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HomeMy WebLinkAbout10533-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ................................................ Location of Property ........ ?9.rl.~.r$.~..tl.l,.~..R.o.~.d. ................F.:~h.e.v.~. I~ncl,..I~. Y. House No. Street Hamlet County Tax Map No. 1000 Section ..... .'[.0. .... Block .... ~ .......... Lot ...... 9. ......... Subdivision ..... .P.e.~.~t~. ~.ll.~.a. ............... Filed Map No ......... Lot No ..... ./~2.-/~.~. · conforms substantially to the Application for Building Permit heretofore filed in this office dated ... p~qe..m.b.e.v...3.~ ..... ,19.7.9. pursuant to which Building Permit No .... .105.~Z ........... dated .l~O¢¢lllber. 3.'l. .............. 19 79., 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 ......... ............... .~.a, aA, ~.~p,n., ,to..qn, .e. E~,~.3*X, .~..e.Z.Z.:t.~g. ........................... The certificate is issued ,o ...... 0'.O.a.l~i~.~. ~,~.,,..~(o~)ne~~_ of the aforesaid building. Suffolk County Department of Health Approval ......... .N'./..R ............................. UNDERWRITERS CERTIFICATE NO ................. ~.e..~.d.~.~.g ........................ Building Inspector Rev 4/79 ~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10533 Z Permission is hereby granted to: .......... ~. ,~. ~,,~.~.../~...... ~//. ........ ... z~. ,~f~c~....Zz.~ ..................... ....~.~,~/,~'~ .~_~Z~...~ .... .,~,...~... ' at premises located at '.~r~./. ......./~.6:.~f~.a....O -~-~-'~2- ...... . ..~~0.~/;/~-~-~-~-~-~-~-~''', ................ ............................................................................ 2...~../,~,~..../~r,.~;,..~...~.~.... ...~..~.x~..~.o/~x~......z ..................... ~z. ........ ~.7~..~.,,~ .............................................. pursuant to application dateCL'~.~.~,~.~.~... .~..0 ......... , 197...~., and approved by ,~he Building Inspector. Fee $..,, .................... FORM NO. 6 TOWN OF SOU'I'HOLD 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~n-cl~jp~ 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. B. For existing buddings (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 ............. House No, Street Hamlet County Tax Map No. 1000 Section .... /...0. ........ Block ... ~. .......... kott~ ............... Health Dept. Approval, .~,/,A:. ................. Labor Dept. Approval . .b/,//~ .................. Underwriters Approval'~(~3. ,~. ;©.~.' ............... Planning Board Approval .~//~ ................. Request for Temporary Certificate ..................... Final Certificate ... ~ .................. Fee Submitted $ .~-~..~ ...................... Construction on above described building an~Y~rmit meets all applicable co~es a~dfregulations. Applicant .~...~'~../..~..~.. ~"~,,~..]~.~,./~(~ /f FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-180;3 Examine . /,... 197.? ' · , Application No../.~..~..o. ........ Approve~..~.~.d. ..... , 19~.~. Permit No.../.(~...'~'~...~...~ ~///~ Disapproved a/c_: ..... :...... · .-'~ .......... ~,J .... ..~,.'// ............................. :: (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ~.tnpl~cat~ 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 issue a Building Permit to the applicant, Such permit shall be kept on tl~e premises available for mspection 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 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,,~ilding code, housing code, a~d regulations, and to admit authorized inspectors on premises and in buildings for necessary l!~spections. _. \ . ~ _f~St'!,n. at_ure ,0f applicant, or name, if a corporation) c..~...~..'s..~. 9.'.c~.. ,~.~.,4.~'. ~.s..~q~. p, ~.1' .o..~.9.o. .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ .0.~ .oy..& ........................................................................... Name of owner of premises .~O-. k~N). ~. ~. . . LO~ t~l_.. .......... . . . . . ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. me and title of corporate officer) Plumber's License No.. O./.~. ................. Electrician's License N .~. · .~..~..Of'. ~ ..... .~..~-..~ ~ ~ Other Trade's Ltcense No I. Location of land on which proposed work will be done .................................................. ' 4~ , ~,~,~s~6~, ~,~t4~lZ~ [~Ca~.c), I~..~.. ............................ (~ qZ,.O.Q.:...~,~,..C~., .~ ......................................... Hamlet House Number Street County Tax~Mav~No, 1000 Section .../..O ............. Block . .'~ .... ~_~ ....... LotY ................. Subdivision ?~ .~./.A.d5.~...~?..' .............. Filed Map No...:. ,'~ .... -.. ....Lot ~..)~..'~:..~..~.. · . · (Name) 2. State existing use and occupancy of premises and intended use and occupan'cy of pr6posed construction: a. Existing use and occupancy . . 4~04..q 0.~. .~. .~. .'0-. .(. .......................... ' ........................ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .......... Addition. X4 Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost . ~. 9.Ot~,..0..e.~.i Fee .' ....................... ' (to be paid on filing this application) 5. If dwelling, number of dwelling,u~/its ..... t. ......... Number of dwelling units on each floor.. ! ............. If garage ............................................... , number of cars t~ ./.~. ...................... 6. If business, commercial or mixedroccupancy specify nature and extent of each type of use .~g/.~ ................ 7. Dnuens~ons of ex~stmg structures, ~f any: Front..8..'&.. p ........ Rear B. ~. ~. ........ Depth .~ ~. 0 .......... 2_ c~ ' Number of Stories Height ....................................................................... Dimensions of same structure with alterations or additions: Front . .~..... ¢~ ......... Rear . .~. ~-.'.°/' ........... Depth . i~..~. ~ 91'. ........... ~. Height . ~..~.~.' ..... Number of Stories . '~. 8. D~mens~onsc~f entire new constrqct~on. Front . ~ 9..o. ........ Rear . .~ ~..o. ........ Depth ./. ~ .O, ......... Height ,...~. ......... ~. Number of Stories ..... .~ .................................................. 9. Size of lot: Front .I. ( .o .......k; ......... Rear ././..~. ~. ............... Depth /.~ 6.~ ................ 10. Date of Purchase ./. q.7'..o., .O.~rt~.: ............ Name of Former Owner I~,,ofg~..t~... ~O..O~.~.-.~. ......... 11. Zone or use district in which premises are situated...,~ .-./...,~.~¢. :~.r4~4 ~Ct~(, ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: .~.O ............................ 14.13' ~ila~l leO to fb; ~ng ~ doe~p re' m~iis~''""s ~..o~i~' ................ .. Will excess fill be remedy, ed from premises: ~_ .... No .~. ~....~D...~..~.C... Addressl-O~'~2.f/-~.~0.~-q ~: [.o.M.~ Phone No.7.0. 07.~ Name of Architect ...... ~./..~; ................ Address . .~./.~. ............. Phone No ................ Name of Contractor .... . .~.-.-.-.-.-.-.-.-.~ !~.O~..q.'~. r.. Address ...~2-~....~: ~/~ .... Phone No.~:~ $.~.~.~,~.~.... PLOT DIAGRAM Locate clearly and distinctly all Ibuildings whether existing or proposed, and. indicate ail 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. STATEOF NEW YORK .~ ~ ~ ....... i Ja d .......... ~/ (Name of individual sign,ing contract) above named. . being duly sworn, deposes and says that he is the applicant He is the .... ~.C4~....O~..1( .......... ................................................................... (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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... ..... '. ...... ....