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HomeMy WebLinkAbout3943-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g. 1.4..4.2.3 ......... DateI~.a. ¥..2.1. .......................... 19.8..6 THIS CERTIFIES that the building ...~.d..d.~.t.~.qn.. 9..~..1.t.e.r.a..~.~?.n. .................... Location of Property ........ 6. .1.3.5...I .ri.al.i.e..n..N.e.c..k..L.a.n..e ............ ?.e.c.o..n.i.c. ......... House No. Street Hamlet County Tax Map No. 1000 Section . .0..8 .6 ....... Biock .... .0 .6 .........Lot..0. ~ .9 ............ Subdivision ............................... FiJed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated ..... Juice..22 ......... 19.6.~ pursuant to which Building Permit No. 3.9..4.3.g. ............... dated ...3.u.l.y..8 ................... 19 .6.8., 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 ......... Addition and alterations on existing dwelling. The certificate is issued to ...%.~.B.~.~. T..3....b.Np..q.U~..E..~.gp.~.~s..*.~.x.~. ..................... (owner~[~(~Yl~ of the aforesaid building. Suffolk County Department of Health Approval ...... .~./.~. ................................ .UNDERWRITERS CERTIFICATE NO .............. .b!./..~ ................................ Building Inspector Rev. 1/81 FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERAAIT (THIS PERMIT MUST BE K£PT ON THE PREMlS~$ UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) N? 3943 Z ................ .t~.~...~..~..i ................. to ................................ ~ .......................................... -:..'.,.,.: ........... ~ ......................................................... ,=,,- p,-e,-,',ises ,,~,=,',e~, ,:,,, .~...~La.~..J~,..~ ...................... i ................. : ....................................... pursuord' to opplicotion d6ted ....................... .~ .................................... , 19........, ~ ~nd oppro¥c~l by tho Building Inspector. Fee $~..~... .............. BUILDING DF..PAI~TMENT ~_T~ TOWN CLE~.K'$ OFFICE ~TH~D, N. Y. o. T~is opplicotion must be completely filled in by t~ewriter or in ink and submi~ in ~plic~e to the Building b. Plot plan show:ng I~ot:on of lot o~ of buddings on prem:ses, relationship to o~join:ng prem~s or public st~ts or areas, and g v ngo deto led ~r pt on of ~oyout of p~pe~ must ~ drawn on the d og~om w~ ch s ~ of th:s oppl cot*on. c. ~e work covered ~ t~is opplicotion m~ not ~ commenc~ ~fore i.uonce of Buildi~ Permit. d. U~n oppr~ol of this application, t~ Building Ins~ctor will issue o Building Pe~it to t~e .pplicont. S~h ~it ~all ~ kept on the premiss ~ailable for inspection througho~ the p~re~ of the wo~. e. No building s~ll ~ ~cupi~ or used in whole or in pa~ for any pu~ose whatever until a Ce~ific~e of ~c~a~y shall have been granted by the Building Insp~tor. APPLI~TION IS ~REBY ~DE to the Building De~ment for the issuance of a Buildi~ Pe~it ~mudnt/to ~he Building. Zone Ordi~nce of the T~ of ~uthold, Suffolk C~n~, N~ York, and ot~r applicable ~, ~i~c, or R~ulations, for the c~struCtion of buildings, additions or alterations, or for removal or demolition, as heroin de~ribed. (Signature~licant, or name, if a co~mt~¥ ........ (~ddre, of ~plicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Name of owner of premises .~ O l- If applicant is o 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.: .................. Street and Number .~..o.~r~.~. ?.~. \~c~,~v~ ..~..~.~...~......~c~.c~ ~' I ~, I :3 ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and acc pa cy ............. .~ ......................... ~:'I ........................... "~ .................................. ~ ..................... b. Intended use and occupancy .......................... ~..~....v~.....~d. ....................................................................................... 3. Nature of w~rk (check which applicable): New Building .................. Addition ~ Alteration ' Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....~.!..~....~...O... ......................................... Fee (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 ...... I..~....~. ....... Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ..... ..~...~..'. ...................... Rear ....~...~..J ................. Depth ....'.~.~.]......~..~.'. ........ Height ........ L~......~. ......... Number of Stories ..........! ..................... 8. Dimensions of entire new construction: Front ..... !..~..~ ......................... Rear .... ..~'...~. ................. ' Depth ........................ Height 1"5' .~" Number of Stories 9. Size of lot: Front .../..D..5'..:..~.~..; ........ Rear ..... ~.!.,..!..0.:. ................. Depth ..~.~.~.'.~..~.~...:~.....~.(~(~ / 10. Date of Purchase ......................... Name of Former Owner ~)..a.~..'..~.)...~....~.!~.......~....o.?¥..~..~..l~ ..... l 1. Zone or use district in which premises are situated ...... ~{\.~. ................................................... ]2. Does proposed construction violate any zoning aw, '~i~ ~'2 '~'~ ~'~;~ ~;;~: ................................. 13. Name of Owner of premises ~l.~.~..(~...~....~i..~.~Rc~ + Address .3.O.~ .~.'WaXo L.~n~occok Phone No.~.'{..~.:...,....~. ~ ...................................................... 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. / ......... ;; ........;..~...; ,. ................. . ........................... 'g y ~ Y ' pp. above named. He is the ..... ~ ................................................................................ ; ...... of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke 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 performe~ the manner set fo~h in thp application filed therewith. Swam to be~er~ me this .......... .............. N , 'c, ....~...= ......... ,.~...~....n.~.,.~... Coun~.j;~; [~;;~;; of applicant) ..... S~MU~ b~ ................................... FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 31971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR ink, and submitted m ~=~=a~a 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 di~posel-(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings. Industrial buildings, Multiple Residendes 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 require~ents where applicable. B. For existing buildings (prior to April 1957), Non-conformingluses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~coperty showing all property lines, strebts, buildings and unusual natural or topographic features. 2,Sworn statement of owner or previous owner as to use, occupahcy 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 dwelling $ ;[ 5.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C, O. $15.0 0 Date ...Ap.r,i..1..2.4,, .1.9,8.6, ........ New Building .... ){ ....... Old or Pre-existing Building ....... : ..... Vacant Land ............. Location of Property 6135 Indian Neck Lane: Peconic House No. Street Ham/er ALBERT ~ &. Owner or Owners of Property .... p.O.D.~..N.S.~.~. ~., ....... . JUNE County Tax Map No. 1000 Section 08.6 Block 06 Lot 019 Subdivision X Filed Mat) No Lot No ' Permit No. °Oc~'~ Date of Permit .Applicant ~,.[,~,e~. J~ . !~od?nstein N/A Health Dept. Approval ....... ,N./.A,, ............. Labor Dept. Ap~3roval ........................ N/A Underwriters Approval ....... N/A ......... Planning Board Approval ...................... Certificate .... Request for Temporary ..................... F~nal Ce~rt~fmate ....................... Fee Submitted $...5. = .0p ...................... Construction on above described building and permlt meets all applicable codes and regulations. ......................