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HomeMy WebLinkAbout6689-zFOR31 NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z9425 Date Februa.x7 2 19. 79 THIS CERTIFIES that the building located at . .2.96.6.5., M.~.i,n., R9.~.~, ........ ~ Map No ............. Block No ........... Lot No. .......... conforms substantially to the Application for Building P~rmit heretofore filed in this office dated .. Jux~e .... 26 ......... , 19.75 pursuant to which Building Permit No... 6689Z dated June 26 lg?~ was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is Addition on Farm Building issued is .................................................... The certificate is issued to ........ ~,...~:..D.e..m.a~e.s..~, ..&..S.o.n..s ....................... (owner, ~ of the aforesaid building. Suffolk County Department of Health Approval ...... ' ....... .~/~ ................... UNDERWRITERS CERTIFICATE No. N127560 : HOUSE NUMBER 29665 Street :Msin Road .O.r. ient, New Yo?.k. Building Inspector FOK~f NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTt~ENT TOWN CLERK'S OFFICE: SOUTHOLD, N~. Y. BUILDING FER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WOP, K AUTHORIZED) N? 6689 Z Permission is hereby granted to: .................. Z.~,.~zt.l; ................................ : ................. B~mild an ada!tlon On exlstin~ farm bul]~ tO ~ at premises located at .......... ~$....~-v~i~..~(~ ..................... · ............. ~.~ .......................... ; .............. ................................................... ~)~t.e~ .......... ~..~.~ ....... ~ ......... ! ......................................................... pursuanf to opplicatlon dated ..................... ~r~.....~.~ .......... i-..., 19..~., and *pproved by the Building Inspector. ~ Fee $...~.~.(~). ......... Building Inspe,ctor / ' FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southoid, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and subm!itted in duplicate 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 e~ectrical 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, For existing buildings (prior to April 1957), Non-conformin~g uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or ~and use 3. Copy of certificate of occupancy $1.00 $5.00 Date...2~(~g~.,. ~ .~...~ ?..~ ...... New Building ~" Old or Pre-existing Building Vacant Land oc , on o f Prop erty . . . ' P. . ' ..., : '-- ............................. ( Namlet House No. Street Owner or Owners of Property ...//. , .~. '....~...~..' .x?.,~..~.~. ,7~.¢..~=~..~... ................. County Tax Map No. 1000 Section ............. Block ............... Lot ................ Subdivision .......... · .-~. · .-'. ............... ,..Map No...~._.... Lot No.. i .~ .~j .-'~. · · Permit N~'~.~. ?'. ~.~.. Date of Permit ~..,~..~.//./..O~.Appticant . ,Z~. ~ 4'¢.. , './"~.'.~-~.~..~.,d~/~-.-~ :~.. 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 perm,it~,heets~a aRpllca~t~"edes and regulations. Appiicant~:~,:'~;:~,,~..¥-.~ii..~?~.~.Z~,~.~.~;~..%~'~..~ ...... Rev, I0-10-78 ,/ THE NEW YORK BOARD OF FIRE UNDERWRITERS 0S ' · BUR~=AU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK. NEW YORK' 10038 ,,..,. ~,o,,,,,~e,. ~.~, ~..~73 ,,,,~.,,o.~o.o.,,,. ~ N 127560 THI~ CE~RIES THAT ~.~. ~.~a~s~ ~ons, n/a ~c.~ opp. ~ar~w ~lve~ ~o., u~tent, L.I. in t~ ]ol~img l~eti~; ~exom~on ' ove~ ~ s~ a~ound~in~m~ia~ewithth~requi~mentso~thb~. RXT~ RXTU~S ~ ~1~ ~] 0~NS ~ W~ ~AUST FANS I 2OO CB x I 3/0 1 2/~ Fe,~der/s: 1-3~6 1st ~. l.~ Orchard St. ~~ Orient, L.I. 1195~ ~Per ~ / ~ COPY FOR THIS BUILDING I)EI'ARTMENT /~ ~- C(. ~' '~ TO~N CLERK'S OFFIGE ~ ~ /~. ~ . .............. ~proved .~ ............ ~...~.~ ....... , 19 ........ Permit No. .~.~...L ............. Di~pprov~ a/c .......................................................................... ~ ~ ................................................ Date ~e 26 19..~. 1~ I NSTRU~IONS a. This application must be completely filled in by typewriter art. 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 Jo adjoining premises or public streets or areas, and giving a detailed description of layout ofprpperty 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 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 Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the. Town of Southold, Suffolk County, New York, and other applJ.c, able Laws, Ordinances~r Regulations, for the construction of buildings, additions or alterations, or for removal or demohtion, 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 insl~'~Rms. . /2 Orient (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Part o~enr 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 ............................................... 1. Location of land on which prqposed work will be done. Map No.: ........ ~ ........................... Lot No .....~ ............... ,, - N/5 Main Road Orient N.Y- Street and ~umDer ................................................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy f'a.T'Ja. ..................................................................................................................... b. Intended use and occupancy ...~..a~...q..1~...1....~......&...~.~.1...~../...~.~....~..~.....~.'~:r~...~.b....~...]~...~./..~..g ......................................... 3. Nature of work (check which applicable): New Building .................. A&:lition ...~ ....... Alteration ..~ ......... Repair Removal Demolition .................... Other Work * (Description) ' 4. Estimated Cost ............... ~.~.(~.(~.....+,~ ......................... Fee 1~o00 (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ ..0. ............. 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 ....~,gZ':l.~ ......... 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 ........ ;~.0.. ....................... Rear ........ 2,0 ............... Depth ..... B.Q .............. Height .................... Number of Stories .~l;~ ............................................................................. 9. Size of lot: Front ............... ~,g.~.f~J~ ........................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ ~,.....~1.~ ................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: .~.~ ................................................... 13. Will lot be regraded ....... ~ ............... Will excess fill be removed from premises: ( ) Yes (Z) No 14. Name of Owner of premises ...~..~.~:~,~l~A.~...~...~p~,~... Address ....0R.;I,I~A~ .............. Phone No ...................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~_m® ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exirting or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according t° deed, and show street names and indicate whether Interior or comer lot. STATE OF NEW YORK. lc ¢ COUNTY Of ........ ....... .................................... T'O~I-I.&..D~I~'e~, ................. . ......... being duly sworn, d~oses and soys t~t he is the applicam (Name of i~ividual signing c~tr~c~ above named. He is the ............ ~.~g.~ .................................................................................................................................................... (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfermed the said work ~d to ~ke and file this application; that all stat~ents contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the ~nner ~t fo~h in the application filed~rewit~ Swomtobefo~ methis ' ~ ~ ~/ ~ ................... ....... ......... Nma~ Pub c~.~-~g~'- ~ ' ~¢' ~ ~ ' · , ,/~.~ .... ~~ounty ~.~...~.~. ~ ...................................................