Loading...
HomeMy WebLinkAbout9723-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z.c~606 ........... Date ....... 0'~1~-3r. .27 .................. 19.79 THIS CERTIFIES that the building ................................................ Location of Property ... 2?.: ............... GSS. ie~;.'ge .Dr .......... l~a~t .Max'j. OW ...... ~ou~e ~vo. Street Hem/et County Tax Map No. ]000 Section ... ~3 ....... Block . .Q2 ........... Lot . .Q~ ............. Subdivision. ~n~'J~Qn .ME~O~' ............... Fi~ed Map No. ~.0~,..Lot No.. 2.~. ......... conforms substantially to the Application for Building Permit heretofore Fried in this office dated ...... M~t~r..'[0 ......... 19.7.~3 pursuant to which Building Permit No... 97~-~7- ............. dated ....... Mawr..~ .............. 19.7/~, 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 ......... ..... qr~. o~cl~Loj~, o~.~. ~. p. rAv.a.~.e.. O~a.e..~?.a~,~r..d.~.e.1..lltr~g .................... The certificate is issued to .......... ~Tohrl. ~81~'oe].l. ............................ (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ..... 1~19.~..I?~.q.Rl, l~ql ....................... UNDERWRITERS CERTIFICATE NO ............. I10.~ .~'~02~l,~'e{1 ....................... Rev 4/79 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLIRK'S Of?ICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION Of: THE WORK AUTHORIZED) N°. 9723 Z Permission is hereby granted to: ...... ............ .~!.~......~ .......... ~ ............................ ~- ~ Building Impector. 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 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 peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 requ ired 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 .¥~'~..~.~'....0-.~ .~?.., ~ ?.,.. New Building ............. Old or Pre-existing Building ...~. ....... Vacant Land ............. Location of Property . .~.?....G//~.~??. ....... 4~ ~ ........ ~.~.. ~;~'/~'~ ~t° ,~ House No, Street Ham/et Owner or Owners of Property .... ~. ............ ~.~.~ .................................... County Tax Map No. 1000 Section .... ~ .~. ....... Block .... .O.~ ...... Lot ...... ~.-~, ...... Subdivision ................................. Map No ............... Lot No ............... Permit No ........... Date of Permit .)~.~'. ~. ~.~..Applicant ................ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate Fee Submitted $ .~.~. :~ ~ .................... Construction on above described building and permit meets all applicable codes and regulations. Applica~~ ....................... Rev. 10-10-78 TOWN OF ~OUTHOLD BUI~ING ~, N.Y. ~, .............. .............. ~pr~ DJ~ppraved ....................................................................... ~ ....................... T-::~ ....... ............. ~C~=....~. ~:~=:.~..~ .......................... (Buildi~ In--or) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter De in ink and submitted in ~'iplicate 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 areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which Js 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 permitr~ 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 NL~DE to the Building Department for the issuance of a Building Perm t pursuant to the~ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or~J 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. APPROyED AS NOTED ~.~/~ ~ DATE, :/~' 2~/'~ ~ ..................................... ~ .,,~' (Signature of apph'c~t, or name, if a corporation) NOTIFY BUILDING DEPARTMENT AT z ................................ ~ ....... ~.,...:. : ............. r, . 765-2660 9AM to 4PM FOR REQUIR. (Address of applica~;i ............... ~'~" ED INSPECTIONS: State~w~,~, ~L~q__~_~t~l~rf~,U~l~e, agent, architect, engineer, general contractor, electrician, plumber or builder. ~,~,N ~C~.R START FRA,¥dNG ~, F~A~.%",:G .N~p.E.C,T.I..L~.t~....'~..~.'~... .......................................... : ..................................................................... ........ :¥'~,'~¥"E'~;!E!~ING Pil~S C~ KI~D ~ H. '.,~¥ ~ aT RESPONSI3LE~I~R DESIGN ,, If appliGl~tCi~RSqt~l~'sjllLiK~~ of duly authorized orticer. : ';.L,CONSTR.UO'ION MUST MEET ............ R':"'(~l~.~,~W~'"::','"~',/'"~'A"m:r~'""~ ......... /~,~_ ~.. ~. ~ ~ . Iq.tle'!)t' carJ c~'-~.~ ~ Builder's License No ..................................................... ~ c~ _ ~ ~ .~ Plumber's License N~ ................................................ Electrician's License Nc~ ............................................ Other Trade's License N~ .............................................. 1. Location of land on which proposed work will be do~e. Mop No.: ........................................ Lot No ......................... Street and Number ....~....?. ........... ..~..../...C..~.~.~.. ......... ~.~.L.~...~.~.. ................... ~.~....~.. ....... ../~.~.a....~.... ......... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occuix~ncy~....~. b. Intended use and occupancy ........ ~,, .... /...~,/, .............. .... ............................ 3. Nature of work (check which applicable): New Bu Idin~ ................ Addition -.~....-.....'....'..'Alteration ................ Repair .................. Removal .................. Demolition;,..,-,,..: .....Other Work ..................................................... :: / (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, numSer 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 ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ 9. Size of lot. Front ............ ./. ~....~)...~ ................Rear ./. ~ .~../. ............... Depth ..../..~.....~. ................. 11. Zone or use district in which premises are situated ...... / ............................ , ................................... 12. Does proposed construction violate any zoning law, Ordinance or regulation: .......... . ..~.. ........................................ 13. Will lot be regraded . .......... ~ ................ Will excess fill be removed from premises: ( ) Yes (~"~1o 14. Name of Owner of premises ...............: ...... ..~, ................ ;' Name: of Architect .............................................................. Addres~ ...., .................... ,.,... Phone No .................. Name of Contractor .............................................. .....i ....... i ASdress ..J.........."~ ......... ~...,. Ph0ne No ....................... pLoT DIAGRAM ' Locete clearly and distinctly all buildings, whether existing Or propOsea~ and indicate all set-back dimensions from property lines. Give street and block number or description according t0 dee~; and show street names and inc[idate whether interior or corner lot. . STATE OF NEVC/Y,~,# ~ '[SS COUNTY OF ~~,'f"'" , .~ .~~¥~ ...... being duly sworn, deposes and Soys that he is the '0ppliconl .................. i~i~'d' ~ ~ signi n~c~'~-~ .... ' ~b:::~:~ ~~ (Contractor, agent, corporateoff,cer, etc.) , ....~ ................................................................................ : ......................... ~ ........................ ~ ......... ;; ....... ~ ....... of said owner or owners, and is duly authorized to perform or have performed the said wOrk and ~o Make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thaf the work will be performed in the manner set foffh in the'applicatioD filed therewith: Swornt~re me this ~ ~ ) //~ ~ f .............. ...... , ........ z. ............ / . ./. , ~ ~ly~~ Coun~ ~t.:~ .......~:.~. ........ ~%.(J~-.::.~ ............................... mo~~~~ ...... ~':// (SignoturCf applicant)