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HomeMy WebLinkAbout3724-zFOP~M N'O. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~..., .3.~..0. ,3. .............. Date ........... ~.une .......... THIS CERTIFIES that the building located at .~.~.¢.~.~...]~¢...~.g~,~.V. fit~.f~. ................. Street Map No ..... ~[ ............. Block No ....................... Lot No~..&..[6.....~S~.e[.~...~e~...~[~ ........... conform~ substantially to the Application for Building ~rmit heretofore filed in this office dated ................. ~ .......... ~.~t. ............. , 19...~. pursuant to which Building Permit No. 32.2~..~.. dated ...... ~.~.~ .......... ~.~ ............ , 19.~Z.., 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 ........ ~.~.~..~...~.~. ~.e~g ............................ The certificate is issued to ....~..~...~.~[~..~.....~.~.) .................................. (owner, lessee or tenant) of the aforesaid building. /~, ~), (:r..~'~, ~__ ......................................................... .......... Building Inspector TOWN OF sOOTHOLD BUILDING DEPARTMENT, TOWN GLERK'S OFFIGE ~- SOUTHOLD, N.'Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON, THE P,I~EMISES :UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3724 Z Permission is hereby granted to: at premises I~ated at .............................. ~/~'..~e.,~,,..~'~'.-.~. ...... ~.., ................... : ..................................... pursuan¢ ,to opplication dated ............................ ~t/ ......... ~.~. ....... ~.,, 19..~.., and approved by the . Building Inspector. ,Fee $...].g.~O~ ......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. (Building Inspec;~:)r) APPLICATION FOR BUILDING PERMIT ote .............................. , 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 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 a 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 part for any purpose whatever until o Certificate of Oc, cupancy 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, building code, housing code, and regulations. (Signature of applicant, or name, if o corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ....... ..................................................................................................... Name of owner of premises ................................................ · ./~ ......... ,.,. .................. ; ....... .~ ......................... %_; ..................... (Address of applicant) If applicant is a 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.: ......... ..~.-..,/ ...................... Lot No.: ../:.~.....Y?.../.'.~ .... Street and Number .Z..~.,..L~..~,:.4./../.?......'.~....~....~......~?...~,.~.x.,~....'.~.~....~,~,~ ......... .~..~.'.i.~?.'~.'..~.~.~.......~....~..~/;T'~.~ ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... :~..~,..~...~..:/}/...T..........~..../.~.. ~./..c.~ ............................................................................. b. Intended use and occupancy ........ /. ...... . ..~.....~,..4. ~ ../..~,~,,, ....... L~....~...-..~.~ j.~...z.,.../~ .~../...~..~. ......................................... 3. Nature of work (check which applicable): New Building .. . .'. .. ~, ....... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ...... ~ ......... Other Work (Describe) ........................................ 4. Estimated Cost ....................................................... Fee ....!..O./. ............................................................................... (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 ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~....~...~..~.L( ....... Rear ......................... Depth ....~..~. .............. Height / ~ / Number of Stories 9. Size of lot: Front ..... Z~...~ ......... Rear ...~,~.~....Z~epth... 10. Date of Purchase ...................................... : .............. ~x m of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~.~ ........................................... .................... .................................................... PLOT DIAGRAM Locate clearly and distinctly all 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 whether interior ar corner lot, r/ .OUN -Y OF ........... be,ng ~ ~ duly sworn, deposes and says that he is the applicant (Name of individual s[gnMg appian) ~--- : ~, aflow~ named. He ,s the .......................... ~ ............................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or h~ve 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 in the application filed therewith. Sworn to b~ore me this . .~-~.~ / 7,~ ........ FOBM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No. 3 Disepproved o/c .........."~,* ....... ~,.., ~ .................... ...... ~:::~, ~'~ .............. ,z~..... ........................................................... . .. .................... ~ . . . ~,-,~;% . . . . . .~: ~ ~ ...... ,. / ~. ~C.,-~ · Application No.~? 7~" ~/ APt~LICATION FOR BUILDING ~EII~IT Date ................ ..................... ...... INSTRUCTIONS o. 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 a 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 part for any purpose whatever until o Certificate of Occupancy shall hove 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 Lows, 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ....... Name of owner of premises ................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ~' / Lot No.:/,~.~..ff...../.~' ..... Street and Number/?~.~..~.~.~.~.~/.{/..~c``/~.~..~`~.~.~.Q~.~..~?.../.z.~/.~.~..~'.~..r~.." .............. ~'.........~.....~...(.~....~.....Iwr:... ..... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use end occupancy b. Intended use and occupancy ....... J ...... ..~.....~...?..~!..L..~... ~.~.. ....... .~...././. !./....~.. ~; ~...]..~'~..~. Z. ............................................. 3. Nature of work (check which applicable): New Building ...... ~(, ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ...... .~ ......... Other Work (Describe) ........................................ 4. Estimated Cost ........... ~.?...L..~.,.~,..~ ........................... Fee .~..~.....I...~ ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ./. ................. Number of dwelling units on each floor ........ .J. .................. ! 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 ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear r)epth ................................ Neight ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...~....7...,....~ ................. Rear ........................... Depth ................. Height / /~' ~ Number of Stories J 9. Size of lot: Front ...... ../..~...¢..../. ......... Rear ./I...J,.~./~../7.~.~........7...~:...r..... Depth ...~.:H..~...t....~...../..7,...~'.. / 10. [)ate of Purchase .... /..~...~..~..../. ........ ./..~...~.....7. ............. Name of Former Owner ........................................................ ] 1. Zone or use district in which premises ore situated ..................................................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation? ......... /f./...~. ........................................... 13. Name of Owner u. UEu..~u~,: ....................................... r~u~,~o~ ............................................ Phone ..................... Name of Architect ..?.:....~..~....~..~.....~.......~.'..~..(.~....~..'...~.....Address ...,.~./.:.~'..:....~.~...'. .................... Phone No ..................... ............................ : ........................ ....... ...................... PLOT DIAGRAM Locate clearly and distinctly all 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 whether interior or corner lot. t7% STATE OF NEW"YO~ ~/' }-cc ~/{~)~ ~.~C~_.~*...~ 'el dulysworn, deposes and says thot he is the applicant (Name of individual signing application) (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to m~ke and file this application; thai' all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Public,/-L.J. f3,Z~z,~r~.....~..,..Ct,~6.-v~I/.. County (Signature of applicant) J NOTARY PUBLIC, S[~Le of Nol~Yor~ No. 52-3233120 Su(/olk CouIIt~ Term ExBires IVLarch 30, s-9 SUFFOLK COUNTY DEPARTMENT OF HE~kLTN Date ,~ Bldg. Permit No. TO WHOM IT MAY CONCERN: The se~ge disposal facilities for a structure located at, /~ ,/,,~ ~/~l~ e d lo'ac afro n )/~/~-~//' ....... have been inspected by this department and found to be satisfactory. District Engineer Bo FORM NO. 6 TOWN OF SOUTHOLD Building P~eparzmen[ Town Hail SouthoJd, N.Y. 11371 APPLICATION FOR C."*RTt?ICATE OF OCCUPANCY Instructions This application must be fi{led in ~;ypewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of properW with accurate location of all buildings, property lines, streets, and unusual n-~tur31 or tooogranh c fe3tures. 2. Final approval of Health Dept. of water supp y and sewerage disoosal--(S.9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, ndustrial buildings, Multiple Residences and sim lar bulldm tions a certifl ' ,,,~ ...... ' ' g~ and insta a ~ ~ ' '. om .ca,~e of C,~,,~ vumpnance ~rom the Architect or Eng neet res~onslble'for ,,. ,,uom~t ,,arming ,~oard approval of completed site plan requiremer~ts where 'applicabl~*~' For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peopert¥ show~n9 all prooerty lines, streets, buildings and ~nusual 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- t/on required to prepare a certificate. 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 .. April 19, 1983 g(×) .. ~ ' - New Building ............. Old or Pre*existing BulJdJn .... ~ Vacant Land ............. Loc ti alp Peconic Bay Boulevard a on roperty .......................... Laurel ~'OU~ NO. ' ..................... ~ ....... "'~ '. · . ....... Srr~e~ Hamie~ Owner or Owners of Property Kenneth p. Co p N 1000 ti 126 unty Tax Ma o. Sec on Block .... 4 15.1 Subdivision Filed Map No ' Lot No ' Perm t No Da~.e of P ' Health Dept Approval ' Dep1~ Approval ......................... Labor . . ..................... ~.. Underwriters Approval Planning Board Approval ' Request for Temporary Certificate ' ..................... Final Certificate ........ Fee ~ubmitted S .... ~ ................. Construction on above described building and pern~;t'~eels al; appL~cab~e,,,Co~es and regulations. ~._~*(3, ~---~tO...~ A~Uca~t Rudolph H: Bruer, Attorney for Applicant ,., ,o,o,a S ...... ....... :: ....... .............................