Loading...
HomeMy WebLinkAbout5036-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED C.O. Certificate Of Occupancy No.Z. 1..5.0.2.5. .......... Date October 22 ., 19.8.6 THIS CERTIFIES that the building..Qram..~t~a,i.l.s?..d.w.e.1.1..i.nsc ....................... Location of Property 155 Manor Road ~ East Marion House No. Stree~ Hamlet County Tax Map No. 1000 Section 38. ·Block 4. .Lot 5.1 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated · Oct. 27 19.7.0 pursuant to which Building Permit No 5036Z.. ......... dated . .O.q~:,..2.8. .................. 19..7.0, 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 ......... One family dwelling with attached 2 car garage. The certificate is issued to [I.~rl~rt J.. Ecjert & wife. (owner, ~x of the aforesaid building. Suffolk County Department of Health Approval .... J.u~O..2.3 ,..1.9.7. .1..R.o.b..e.r.~..~.:..Vi:. ~..1.a .... UNDERWRITERS CERTIFICATE NO ............ b]13 ~3 p.3.q,~ .............................. ****Update of C.O. Z4272 June 23, 1971 Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE~ UNTIL FULL' COMPLETION OF THE WORK AUTHORIZED) 5036 Building Inspector. Permission is hereby granted to: ~ · ; ' - ' ............ Wee>,,baa~tea~:.....~3f~* ....... r ................ to .. lh~lcl.,.~t...o~..~l~..~ ~ .............................................. ~.: .................................. at promises I~ated at ......... 1~2~...,,..-.~.~ ...... ::g ............... ~..,.}~ ................................ FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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 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 iprior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pZOperty 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 oc_cupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 ~ed C.O~ $15.00 Date. 10/22/86 NewCons truction Old or Pre-existing Building Vacant Land 155 Manor Road East Marion Location of Property ................................................................... House No. Street Hamlet Owner or Owners of Property .Herbert J. Egert & wife County Tax Map No. 1000 Section 3.8 Block .4 Lot .... 5....1 Subdivision MARION MANOR ................................. Filed Map No ........... Lot No .............. 5036~ Date of Permit 1.?./.7.0 Appmicant 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 perrptt mepts all applicable go,des and regulations. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy ...~ ~ .3. o ............. Date ............ , .... THIS CERTIFIES that the building located at ~~..1_ ~..,/ /'~..f~....~. ~C' .... Street ~a~ ~o.~~~o~ ~o ........... ~o~ ~o.. ~.~ ...... e~.~~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ... (~,c... ~'.~ ....... , 19~.~. pursuant to which Building Permit No. dated .... .(~... ~-..~. ...... , 19 .~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is .......................... -- ' ........... ~.. .... 1 ................ The certificate is issued to .f~...~~. <owner, les'sb~' ~; 't~t'>' ' ' of the aforesaid building. Suffolk County Department of Health Approv~ ...~..~... ~.~.?./......~....~.'...~. "~ff~-- ...... .... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH TO I~HOM IT MAY CONCERN: The sewase disposal facilities for a structure located (Give deed have been inspected by this department and found to be satisfactory. Chief of General Engineering Services JUN TOWN OF soUTHoLD ~/~/~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~/ S~THOLD, N. Y.. -- Approved ...................... ~.] ............... , 19..:I... Permit No.."~...~....~.....~.....Z'~... ........ Disapproved a/c ........................................................... ~ ..~ ~,~ APPLICATION FOR BUILDING PERMIT ~ Oat, ............................... ,19Z ..... INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink und submitted Jn 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 data,ed description of layout of property must be drawn on the diagram wl'~ch Is part of thle appllcation.~] 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 wJJl 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 port for any purpose whatever until a Certificate of C~:c~ancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY NgkDE to the Building Department for the issuance of a Building Permit pumuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~,nd other applicable Lay4, Ordinances or Regulations, for the construction of buildings, additions or alterations or for removal or demolition, al herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and rogulatlons.. (Signature cf applicant, or name, if a carparatlon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genercl contractor, slectriclon, plumber or builder. ........ .................................................................... owner of premises .......~...~...~.~...~<...~/~...........~....~..~-d~- ..~.... ........... ............................................................. ..~ Name of If a~ isa corporat~~f~.,~duly authorized officer. (Name and title 'of corporate officer) ~ 1. Location of land on which proposed work will be done Map No,: ..... .............. Lot No.: ,.~...~.. ........... Street anON, umber__ ........... ,/..~ ~ ~Lu .............. m '. Municipality ''''''~''( ........... '/~ ........................... 2. State existlng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ..k(.~l~..~..~l~.,~,,4~....~..~....'~... ........................................................................ b. Intended use and occupam:, .. ..,~J~,-4~....~r'~--,~'/.4~..~.. ..................................................... 3. Nature of work (check which applicable): New Building ......"~... ......... Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ....~...~.~..4~'4:~....'.....~._. ...................... 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 ........................ 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 ..... ~ .......... ~'. ............. Rear-~../.......~. ........... Depth .~.~,.~....:~.. ........ Height .,~-~..../.. ....... Number of Stories ....~... ............................................................................................................. ' 9. Size of lot: Front .../..~..~..:...~....../..... Rear ../.r-~.......~..~.. ................. Depth ../...~. ~'~.....:....~..?..../. .... 10. Date of Purchase ....... ~....~*...,T~...~...?..~.. ......................... Name of Former Owner ..,~..4F4~,~.~...~........~..~.~.DX'~. ................ 11. Zone or use district in which premises are situated ...... -a~ ........................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... . .~...~.. ............................................... 13. Name of Owner of premises,,~:~.....~..~....~...~T~... ....... AddressZ~.,~'...x~...~..4~'.~..~...~.. .......... Phone No~.~...7...-'/...~-.~...~.. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor~fae-n~.a~.'.~c~.a.~..,~e..~,l~'x:~-,~...Address .~..~',L~...,~.~~ ........ Phone No?-~...-C..?,~.?-,~. 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. OF NEW YOR . t S.S e -I 'l COUNTY OF · ~....~..s~-~..~.. ~..' .~..~...~.s~..~ .............. being duly sworn, deposes 'and says that he is the applicant (Name of individual si~ning application) above named. He is the ....... ~,~F:~'.f,~/,~...c~.~'..¢::~:~.~ ............................................... ~ ....................................................... (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 applicatio~ 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. Swam to~fore me this ~ . ~,' ' .......... day of ....... ........ . Notary Public, . ............ County. (Sign~...~ ~. _~.~...~,,..t) Ii Jj ~AbT ~AP..lOt, J - LO~IC~ ' ~CALF~: ISLALJD byu ~¥ it-o iL~ T ........ t%_?Z' ~ ¢7~LK ~' LLo, cLe. bED~2OOM ~' BEDROOM EAST MAI~IO~ - LOW& IOLAHD -t '~ ~ LE ~"-- I'--o'~ EAST MA~IOIJ ~ L©t, J4 :~5LAt, JD