HomeMy WebLinkAbout727-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF OCCUPANCY
No. ~./+~.2. ................ Date .................... ~{~r,V....],]. .............. , 1~i) .....
THIS CERTIFIES that the. building located at ..,~.S....~t..~.o~.i~..(.~,~,~..R~L) ................. Street
Map No, (~,l~a~'~ ..........Black No .....~ ............. Lot N~......]~t..~&on~....~i,~% .................
conforms substantially to the Application for Building Permit heretofore filed in this office dated
............................. ~lrtme....20 ............ , 1~).5~J.., pursuant to which Building Permit No..~,..~/~.~ ...............
dated ......................... ~,~.......~. ............ lc)~,~...., 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 ................
............. P, ri.~ .t~.. on~. £~ m~ -~ y.. ~11 in~ ..............................................................................................
This certificate is issued to Ja~...~uc~uskis ........ .(o~'.) ............................................................
(owner, lessee or tenant)
of the aforesaid building.
Building Inspector
FOI~M NO. 2
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 AUTHORIZED)
N? 727, Z
Dote ............................. Ju~y....& .............. 19~9 ....
Permission is hereby gronted to:
~rles ~umble. l~.~ ..~mes..~=moukfs ....................................
...... · 3;~9....4~h..Ave....~een~r~.~.... ~..~. ...............
to .~ufld..~..d~eltin~ ......................................................................................................................
ot premises Iocoted at E/~-.Pri~a%e..R~.d-..(~l~.~..Rd~ ......................................................................
.......................................... ~ff..4q.~,v~.e~..~a .......................................................................................
.............................................................. ~.~io~t....N,X ...............................................................
pursuont to oppJicotion doted ............................. ~e"-.~ ................... 19.~..., ond approved bv the
Buildin9 Inspector
Fee $.l..9.,..qR ..............
FOR!~ NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
File No ...... Z..7,?,7 ................................................... Date ........................... ~une....22 .............. 19..59..
PL~A$~ TAKE ~OTIC~' t~a~ your application dated ........................... June ...... ~0 ......... 19~.~ ....
for permit to construct .~.w,e~l,~ ........................ at the premises located ot ..E/.3..P.~..~e..t~,Qed ....
.... ~/~. ~c~u~..¥~ew..Ave ................................ Street
M a p G oll.t,~.... ,~+,,~,r.~ .............. Block .................. ~ ..................Lot .:;~. ...................................... is
re~[,~~ disapproved on the followi ng grounds ....... .t~':[~',~.t,e..z~a~.~eees~..h~.s ......
......... n~t...~e~t~..~.l~lor~ve6..by...pr, oper...~u~o~Lty., ...........................................................................
Building Inspector
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 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.
Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancv on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$§.00
Date .... Sep~.~Bbe~..30,..1.98J.
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property E/S Pvt. Road (Stars Rd! . .E.a.s..t..M.a.r..i.o.n.,. Ne~,/ Yor!¢
House No.Street Hamlet
Owner or Owners of Property ,Tames ,Saz~mous!<is
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No... ;g,?.g?. ·. Date of Permit .8/8/.59..Applicant ..................................
Health Dept. Approval ........................ Labor Dept. Approval ......
Underwriters Approval ........................ Planning Board Approval .................
Request for Temporary Certificate ..................... Final Certificate 7,
Fee Submitted $ ...... 1.;0, ,0..(.C.o. Dy.) ...........
Construction on above describedApplicant.building and, .~' ~-h.permit meet~ .~'..~~aFI applicable codes and ........... reg~ ~ .....
~~~,...being duly sworn, deposes and says that ~e is the applicant
above named. He is the ............ ~ ........... ~Contractor, agent, corporate officer, etc.) and file
ned in this application are true to the best of his knowledge and belief;
of said owner or owners, and is duly authorized to perform or have performed the said work and to make
this anpi c~tion; that oil statements,~on~ manner set fo~h in t~e app[tc~ fil~d therewith. A ~
and t~t the work will be performea ,n ,~e. ~~ ~~~
Sworn to before me this ~ - of
~ ~ . 19.~.. JU~T~ T. Bq~Si?~ture applicant)
. ~ aa of · -- Rotary Public, St~e OT t4ew yor~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN C,ERK'S OmCE
SOUTHOLD, N. Y.
Examined ...... ~ ......... ~~.. 19...~.~.. Application No ...........~....~.....~......
App roved....//.~...:.m~.~.......~......~ ...... 19 .~.~.'..Permit No ........... ~... ,.~..¢~../~
D'sopproved o/c .~/~...~~ ....... ~¢~.....~.......~. -'~--?~.r~¢,/
......... .......
......... ............................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
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 location.
c. 'The work cov. ered 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 progress of 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 hQve been granted by the Building Inspector.
APPLICATION 1S 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 a Iterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances and regulations.
(Signature of applicant, or name, if a corporation)
........ ............... ......
(Address of applicant)
State whether ap licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises......;~......~.......~,~4~'~':~......~.~.~~ .............................
if applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map,~No: ~..~.~..~..~c~..~x~..~.~. ..... Lot No:: .................
Street and Number ........................ ~;, ....... ~i'~alit~,
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ............................................................................................
b. Intended use and occupancy ..................... .~~ ......................................................................
3, Nature of work (check which applicable): New Building ...... ..............~ Addition .................... Alteration ....................
Repair .................... Removal .................... Demolition ............. .~....Other Work (Describe) ....................
(to be paid on filing 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 ..............................
7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................
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 ....~. ..................
Former?Owner
Zone ar use d,st.ct ,n wh,ch prem,ses are
12. Does proposed constructio~vi~la~e any zoning law,, ordinance or regulation? ....................................................
Name of Architect ........... ,'~/] , ~ ¢¢~ .......................................... Address .................. ,~¢/1/~..;: ........................ Phone NO .....................
PLOT DIAGRAM
Locate clearly and dlstinctl¥ all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW ¥~:)R~,~, ,,~) S S
COLJNT¥ OF .~.¢'.3- - '
duly sworn, deposes and says that he is the applicant
(Name of individual ~~a~) ¢
above named. He is the ........................... % .............................................................................................................
(Contractor, agent, corlborate officer, etc.)
of sa d owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this application; that a 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 applica,tio~ filed therp~ith.
Sworn to before me this ~:~'~
........... ~otary Public, State of New York
Notaw Public~--~ ~~..,~c, unty ,o. 52.0344963, Suflolk
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
ned .......... ^pp cat
........ 'z~.~:r:: , ..........................
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
o. This application must be completely filled in by typewriter or in ink end submitted in duplicate to the Building
Mspector.
b. Plot plan showing location o{ lot and o{ buildings on premises, retetionship to odioining premises or public streets
er areas, and giving o detailed description of layout of property must be drawn on the diagrem which is port of this location.
c. The work eoYered by this app{icotion 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 progress o{ 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 hove been granted by the Building Inspector.
APPLICATION IS H[R[BY MADE to the Building Department for the issuance of o Building Permit pursuant to the
Building 7one Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or
Regulations, for the construction of buildings, additions or o Iterations, or for removo} or demolition, as herein described.
The applicant agrees to compty with oll applicable lows, ordinances and regulations.
............ ......... ........................
(Signature of applicant, or nome, if a corporation)
......................... i'~i~i~g~ ' ~"~;~'~'l'ica nt) ' '~'""~'"~
State whether applicant is owner, lessee, agent, architect, engineer, general conti,~ctol, electrician, plumber or builder.
................. ........................................................................................... i' ....... : ...............................
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No: ...~...t~_~. Lot No: ....................
Street and NumBer ...... "¢'~ ' -- '- f ~'P'*~'"'"'~d~'""~'i~~'~)'"'~'"" "~"'~~~'4/ ~n cip it~l v ........
2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction:
a. Ex~stimg use and occupancy
b. Intended use and occupancy .......................................................................................
3. Nature of work (check which applicable): New Building .......... ..~.......Addition'. ................... Alteration
Repair .................. ..J~emoval .................... Demolition ................. ~..Other Work (Describe)
4. Estimated Cost ...... ..~.......~...~.....~....~.,..~....~.. .................... Fee ...... .~...~...~%'..:......'~7.... ...............................................................
(to be paid on filing 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 ..............................
7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth
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 ........ I~.. ...........Rear ........ ~ ............ Depth ..~ .................
Height ...... /./...:....~. ..... Number of Stor~es ...~ .................
9. Size of lot: Front ......j/.~).0.-- ............... Rear ....... I..~ ............. Depth ....l....~....~ ............ .
10. Date of Purchase .~f~.~......~..../.~..~. ...................... Name,of Former Owner ..~........~~ ...........
11. Zone or use district in which premises are situated ........ /PC~...,/t.~¢~¢~.~.~.~'~. ........................................
Does proposed construction].viqlate any zoning law, ordinance or regulation? ....................................................
13.12' Name of Owner of premiX. .......¢O-~.~....~.Address ~.i.~..~..~..:~..~....~....~..~.*...~...Phone NO~.....~...~.~.?..~
Name of Architect ........................................................ Address ............................................ Phone NO .....................
Name of Contractor..~_~....~..~...Address ............................................ Phone NO.
PLOT DIAGRAM
Locate cleorty and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
·
STATE OF NEW~)R,~, ,~.) S S
COUNTY OF ................ '
....................... .......... swor., d .o,e, ,.
above · ' ...............................................................................................................................................
(Contractor, flgent, corporate officer, etc.)
of s~Jd 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 a~d belief;
and that the work will be performed in the manner set forth in the applica~on filed therewith.
No a y Public State of ~ew Yor~