HomeMy WebLinkAbout3348-zFOI~I~ IV'O, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
CERTIFICATE Of OCCUPANCY
THIS CERTIFIES that the budd,ng located at ..l~i~,~/ll.~.~ ...................................... Street
Map No ~ ......... Block No .... ~ ...... Lot No .... ~ ............. ..~.~t~.~..~{lt...~..~.~...~...d..,..
conforms substanhaliy to the Application for Budding Permit heretofore filed in thru office dated
............ ~.~.~J]~...~J], .................. , 19.~. pursuant to whmh Budding Permit No ..~t.~.~..~..
dated....J~.~.~r(~::~....~..~. ..................... , 19 (~tj , was ,ssued, and conforms to all of the requirements
of the apphcable prows~ons of the law. The occupancy for which th~s certificate ~s ~ssued is ........
............. ~. ~.. ~....~m..~.. ~....~.. ~..~.....~..e.}...~..t..a.~ ...................................................................
The certificate is ~ssued to ......... ~tJ.o...J~ll~CJ.~l~tJ~.~....(~l~. .........................................
(owner, lessee or tenant)
of the aforesaid building
FORM NO. 2
TOWN OF $OUTHOLD
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? 3348 Z
Permission is hereby granted to:
A.John Gada Contractor C Mrs. Hoadley
................... ~.isl~ra....Is~n~l ........................
to .~.~ ~ addition ~'. make alterations on existin~ dwelling
at premises located at ..~.~1,11~1~.1~ ......................................................................
...................................... Elshex. s...Islands...~..%.. ..........................................................................
pursuant to application dated ............................... ~.eg.~.....2~L ......... , 19.~.~..., and approved by the
Building Inspector.
Fee $....~........0~.. ...........
'"" i Hall
'd,~/', :~.,~_~.~'~..<_~".4..~_~ LY. 11971
IFICATE
OF
OCCUPANCY
tor with the followinfl; for new buildinfls or ne~ usa:
1. Final m~ag of prop,rW with accurate location o~ all buildings, propo~ lines, ~reets, and unumal
naomi or topographic foamms.
2. Final a~roval of Health Dept. of wa~r supplg and sew,rafle disposal-{S-0 form or
3. Approval of eloetrical [n~allation from Board of Fire ~nde~ritem.
4. Commercial buildings, Indu~rial buildinfls, Multiplo Be,idences and similar buildinfls and
tions, a ce~ificate of Code compliance from th~ Architect or ~n~ineer responsible for the buildinfl.
~. Submit Planninfl Boaffi approval of completed sito plan mquimmen~ where applicable.
For existing buildings (prior to April 1957), Nonconforming 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.
C. Fees:
1. Certificate of occupancy $5.00
~/~<'. Certificate of occupancy on pre-existin.~l-dwa~ng or land use $5.00
Copy of certificate of occupancy, o L?'O0~,z,,
~^ Date .... ./. ........
New Building .~.. .......... Old or Pre-existing Building . (.~. ...... Vacant Land .............
Location of Property ~q~..~../,,//.~. / ~ .~./c/~o~/.,~, ~..~ . ,~.~,. _..~....,
. LO'. C,,. . .0Z77 ........ ' ...
~ ~treet Hamlet
Owner or Owners of Property . J~..~...,~. ~. ~.~../~. ~..../-~./~../?. ............................
County Tax Map No. 1000 Section . .(~../. ~ ........ Block ....0..~. ........ Lot....~..c?.? .......
Su bd ivisio n .~/t~. ~'~-~/~. ~2. ~-' "~'- z /-~/~ -
.~'.~7.¢.~/~./~. i~. ....Filed Map No...'~.~-..~...Lot No..¥..~..--..d~f.¥.
Permit No. ~"- Date of Permit .......... Applicant
Health Dept. Approval - ~ .Labor Dept. Approval ~
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate . . .J-~.... ...............
Fee Submitted $ .............................
FOlh~ NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ........................................ , 19 ........
Approved ........................................ , 19 ........ Permit No .................................
D,sapp roved a/c ............... ~.. ...... ~..~
........................... ......................
(Building Inspector)
Application No ...........................
APPLICATION FOR BUILDING PERMIT
............................. ,
INSTRUCTIONS
a Th~s application must be completely filled in by typewriter or in Ink and submitted in duplicate to the Buildin.
Inspector. ~
b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises ar public streets o
areas, and gwmg a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatio~
c The work covered by this apphcation may not be commenced before ~ssuance of Building Permit.
d Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant. SucJ
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 i~or any purpose whatever until a Certificate of Occupanc
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE lo the Building Department for the issuance of a Building Permit pursuant to th;
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o
Regulahons, for the construcbon of buildings, additions or alterahons, or for removal or demolition, os herein described
The apphcant agrees to comply with oil apphcable laws, ordinances, building code and regulations.
(S~gnature of applicant, or name, if a corporation)
A. Jo]am Gada - General Contract~ng, Inc
.... ..................................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
/ Contractor
Nome of owner of premises 1/~'~. RaF~on~l Hoaclley
If applicant is a corporate, signature of duly authorized officer
A. John Gada - President & Treasurer
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No' P~_~ninstll& Lot No: ...................
Street and Number F:i. s1~S Ts].n_n_~, Nt~' York
Municipality
2. State ex~sting 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) ....................................
4500.00 $5.00
4. Estimated Cost ............................................................ Fee ........................................................................................
(to be paid on filing this application)
.5 if dwelhng, number of dwelling units ............................ Number of dwelling units on each floor ..........................
If garage, number of cars
6. If business, commercial or mixed occupancy, ~ec[~..nal~,e and exte~o~a.cho"Ype of use .......
7. D~mensi~ ~te.x~s6i~g structures, if any: Front1..~ ..................... Rear .......................... Depth ..........................
Height ............................ Number of Stories .............................................................................................................
Dimensions of same structure w~th alterahons or additions: Front
19 Fto O" ' 'u 'e .......... ]""~' .............. Rear ..............................
Depth .............................. Height .............................. ~,~ m~ r of Stories ........................................
8 Dimensions of entire new construchon' Front ............................ Rear ............................ Depth ..........................
Height ............................ Number of Stories ............................
9. S~ze of lot: Front ............................ Rear ............................ Depth ................................
10. Date of Purchase ........................................................ Name of Former Owner ......................................................
! 1. Zone or use district in which premises are situated ...............................................................................................
12. Does proposed construchon wolate any zoni_n~q law, ordinance or regulahon? ....................................................
· _ . Mrs. R. Hoad.Iey Fishers Tsl~nd , 670
]3. r, lame of (2whet or premises ........................................ Address ........................... : ................ Phone NO ...................
None
Name of Architect ..X;,...,,~a~:[..~ .......................Address d~.j...~,.~.~...~E;, ,,~ ........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 froi
property lines. Give street and block numbers or descnpt~on according to deed, and show street names and indica
whether interior or corner lot.
Alterations consists o/~ a Dormer lenghts of House on
STATE OF NEW_¥OJ~_ }
COUNTY OF .......... S.S.
~o Jo~g~ i~.,.~...~.. ...................................................... being duly sworn, deposes and says that he is the applic
................ i~'(~'&'~' c~' individual si~ning .application)
above n~med. 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
this application; that all statements contained in this application are true to the best of his knowledge and bel
and that the work w~ll be performed in the manner set forth in the application filed therewith.
Sworn to ~be~ me th,s ~
....... .>....:. ......... ......