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HomeMy WebLinkAbout4112-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPAHTMENT Town Clerk's Office $outhold, N. Y. Certificnte Occupnncy No. Z.3788 .... Date ............. Apl':L1... ~1~.., lg~0. THIS CERTIFIES that the building located at ...~. 8~ '~ '~ .'. Street Map No.. ~ ........ Block No .... ~ .... Lot No...~ ..... ~~.. ~.~ ...... conforms substantially to the Application for Bulldog Permit heretofore filed in this office dated ........... 0e~"31' ' ' 19.~ p~su~t to which Build~g Permit No. dated ............ 0~'~' ' ' 3~" 19.68' was issued, ~d conforms to ~1 of the require- ments of the applicable provisions of the law. The occup~cy for which this certificate is issued ~ .... ~vate' ~e- f~l~ .d~.l.l~. ' The ce~ificate is issued to .. Jo~' D~VOl.~O ........ ~ ......................... (owner, lessee or ten.t) ~ ~e aforesEd building. S~olk County Dep~tment of Health Approve .- AP~. t'7" ~970' by'R-...~lla- · , ''/~ '(~~Mg Inspector( .......... I~OP~M NO, ~ TOWN OF $OUTNOLD 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) 4112 Z - ~,-~ission is hereby granted to: ~---~ J,,..,hnm~l...,l~ .... ,~olm. ~LJJ3.Zn ............... at premises located at ...................... ]ll~'J~....~Jl~..~,CRg..&.~1~ .......................................... : ......... i.~. ............................................ I~.~.t~.t~r ......... ~I. ........................................................................... pursuon¢ to application dated ........................... .~ .........~], ........... , 19.~.., and approved by the Building Inspector. F. s......~..O..~...~... ....... Building Inspector S-9 SCHD Bldg. Permit No. TO WHOM IT MAY CONCERN: at have been inspected by this department and found to be satisfactory. Di~trlo~ ~ineer APR 1 ? District Engineer FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~;outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions BLDG. DEPT. TOWN OF SOUTHOLD 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. Fn[r~ualra~UoWr~Yop°ofgrP, r~P.arty with .accurate location of all buildings, property lines, streets, and unusual 2F ne approval ofa~he~t~e~)~[~Of water suppY 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-ex,sting or land uses: 1. Accurate survey of peopertY showing all property lines, streets, buildings and unusual natural hic features. topograp ..... ,,in.~ ow r as to use, occupancy and condition of buildings. 2. Sworn statement ot owner or pr= ....... ne 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'existmg aweHmg landuse __~re-E×lst. ing C.0. $15 00 /~,,~G.~opy of cert f cate of occupancy $1.00 ~/acant. :La~d C.O. $ 5.00 Date..~/~.;...o~.~/../?..~.~.~. ..... Old or Pre-existing Building ............ Vacan.t L~nd ............. New Building ............. ~//~.,~c¢) ~ ........... Harnle~ Location of Property ·. · ............... House No -- . ,Street Owner or Owners of Prope ty · ~ .......... Coun.ty Tax Map No. 1000 Sectio.~n .... .~.~. ....... Block ..... /. ......... Lot .... ~ .......... ~ ~~ ~..~l~-. ...... Filed Map No ........... Lot No .............. Applicant .............................. Date of Permit .......... Permit No ........... Health Dept. Approval ......... ' .....Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate .................. Final Certificate ....................... Fee Submitted ............................ Construction on above described building and/l~rmit meets all applicable codes and_.~ations. Rev. 10-10-78 APPLICATION FOR BUILDING PERMI*[ Dote ....... 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 O. detailed description of layout of property must be drawn on the diagram which iS part of th s app cation. c.' ,The work co~ered~ by this application may not be commenced before issu~ce of Building Perr~.it. d. Upon approval of this application, the Building Inspector wil ssue a Building Perm t :to ~he ol~p leant Such permit ~. shall be kept on the premises available for nspect on 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 have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ssuance of a Bui d ng Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other app cable Laws, O~inances or Regulations, for the construction of buildings, additions or alterations or for remove or demolition, as herein described. The applicant agrees to comply with all applicable aws, ordinances, building code, housing code, and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized oh'icer. (Name and title of corporate officer) 1. Location of land on whic~pro~osed work will be done. Map N~.: ........... ~ ........;~..~; ........ Lot "o.: ..'"~" ... ....... 'Sfreet and NUmber ~'.~.~..~, ~ ~.~.~ x~ I~.c~. ~ ~: ~ ~.,.~.,..~.. ~ ' '~' I -- '"7 ~"~' ~ Municipality 2. Stote~xistinguseand occuPancy o~pi~_,mises and /~]~nded use and occupancy of proposed constrUcfi0n~. . a, Existing useand occupanCY ..~...,.~:......~..~._.....~ ....... .~.. ............. ~,.,.,; ....... ............. ;..,...,.;:.~.~..; ........................... b. Intended useandocc'uPancy~,~.~..~..~.~..,;;~'~0.~;..~-. .................. : ......................... i,.... 3. Nature of work (check which applicable): New' Building ..i ............... Addition .................. Alteration .................. Repair ............ ~,... Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .........~. .................................................... (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, cbmmercial 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 ................ y .............. /. ?~ 8. Dimensions of entire new construction: Front ....~. ............................ Rear ....~...7... ................ Depth ..,~...~. ............... Height ....,/...~...~ ....... Number of Stories ........ ~ .......................................... ,[ ~ .................................................. 9. Size of lot: Front ..... ~.~...?....~. .......... Rear ...... ,Z...O....o. .................... Depth ...... ~..~...~ ............... 10. Date of Purchase ..../~~ ................................. Nome of Former Owner~' ............................................ 1 !. Zone or use district in which premises are situated .~. .................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation?~ ....................... :~jO' ................... ', ........ Name of Architect ...~.i¢?..k......~'...4...~S..~.....~...D....O......c~... ....... Addres~ .~.~ ............... .~......~.. ............. Phone No..~.?....-..J..~...~? Name of Contracto~..~....~......~.~.~....~.~...~..-~. ........ Address .~ ............... Phone No. )..~.~..-:.~..~.?./. PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate ~hether interior or corner lot. ST^T~ OF N~t--YO~'C~ . ~ ~ S S Cou~r~, OF ..~...~" ~. ............................................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing application)~ above 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 all 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 Jn the application filed therewith· Swam to before me this ............... s.t.,yof ............. ............. , ' ~ .~ ,~,_ , --~~ . ,o, .... /..L.....r..!..~.....c:~....~...~ ......... ~ ...................................... Nata Public, (Signature of app,cont) NOTARY P~[~LIC, Sl/ate of New Yo~k · No. 52-0618100 Suffolk Coun~f Commission Expires March 30, 19~L~ NOTE · · MONUMENT SURVEY FOR JOHN ~ FRANCES MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY~ N.Y. SCALE' I"' 50' SEPT, 4, 1968 DIVELLO LANO N.Y.S. LIC. NO.~STE5 RIVERHEAD, N. Y. \ oB° · · MONUMENT SURVEY FOR ,JOHN ~ F'RANCE$ MATTI'I'UCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SCALE' I"' 50' SEPT, 4, 1968 DIVELLO LAND SURVEYOR N.Y.S, LIC. N0. ~-87,~5 RIVERNEAD, N. Y. 60o~° NOTE i=MONUMENT SURVEY FOR JOHN ,~ FRANCES MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, SCALE~ I''~ SEPT. 4, 1968 AUG, I, 1969 APR. 8~ 1970 DIVELIO i~id;Island'rLumbe~ &-$~p,,ply (:o,, InC.