HomeMy WebLinkAbout6584-zNO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Ot~i~e
$outhold, N. Y.
Certificate Of Occupancy
No. 2~7.51~ ...... Date ........... .Fob.. P.~ ...... , 19..7.~.
THIS CERTIFIES that the building located at . t~la~'k. Road ............ Street
Map No. Dee~, Park. Block No ...... Lot No. 8.. I~1~t::~;nck.. I~.Y, ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ..... .M.a.~r..2.~ .. , 19.73. pursuant to which Building Permit No..(~Z.
dated .... M..ay. 2.1..., 19.73., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .. P~.ivata .~¢eas~oz,~..bu~lding. (Storage. etc) ......................
The certificate is issued to .8. f4~u.~ey .E ,. .K,uigh$ ..... .0w~e~. .......................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval N ,R, ........................
UNDERWRITERS CERTIFICATE No..N,R, ....................................
HOUSE NUMBER . .7~ .... Street ... l~,ark. Road ..... Na.ttitue-k ............
Building InspectOr
FOF,~ NO. ~
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)
Ne 6584 Z
Permission is hereby granted to:
.... ~.~..z.._~.£~..x.,./.~..~/.: .
...~_~,~.-~.~..;r~ c~.......--...d~...~., .........
to ............... ~.~.g-.,,-z.,~.~....~..~......,,~c,c::..4~.~.,~.~ ..... ..~..A.~.~..~... .........
~, ....... ~T';'T';"'i~m.~ ~ o~ e~ ...... ~i; .......................... ...... Z-~-----'~-~- ~"~'-.-',~ ....... .......................................... ~'~"..~,'~''~-.-.~-,~---~: ............. .....
....................................... i .......... /~.~.~.~/c.....-,...~...~---~.., .......... ../.... ......................
Building Inspector.
Fee $./.-~,.~. ....
FORM NO. $
TOWN OF SOUTHOLD
, Building Deportment
Town Clerks Office
Sou~hold, 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:
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. I-'or existing buildings (prior to April ]957), Non-conforming uses, or buildings and "pre-existing"
land uses:
]. 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 in-
formation required to prepare a certificate.
C. ~:ees: I. Certihcate 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
...... .....
New B~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land ..............
Property ...... ~''-- ~ -- :..~..C~....~...~....,.~:.....~,,.~--~ ~. / _~"-- ....... ~..,~......~~~~ ..............
Location
Of
Owner Or Owne~4~ Of F~rope_,~'y ...... ~......~..~...../..~.~ ...............................................
,o ............. ,o.....7....C
Permit No....~.~..~..~Date Of P,~ermit ~..~.~plican, ..~~..
Hecllth Dept. Approval .... ..~....~....~..~:..'. ........................ Labor Dept. App~;'l"~.~;i;;~ ......... ::::::::::::::::::::::::::
Underwriters Approval ........... .~...,..!..~..': ..................... Planning Board Approval .....~...:.!~ ....................
Request For Temporary Certificate ........................................ FinoJ Certificate
Fee Submitted $ ...~..~ .................
Construction on above described building and permi~ meets all applicable codes and regulations.
Sworn to before me this __ / / / ~/~'~_~/~F
........ ~ay o, ...... ~....-~.~..~.Z (stamp or
ACCUSATORY INS'rRUMENT
INFORMkltON - GENERAL C P L lO0 15 FORM NO. 256 ','.ILL,~:,OS LAW BOO~ CO ~OCH£Sl~ N )
STATE OF NE~ YO'RK COUNTY OF_._.s_~?_.~_o..L..K_ .................................................
__ JJJ~LT~C4~ ...... COURT ....... _T_O.._W~_. .......... OF ...... ~ ~i!2/~[O_ID .................................
~f!r ~p[~ ~f ti? ~lale ~f ~rm ~urk }
.... 5Z.~.~ ~_~__~ ni~h~_ ............................... ~
DefendanL
t
Howard Terr}r.L__B_u__i__l.d_i..n_g_._I_.n_s_pector ,__, resid
._..J_°_c_k__e_Y___C._r._e..e_.lS__.D_r_i_v__e_,___S_°_.u._t~.c_E~.~__Xg.E~_ ............. , by this information i
written accusation as follows:
That ....... _S_ _t_a_ .n_l._e_ _-v. __E_ _- _ _ _K_ _n_ _i~ c; h _t_ ............................................... on t he__2_~
day of___J_a_n_q_a_r~ 19__7_.7_ ...... , at__7_5____M_.a_.r..k___R_o_a__c]_;.__LQg_$_,.__D_e.e.r..J~a.rk ................
(Locatmn)
in the ...... __H_..a~_.l..e_.t. ................... of .... .M_a_ .t_ .t_ _i_ _t_ _u_ .c_ .k_ _ _: ...........................................
Count)' of ...... S.u__f__f_.o__l_.k_ ......................................................................... , New Yor
commit the offense of occu >.zi.n__q accessor buildin wi ~ ~
......... ~_P. ................... kY_ ............ g_ ....~_ ~.U~ ___t.h_e ...........
__ .y_e__q_ _u_ .J: _r_e_ .a__ _c_?_rA .i_ f_i_c_a_ 3_ __e__ .o_ .f__ _9._c__c._u 2.a_ _n_c_ x .._ .........................................
a (mi~emeenor) (violation) in violation of Section..__A_~r__%t.,__.X__I.¥.~._.s_.e__.c_._._l_0~(L-_~L.4.t__~_L13
Chapter 100 of the Code of the Town of Southold
.................... E'aw-~f-the--D~e-o~- ,A~e~,-Y-c~k-, in that (s)-he did, at the a[oresald time and p
CountOne: occupy accessory building located on the abo~e captionc
premises without applying for or receiving the necessary
Certificate of Occupancy.
Thefactsupon ~hiehtMsinformationisbasedareas ~llows:
Stanley E. Knight obtained Building Permit #6584Z on May 21,
and built an accessory building. After due notice by mail, ht
has failed to apply for or obtain a Certificate of Occupancy.
Wherefore, Complainant prays that____S__t__a_.n_.l_e_-y__E-z_---K_-n--i--g-h-?-- ..................................
be dealt with pursuant to law.
Howard
"'Subscribed and Sworn to before me on
/ '~'o
Name
Town Justice
T~tle or Office
Complmnant ,/
Terry, auildinf Inspect
*set forth statutory language constituting the offense
**use only one
The foregoing factual allegat,ons are based upon personal knowledge of the complainant {and upon ,n
ACCUSATORY INSTRUMENT
INFORMATION - GENERAL C.P.L. 100.15 FORM NO. 256 WILLIAM$ON LAW BOOK CO . ROCHESTER. N. Y 14609
ST3(~ OF NEW YORK : COUNTY OF ..... ~.~ ..... .~ ..............................
.__L~~__~_COURT ....... ~_.0~..._/..~ ..............................
3uf~rmat
............ ~~__.~~_: .............................. , by this information makes
written accusation as follows:
~,~,._..~~...~=~_~ ............................. ,o,~,~.~z .....
i, ,h~~~ ......... or .._i.~.~_~ ........... 2 ........................ ,
County o1.~.=.~ ..................................................... ,New York, did
commit the oIfense o~.~.~__~ ..... ~.~..~~_~ ........
............. .%....~~ :_..~, ....... , .........................................
~.(~io~atlo~) i~ ~iohtlo~ of Se~tlo~ ~~._~.~.:2.~.~.A..~ ..... o~ the
Cou tOne: ~~ ~ {~ ~ ~% ~( (~
The foregoing factual allegations ore based upon personae knowledge of the complainant (and upon ~nformatlon
behef, the sources of complainants reformation and behef being,
rOaM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN C:~RK'S OFFICE
SOUTHOLD, N. Y.
./ ~ (B§ilo~n~ Inspector)
Application N~ ...............................
APPLICATION FOR BUILDING PERMIT
Date .............. ~ ................. ,
INSTRUCTIONS
o
a. This application must be completely filled in by tybewriter or in ink and submitted in triplicate to the Building Inspector, witht~
3 sets of plans, accurate plot plan to acale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to,adjoining premises or public streets or areas, and~1~
giving a detailed description of layout of property must he drawn on diagram which is pert of this application. (~
c. The work covered by this application may not he commenced before issuance of Building Permit. ~
_.d. Ul~.n apl~...ov.a! o,f this apfflication, the Building Inspector will issue a Building Perm t to the app cant Such permit.she he kept on~
zne premtses lVaillDle zor inspection throughout the work. ~
e. No building shell he occupied or used in whole or in part for any purpose whatever until a Ce.rtificate of Occupancy shall have bee~l~
.anted by the Building Inspector.~I
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 RegulatJom, for the =omtructJon of
buildings, additions or alterations, o~ for removal or demolition, as herein described. The applicant agrees to comity with all applicable laws,
ordinencaa, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for neolssery inspections.
(Signature of a~plicant,
(
. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
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 .....................................................
Other Trade's License No .............. .T. .................................. ~ ,-~ ..~i(.~Z0 ,~/
1. Location of land on which work will be done. Map Noc;~.,~._~..[..~.../..~. ............... ~:' Lot No ........ ~.. ............
2. Stat~ exi~tin§ use and o~u~ncy of prcmi~ and intended use and occupancy of proposed construction:
ao
10.
11.
12.
13.
14.
Nature of work (check which applicable): New Building ....................... Addition ..................... ~aJteretion ...............
n~,-nv, l .................. DemoliJcion .................... :... Other Work,~'~C.¢~...,~..:
Repair
............................... ._~ (~rescription)
Estimated Cost ................. /~... ....... ..... ...................................................................................
(to be paid on filing this application)
If dwelling, number of dwelling units .....-~......~:".. Number of dwell)ng units on each floor ----'
If garage, number of cars ............................................................................................................................................
If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................................
Dimensions of existing structures, if any: Front ..................... Rear ........................... Depth ...................................
Height.. ................................... · . .... .. ... ...... .... Number of Stories ................................................................. ....... ... · ·
Dimensions of same structure with alterations or additions: Front .......................... Rea~ .........................................
Depth ....................... .. .... ..... ... . .. ... Height ......................................... Number of Stories ........................................
Dimensions of entire new construction: Front .,...../,~...'~....... Rear ...... ./.~.....-:.. ........ Depth .../....(~.......--'.. .................
"~' '~ .......... ~d::'2~/~. ...................
Height ...................... ,.~,.~....-~...; ......... r~umDer oi =[or~s; .............. 4,~.,~.,~ .........
Size of lot: Front ..... _~-- _~"~'A'"--"~ ........ Rear ...~..~..~...--..~.......,~,,_.~_ <~_ ........ Depth~/'f~.../.~,.~.~.~-~/~......-.~..(:.~
Date of Purchase ...... ~...~.~.-,~'~ ............. Name of Former Owner ~.,~Z~'.~..~'~'<~y~.....¢-~ ,~--'~/...i~r,~j~ ./,
Will lot he reoraded ~ .... -~-.¢~..:. ............... Will excess fill beremoved from premises: [ ] Yes ,,~No
Name of Owner of prem,sas ....~,l~',<:~,/,~.~a~.~.;.....~.~..g.~./.x.~.... ......................... .,.,.:.......::..: ................
/ (Address} [~none
Name of Architect ...... ~ ..............................................................................................................................................
(Address) (Phone No,)
Name of Contractor ...............................................................................................................
(Address) (Phone No.)
PLOT DIAG RAM
Locate clearly and distinctly ell buildings, whether existing or proposed, end 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 NEWY~RK, _ )
COUNTY OF ........~..~...~....~...~.~.~.. .................. ) ~
-- ~"~'~"t'~--~Na~e o[ indivl ..... ~t~ntng contract)
He is the ...................... .~.t,.~..~._.~.. ......................................................................................................................... : ..........................................
(Contractor, agent, corponte 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 application are true to the best o~ his knowledge end'belief; and that the work will be performed in the manner
set forth in the aoplication filed therewith.
:.~ - ~ ~ TERRI LEtEatEU~oK
................ ~- ................ day of ............ .~..x...~.[..-~...~. ........ ~...52,a16t~5 ............
~ ~ c-~ ~.-~.~llalif. ied in Su[folk County
Notary Public..',..~,~%7:~.~, ........ ...'~-,.,~~ ...... County .... ~~.~.~ ............... :.~...~.;;..~n~..; ................. ; .......