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HomeMy WebLinkAbout10198-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 .... ?..~..~..O.a.k...~.~.I~.~..O.~ ....................... .~.tl.~.q .h.ol~.~' ,. ~,.Y. ,. House No. Street Ham/et County Tax Map No. 1000 Section ....'1~.~. ..... Block .... .1 .......... Lot ..... ~.2. ......... Subdivision...Eugene. He. igh~e ........... Filed Map No .... 85.~ .Lot No....'Z. 0..-..~.1.. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... l~Sy../{ .......... ,19.7.9 pursuant to which Building Permit No .... ?.0fi.0..8.Z ........... dated ... iv/~ty.. 8 ................... 19..~..~ 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 ......... ........ O~e. Family. rlwelllng, w./Addt.tion..~nr!. Al~O.r.a.~.~o.n .......... : ....... The certificate is issued to J.O. hl0 CaP. oglaa . ................ (owo'e~) ...................... of the aforesaid building. Suffolk County Department of Health Approval ........... .Iq/.R. ........................... UNDERWRITERS CERTIFICATE NO ................... E..~.b. 6. ~7.5. ..................... Rev 4/79 Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10198 Z Permission is hereby granted to: /~_~// /// ..... .~.~...ZL~..~.~ ................... ot prem,ses,=ted ot~/~.....~..~Z~._~d~-~ ......... (..Z./..~.). ................. ~: ............... ................................................................................................ .~....~./..~**.. ~rs~ont ,o op~at~o~ doted ........... ~..--..-....~ ........................... , ~.Z~, o~d o~ro~ed ~y t~e Building Inspector.~..~.L /~/~/ / / Fee $,/,~,,,, ............ Building I~pector 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 featu res. 2. Final approval of Health Dept, of water supply and sewerage d[sposal-(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 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. 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..ll.~.. . . ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .-.~./~'~..~ ~ ~..~.~., . ~"~L2.~?i~ .~.'C.~..~-.~. ~..~.~.; ................... House No. Street Hamlet Owner or Owners of P roperty~-~O ~ ./~ .... .~...~.~..~./~J ~ .............................. County Tax Map No. 1000 Section ... J.,,~,~ ...... Block ... l ........... Lot. ~,~4~- .......... Subd~v,s,on ¢~.(~. L~ ..~. ¢../d~ (~-/'~.~.,~ ...... Filed Map No. ~=.~.~. .. . .Lot No..7.~. '.-. Permit No. t [~ I.~ <~.~,. . . Date of Permit ~. , ~ . ~.~.Appl,cant~. .O,~S,,~-~q,~..' ~ " ' ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval..~ .~ .~ q.-~. ~. .......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....L~'.. ................. Fee Submitted $, ~, ~..~...~. ................... Construction on above described building and pe.rmit meets a~pplicable codes and regulations. Memorandum from.... BUILDING INSPECTOR'S OFFICE TOWN OF $OUTHOLD TOWN HALL, SOUTHOL~ N. Y. 11971 765-1802 ~ TOWN OF BUILDING DEPARTMENT ' TOWN CLERK'S SOUTHOLD, N. Y. Exam ned . ~ - ~ 19..7...~.. .............. ;;'~, .................... ' ;.i.Z~Z' .--. -z, ,../ p~lcat, .--../..~.,';...,4...c4.~ ............ roved o0--.dZ.., c.;. /0/ ....................................... , Perm,t No ................ ._,.,. ........ 5 ................. 7 ............ '/7 ................ ................................................................. //' ........ 74-'~";/' .................... w~,,.~- x:.e~ 04.. ,,.-,~ ~.,...,/'Or...~,,,.,.,~,r_.~ Z L ~,'-.~z~,_////.Z4~ APPLICATION FOR BUILDING PERMIT Date .................. , 19 ........... INSTRUCTIONS a. TMs application must be completely filled in by typewriter o~ 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 ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be comme.nced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl 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 necessary inspections. ~~¥~'r~pp'~nt, or nZ"~'S~b~'~'~'~7'i~"~"~'~'~'~'~i~i ........ O,,~.g....~.,..~p.W..t,.&r~.~%..~ .,.~.~.sx&r.~--~ ~ ~...p..,~:~x ~/ (Address of applicant) ll2~,-~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.% If applicant is a corporate, signature of duly outhorizec~/offic~// Builder's License No. ,....'~.'/~..,4~.~./.,6z..~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. 2 Locat on of and on wh ch prol~.oosed work w be do~e.~Map No.' ...~.:.~../.~...?i.,.4...o~_ /~. Lot No. Street and Number ...... ~..~Z~....;~ .......... ~.'~ ........................... ~7/~ , Municipali~ State ex,sting use and occupancy of ~,Sr(~],imended use and occupancy of proposed construction: a Ex s t ng use and occupancy ~{ ~ , ~ ......................... b. Intended use and occupancy .................. J;~.: ......... ~..,.~..~4....~.,.~ / 3. Nature of wor~ (check whict~,applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Remo,vaP .... ,,,,~; , Demohhon .................... Other Work ' C~//~ ~ ~L ~ ~.,..~... Fee /l~Om_~2 (Description) 4. Estimated Cost -j~...~>,..,/ ................................................................................................................................... ...~, ) ' (to be paid on filing this applicati~)#/~ 5. If dwelling, number of dwellj~ng units ............................ Number of dwelling units on each floor ........................... If gbrage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, ~pe~y__,,, nature and ext~j, of each type of use '"11~'~ 7. Dimensions q~e,~-~Jst~ng structures, if any: Front ...~,... .................... Rear .........'"' ....................... Depth .................. Height ....... ~"~'~.'....: ......... Number of Stories ....... ~ ...................................... ,~..~'. ....... : ........................ .~,..~ ............... Dimens,ons of¢~/~ structure with alterah~ or additions: Front ................. O..~¢/~ ...... Rear ........................ Depth ................................ Height, ....................... ..~,.lil~mber of Stories .......... ~..~ .............. 8. Dimensions,of.~ent.re new construction: FrontA,.t.l~, ........................ Rear ............................ Depth ..................... Height .....~....~../'~ ......... N~t~t~b~er of Stories .............................. c/tu-,~ ".~]) ................................................ .~.~..~ ................ 9. Size of lot. Front .... ...~....~ ....................................... Rear .......................................... Depth ................................ 10. Date of Purchase ................................................... '.....Name of Former Owner ...................................................... 11. Zone or use district in whlchlpremises are situated .................................................................................................. 12. Does proposed construct~J~olate 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 pr,~i,~e,~~...,.~,._..~.~/~...%/~ ,~v~'~ ~''~- ......... Address~.~.~.~,~. A ........ Chon* No.~W".~.~'..~..~, Name of Architect .rL.L:L...'Z~ .............. ~...:. ........................... Address ................... z ........... Phon* No ....................... Nome of Contractor ......................................................... Address ................................ Phone No ....................... PLO'[ DIAGRAM Locate clearly and distinctly ~II buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and bl~ck number or description according to deed, and show street names and indicate whether interior or corner Iol. STATE OF NE~/~'QRI~ ~^ ,__ ,[ c c ................ ~_~.~...~ .................. being duly sworn, deposes and says that he is the appllccmi . (ContraCtor, agent, corporate officer, etc.) of said owneF or owners, and is dply author zed 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 know edge and belief; and that the worlgwill ~rmed in ,the manner set fo~h in th~ filed therewith.