The URL can be used to link to this page

Home My WebLink About10097-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. ,..Z.98.~.9 ......... Date ....D.e.~. 9.~I.~,~.lT.. ~ ................. 19.7.9 THIS CERTIFIES that the building ................................................ Location of Property 'J65~...Ry.~.~..I~. .~.8.~..~..~.8.1~. ? ...................... .0~...]..e.~..~,..~. :¥. Street County Tax Map No. I000 Section ...?.~ ....... Block 4, .Lot '1 Subdivision O~,:t. ellt-by-~ghe.,Se8 .Filed Map No. ~ .Lot No. 5~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ... 0O.~O~P..~..: .... , 19 7.~ pursuant to w~ch B~lding Pe~it No ....... ~.0097~ ........ dated . .~OB~8~. J.~ .............. 19, ~.~ was issued, and conforms to a~ of the requirements of the applicable provisions of the law. ~e occupancy for w~ch this certificate is issued is ......... ................. ................. The ce~ificate is issued to A~hO~y. ~ .~95.~. ~g ..................... .......... town,r, ~ of the aforesaid building. Suffolk County Depa~ment of Health Approval ........... ~[~. ........................... UNDERWRITERS CERTIFICATE NO ................... ~. ........................... Building Inspector Rev 4/79 FOI~M NO. 2 TOWN OF SOUTHOLD BUILDIbIG 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) N? 10097 Z Permission is hereby granted to:/,~ --.~ ~ ...... ..~../.~.z'. z¢~. ~...~.....~..,.....~.,~.... ~v.. z ,~. ...... ~ ~.~../.~.,~r~........~.~,.~../~. · ............... : ........... ~ o . . .C ~. ,~.~ z~ ~. .c . / ....... . .c_/. ~. .c4. . .~ . cT ~. . . . .,,~. . ~ ~,. ~o.. ,~. . . . . .z". o. . . . . ~ ............................ ..... .~...4~.~z-~ ....... .o.~_......~..~,~'z ~ ~_Z"~'~u~' ..r.~¢.~ .......................................... at premises located at ~- ./.~. ...... ~K~.....~'.--~./.~...':(/~.~/~X'..../v~,~/~?,...~...,...-~.,.~4:~-.~.~.. ............... .............................................................................................. ..O.~.,.~Z....~..:~:. ....................... pursuant 'o application dated ....~.~.~¢......~.. ................... , 19.~...~., and approved by the Building Inspector. ~ee *..Z..~.......~... ..... 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: 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. B. 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. 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 New Building ............. Old or Pre-existing Building ............ Vacant Land .............. Location of Property../..~..~.'.~.... ~.y~.~'. ~../~./~2~,~...~. ........... . .~..~//~../~...~.,. , House No. Street Hamlet Owner or Owners of Property ........... ~. .............................................. County Tax Map No. 1000 Section '-~-~ ~...'~.. Block .... , .~Z~.. ...... ' / . · ........... LOt .... ;¢;.../ ..... Subdivision (-~.~//.~.~.~'~ ~'~Z .~/~¢ .~./~...Filed Map No. =~. .Lot No...~..~. ........ Permit No, /~.~. ~. ~... Date of Permit /.~../.~.2..~. ,Applicant .,<~:~,~y .~..~.o.~,,~,¢'.. ' .J~¢.. ~.'..~.~.~y~.~..,,~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Tempo raw Certificate ..................... Final Certificate .... ~ ............ Fee Submitted $...~.~.,. ~.~.. (.~.t~."~;{": ~1 .... Construction on above described building and permit meets all applicable codes and regulations. Applicant..~....,~.. ~ ................ Rev, 10-10-78 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. PLEASE TAKE NOTICE that your application dated .............................. ~/~'~'..~'.......-~..., 19...'~...~ for permit to construct ~Z~(~.~....~.~,~.~.at the premises located at .................................... ~.~...~}:~.~..~ ....... ~.~..~ ...... .~ ...... ~(~ z~ ~,:',v~ ~ ~ ~r Map .................................... Block ............................................ Lot .............................. : ................. is COo~Y TA~ ~Ap ~- i~o-i~_~_I returned herewith and disapproved on the following grounds ....... ~.~.~/.~.~. .............. .~.~.Z ......... ~.c.~ ............................... E~L~.....Z~.~h.~ ....... N.e:..~ .~;. z ~.~:......~.'...~.~ ........ .~.......~.~.~ .......... .%.~.~......~L~..~ ....... ~...~.~Z....Z~.~.~.~ ........................................ Building Inspector SOUTHOLD, N. Y. Application No../.~...~...~.....~'. ............. APPLICATION FOR BUILDING PERMIT Date ...... . .~/.'.~..~...........~... ........... . INSTRUCTIONS a. This 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 oF areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which Js part of this application. 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 port 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 ~onstruction of buildings, additions or alterations, or for ~moval 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, j' /~//~ ~ · , //?~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................................................................................................................................. Name of ow.er af premises ..... ................................................ If ~pplicant is a corporate, signature of duly authorized officer. Builder's license No .................................................... Plumber's License No ................................................. Electrician's License No ........... m ............................... Other Trade's License No ............................................... 1. Location of land on which propose,,d work will be~done. Map No.: ...... ~ ........................... Lot No....~....../... ............ Street and Number ./..~..,~'...J~'........~..7..~..~..~....~..~..4/......~.~.~..../~.4~......-~.....~./.4~-..~-~ ...... ..~...~., ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: H a. Exisiting use and occupancy .....~...0....,~.~. ....................................................................................................... b. Intended use and occupancy .. ~../~.- .................................................... 3. Nature of work (check which applicable): New B ~. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ (Description) 4. Estimated Cost ..... .~.) .................................................. ~-ee ...¢....-~¢ ............................................................................... (to be paid on f,iling this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ......~...~...~,. .............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ a' .....~..~.: .................. Depth .¢~..~. ~ .......... 7. Dimensions of existing structures, if any: Front .......~.. .................. Rear Height .....//~.~' ....... Number of Stories ...... ~. ....................................................................................................... Dimensions 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 ....... .~,,. .......................................................................................... ~ ............. Size of lot: Front ..... ./..~...q../. ...................................... Rear ...~...~...~...,/. ......................... Depth .....,~..,..~,.? ................. 9. Date of Purchase .~......./..~,2.~.. ...................... Name of Former Owner ...'.~..~.~......'.~../~., .................... 10. 11. Zone or use district'in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: .... ~ .......................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premises: (~--'Y'Yes ( } No 14. Nome of Owner of premises ....~...H.....~./~..?..~../.,...~...~...~...~..~... Add reL~'~.]~.~..~..~,ff~_~ Phone No~ ~.Y~..~ ~.~ Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, 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 corner lot. If---- /yo -- STATE OF NEW.OR.K,/ . COUNW ........................... ~:~ ................................................... be' g duy orn, deposes and s~ys th~, he is the applicam (Name of individual signing contract) abow~ named. He is the ................................................................................................................................................................................. (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 eH statements contained in this application are true to the best of his knowledge and belief; and thor the work wJJl be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ............ ....... o, ......... , ........... ........................... Lc:,+ ~S