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HomeMy WebLinkAbout6828-zFORM NO. 4 TOWN OF SOUTHOLD BUHDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.. 7.~681 ..... Date ..............D.e.e. .... .6. ..... , 19.7.~. THIS CERTIFIES that the building located at . 14s~atot~ka. Road .......... Street Map No...xx ........ Block No. XX .......Lot No... ~X... Ha.t..t~.t.u. qk...N. ;.Y.; ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .........A~g.. 27. .... , 19.7.3. pursuant to which Building Permit No..6.~.2..8.Z.. dated .......... AUg.. 28 ...., 19.73., was issued, and conforms to ail of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .P. ri.v~te..Cacce~sorY.)., sw~u~J~g, p. O0~..~..f.e.nAq ...................... The certificate is issued to Baro~,d. ~a~.r ....... . .o~..e..r ............................. of the aforesaid building. Suffolk County Department of Heaith Approvai (owner, lessee or tenant) · .~,R* ............................. UNDERWRITERS CERTIFICATE No..N..tt~;~;l.~. ...... ~ept..i3 .... ~.973 ........... HOUSE NUMBER...218.~ ...... Street .... .l~rs,~o. oka .~.o~.~ ..................... ..... /.. ~o:.~. ........... "~':' :" '1' ....... Building Inspector FO~.M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUYHORIZED) No. 6828 Z Permission is hereby granted to: .ttl~A..~..~ ....... ~..~......1~r.~J...~. ........... ...~.~.o.......v..e..~.?~..~?.......~.s...~...~ .............. to ~nstall and maintain a p. rivate ~..V~..i~..~..p..~..~...~....w...i..t...h.....r"e..q..u~...~....f..e...~....e.. ere at premises located at ...J~...Z'...a..~.O.°..~...a.....R.g..a..~. .......................................................................................... ~attituek ~.Y. pursuant to application dated ........................... ..A..~..g.....~. ........... , 19.~.., and approved by the Building Inspector. ~JO'A~l aeect u~derwrtters certifioal~e & C,/0 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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: l. Final survey of property with accurate location of oil buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposol--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences end similar buildings end installations, o 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" land uses: 1. Accurate survey of property showing oil 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. Dote of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare o certificate. C. Fees: I. 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 I"~ / b / ? ,~ New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...~. ............... .~.:.~....~....~ ........ ~ ............................................ Owner Or Owners Of Property ..?.~.....~...~....~ .................................................................. Subdivision ................................................................ Lot No.....~. ...... Block No.......'-q, ..... House- Permit No.~..°cPd...~....~'..... Date Of Permit .~../...~.~,/,7..~..Applicant .....~. ............................................................ Health Dept. Approval ..... ~ ................................. Labor Dept. Approval ........-~. ....................................... Underwriters Approval ...~...../.../...?'....~..~...~.. ................. Planning Board Approval ........ '---. ............................... Request For Temporary Certificate ...........'----~. ............................ Final Certificate >/ Fee Submitted $ 5 Construction on above desc~'ibed building and permit meets oil applicable codes and regulations. Applicant ....... ~....7~..2 .~ ........................................................... Sworn t.~..before me ~ Notary Public .................................... County · ,i i .$'~ c r ~ o ,., ~ ' Id, N 114414 ~..=,~do. eptembe~ 7, 1973 andfoundto~,n~mp~ta~ew, ththe~qulrementsofth~B~rd, ]~,~ .KKS I 0mS [m~ WA~ERS ~HAUST FANS TIME~S ~ [UHITHEAT~ MULTISTAT RXTURE L A FIXTURES OUTLETS ~..ECEPT CIES SWITCHES INCANDESCENT FLUORESCENT ! ! , ~ 1 1 1 DRYERS FURNAC~ MOTORS FUTURE APPliANCE ~EDERS ANJ, K,W. OIL H.P. G~'~ M.P. MT. NO. A.W.G. iPE<:IAL REC'PT DIMMERS S R I C A. W, G. NO. OF HI-LEG A.W.G. N~. ~ NEUTRAL5 A. W, G. OF NEUTRAL (Swimming Pool) This certificate covers compliance at the date o;f inspection only, Because of unusual environments it is advisable! to have f~equent test and/or repairs made b~ a qualified person.I BUILDING DEPARTMENT ~'~ ~-~.~-~ ~:~/~.~.~.~A/~- TOWN CLERK'S OFFICE ~ . /~. '. SOUTHOLD, N. Y, Application No. Approved ........................................ . 19. pemit NO.. .....- ........ DisopproYed a/¢ ................................................ - ' ..................... ............................. APPLICATION FOR BUILDING PERMIT Date ....~&l~l~l.~...~. ..................... , 19..7.,,~. ..... ..... ~ :INSTRUCTIONS- a. This application must be completely tilled in by typewriter.or im ink ~d~submitted ,in triplicate to the Building Inspector, wi 3 sets of plan~, accurate plot plan to acale. Fee according to schedule. b. Pldt plan showing Io¢~lfiod'of lot and"of buildings on'premises, relationship to adjoining premises or public streets or areas, giving e detailed description of layout of property must be drawn on 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 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 MAOE 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 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, and to admit authorized inspectors on premises and in buildings for necessary inspections~ SESAME CONSTRUCTIDN SERVICES INC ................... ~~ ( ....... ........ (Address of applicant) BoboBI&, New l~ork State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plu .mber or builder. builder ~ame of owner of premises ................. ~H&Eo~Ld...Gs~.J~ .................................................................................................... If applicant is a corporate, signature of duly authorized officer. /Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... O;ther Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ......................... Street and Number 218~. t4~rratooka B. oad~ ~attltuck Municipality 2. State existing use and occupancy of prem(ses and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~{~.ql;~...~W.~.~,~,.tl3&...-.....~.~.!~..~...;~.~t.~,~. .................................................... b. Intended use and occupancy ~1~.~..~.~g&~..q~j*~..-*~.~.~*1.~*ig`.~*.e.~.~.~.~..~..j*.~.1.~.~ ........................................ 3. 'Nature of work (check which applicable): New Building ......... ,~ ........... Addition ..................... Alteration ...... .'. ....... · Repair ..... Removal ................. Demolition ........................ Other Work .~t~/~ll~,..~,o~.l?...' ............................ · (Description) · 4. Estimated Cost ~2 e 900 Fee 15 · O0 ................................... ............................................................. i[;'l~'l~';i*~l*;~"~i'li~g thi; a~;i'~;~ti*(~n) .......... 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 occuoancv, 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 ....... .1, .~.. ............. Rear ...... ~ ................. Depth .....,~.-..?.~ .................. Height ................................................. Number of Stories ............................................................................ ... .. .... .. · · 9. Size of lot: Front .............. 1..0...0. ................. Rear ....... .~.~.0........1..0..0. ............... Depth ....... ~,.~. .................................... 10. Date of Purchase ..................................... Name of Former Owner ............................................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed constructiOn violate any zoning law, ordinance or regulation: nO 13. Will lot be regraded .............................. Will excess fill be removed from premises: [z] Yes [ ] No Harold Carr 2185 Narratook Road, )(att/tuck 2~8-½68½ 14. Name of Owner of premises ........... ! .............................................. (Address) (Phone No.) Name of Architect ....G.y. qll~.~..,~;I..v, fl~'...~.~.it~...~.P.~,..~.~O...Y.~.t~li ~1~.~ ~.IAI~JII~.~, ............. ~[~.-.,,~.~. (.A.d(~ress) (Phone No.) ~ _ Groat River Pool Corp, 3½50 ve~e lt~y, Bohemia dU8-33b~ 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 wheth- er interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ................. ~1~ .................. ) CAROL CARROLL ~OTARY PUBLIC, State of Ne~ No. 52-4501567 PLEASg ltOLD FOR FICK UP Qualified in Suffolk County Commission Expires March 30,19 ~ SESAME CONSTRUCTI DH SERVICES INC, ...................... ¥~,l.liaa...v,o...;,.~Au ....................................... being duly sworn, deposes and says that he is the applicant above named. (Name of individual sign lng contract) He is the .................................................... ..b...u:.'.l..1...d...e...~. ......................................................................................................................................... (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 applicatio~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. .............. ........ ...... .............................................~ ~ff/~ ~(Signature of~icant) ........................