. ~,~'_-~,-'~'x L ~:~-', '
Lie is the .................................. ~~... ......... '. .....................................................................................
(Contractor, a ' ' .)
of s~id owner or owners, and is duiy 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
tk.e~ the work will be performed in the manner set forth in the application filed therewith.
........
............ ....... Coun .................................... .....................................