The URL can be used to link to this page

Home My WebLink About10397-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ..... Z9.7..40 ....... Date ... l~Iovemher,. 5 .................. 19.79 THIS CERTIFIES that the building ................................................ Location of Property .. ~..~. 5..l~.ql?!;h. l~a.y%',l~'. R.o.$~t~ ............. ~.o. uthold~. N...Y.. [43~se No. ' ' ' Street Hamlet County Tax Map No. 1000 Section ..."~.8 ....... Block .... .~ .......... Cot .... .'l~..~ ........ Subdivision ............................... Filed Map No ......... Lot No .............. c~l~forms substantially to the Application for Building Permit heretofore filed in this office dated''~ ·. $.Otl~;Offi]0.~l?. 6 ...... , 19 .~.9 pursuant to which Building Permit No .... .10597Z ........... dated . .~ol~.~;el~12e~.. 10 ............ 19 ?~t, 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 ......... ........ Oar.age Ad,. ~. :~ .~.t,.qn.. The certificate is issued to ...... ~..:i, glrk'l;..I~..a~C[. Ota,P..OJ, .An..B~ia~tl, ey ................. (owner, ~ of the aforesaid building· Suffolk County Department of Health Approval ................. ~I/R., ......... ./ ........ UNDERWRITERS CERTIFICATE NO ......................... I~I/F[ ' .... .-./. ........ Building Ifispector Rev 4/79 TOWN 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 ^UTHORIZED) N°. 10397 Z Da, e~~....~.~,~ .... 19.~...~. Permission is hereby granted/6] t~ ) ,~/' .~/~~.,.~..~.~.~.~~ ........ ~~...~.....~~....~~~~~ ............................... ........................................................... ~~.~.~ .............................................. opproved by the Buildin~ Inspector. [~ ,..Z~ ............ Bui~in~ In~ector 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: t. 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....~.~-,-...,~.~...~. ~. · · · · New Building..~"~/. ~OId or Pre-existing Building ............ Vacant Land ............. Locet,on of Property ~o..;~/o..~.-. .... ~'~'" '~'~r ~; '/~ .... ~ .......... ~;,;; Owner or Owners of Property '~/_,<)f'.~ ~,, ~ 0~., · ...... · d ~ ...... '~'c~'~, ............ County~ax ~ap.o. ~000~ection ............... ~loo~ .... .~ ........ Lot...~:~'~... Subdivision ................................. Filed Map No ........... Lot No, //~..,~T' ...... Permit Not~.~ .~... Date of Permit ~:~_./~,. ~ .Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporar~ Certificate ..................... Final Certificate ....................... ~ee submitted $. ~.. '5'"~' o.0. i~) ....... Construction on above described building a~d permit meets all applicable codes and regulations. , I ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 Examln~.~Z/. O' .... ,19 X? ^pplicationNo./n.~?..7. ...... Disapp o ed a/ ........ ~.. ................ 4 .......... ................. : .............. (Buil~n~ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be c6mpletely filled in by typewriter or 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 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 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 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 buildings for necess~y inspections,~ ~X'.?.,~.. x. ~o~ o.~.~.~;~. ~,'.. (Mailing a~ldress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner or premises . .~c~ [ .~. I.~. T...'~...~).h~...&.. ~ ~.(~. ~.£.~ ..~. ............................... (as on the tax roll or latt~st deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... .~. ~2. ¢ .......... Plumber's LicenseNo. ' ...... Electrician's License No .................. -~. · Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. ·. ............ ................. House Number Street Hamlet County Tax Map No. 1000 Section ~ Block ~>~ / ~' Subdivision .................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and 0ccu'pancy of proposed construction: a. Existing use and occupancy ................................. ; ..................................... b. Intenaeu use a a ucc p y ...... ~/~./ ................. .~ .................................. 10. 11~ 12. 13. 14. ' · .~J~.. · Ad Nature of work (check which applicable): New Building .,~. dition .......... Alteration .......... Repair .............. RemoVal .............. Demolition ............ Other Work ............... / (Description) ,~.). i~> ~...~. Fee ' /'.'.~...~----. Estimated Cost ' (to be paid on filing this application) If dwelling, number of dwelling Units . ~. ............. Number of dwelling units on each floor ................ I~number of cars ........ i ~r_-_-_-_-_-_-_-_-~. ....................................................... If'l~Tness, commercial or mixed occupancy, specify nature and extent of each type of use ................ ... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i · Height ........ ~..., ......... I~lumber of Stories ....................... D~mens~ons of en~t~re~ new construction: Front .... O~. ....... Rear ... O~2. ........ Depth .. ~_,). ........ Height '... ,/,.$.../. ..... Number of Stories ....... ..~..~ .......................................... S~ze of lot: Front .. / .~.~.'.~..~ .......... Rear.. Z~.,.;~.;~ ......... Depth . o~.4 ~3.~. ......... Date of Purchase ~4k ~.~ ~ j.6~ .~ (o .... Name of Former Owner . .~lOg, l~ I~.'~../~tO.~t~$ .... Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ...... ~t~. ~ ................... Will lot be regraded .... '.'7~. ~. .................. Will excess fill be remove~d from premises: ~ Yes Name of Owner of pl;~mises ~)~01~ ~..'~g~..~,/,T~ Address ~/~.O./~ ~-~.. ~'.~. ~fl~one No.. 7/-*~5'7.:' PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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 cornerlot. ~opl..ht~i~£~ ~ldF~ etO ]}6~T/~ ~/~ ~Ot .~'1~9 STATE OF NEW_YORK ..... ~.~.. ~. ~~ .......... being duly sworn, deposes and says that he is t~e applicant (~ame of indivffiual signing contract)~ above named. (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file this application;, that all statements cont~ned ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~n~r set forth in the application filed therewith. SWO~ tO before me~~ Nota~eublic, .... ~ ...... County ~~ ~.~ ~ERT JAMES WIE~EHAH~ , NOTARY PUBLIC, State qf New York r ' No. 52.4612739 .... Commission Expires March SO, 19~