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HomeMy WebLinkAbout6838-zFORM NO. 4 TOWN OF SOUTHOLD BU~.nING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupency THIS CERTIFIES that the building located at liai~. ]k~d. ' Street Map No... X~ ....... Block No. Y,X ....... Lot No.. XX.. liatt~,.~lOk ................ conforms substantially to the Application for Building Permit heretofore fried in this office dated ........ ~pt...~,~ .... , 19.7~. pursuant to which Building Permit No.. ~dated ........ Sept,..lei ..... , 19. ?3, was issued, and conforms to all of the require- /~..___.___.mehts of the applicable provisions of the law. The occupancy for which this certificate is issued is .. l~v&te .9U .falatJ, y. ~heeL].~ ..................................... The certificate is issued to ... A2_el*e~ .~t*on... ~ ................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....~r~..e;r~$.~ .................. UNDERWRITERS CERTIFICATE No ..... .~..~...e~...~...$~. .................. HOUSE NUMBER ],3.3.60 Street ~ ~ ...... ~att~tu~k Building Inspector FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTIHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~REMISES UNTIL FULL COMPLETION OF THE 'WORK AUTHORIZED) N9 6838 Z Permission is hereby granted to: Alfred Kron ............ .~aJa'k.xqoad. ............................................ at premises located at .......~.~.....~:*,~:J~...~OaJj. .................................................................................. .................................................. ~l~ck ...... .r,.~., ........................................................................ pursuant to application dated ...................... ~p% .........]4- ............ 19.~.~.., and approved by the Building Inspector. F~ $A5,~0 ........... Building Inspector ]FO~M N(X I TOWN OF SOUTHOLD Building Dqmxtment Town Cledm Office Soutkold, N. Y. 11971 APPLICATION FOR CERTIFICATE Of OCCUPANCY In~tmctkml ^. 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: I. Final survey of property with accurate iocation of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final a~oroval of Health Dept. of water supply and sewerage disposol--(S-9 form or equaD. 3. ^pproval 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 reqx)nsible for the building. 5. Submit Planning Board approval of completed site pMn requirements where oppficabte. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Swam 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: 1. Certificate of occupancy $5.00 ~ ~ 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 New Buildin- O d or Pre-ex st n Bu Id n ~ ..... g .............. g g ........... ~ ........ vacant Lana ............................ Location Of Property ..~.~.~. ........... ~ ................................................ Owner Or Owners Of Property ../..~.~;J.~.....~ ................................................................... Subdivision/~ t- -~" ................... ~'"""~'"'" ................... Lot No. '"'~/IBIock/./N° ..... ~)~.. House No./.~.~..~..O Health Dept. Approval .....................~....~....:...... ....... Labor Dept. Approval ........... ............................... Underwritem Appro~ol .............................................. Planning Board ~proval ....... ~...~.. ........................... Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ .................................... Construction on above described building and permit meets all ap~.licable codes and regulations. Applicant .............. C~ ..~..~...~k...l~ ........................................... Sworn to before me this U .... ~".~..... day of ...... ~.....~..~...."~....~.,. ....... (stamp or seal) Notary Public .................................... County Examined ....... ~ ...... ..~./....., Approved ................ .~. ...................... , Application No. ]9 ........ Permit No ........... Disapproved o/c ..................................................................... ............. APPLICATION FOR BUILDING PERMIT ........ ................. INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building~ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lat and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofpraperty 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 work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY /V~ADE 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. ....... ................... .... ~~re/~.~j ~°f applicant, or nf3me, 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 ..... ';"/~-~'7 ')~'-'Y (~.....~..~.....~...f...~....~ ........................................................................................... I / If applicant is a corporate, signal/re of duly authorized officer. (Name and title of corporate officer) Builder's Liconse No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which pr_opos~[ work w, ill be d~qe. Moo No.: .......... ~ ....... ~....~.... Lot No...../~... ................. Street and Number . ...~..~......?,/~.....1~ ~...~... ......... ..~.GI, L~...~'~:~ ..................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~~----~..~ ............................................................. ~, ................ b. Intended use and occupancy ~......-Z~'~u,~..~.~~..~ 3. Nature of work (check which applicable): New 'Bullding .................. Addition ..... Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . ..... (Description) 4. Estimated Cost ............................................................ Fee ..... /..~ ............................................................................... - (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... ~..t ........ Number of dwelling ~r~its an each floor ................. If garage, number of cars .................................................................................................... 6. If business, commercial or mixed occupancy, sl~ecify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ,p ................... Rear ........... ~ ....... ............. Depth .................... Height ...... /.,~ .............. Number of Stories: ............[. .................................................................................................. Dimensions of same structure with alterations or c~dditions: 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 Depth -'' ' 10. Date of Purchase ........................................................ Nome of Former Owner '"f;"~'t,;'":'7'"',"~".-~ ..................... 11. Zone or use district in which premises are situated ........................................................................... /.. ........................ 12. Does proposed construction violate any zoning law~ ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No ~ · fl ~ l,,- ' -'~ ~ I 14. Name of Owner of prem,ses ...... ../...., ...... Z...-~......~ .......... Address ,~.,.,t.~....~ ...... .Z.~,~°hone No. ,~;..~..../'.,...~.... Name of Architect ...............:~/ ............................................. Address ................................ x '/ Phone No ....................... Name of Contractor ............................................. '1 ............. Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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. ,,q V sTATE OF NEW {ffOP~__~, J~. I¢ ~ ..................... i.....~.; ....... ~..."....~ ............................... b*in~ .----~....~/~X~r~dual signing contrac~ J duly sworn, d~oses and says t~t he is the applicanl above name. / He is the ............... ~,,_,,~;. ............................................. ~ ....................................................................................................... (Contractor, ag~t, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or h~e performed the said work and to ~ke and f~e this application; that all statements contained in this ~pplication am tree to the best of his knowledge and belief; and that t~ work will be performed in the manner set fo~h In the application filed therewith. Swam to before me this ~/ .............. ~ ..................... Noto Pu ~ m~cF .................................................... cmn~ .................... .[.....,¢~ ....... :..,.t../;..~..~.~:~ .............................. JUDITH T. BOKEN j ,/,~ignatu'~e of apPl cant) Ngta~ Pubfic, Stale oJ New Y~ Ne, ~-0344963 Suffolk~ ~1~ ~ ~rch 3fi, Tg~ THE NEW YORK BOARD OF FIRE UNDERWRITERS C~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ...,e N 123658 THIS CE~IFIES THAT onl~ t~ e~t~uip~t ~sc~ ~ ~jn~ ~y t~ ~t ~ on t~ a~ appl~at~ number in t~e premises o~ in the following location; [] Basement [] lst FI. [] 2nd Ft. outa[!de Section Block Lot was examlned on ©~;t, ob~I' ~j ~ 1~.]~ and found to be in compliance wlth the requirements of this Board. DRYERS FURNACE MOTORS I FUTURE Af~UANCE FEEDERS A,M,T. K, W, O H.p. GAS H, P, AMT. NO, A.W.G. RANGES SPECIAL REC'P1 ICOOKING DECKS I OVENS I DISH WASHERS AMT. K.W. J AMT* K,W. ~T, K.W. TIMECLOCKS BILL~UNITHEATERS MULTI-OUTLET SERVICE DISCONNECT 1 NO. OF [ S METER A~T M.~P, IYPE EQUIP. 1.e'2W 1.,~3W 3.e'3W 3,e'4W t I00 CD x 1 OTHER APPARATUS: R V I C EXHAUST FANS DIMMERS A. W.G. NO, OF HI-LEG A.W.G. Of CC. CO~D. OF HI-LEG 2/0 1 OF NEUTRAL 2/n ,P? t e r Bo Movie ~7 Nain Road q' I ~ P~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.