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HomeMy WebLinkAbout4161-zFOF,~ NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No...~.~3.0.1 ..... Date . .J'.l~-..Ir. .2.6. .................. , 19..7.~. THIS CERTIFIES that the building located at .... ~.2..0..~..~.~.s.e.t...L~..t.e. ...... Street Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .Dec~b®r. 30 ........ , 19.66. pursuant to which Building Permit No. ~.1.~.1..Z.. dated .D..e.c.e.~.b..e.r..~.0 ......... , 19.~..8., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....Pr~v..a.t.e..0..n.e..~!..w~.~.~.y.. ~.e..3~. ~n. g ..................................... The certificate is issued to ........ ~.~..b.e.r.t...D..S~...z~.o. ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........... .N. ~R.: .................... UNDERWRITERS CERTIFICATE No. N.Ro HOUSE NUMBER . ~.2.0. ......... Street .~.u~..s.e.t....L~q..e.s..G.~...e~m. ~.o..~.t.,..~; .~... ........ Building Inspector FOR.,~ N'O. ~ 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) NV 4161 Z Permission is hereby granted to: ................. ~,~'cc,r.t;..,~,.t~Izi~ ............................ ................. ~uase. t..~. ......................................... ...................... ~lr~el~.~r.t.....~.,~.~ ..................... to ~lld,~,~ ..~,.. ad ~.tJ.cn ..m~.. ~r,..~ x~.s.t Iz~ ..d~e.~,i~n~ ...................................................... at premises located at ....~. ....... l~,$f~.~...T~ ..................................................................................... .................................................. (J~e~z~ol'.t ........... ~;~.~;, ................................................................... · '3 pursuan,t to application dated ........................ ~..~.~.* ....... ,~. .............. , 19...~[,.~1, and approved by the Building Inspector. Fee $...~.'.~.). ........... Building Inspector FOI~ NO. $ TO'lq OF $OUTHOLO Building Department Town Clerks Office Southold, Iq. Y. 11971 APPLICATIOlq FOR CERTIFICATE OF OCCUPAlqCY Instructions A. This application must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector 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 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 installations, 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 property 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 formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ~ Date December 13, 1978 New Building................X Addition ...... .X......... Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...4..4....S...u..n..~..e..t;...L.~,~.~.,....~;~.~.~D.P..9.~.,...~w...X~rk .............................................. Albert and Mary Ann Dinizio ....................... Owner Or Owners Of Property .............................................. SubdiviS'u~ .................................................... ~ ........... Lot No ............. Block No ............. House No ............. permit"t~6~. .............. Date Of Permit .~.~.Z/..:/.'~...Applicant .................................................................. Health Dept. Approval .............................. Labor Dept. Approval .................... Underwriters Approval ........................................ Planning Board Approval ........................................ X Request For Temporary Certificate ........................................ Fined Certificate ................................... Fee Submitted 2.0 0 Construction on above described building and~/d~//~,~ me~t~s ./aleph, codes and regulations. ........................................... Sworn to before me this ...1.~.h...... day of ....... .D...e..c..e....m~....e..r..,....1...9..7...8.... Notary Public ....... .S..u,..f..f, .?_1., .k. ............ County (stamp or seal) ~ARA D1ACHUN pub c, State ?~ ,,New yor? ~635i90 Sudo~ Cou~Y~0 .......................................... , .... _, . .~ Apphcatfon No ........ ~.~. .............. c~ ^ppmved .............. ; .. 19 ..... Permit No '~/ /' ~. --4 .... ' ............................ u,sa rovee a/c ................... . ~ PP ............................................... ~ ............... ~ ~4' lqT/ 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 adjo ning prem ses or public st.reets or~' areas, and giving a detailed description of layout of property must be drown on the diagram which is port of this apphcation. ~:~ 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 a Building Perm t 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 have been granted by the Building Inspector. ~ .A..P?LI~CATIO~N ,IS HEREB. Y. MADE to the Building Department for the issuance of a Bud ng Permit pursuant to the ouilaing Lone uroinance 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, building code, housing code, and regulations. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. am f net premises/~ ~*- · If applicant is a corporate, signature of duly authorl~z~d officer. , (Name and title of corporate officer) I. Location of land on which proposed work will be done. J~Aap No.: ...................................... J. Lot NO.: ........................ Street and Number .... ~'~//~~....~ .................... ~i..i.....I ................................. ~4Vluaicipohty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use~n~ occupancy ......................................... . ..... b. Intended use ar~l occupancy . . .i ....................................................................... ~t 3. Nature of work (check which applicable): New:Buildlng '.] ................ Addition ................. ion .................. Repair .................. Removal .................. : Demolition. ................. Other Work (Describe) ........................................ 4. Estimated Cost ........~ .................................................. e .,?: ..................................................................................... ' '(to be paid on filing this application) 5. If dwelling, number of dwelling units ........ J:i .~..J ........ :...N~ml~er of dwelling units on each floor ............................ If garage, number of cars' .......~.. .................................................................................................................. :;... ............. 6. If business, commercial or mixed occupancy, speci~ nature and extent of ee~ch type of use ............................ 7. D .... of tf Front 3~C'---' mens,ons ex st,ng structures, any: ....... ............. Rear ...... ................. Depth ................. Height ....~..] ............. Number of Stories ..,./. ................................................................................................... DimensionsI of same structure with alterations or additions: Front ............. .~.....~:.. ............... Rear 7~L: . ' Depth ~......,~... .............. Height .......... .~....~. ........... Number of Stories ........ ./.. ..................... 8. Dimensions of entire new construction: Front ........ ~...~.. .................... Rear ..~..~.. ................... Depth ......~....4.~.. .......... Height ....... ~ ....... Number of Stories ....~/..! ..................... : ....................................................................................... 9. Size of lot: Front ....... ~.~. ........... Rear ...... ~..~..~.. ................... 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.;> ...~ ............................................. Name of Owner of premises ~'~.. ~~Address~ ~ ...... ~ ......... Phone No.~..~.....-~.....~..~ 13. Name of Arch tact // ' c~/' '~ ........................................ ........:....Address ............................. .e ............. Phone No ..................... Name of Contractor ~e-~.~~ ............. Address~.~ ' '"/ ............. Phone NoT~'. '.~..--~..~...~...~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setd~ack 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. STATE OF NE~OI:~D/~ i.~ ¢ (Na~e of ind~idual signi~'applicati~) ' above -o~d.SHe is the ........ ~..~.~ ............................................................................................... (Contractor, agent, co~orate officer, etc.) of said ~ner or owners, and is duly authorized to pe~orm or have performed the said work and to ~ke and file this application; ~at all statements contoined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fodh in the application filed therewith. ................Swam to ~fom~d~o[me this ~~ , 19..~ ~~--~ ' ....... .......... ..... .. o¥ ..........................