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HomeMy WebLinkAbout6669-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, BI. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .]~Y..Aye / Street Map No.. ;XX ........ Block No... ;~X ..... Lot NQ. ~...$~.s.~;/~J.a.r.i.o.n ~ .Y conforms substantially to the Application for Building Permit l~eretofbre fried in this office dated .......... J~e.. J.~..., 1972. pursuant to which Building Permit No. dated .......... .J..u~.?...~.~...., 197~.., 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.r..i:?.t.e., .o.n.e., f..~.l..z~..d.v.e.~.Z..~.~ ...................................... The certificate is issued to . .Victor..Norsk .... , ...~nel~ .............. '.. ............ (owner, lessee or temmt) of the aforesaid building. Suffolk County Department of Health Approval .... .N.,.R.: ...... , ........... .......... UNDERWRITERS CERTIFICATE No..P.e.n.d..~..g .............. ',i ...........:, ........ HOUSE NUMBER ..... ~. ] 7.0. .... Street ... ]~.. ~,.?e. ........... .", ................. FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6669 Z Date ......................... .~l,O.e ........ ~.8 ........ , 19..~..3.. Permission is hereby granted to: /;. r l~.,..J~als~.....AZC.....~J~c.tor...l~ovak ............... ................. Qr£ent ................................................. at premises located at ...... ~/.'q....~b~/...~;ge ......................................................................................... .................................................... .s.~..s.~....~j~r.~..~.a ...... ~..,.L. ................................................................. pursuant to application dated .......................... ~.%!4~..e ........ .1.~. ........ , 19~.,~...., and approved by the Building Inspector. Fee $...1.~',.~ .......... r , Buildi~0 InspectorJ THE NEW YORK BOARD OF FIRE UNDERWRITERS O~; BUREAU OF ELECTRICFI~,.,'~ -".. .' --m 85 JOHN STREET, NEW YORK, NEW YORK i~038 THIS CE~IFIES THAT only t~ eEt~ ~u~nt ~ ~c~ ~ ~ int~ Vleso~ Nov~. Bay Ave., inthefollmVinglocation; [] Baser, tent [] lstFI. [] 2nd Fl. garage outside s~t4o, elo~4 rot ~xami~on Octobe~ 1~, 197~ ~/o..dto~.~.~ dia~cewlththe~uir~men~ofthhB~. ~XTU~ ~AC~[ SWITCHES [ RXTURES [ RA~E [C~KmNO ~KS 0~NS Ol~ WASHE~ ~HAUST FANS 3 DRYERS ~AcE MOTORS ~TURE A~E ~G S~IALRKK ~fC~KS*i. ~~ IUNITH~TE~ ~MULT~T~ raMMERS I [II I Mike Main East Ma~lon, L.I. 119 39 Per : COPY FOR BUILDING DEPARTMENT..THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER, FORM NO. 6 TOWIq OF SOUTHOLD Building Department Town Clerks Office Southold, iq. ¥. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. 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. 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 ............ .~ .z.~.. Z .?....~....~. New Building .................... Old or Pre-existing Building / Vacant Land Location Of Property ................~........~.......~ ......... ~ ....... ~2,.......~..:..,~..'. .......... Subdivision .................... .'.~."~. ..................................... Lot No, .,.....-~...., Block No. - House permit No. ~...~.~.~.....~.. Date Of Permit ..~/..~.~.~.~...Applicant .......... ~.....~..:...~ ......... Health Dept. Approval ........ ..~...,.../~... ........................ Labor Dept. Approval ......... Z~..,.~ ............................ /v, Underwriters Approval ...............:../~... ......................... Planning Board Approval ........................................ Request For Temporary Certificate ..... ~ .......................... Final Certificate .....~ ............................. Fee Submitted $ .~,.. ............................. Construction on above described building and perq~it meets all applicable codes and regulations. Applicont ........... ~.....~..~..~ .............................................. / Sworn to before me/~t~is ..~*/.~ .~. day of~....!;.[...'/..~( ..... (stamp or seaIZ~':~ 7 Notary Public .....~ ......................... County Approved IPO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Pernit No ........................... z ' (B~ildimg Ins~tor) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or 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 lot and of buildings on premises, relationship to adjoining premises or public streets or areas, giving a 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 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, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Address of applicant~ State whether applicant i~ee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer· ~ I Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No ......... , ...................................... Lot No ......................... Street and Number t...~ ~: ~ ~ .....'~--. '~' ........................................... · ....... ~ / Mun c pa ty 2. State existing use and occupancy of premi,~_~ and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ..~-c~.....c~:.....~f~...~~ ......................................................................................... b. Intended use and occupancy ..... ~ ....................................... -.~....~.~ ..................................... 3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work .................................... Cost ~; ..~.,..~... ~ (Description) 4. Estimated ................................. i.. Fee / ~--- ~" L (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 ..... .~. ...................................................................... DDie~;t~sions ~.~.~!.~.,e structure with a~ri~ns or a.~.d.~i?ns: Front i......~'~l~;~.~..~tRo~;s.,...~..~.. ....... ii ............ i.. 8. Dimensions of entire new construction: Front ........ ~ ............ Rear ....... ~... ............... Depth .....-~..~.. ........................ f / Height .............. ~'.~. ............................. Number of Stories ......................................................................................... 9. Size of lot: Front ....... ~.~ ..................... Rear ....... ...~.....f. ......................... Depth f 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: .. ..~....°. .................................................. 13. Will lot be regraded -~..~....~ ......... ,.~ ....... Will excess fill be remo~d ;[r,o~ premises: [ ] Yes [ ] No 14. Name of Owner of premises ............ ~.../~.(~;L (~..~. ~. ~/~. ~. ..~..~ ~/- .~.~ ..~-~.. / ,~ ..~..'~.. .... ......................................(Address) ~" ......i~'~;;; '1~1'~ .i ................ Name of Architect .......... // ~ . (Addre~ ~ , / (Phone No.) Contractor .............. ~.~...,~....%~. f....~.,...../...~'.~...~.4.~. ................. ..~.,~'~/..e ~ .~. ,,~'.~ ....... ~.~..~..?...~..~..~../..~. ........ Name of (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 YO~(~__,,,.~ ) COUNTY OF ............ ,/.~..~/ .............. (,...J,4 ......... ), w ..... .......................... {A~,~.r~,~.~.~.i~ ............................................... being duly sworn, deposes and says that he is the applicant above named. He is the ................................................................................................................................................................................................................. {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 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 app.[i(;ation filed therewith. ,~--~ ............................ ...... ....................................