HomeMy WebLinkAbout9700-zI~OR~ NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. ¥.
Certificate Of Occupancy
THIS CERTIFIES that the building located at J.?.~?.0..~..o.u~..d.¥.~.e?..A.¥.e ..... Street
Map No ............. Block No ........... Lot No ..................................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ...~.p.r.i.1.....2.8. ....... , 19.7.8. pursuant to which Building Permit No .... ?.7.0.0. Z
dated ...~I.~y...2. ............. , 19..7.~., was issued, and conforms to all of the require-
merits of the applicable provisions of the law. The occupancy for which this certificate is
issued is ......... P..r.iy.a.t..e..One...F..aM.i..ly..Dw.e.I. 1..i.ng .~..i.t.h.., .A.d.d.i.t..ip.n. ..............
The certificate is issued to ....... .H.e.l.e..n..&..G..e.o.r. ge...M.i.c.h.e.1. ........................
(owner, ~~,~.-~
of the aforesaid building.
Suffolk County Department of Health Approval ......... ~/.I~ .......................
UNDERWRITERS CERTIFICATE No ..... Pending
HOUSE NUMBER . .~?.1.90 ...... Street .. Soundview Ave
Southol .d~ New ........
............................................................ ~ork .........
........ ........
Building Inspector
NO. ~
TOWH OF $OUTHOLD
BUILDING DEPARTMENT
ToW~ cLERK'S o~FIGE
SoUTI HOLD, ~. V.
BUILDIHG 'PERMIT
"(THIS PERMIT MUST BE KEPT ON TI-~ PREMISES gNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
lg'9. '9700 Z
pursuant to application dated ................................. ..~..~.~Ji..!.L.L..,,~,'.,~lg..Z..~., and approved by the
Building Inspe~or.
.. , ~ / / ./,,~.,
Building Inspector
TO~N OF $O~THOLD
Building Department
Town Clerks Office
Southold, H. 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
Inspector with the fallowing; 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 disposol--(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 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 $5.00
3. Copy of certificate of occupancy $1.00
Date
New Building ................ Addition ..... ,~ ...... Old or Pre-existing Building ................ Vacant Land ..............
Lo,at,on Of Property ..................... ......
Owner Or Owners Of Property ~
Subdivision ................................................................ Lot No ......... -.. Block No ............. House No .............
Permit No. ~.'7..~..~.....~.. Date Of Perm, .~dl~./~.Z~.....Appl cant .....~...;....~...~../...~.~.~..~.Z ..............................
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ...~.~. ...................
Fee Submitted $ .~...C.o..d..~... .................
Construction on above described building and p~r?it meets ~l.,a,~h'c:~bl~codes ond regulations.
Applicant ........................................................................................
Sworn to before me this
................ day of ............................................
Notary Public ................................... County
(stamp or seal)
CO
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Ha~l
$outhold, N.Y. 11971
765 - 1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in 'typewriter OR ink, and submitted m ~ to the Building Inspec-
tor with the following; for new buildings or new use:
1. Finat 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 or Engineer responsible for the building.
5. Submit Planning Board approval of completed site plan requirements where applicable.
B. For existing buildings iprior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~operty 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 informa-
tion required to prepare e certificate.
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.00
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
5.Updated C.O. $15 00 Data . .~.C-/P.~.C .... ~7). 1.~.~...
New C OhS t ruc t i on ...... Oki or Pre-existing Building ............ Vacant Land .............
Location of Property..I.'7. ~.~.~. ...... ~. ?..h~.i~'. j.6~. .... ?. .............. Q.~. -. ....
t¢ous~ No. Street Ham/et
Owner or Ownersof Property . . .~'.~.~.6~. .............. .~.t-~i) l~te/~.~/'/ ...... ~1~ ~h ........ ..................
County Tax Map No. 1000 Section ....... Block ............ Lot
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No.~...~'..D.-.~.~.'. Date of Permit ~.//..~/'Z~..Applicant..5.C~..¢~ .~....~.; .~..~.'.¢--:'.' .f.').~.:C: ....
Health Oept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning ~oard Approval . .....................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .~.~..~.~. ......................
Construction on above described building and p&rmit ~ee, ts alta~p.plicable, codes and regulations.
App,na t... .......................
A~OVED AS NOYED
~o ~,~ ~ ....
~ ~sp~cno~s:~ ~ ~o~u~.
FINAL WHE"
NOT ~ ~g~J COMPLETED ~ "'~
RESPONSIBLE FOR DESIGN
OR CONSTRucTION ERRORS
ALL CONSTRUCTION MUST M~ET
REQUIREMENTs OF N.Y. STA
-~D TOWN HOUSING COD~
/
ut, b'rt~i
ii
THE NEW YORK BO/~RD OF
~,~, Au~u~ 3~ 197~ ~o.~
~ ~IES ~T
N395668
QeorEe ,*4J.~=ha&l~ 171-90 SoundvLew Ave., Sour. hold, I,,I.Y~
1-smoke
Pe~r Bogdvio Elect.
Main Rd. Oaklawn Ave.
Southold, ~.Y. 11971
TEL. ?~5-~6~0
TOWN OF ~OUTHOLD
OFFICE OF BUILDINB INSPECTOR
TOWN FILERK'S OFFIOE
SOUTHOLO, N. Y. 119'71
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
^ppro.d ...................
19 ........ ermit No .....................................
DisappreYed a/c .........................................................................................
........................................................................ ........
(Building Inspector)
Application No
APPLICATION FOR BUILDING PERMIT
Date ..... ~....'..~,..~?,, ............ 19,..~....~.,.
INSTRUCTIONS
a. This application must be completely filled in by typewriter or. in ink and submitted in triplicate to th~ 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 m
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
shell 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 $outhold, 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, general contractor, electrician, plumber o~ builder.
.......... ...............................................................
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 .............................................
Other Trade's License No ...............................................
1. Location of land on which proposed work will be done. Map No.: ........................................ Lo,t~ No. _., ....................
Street and Number ......... *~..~.. ........................... ,.~. ...................................................................... ¢.¥. ..............
Municipality
2. State existing use and occupancy of prem!s~s and intended use and occupancy of proposed construction:
b. Intended use and occupancy ................................................................................................................................
3. Nature of work (check which applicable): New Building'. ................. Addition ....~ ..... Alteration ................
Repair .................. Removal .................. Demolition .................... Other Work ................................................ ....
~ '-- O c~ Fee / ~ (Description)
4. Estimated Cost ........... /...~.......~.. ............................................................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ......... J .................. 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 ...... '.~'z...~.. ................. Depth ....~......~. ........
Height ......... .?T....~.. ....... Number of Stories ...........~ ..............................................................................................
Dimensions of same structure with allerations or additions: Front ............. ..~:....¢. ............. Rear ..... ~....~.../. .......
Depth ....~...~.. .................... Height ....... ..~......~. ............ Number of Stories ....... ..~.....': .................
8. Dimensions of entire new construction: Front ............ ~...'~......~.,... Rear ......... ..~..~,,. ......... Depth ..... /....~.. ...........
Height ........ .¥. ........ Number of Stories .......... ~. .........................................................................................................
9. Size of lot: Front ............. ./...!...~. ............................. Rear ........................................................................ .~ .~..... ~Depth ~.?..~..
10. Date of Purchase ........................................................ Name of FormerOwner .~....~./~...~..../z~..-~(."..~.../..,~.~-~..¥.~..~. '.-~.. ........
11. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regutatJon: ..¢~R'~5~ .............................................
13~ Will lot be regroded ............/~......~.. ........ Will excess fill be removed from premises: (~'~Ves (') No
Address ................. ~ ........... Phone No.
14. Nome of Owner of premises ..... .~..T.~/~..~.~.....~./.../..dw../.l~.-.~.. .~..... ~'~ ~/rJ ~o
Name of Architect .............................................................. Address ................................ Phone No .......................
Nome of Contractor .....~...~..~../x~-/...~.....~.....O...l~.~...~. .............. Address ....~..~..~...Z.~.~...~..1~ ...... Phone No.
PLOT DIAGRAM
Locate clearly and distinctly ell buildings, whether existing or proposed, and indicate all set-bock dimensions from
propcrty lines. Give street and block number er description according to deed, and show street names and indicate
whether interior or corner Io~. ~' ,~
S]'AT~ OF NEW YORK, ~S S
COLIN'FY OF ................................. ~' ' ~
............ [~.~....~.~ .............................................................. bng duly sworn, deposes and says that he is the oppliconl
(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; thal oil statements contained in this application ore true to the best of his knowledge and belief; and
thor the work will be performe~n the manner set forth in the~pplication fil¥ therewith.
Sworn to bef~ me this ~ ~, ~ ~/ ~ / ~ ~
..........
................................ .............................