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Home My WebLink About9945-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property . . .25.7. ~ 9..H.a. J:.n..R.q a..d .,..qr. .Qe.n.~. ................................. Houxe No. Street Ham/et County Tax Map No. 1000 Section .... .0.2.8, ....Block . .0..6 ........... Lot . ,9.1.2 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · S.e.l~ i~ern.b.e r'. S., ....... I97.8. pursuant to which Building Permit No. 995.5g ............... dated .. £.ep i; e m.h e ~. 2.8 ........... 19.78, 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 ......... buzi_.iLd, a..ac c e&so~'7..BuS_Z~t, ing .................................................. The certificate is issued to .... ~J. olan. ~ppe3..t, ......... ,:_t:_'2_',',;,~'~' ...................... (owner, ............... 0 of the aforesaid building. ; Suffolk County Department of Health Approval . .~ / 3. ..................................... UNDERWRITERS CERTIFICATE NO ......... Ix!../g ...................................... Building Inspector Rev. 1/81 TOWN OF' $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N- Y. BUILDING pERMIT (THIS PERMIT MuST BE KEPT ON THE pREMIsES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 99~5 Z Permission is hereby granted to: ............................. ~. ..... L..L .... ~ ...................... and approved by the ' : ', FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 installa- tions, a certificate of Code compliance from the Architect o? 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 peoperty 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 premisest or other pertinent informa- tion required to prepare a certificate. ,' Fees: 1. Certificate of occupancy SB.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ....... New Building .l~(~O~_.~/ ..... Old or Pre-existing Building(~:) .. ........ ~/Vacant Land Location of Property .2.~:~.. (~, ...... ~.~..g~ .................. ~.. House No. Streo t Ham/et Owner or Owners of Property ...~.~ ~.L~ .................................. County Tax Map No, 1000Section .~.t~. ........ Block .~ .......... Lot...~l~ ........ Subdivision .... ~ ............................ Filed Map No...~ ....... Lot No. ~ ........... Health Dept. Approval .,~/.~ ................ Labor Dept. Approval ...~./~ ............. ,.. Unde~ritersApproval.,.~/~ ................ Planning Board Approval ...~./~ ........ ', Request for Temporary Certificate ..................... Final Certificate ............... Fee Submitted S '- ~ ' .,. ..... '" '- '""' , '"" '""- ' ,i TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. am,ned ............ ^pp,,cat,on .................. Disapproved a/c ........................ ~ .................................................. · APPLICATION FOR BUILDING PERMIT ...... ............ 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 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 nece/ssary inspections. //~' / ~ignature of applicant, or ~'ar~, if a corporation) ~ ,,~ ~ (Address of applicant) ~ ~'~' ~ox c7~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................... ~/.,..~,.~?.c~..- ....................................... z ...................................................... of owner of ........ ........ .................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of ,~,orate officer) Builder's License No ...... ~...~...,~,.,,~~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... d lib do e Ma No Lot No ~--2~ 1. Locatiog, of I.ar~J on which propose worl~i e or~ . AaJ;~Z .: ............ ~ ........................ s.. . ~. .................... Street 6~n~uUmber ../..~..Z~../../~...(......~ .~. ~./~.C ./~.. ...... ~,/....2~.../....~'.~.....~........~,5..~.'. ~...C.~... ................................ Municipality b Intended use and occupancy ~ ~--~~..~. S ~...~-,-~ / .... Z .... 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ...... Repair .................. Removal .................. Demolition .................... Other Work' .....(;~.......~.V.......~.J~.~d.:. (De~/cription) 4. Estimated Cost ....~./,..~.,. ................................ Fee ...........:.~..~...:...~ ................................................... ~to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ 1~ garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each ~pe of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stori~ ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ................... , ................ Rear ............................ Depth ........................ Height .................... Number ~f Stories ............................................ ,,~..t. ....................................................... i ........ Size of lot: Front ....... ~.~.~. ................................. Rear ..... ~..~..~..~. ................ ,.. D~h ....~.~. ........ 9. ~,~ o~ ~,~,o~ ........ .~..~..~...~.~ ............. ~o~ o~ ~ o~.~..(...~~ ....... 10. J ~ t ~ ~~ 12, Does proposed construction violate any zoning law, ordinance or regulation: .... ~ .................................... w,,, ....... Nome o~ Architect ................. ~ ......................................... Address ................................ Pk~ No ....................... Nome of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate all set-~ck dimensions ~rom prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. - (Name of in~ivi~k~l signing contracf) 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 ali statements contained in this application ore true to the best of his knowledge and belief; and thor the work will be perfor,~ed in th~men~a~..~t forth in the_gl~lication filed therewith. Swo rn..t omeefo re me th i s Il/ / . /7 ~./~ .~. ~ ~ ...... .............. .......................... . , ... .x... Note Public, . ..... Co~¥ ,~,.~. .............. , ............................. ~ '"~'~'~'-'i'"~"'. ..... ,,, :R'x?.' .__(S,gna~~'~'~')"~" ,..,.,,,~.,..,. x.. H-z~.... //,