The URL can be used to link to this page

Home My WebLink About10160-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ....;! .~..~.3 ....... Date ....~t~.l~..~. ~IS CERTIFIES ~t the bu~d~g ................................................ ~on of ~p~ .~..~9~ .~e~ .~9~ ............... ~~1. ~'~' ..... H~ No. ~t Ham/et ~ T~ Map No. 1 ~0 ~ion . 11~ .Block ~7 .~t 011 S~on ............................... Filed Map No ......... Lot No .............. confo~s subentry to ~e AppOrtion for B~g Pe~it heretofore fded ~ ~ offi~ ~t~ .. ~ll. I.OS ........ ,19 ~ p~t to w~ch B~g Pe~it No... ~O~0: ~ ~ ......... ~t~ . .~. ] 0.~ ............... 19. ~ w~ i~ued, ~d confo~s to ~ of the r~ments of ~ ap~ble p~o~ of ~e law. ~e occup~cy for w~ t~ ce~ificate ~ ~d ~ ......... ... ~$~ion. or..~.~. ~. $~..~l~s~e. ~s~$y..~, ........... ~e ~ffif~ate ~ ~ued to ...~. ~.~..~9g~ ...................................... of ~e ~o~d b~g. Suffo~ Co~ty Dep~t of He~th Appm~ .... ~. .................................. ........................................... Building Inspector R~ FOP,~I NO. ~ TOWN O~ SOUTHO£D 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 AUTHORIZED) 10160 Z pursuant to application dated ...... ...~...../...../....~.. ............................... , 19.~...~.., and approved by the Building Inspector. Fee $.L,~.......~ ....... 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: I. 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 a~ property lines, streets, buildings and unusuat natura~ 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ....~.e)p.~e..~.~.e.~..~..1.(~.8.0... New Building ............. Old or Pre-existing Building ,...~ ........ Vacant Land ............. Location of Property .... ,2.2.~..0..C,o.~...~.e.c?,..R.o.~.~ .......... House No. Street Hamlet Owner or Owners of Property ...... ~..['z,J..)..~...~....~.. ,~.~?..o.z,.e..~,. ~.q~;~.~ ..................... County Tax Map No. 1000 Section .... .1.1.~. ....... Block ....... 7 ....... Lot ...... .1.1 ........ Subdivision ................................. Fded Map No ........... Lot No .............. Permit No..1.0.1.~..0.~.,. Date of Permit . .~../.1, .04'.7.~.Applicant ...~.~. ~.~. ?.:..E.o. 8;.~.~. ............. Health Dept. Approval UR .Labor Dept. Approval Underwriters Approval ~R .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ......... ~ ............ Fee Submitted $ ............................. Construction on above described building ~eC~s all appli~a~b~ codes ~)nC/regulations. Applicant.{ ...... ',~...'~,~....~. ~.~. . , . .......... TOWN OF SOUTHOLD OFFICE OF BUILDING INSI~ECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 Philip M. Hogan P. O. Box 1241 Mattituck, New York 11952 Dear Sir: This is to4/qO/7'ng't~i'f-Y9 you that Building Permit No. 10160Z issued to owner will expire on If more time is required to complete the Job and obtain a Certificate of Occupancy, you may apply, ~y letter, for a six (6) month extension. ' If the work is not completed and the Certificate of not issued after the six (6) month extension period, than required to apply for a new building permit. Occupancy you are Very truly yours, GEORGE H. FISHER Sr. Building Inspector FORM NO. ! TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ................ : ......~......~' ..., .' '~". ............................... ../..... x.~,.. ............. ............................ .................. .: ........ .../..../... ................. ( B u'i laYng Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 sate 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 ar public streets oJ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before ~ssuonce of Building Permit. d. Upon approval of this application, the Building Inspector w~ll 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 fj~r-m-mm~,sary inspections. / -\". ,O. '~i:)'o'~ I ........ .................. (Address af applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder. ¢_¥ f¢.~ f:.4,c.Z...~:~... .... r.:,,J.:?', ~ ........ >.~:.v..~:~,~,..~%. ......................................................... ~ ...................... 1'~ Name of owner of premises ~..i:.~..,.~..~...~.. ....... ~ .......................... ~,....~.-.}..~Z....O,...~...~.......~..'.....~.:!.,~'.)..~...~...!: ...................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's bcense No ............ ~....~ .................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... No.l.!..~.:. Location of land on whic~h, p~ropose, d_worlcFi~l be done~,M? No.: .)..O,~.....O...w~..~ ............... Lot ./.:.~..! .~. Street and Number ...~...~.....~.Z.'~... ....... ,.,t?:"~,.~....,~.,....~..x~...~.?...~....,.~,,.~.,..~...:...~.W..L./~,.~.~....'~...! .T..L)..(~.J~ ...................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ......~.. ............................................................................................ : ......................... b. Intended use and occupancy .................... ;?~..~..~...(..~....)..~.~......,.~/...~../.~.~.~.4== ............... 3. Nature of work (check which applicable). New Building ................. Addition .............. Iteration ~ · Repmr .................. Removal ................... Demolition .................. Other Work ........................................... ,,~ ~ (Description) 4. Estimated Cost ........................................................... F e ........................................ ~ (to be paid on filing this application) 5. If d~elling, number of dwelhng units ..... .~&~..~ ...... Number of dwelling units on each floor ............................ If garage, number of cars ..... : .................... ~.~..~ ............................................................................................ 6. If business, commercial or ~xed occupancy, specify nature and extent of each type of use ................ ~ .......... ~.Di~,o~ of ~x,~tmg ~t~c~, if ~W: ~ro~¢ ....... ~ ............. ~r ....~ ..................... ~p~h ...~ .......... Height ....~.,..~ ........ NumBer of Stones ............ O.~.~ ...................................................................... .~ .............. Dimensions of same structur~ wffh ' ~ ........................................................... ~ ~8. Dimensions of entire new co~struchon: Front ....................... Rear ................. Depth ............... .~ ~. S,~e of o~ Fro~ ........ .~.L,.~.I ...................... ~ ..... ~o~r. ...... L.~'-.~.~.~ ....... D~pt~...~.~.~.8~ ............ ] 1~ ' Zone or use dJs~nct Jn which premises are sitbated .......... ~ .................................. :.~ ............................................. t2 Does proposed construch ~ te any zoning IQW, o d rice o lotion: [~) Yes 13. Will lot be ,regraded .............. ~..~ ...... Will exce~s fil re~ ~ m pre~ '. (~) ,( ) No 14 Name of Own~?~ premmes ....( ............................................... Address ................................Phone No....~. .......... 1 Name of Architect ......... ~ [~ ~ ...................... Address ....... '. ........................ Phone No ........................ , Name of Contractor .......... [~.O..[~.~ .................... Address ................................ Phone' No ....................... PLOT DIAGRAM Loc~t~ clearly and distinctly ~11 buddings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y ines Gwe street ~n~ ~lock number or descnphon ~ccordmg to deed, and show street n~mes ~nd indicate whether interior or corner lot OF ...................... '..~ .......; ............ i ...................................... being (Nome of individual signing contract) APPROVED AS NOTED 765-2660 9AM ia 4PM FOR REQUIR. ED INSPECTIONS= 1. BEFORE BACKFILLING FOUNDA- 2. FRAMIHG INSPECTION 3. BffFOR~ COVERING P~P~S OF ANY KIND 4. FINAL WN~N JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR COffSTRUC~ION ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y, STATE CODE AND TOWN HOUSING'CODE & ZONING duly sworn, deposes and scys that he is the applicant above named , , He is the ....... ~....,.i ........................................................................................................................................ (Contractor, agent, corporate officer, etc ) of said owner or owners, and is d~ly authorized to perform or have performed the sa~d work and to make and file this application; that all statements contained in this apphcation are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. / Sworn to befo~-~'~is ~/),~,r/ ~-- / , 7 / NOTA"Y PUBUC' St~/o~E~l~: Y°r k