HomeMy WebLinkAbout9701-zFOR~ NO. ,I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Occupancy
No .... Z9299 Date November 8 lg Z8
.705 Narrow River Rd.
THIS CERTIFIES that the b~lding located at . .2720 .Kin~ .Street ....... ~
Map No ............. Block No ........... Lot No ..................................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ..... Mar. ch ....29 ..... , 19. ?~ pursuant to which Building Permit No... 97.0.1.~
dated ..... Y.c£am. ch .... 29 ...... , 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 ....... ?.r.i. ¥.a.t/~..O.n.e.. ~F.a~. :i.l.y.. ?.w.e.l.l.i..n~..w.i..t.h. At/.t.a.c.h..e.d' .G..a~..a.g.e. .......
The certificate is issued to ......... .~.r.:..C.:., .S.c.h.a.p.e.r. ............................
(owner, :~:~)
of the aforesaid building.
Suffolk County Department of Health Approval ........ ~.7.-.S..O.-J?.~. ..................
UNDERWRITERS CERTIFICATE No. N406322
705 Narrow River Road
HOUSE NUMBER . .27'20 ....... Street ....... ~A~g. Sl;re~t ...... ~ ..............
~rient, New Yoz~
Building Inspector
County Tax Map #
1000-26-3-7
~0~ ~0. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OPFICE
SOUTHOLD, N. Y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP~EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 9701 Z
Permission is hereby granted to:
at premises located at .........~ .......................................................................................... : .......... ;......: .....
.......................................................................... .............................................................
pursuant to application dated /'1/~ /',~ ~,~ 19.1.~...~'ond approved by the
Building Inspector.
Fee $..:;~...~...
Building Inspector
TOWN OF SOUTHOLD
, Building Deportment
Town Clerks Office
So.thold, 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
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), Nan-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:
]. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use $5.00
3. Copy of certificate of-occupancy $].00
..... .....................
New B~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
,oca,ion Of Property ......
Owner Or Owners Of Property ~ ..~,. ~...~.._~ ~.i ~"
Subdivision ................................................................ Lot No...,.~. ...... Block No. zr?.. ....... House No..'.~..~...~.~'
Health Dept. Approval ..,~....~......~..,.,/.,~..../.. ................ L~bor Dept. Approval ................................................
Underwriters Approval. ,.~..~..~.,...~..~...~..._.~,...~.. ............ Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate ........ ~ ........................
Fee Submitted $ ........ : .........................
................ day of ............................................
Notary Public .................................... County
Construction on above described building/~;pezi.t' i~zal! applicable codes and regulations.
Applicant ...~ ,.~.......~....:...~...,.~... ......................
Sworn to before me this ~_~/~,/~
(stamp or seal)
TOWN I-IF SOUTHOLD
nFFIIDE OF BUILDING INSPECTOR
TOWN OLERK'B FIFFIOE
SOUTHOLD, N. Y. 11971
TEL.
· ..¢
IFO~~W ~qO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT1
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
rove , Z e mit o c27 / ?
x Z) .............................
D,sappra d ........................
............................................................................ .............
(Building Inspector)
Application No .........................
APPLICATION FOR BUILDING PERMIT
~)ate ..................................... ~..., ~..?..,.
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 o*
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 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 code, and regulations, and to
admit authorized inspectors on premises and ir~ buildings for necessary inspections.
........... .....................................
(Signature of applicant, or name, if a corporation)
· .~i~ .~.... ~..~.../.,..-. ~. ~....¢/.:;,.....C.~.~,~. ~,..~...,Z.'.:.~...
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
If applicant is a corporate, signature of duly Quthorized 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. MaD No.: .~ .......... Lot No..~ ...............
Street and Number ......,~...~/..f~.....?~..../..'...~....~f?.t~'2.~(..~(.(..u...~.=.:.~.. ..............................................................................
Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ....... .~.~.~...c. .......... .,,.~......~... ..........................................................................................
b. Intended use and occupancy ..~,.,/.~,.(.,~..,~'.~]..~..,....../.,'."~...(,~.~.f~,T .....................................................................................
3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................
Repair .................. Removal .................. Demolitior ..................... Other Work ...................................................
,> , ' c/ b '~ (Description)
4. Estimated Cost .............................. ~'~ ............................ Fee ..........................................................................................
(to be paid on filing this application)
/
5. ff dwelling, number of dwelling ur~j.ts ............................ Number of dwelling units on each floor ............................
/
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, specif_,y nature/ and extent of each,, type of use ............................
7, Dimensions of existing structures, if any: Front .......: .................... Rear ..'.::..; ........................ Depth ..~(~..../.. .....
Height ..... '~.*~..: ............. Number of Stories ...... ~d?._..~'. ...........................................................................
Dimensions of same structure with alterations or additions: Front ....................................Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
~:-~' Depth ........................
8. Dimensions of entire new construction: Front .............
Height ...,~..J~ .......... Number of Stories ...................
9. Size of lot: Front ....... ~...,r,..>¢ ...................................... Rear ,¢.(~:~..?..../. ......................... Depth
]0. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. Zone or use district in which premises ore situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
13. Will lot be regroded . .......... ; ............ ;,... Will excess fill be removed from premises: ( ) Yes (Y~) No
C~- b.~,~ , ~c -
14. Nome of Owner of premises ..:....:...:.....,J.".~.~....'. ........................ Address .~.. ......... d ......... : ...... Phone No.,~.~.'. ...............
~o~e of Architect .............................. ..~ .............................
Nome of Contractor ...~.l.,~:.-~ ...... ~.~..~.~..:..*~..~ ...........
Address~:.~.z.':.~...;??.:;..:.?....~ thane No,-~...~...~...~ .~..9~..&
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, end indicate all set-back dimensions from
property lines. Give street and block' number or description according to deed, end show street names and indicate
whether interior or corner lot,
STA-rE OF NEW YORK,
COUNTY OF ................................
~I.IhT~L~, 7~E Vol'
................................................................................................ being duly sworn, deposes and soys that he is the ~pplicam
(Name of individual signing contrac0
above named,
Fie is the .................. .~Z,~.~.~.~..~ .........................................................................................................................
(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 all statements contained in this application are true,to the best of his knowledge and belief; and
tha~ the work will be performed in the manner set fo~h in the application filed therewith.
Sworn to before me this
..................
.......... ...................................... Cou. ........................................................
~/ / I ~- (S~gnafure of applicant}
No. 52-4643721, Su~lolk Co~
Term Expires March 30, 1~
~iiUiFF'CO~H DEpT. APPROVAL
j sT^~p
~ ~E WAT~ SUPPLY AND SEWAGE
DATE: OI~ ~Y~TEM~ FOR THIS ~ESl.
O~ H~L~H. ~ERVIG~S.
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