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HomeMy WebLinkAbout9930-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ L0~ation of Property ....... I. 9./4~.0...lyI.a.:[.lg...R.O.a.d. .................. I~I .a.~.~.:l,..~9.k. ~. 1}I.o.Y.. ,. )~* House No. Street Ham/et County Tax Map No. 1000 Section . .!.1~ ....... Block ..... .7. ........ Lot .... .'l.~. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..8.e.l~'l;01n.b..el;'. 6 ...... ,197.8.. pursuant to which Building Permit No... 99~..0~ ............. dated ... ~.el~l:elli.l:tel?..'1.'1 ........... 19 .'?.6, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ...8 ...... .............................. ...................................... The certificate is issued to . . .'I...a!a..o.8...AI'I..d.e..l'.~.o.r!...eA'l..d..V.~..C.a.~.¥.o ........................ of the aforesaid building. Suffolk County Department of Health Approval ........... .N/.R. ........................... UNDERWRITERS CERTIFICATE NO ................... .I~I/.R. ............../ ........... · ' Building Inspector Rev 4/79 TOWN OF $OUTHOLD ~U,L~; TOWN CLERK'S -~FIGE SOUTHOLD, N.. Y. BUILDING. (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N? 9930 Z Permission is hereby granted at premises I~ated at ................. . . · ~,,.-..:..~.. ~ ........ ,..,m,.. ,:~..,~ -:.,.,.: ,-: ........ -,..,-..:.~ ..... ........................................................ .......,. ........ ,..., ~ ', .~ ......... ~ ,..-,? ,,-.,~,...,-~.....~ ......... , PUrSUant to appl,catmg% dated ......~ Building InSpector. ' ,...f:...O...... .......... TOWN OF $OUTHOLD Building Depas~ment Town Clerks Office Southold, bi. ¥. 11971 APPMGATION FOR GERTIFICATE OF O~GUPAHCY instructions ~ A. This application must be filled in typewriter OR ink, and submitted in t~e to the Building Inspector with the following; for new buildings or new use: 1. 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 o'f 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 in- 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 $1,00 $5.0O Date ............. New Building ........ ~ ......... Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property /.~ Li~,.,~. ~-~;J~.L J~/~,,.~......~'~'~"~"~'~"/~""~'~;~'"~'~ ........................ Owner Or ~ners O' Prope~y .....r~.~.~.....~~.~.~,~...~.~...C,.,.~..~.C ~' , ~ , ............... · · Subdivision ........... ~ .................................................... Lot No ............. Black No ...... ~,.,, Hguse No ............. Permit No,~.~..~.... Dote O' Permit ~.~.J~,2~AppJicant .0.~.....Z~~'.~-( ........ Health Dept. Approval ............................................ Labor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Tempora~ Ce~ificate ........................................ Final Ceffificate .....~ ......................... . Fee Submitted $ ................................. Construction on above described building a~ permit meets all a~able c~es and regulati~s. ................ day o~ ............................................ (stamp or seal) Nota~ Public .................................... County ~ 0' ,'! '": 5 L)G [7_ ~0~ ~TO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. r" e ............... 7__ App v d .............. ~./... ......... , ]9 ........ Permit No ................................ Disapproved a/c ......~,~.......~ ................................................................. ................................. (Building Inspector) Application No. APPLICATION FOR BUILDING PERMIT Date ...... ~...~. ............................... , ] 9.....~....~ ,.STRUCT,ONS 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 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 ~dmit~uth~rized~nspe~t~rs~npremisesandir~bul~d~ngsf~r~essaryinspecti~ns~..~(~.~ /~..~.. ~' |,~,,~,,,~,,~,~ u,( 'g e of applicant, or name, if a corpor~ti~on) ....... (Address of applicdnt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ................................. ...................................................................................................................... Name of owner of premises ....~I.~..~.L~.~/. ...... ~.kL.~..~. ~..~..~-/ ....... ~.~.¢g.L~.~......~.L.~C .................................. If applicant is a co~orate, signature of duly authorized officer. (Name 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 proPosed work will be done. Map No.: ...... .~..~..~.~ .................... Lot No ......................... Street and Number ~`~.~..~..~k~`~:~`J.~..~.~E~t/~"~..~.~.~....~.~.~.~ b.C.~.O~ x~.?...~. ............................... Municipality State existing use and occupancy of ~'r~ises and infended use and oc~cupancy of/~roposed construction: b ntended use and occupancy ..... ~u~~~-- ....................~...............................~/x............... 3. Nature of work (check which applicable): New Building.~. ............ Addition .................. Alfe,ra,~,,,j~, ........... Repair .................. Removal .................. Demolition .................... Other Work L;~x~.~ ~...~~ , ~ (Description) 4. Co, ...... .......................................... ....... ............................................................................. (to be paid on filing this application) 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, if 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 cons~ctjon:,Front ........ ~.~ ..................... Rear ..... ~.~ ................. Depth ..... ~. ................ Height ...J....~.~ ....... ~umaer at ~tariesb}l..~(.~...-.~.,-~;z;;.~ ................................................................................... 9. Size of lot: Front ......... F/..J.. ..................................... f.. Rear ...... ~.....~.2 .........u ...... Depth ..f.Z.~ ...................... 10. Date of P.~rchase .......... t..~.~.A.....; ........................... Nome, of~,, , ,~,~/~'jF°rmer~wner ....~.'.~¢.[. ...................................... 11. Zone or u~e district in which premiss ore situated .......... /~.~,-~.~.... ................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ~~ 13. Will lot be regraded .......... ~ ........ WHI excess fill be removed f?m premises: ( ) Yes (~) No 14. Name of Owner of premises ..4.%~2...~.~.L~.~.~.. Address ............ Phone No. Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ............................................................ Address ................................ 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 end indicate whether interior or corner lot. OF NEW ., ..... ~,~~ ............... being duly sworn, deposes and says that he is the applicam "-/ (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 ail statements contained in this application are true to the best of his knowledge and belief; and that' the work will be performed in the manner set fo~h in the a~ ~lication filed therewith. Sworn~to ~fore meday this~~~~ _ ,19 ~/.~,, .~.~ ~~.~ Notary Public,. ........ ~~~ .~:.... .... ~ ...................