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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 ~ ~, ~ ~/ ~ / ~ ~ .......... ................................ .............................