Loading...
HomeMy WebLinkAbout12487-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No, ~3.2.7. Q.2 .......... Date ............. A.u.q.. ..... 3.5. ....... , 198.4.. THIS CERTIFIES that the building .. lD.e.c.l~ .... ! .a.d.d.e.d...t.o..e.x..i.s.t.:..c.o.t.t..a.g.e.) ........ Location of Property . .6.8..5. Orchard St. New Suffolk House No. Street Hamlet County Tax Map No. 1000 Section . . .1.1..7 ...... Block 05 .... Lot 038 Subdivision ......... X Filed Map No. X. Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ....J.u.l.y...1.1. ......... 19 .8.3. pursuant to which Building Permit No..1.2..~.8.7.z. ............. dated .... .AD.c/ .. ..... 1..2 ............ 19 .8.3., 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 ......... ]3.e. qk. ladded to exist, cottage) The certificate is issued to ...J.°..s.eRh. & Ann6 Nolar{. (owner, le~ee~'terrand of the aforesaid building. Suffolk County Department of Health Approval .... N../.A ................................... UNDERWRITERS CERTIFICATE NO ............ N../.A ................................... Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ng' 12i87 Z Dote ................................. ...~......../.?...., 19..°°.~' Permission is hereby gronted to: .....o..~T~.~.~.......~L...~..&~7.. ....... ~..0.~.~,~/ ............... .~.s..L..e/.r:/:/..~.~:.,b. ........ ~. ............. .................................... /y..:c..~ ........ ..r.~£.?...%<... ot pre~i,e, ~ocoted ot ............... ~...8..~7.. ......... ..O..g.C.~&.~.O. ....... ...?..;Z. ............................................. ....................................................................... ~.'.~ ....... .~...¢z..~..~...v...qf~ ....................................... County Tox Mop No. 1000 Section ............ /...(..~.... Block '/fi' ... Lot No. pursuant to application dated ............................. ...'.~...~./'..~.. ....... !.!..., lg....~.., and approved by the Building Inspector. Fee $....?....~.~.. ~ ~_~l U d, ing nspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must l~e 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 featu res. 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 "pm-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 required to prepare a certificate, C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling fr land use $/5'/$5.00 3. Copy of certificate of occupancv $1.00 ~ .~!~O . Date ././/~...~. / .~. ?. ....... r Pre ex~stmg Buddm .......... Vacant Land ............. New Building ............ - .... g Location of Property . ~"~ ~..~..- ~..~~..,t~2~ .~.-~'~',..~..~e~ House No. Street :::::::: ::::::::::::::::::: : :::::. ........ .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /~.~¢,~.,Z.~Q ......... Applicant .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . . .~./..~. ............... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ~ .............. .,tted $ ~ b~d ~ 'and p. ermlt me~t.s,~~ code ~~ FORM NO. 1 TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 /'~ 19 q~ Approved ............... ;19 ermit No..-......... Disapproved a/c ........... ~-.-- ' /--_-.. ....... ~ a.z,~ ..... ~-'(Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .... (.~. · .~- -~- X · ·. INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted 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 of property must be drawn on the diagram which is part of this appli- cation. 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 issued 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 what6ver until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATI(~N IS HEREBY MADE to the 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 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 building for necessary inspe.~/ns. ~ (Signature of applicant, or name, if a 'c~;;a'ti(~l~) .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate o~ficer) Builder's License No. 'd '~/"~ ............. Plumber's License No ...... ~ ................ Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ................. I~ouse Number Street ...... ;i ......... County Tax Map No. I000 Section ../.l..'7........... Block ... ~ .......... Lot..~...~7.... / Subdivision ............ ~(. ....................... Filed Map No .... /~ ........ Lot.../.. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... . .~~. ~-d~-~..,~...,~/~, . '*'f~. .................... b. Intended use and occupancy .. ~ .,~m'~. ].~*.. o~.... ~. ~. ..... ~..--..~.__ ..... 3. Nature of w~ortk (check which applicable): New Building .......... Addition . .,~. ..... Alteration .......... Repair ... )~.. ........ Removal .............. Demolition .............. Other Work ............... ~/ i ~ (Description) 4. Estimated Cost../..~. ?.?.,...~.!~. ....................... Fee. ~..~.~ ~t...~. ......................... (to be paid on filing this application) 5. If dwelling, number of dwelling hnits ............... Number of dwelling units on each fioor ................ If garage, number of cars ..... i ................................................................... 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 Bimensions of same structure with alterations 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 ...... t7''7 ........... Rear "7'~;e''"'""'" ........... Depth .../.~.f~/. ............. 10. Date of Purchase ........... .................. Namex>fFormer O ................... wner. . .. , . . . ......... 11. Zone or use d~stnct tn winch premises are s~tuated... ~.,..~:. ~. ~ .................................... 12. Does proposed construction viofate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ..................... Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No ................ Nmne of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. r STATE OF NEW/~ORK. C..O.U.~. -~~............ :~ ~ .................. being duly*sworn, deposes and says tha~he is the applicant (Name of individual sign!nh 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 thej~ai~d work and to make and file this application that all statements contained in this application are true to the best of 4irs"-k~owledge and belief; and that the wbrk will be performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Public, ....