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HomeMy WebLinkAbout9716-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 accessory bldg, Location of Property q975 Cox Neck Lane Hattituck House No. Street Hamlet County Tax Map No. 1000 Section ~ ~ 3 ...Block 7 .Lot 16 Subdivision X ...Filed Map No. ,X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated May l0 7.8. 97!6Z ..................... ,19. pursuant to which Building Permit No ..................... dated ........ ~,a.y... ] .0 ............. 19.7.8., 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 ......... Accessory buildiI~g. The certificate is issued to PHILIP NEUDECK ..................... ? d4,,,'o; WI( ..................... of the aforesaid building. Suffolk County Department of Health Approval ......... lq/3, UNDERWRITERS CERTIFICATE NO ........................... N./. ~ .................... Building Inspector Rev. 1/81 FO~M NO, 2 TOWhl OF SOUTHOLD 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? 9716 Z Date ........................ ' / 19 ....:.. Permission is hereby granted to: at premises Jocated at ~ /...¢ ~,. ............ .~ ........... ' : : :..~ - .. ........................................................ , 197~....., and approved by the pursuant to application dated f~"//~ / I O ~ Building Inspector. Building Inspector FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall [;outhoid, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in duplicate A. This application must be fil~ed in typewriter OR ink, and submitted V 't:o tt~e Building Inspec- tor with the following; for new buildings or new use: I. 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 or Engineer responsible for the building. §.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 p~operty showing all property lines, streets, build!ngs and unusual natural or topographic features. 2.Sworn statement of owner (~r 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 predate a certificate. C. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. SS.O0 ,.~ Date . . .~/".'.'.'.'.'.'~, · · . ~. · ~ .... New Building ~. ~ [i ..~ ..... Old or Pre-ex isting Building ............ Vacant Land ............ · Location of Property } .c['l~' ~?.K. ~ ~e,_J~ . .~..~?. ~ House No. Street Ham/et Owner or Owners of Property ...~,~.'.~!'~...~ County Tax Map No. 1000 Section .,. ] [ .~-. ........ Block .... ~,.~, ....... Lot... ,I,~ .......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 9.7./.~. , .. Date of Permit ,~,/),°.~,~, ~. ,Applicant . .,~-. .... Health Dept. Approval ........................ Labor Dept. Approval ........................ ~ Planning Board Approval Underwriters Approval .............................................. Request for Temporary Certificate ..................... Final Certificate ...... .~./ ............. Fee Submitted $. ,~; ? ...................... ~onstr, uction on above described building and permit meets alL~pp_[[cable codes add regulations. 2flq ............................ Rev. 10-10-78 TOWN OF SOUTHOt;D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ..................... ~isapproved a/c ................... ~.t ....................................................... (Building Inspoctor) Application No, , ,~,/~_.'~_~:.,: ............. APPLICATION FOR BUILDING PERMIT Date ................................................ ,~ 19 ............ INSTRUCTIONS o. This application must be completely filled in by typewriter o~ 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 tile 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 otherApplicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, o,r for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances,, budding code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ......... ',;;"'ha 'if ........ ...... (Address of applicant) u State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............................................................................... .,'~ Jf 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 ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ........... ~..~..../..._:~........(.:..~....~..,..~..V../C.C.._/.~. ......... ................ ./~,/.:?....//..../..,/...:.c..~... ............... Munic~ality State existing use and occupancy of premises and interJded U~e a~nd occupancy of proposed construction: a. Exisiting use and occupancy ........................ .J ....... ~ ....... ~ ................................................................... b, Intended use and occupancy ......................................................................... ..~. ................................................... / 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... ~ (Description) 4~ Estimated Cost ......... z ..........: ...................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each float ............................ 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 ................................ .................................. Rear ....... .~..P. ............... Depth 8. Dimensions of entire new construction: Front ./..D / , / ..... ./..~?...../.. ....... Height .............. Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ........................................................ 13. Will lot be regroded ....... ..~...G ............. Will excess fill be removed from premises: ( ) Yes (r'~,) No 14. Name of Owner of premises .................................................... Address ................................ Phone No Name of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ...~..4.~..~...'~...:....~.~.'.~..~...~..~.~...~'.'~' .......... 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 and indicate whether interior or corner lot. STATE OF NEW YORK, COUNT'r' OF ................................. .......................... ~...¢....~....~...~.~.,. A/~-6/J~L~C (..~. being duly sworn, deposes and says thor he is the applicam (Name of individugi signing contracfl above named. ......................... ....................................................................................................... (Contractor, agar, corporate officer, etc,) of said owner or owners, and is duly outhorized to perform or have performed the said work and to make and file this application; that oil statements contained in this applicctlon are true to the best of his knowledge and belief; and tk, ar the work will be pert,armed in the manner set fo~h in the application filed therewith. to before me this ~9 Sworn..~y of "~:'."::::::.':.';:':.'::.'.'.'~."~u~;'~ ........Y~~ .......................