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Home My WebLink About11599-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy ~cation of Property ...[.0~.~.. H't~. tU~.~ ~ ~ 7 ~OU / lO House ~o. ' ................................. Street ] ........... ~/et Cou.~x~ap~o. ~000~.o. .... ~.. .~oo~ ........ ~ .... ~o~ .... ~) ......... Subdivision ..... Filed Map No. -~;-7~ ~ .Lot No. ~ .... conforms substantially to the Application for Building Pe~it heretofore ~ed in t~s office dated .......... ~. 'A.. ~ ~ 19. ~ ~ursuant to w~ch B~lding Permit No... ( ~. ~.~. ~ ...... dated ...... ~?)~ .... ~. 19 .~s issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Thecertificateisissuedto "r/iolffl~5 t~' /~'[~'t/<"/~ ~ ~~ ...................... b~.;k'f~ .................... of t~e aforemid building. Suffolk County Department of Health Approval ~ ~ UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev 4/79 TOWN BUILDING DEPARTMENT TOWN HALL SOUTHOLD, Fl[. Y. BUILDING (THIS PERMIT MUST BE KEPT ON THE PRE~iSE~S UNTIL FbLL COMPLETION OF THE WORK AUTHORIZED) il .............................................. .~ .......... ~...,~ ............... Cou~W T~X M~p No. 1000 ~ct~on ......... , ...... , ....... BIlK T'"~ .............. ~¢- ' ............ pursuant to application dated ............................................. ~..' , 1 ..... ~., pp y Building Ir~spector. Fee $ ........ : ............... Re~. !6130/80 rtspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. 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 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 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 New Building ...... .~....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .../.(~.'.~.~. ........ Hou~ No. Street , Ham/et Owner or Owners of Property ........ County Tax Map No. 1000 Section ...~.~ ...... Block ...~;~ ......... Lot...~ ....... Subdivision ..... ~ ................... , ...... Filed Map No...~ ...... Lot No. ~ ........... Health De~t. Approval ........................ kabor Dept. Approval ........................ Underwriters Approval Planning Board Approval Request for Temporary Certi~ate ..................... Final Certificate ....................... Fee Su mitted ............................. Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 Applicant .................................................... CoZ. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1802 Examined ......... .'7./,, .,~.~ 19.,. ................ 19 . . .Permit No ......... ~.. Disapproved a/c ....... : ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. t/( ~'~ ~ INSTRUCTIONS a. Tlus application mnst be completely filled in by typewriter or in ink and submitted in triplicate to- the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap[ cation. c. The work covered by this application may uot be commenced before issuance of Building Permit. d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such Pen: shall be kept on the premises available for inspection throughout the work. e. No buikting shall be occupied or used in whole or in part for any pnrpose whatever until a Certificate of Occ~iPa~ shall have been granted by the Building Inspector. APPLICATION 1S t-tEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to t Building Zone Ordinance of the Town 'of Southold, Suffolk County, New York, and other applicable Lhws, Ordinances Regulations, for the construction of buildings, additions or ~.;lterations, or for removal or demolition, as herein describt Tl:e applicant agrees to corm,ly with all app!icable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary in~,t, ctions. ' (Signature of applicant, or ffrgm~', if a corporation) (Mailing address o£ applicant) State whether applicant is owner, lessee, agent, arc!fitect, engineer, general contractor, electrician, plumber or bnild Nmne of owner of premises.'~..//¢(.~./..~....~. -S..... ...... . .....g .~../(q/./'~. ~. ...... . "7'~. 1~.~'~..~.' ~'-,,(. ............. ,. (as on the tax roll or latest deed) If applicant is a corporation, 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. ..~/'..~. ~.../~. ~. ~.'~.- .~. -:~....~.~.. ~../~.. ......... .................... ./.-./,9. ......... . ....................... House Number Street Hamlet County Tax blap No. !000 Section .... ~'.).'"[.~ ........ Block .... 0.,~3. .......... Lot... ,O,&,~. Subdivision 2( Filed' Map No. X Lot X (Name) 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .<~ .~... ?./q....a-A~... ?..~...~..C~...~. ~ ............................... ! .b, Intended use and occupancy ,-?,,, ,~"~q~,, ................ , ,, , , ,; ..................... 3. Nature of work (check whicl! ::pplicable): New BuUding ......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ............ Other Work ............... ' Estimated Cost ...... ........................... Fee .. . ·. (to be paid on filing this application) ;. If dwelling, nmnber of dwelling units ............... Number of dwelling units on each floor. '-'---- If garage number of cars .'..'w': - i. If business commercial or mixed occup, ancy specify nature and extent of eact~ type of use . :~. .................. nens OhS of ex sting stnctures if any: Front ' Rear Depth t. Dir . . . .................................. lteigilt ............... Ndmber of Stories ................. ~ ...................................... Dimensions Of same structure with alterations or additions: Front ................. Rear ............ Depth ' Height ' Number of Stories t. Dm~ensmns o tire new constructmn. Front ....... Rear .............. Depth . Height ............ Nt tuber of Stories ....................... ' .............. Si ' pth 1. ze of lot: Front ......... ~ ............. Rear ........ De ................ ) Date o'f Purchase . Name of Former Owner I Zone or use district in which premises are situated ' L Does proposed construction violate any zoning law, ordinance or regnlation: .......................... L Will lot beregraded ' ' ................ ....... ~ ..... Will excess fill be removed from premises: Yes Nc I-.Name of Owner of premises., .............. . ..... Address ................... Phone No ................ Name of Architect · Address Phone No Nmn~ of Contractor ....... . ................. Address .'~., ................ Phone No ................ · I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and bloc~k number or description according to deed, and show street names and indicate whethe~ ~te~ior or corner lot. ...... tf'~ i. ~ ..... 2. ~. ~.~ ...... being duly sworn, deposes and saya that he is the applkam . (Na~e of indMdual si~ning c~tffact) )ore nanled. (Contractor, agent, corporate officer, etc.) said owner or owners, m~d is duly a~thofized to perform or have performed the said work and to m~e and file )plication; fl~at all statements contained in this application are true to the best of his knowledge and belief; and that thc 'ork w~l be performed in the manner set forth h~ the application filed therewith. worn to before me this .............. day 6f ........ , ~5' Puplie, ....... ~ ......... County > / ~