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HomeMy WebLinkAbout2285-zFOPoM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~..2304 ........... Date ............. N~vem]0e~....2.3 ................ , 19.65.. THIS CERTIFIES that the building located at Map No..3Q{~ ............. Block No .....3Q~ .......... Lot No ................ Z3Q~ ............................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... Jatl,eta:~y...3 ........ , 1964.... pursuant to which Building Permit No. 22852[ .... dated .......................... Jal~aa,l~y...2~......, 19...64, 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 ........ ............................... One ·. ~em.~.~' y .'. clw e-l.~..~.n g. .................................................................................... The certificate is issued to ............... JO~I't..~'.~[~OI1~Ls ...................................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector~ FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. RUILDIN~ PERMIT (THIS ,PERMIT MusT BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 2285, Z Permission is hereby granted to: to ....... ~l,.~d...aew.. e~e ...~,~- ~we~.~n{t~ ......................................... ...................... .'..'.'~ ........ at premises located at ,..,zd~/~,.,.'~{~Td'. .~..~..-.' ....... .;.{{~t.{'.~,~&~.'.,,.....~...:.,...:i,.; ............. ~ ...... ...................................... ~ ...... .Oe~T~U.r-.~, ~, ........................ ...: ............. ?.:.....:, pursuant to applicatlon dated. .................... ~11tlt~ ....... .~......:......, 19t~..., and ~pproved by the Building InspeCtorr FOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....:Z....'l~ ......... Date ........................... .A~i~.'I. ....... 3. ...... , 19.6~.. THIS CERTIFIES that the building located at ...'~llS......l]a~,..'~,l.:~e%t..~o~t ....................... Street Map No: '"X~:X~ ......... Block No ........ ~,.~ ..... Lot No. '"~:X~ ......... ~tt%~',O']',~'W"~',"~' ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... · ,~a'zl~'a'l'y'""'~ ...... , 19.~br. pursuant to which Building Permit No ..... ~,~, dated .......................... J.~:It~al'.y..'~..-..., 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 ........ ....... Prt.v~t~...one...~'~mi.~.~..d~et~.i.ng .......................................................................................... The certificot~ is issued to ...~T~)[~'1..(~I?~,~C~$$ ....................................... 0~. ............................... (owner, lessee or tenant) of the aforesaid building. .......................... .................... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y, 11971 V TOWN OF SOU'?HCi F~ : APPLICATION FOR CERTIFICATE OF occUPANCY Instructions A. This application must be filled in tvpewriter 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperW 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: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing d~velling or land usa $5.00 3. Copy of certificate of occupancy $1.00 Date .. A~ril 18,1985 New Building . X g B ildi g(X) V' ............ Old or Pre-existin u n ...... ~ f acant Land ............. Location of Property ........ .B,ayview Ro~d Southold House No. Street Theodore & Eileen Carpluk Owner or Owners of Property ................ -.- ~ .................................. County Tax Map No. 1000 Section ..... 70 Block 07 Lot,.. 17. Hamer Subdivision ...... , ......... ,, ............. Filed Map No ........... Lot No .............. PermitNo ....... :~,., Date of Permit ....... Applicant H~oh~eL ~z. Health Dept Approval Labor Dept Approval Underwriters Approval Planning Board Approval Request for Temporary Certificate Final Certificate Fee Submitted $ 1.00 Construction on above described building and permit'mee[s all app~i,cable.~co.des and regulations, Applicant .,Mi, ch~e~.. J. Hal.15 F~.s9. Rev. 10-10-78 FORM NO. 1 TOWN .OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............................ ~' ~ ........ ,19 ........ Permit No. c~...~...~.....~... ....... Application No..~.....'~. _ .~...~. ,....-~... ...... Disapproved a/c ........................................... .................... ................................. 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 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 o 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 po rt 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 and regulations. ~ ............ ......... ...... ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...... ~T.q~g....g~.~p.~D ................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No: ........ ~ ............................ Lot No: ~ ............ Street end Number ~..~/..~.~.j:..~.~.~¥..~:~e.~.~.g~.~`.~.~.~.~.~.~.:~.Z.~ ........................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~.ftg.(L~l;...,~,8,~C]. ...................... .... b. Intended use and occupancy .......... .(~,'~fD.].,'[.J,~L~ ................................................................................................... 3. Nature of work (check which applicable): New Building ..... ..X..~...x..~_. Addition .................. Alteration ............. Repair .................... Removal ....................Demolition .................... Other Work (Describe) ........................ ' /30oo 4. Est[mated Cost .......................................................... Fee ...~..0......0..0. ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... o~f~ .................. 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. Dir~ensions of existing structures, if any: Front .......................... Rear .......................... Depth ......................... Heij~ht ............................ Number of Stories ........................................................................................................ Diniensions of some structure with alterations or additions: Front ................................ Rear ........................... Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front....3.';~..~. .................. Rear ...... ~...-..~. ............ Depth ....~.~..-:~ ......... Height ............................ Number of Stories ......>4 ......................... 9. Size.. of lot: Front .....],0.0. .................... Rear ...... ~..O..0. .............. Depth ..... J.~7..5. ........................... 10. Date of Purchase .................. ~.9.(~3 ............................. Name of Former Owner ...... .k3.e.D.,...Id. az.~.c~s.oJ~ ................. 1 1. Zo~e or use district in which premises are situated ........... ~.~.'.:0.).'....0.~.'.~ ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~..o. .................................. 13. Name of Owner of premises .....'~.~'Cl...~ZLZkg~.'r.]:[.~....Address ...... ~.olzLl'~.cal~'.l~ .................. Phone No ................. 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 fr( property lihes. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. o /o"iF STATE! OF NEW ,YOR.K, ) COUNTY OF ..:~-',..~..$'.~..o.~.c~ ........ ) ........................... ~k-~.....**:~ .................. being duly sworn, deposes and"says that he is the applicar (l~,arr~of individual ~io~,,. ~/~,/~ ,~) above named. He is the ........ ~..~..~L ................................................................................................ ~ (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 fil~ this application; that all statements contained in t~is application are true to the best of his knowledge and belie[; and that the work w be performed n the m~rp,~t~0~the opplicotlon filed therewith. ' e fhi ~0 ~., ,~,~ate o ~ev York Sworn to be~or me s ~- 'i ~3 ~"%11 ' ...................... ..... ...................... : ....