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HomeMy WebLinkAbout6635-zFOF, M NO. 4 TOWN OF $OUTHOLD BUN,DING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z~f~¶ ~ ...... Date ............ .0~..~ ..... ~j~ ....., 19.7~ THIS CERTIFIES that the building located at . ~t~t~et. J~$.~. .............. Street Map No. Ca.~J;. ~ L~bck No ........... Lot No.. ~9. ~ .~0....~$.t~t~. k ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated ........... &pr~.. ~0 19.73. pursuant to which Building Permit NO...~.~... dated ....... ~[~ .~ ........., 19.73. was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... Pr&vat~. (aoceaso~). w,t~ssn~l~ .poo~ ............................. The certificate is issued to ....Ar..t.h..1~..S.~.~gF.~..~. g ....0v~. 9.~. ..................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ~,R... .............................. UNDERWRITERS CERTIFICATE No....N..(~.~,,~.~. ................................ HOUSE NUMBER ..... .~.~..~. .... Street ....~.t;..D.~';t..~ ......................... .... ............... Building Insp~tor FORM 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) N? 6635 Z Permission is hereby granted to: ~k.!r~ y...;~.i.~ ...~ o~te ...i~o...A/G ...A~.t,h~m .. F., $1merl~n~ ...... ~.,~,~...%~ ............................................... ............. ~ia~.~i.%u~k.....~. ~.~. .............................. to ...~..n-.s.~.a...i.~....R~..l..v...a..t..9...~.~.~t.*.~....i..n.&..D.9.g.~...9....~[~%~..~......~..AppJ¢o.v.e~i..b~...Ad..,~p:.ae~ls.). at premises located at ...... ~.g.%~...~...~9...t$...?.Q......g.ap.~..~:i~,~...i~.~ ................................................ ....................................... z~..~...~.~z.e. .............. !i'~.~.~. .......................................................... pursuant to application dated ......................... ,'~p~il......%~. ......... 19..~d.., and approved by the Building Inspector. Fee $...~.~.e.g.Q .......... pER;/,IT iNCLUDES AppI~OV~t TO ~,EMOVE EXCESS FILL FROM ABOVE pREMiSES B~ RE GP,,~IDiNG LOT J DRIVEWAY coNSTRUCTiON -- CESSPOOL cONS[RUCTiON -- CELLAR CONSTRUCTION oTHER I /-- Building Inspector / / FORM NO. 6 TOWN OF $OUTHOLD Building Department Town C~¢rks Office Soutl~old, hi. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfrucf~ons 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, aha 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 J'~'~, I ,-, .--, ,~, /~ / Date ...(~.~ ...... ~. ................ ~ r'"(~:~dr~n~P:!iQil i~~~~'~'''''' ' ............ ' .... ' ............................ No ..................... Date Of Permit .................... Applicant ..... /R/~.C~.IL.UiC?:11......l...:.....: 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 ~me s all a~ablen~s ana/regulation/~ Applicant ............ ~~.....¢.~......~.... Sworn to before me this ............ ..~doy of ..... ~....T.....(.~...?....~.... (stomp or seal)/~- Notary Public .....~~.._.... County ~ /' J //~"' J -~ ,~ JUDITH T. BOKEN N NOTES .' Z · = MONUMENT 2. SUBDIVISION MAP FLIED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON ,1AN 19, 1949 AS MAP NO. 1672 YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOLII~G HOWARD W. YOUNG SURVEY FOR: ARTHUR F SIEMERLING LOT NO. 70 ~ PART OF LOT NO. 69 "CAPTAIN KIDD ESTA TLS. lrO~m' NO. 1 BUll. DING DiD&I~TMINT TOWN C[~EIIK~ OFFICE SOUTHOUI, N. Y. · · ..- , ^pphcano~ Approved .... ii~..~;i....~........, !' .~....~.... Pemit No. ~Z...~...~...Z~ ......... D o,,o,,ed o/Z .......................... ,., ........... ....................... .................. ........................ ...... ....... ......... ........ ............................. ........................................... ~/~' ~ /_, ~/~., (Building'Inspector) ~'~' Date .. ............ 23 ................ , ~ ............ INSTRUCTIONS ' :~ a. This application must be completely filled in by typewriter or in ink and submitted ntr p cate to the 6ui ding Inspector, w 3 sets of plans, accurate plot plan to scala. Fee accorciing to schedule, r b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, andJ giving a detailed description of layout of property must be drawn on diagram which is p~rt Of this application. ' ¢. The work covered by this al~lication may not be commenced before Issuance of Building Permit. ~:3 d. Upon alX~'ovel of this al~olication, the Building Inspector will issue a Building Permit to the applicant. Such permit ,shall be kept o the premise~ available for inspectkm throughout the work. e. No bulldin~ shall be occupied or u~d in whole or in pert for any purpose whatever until a Ce,rtificate of Occupancy shall have been ~ranted by the Building Inspector. APPLICATION. IS HEREBY MADE to the Building Department for the iuuanca of a Building~ermit purmant to th~uilding Zor~ .Or.al. manta o~. ~ Town .of So?hold, Suffolk County, New Yo~, end ot .bet af~olicable Laws, Ordin~ce~ or Regulatiom. for t~'uetien of c~ nmi nn~'~,~i'~c'~'~ °rcocl~,teretlhm~4' orcodef,°ran~la, It '~rn sds, ,~lloti°a~ 'm '~ ah~u ~'c nr, ze dC~i nl~d~toTber s~~ ~bu~.l / ~~~t° comity with ~ IJl~llea~le I~ (Signature of applicant, or name, if · corporl tion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ~ ........ Name/6f ~vner of premise~ ....... .a,~l'll~:.~.~..~fl~e.r~l~., ................................................................... , ........................... I' a~p~~ra~g~natu re ~..du ,y au thorized officer.//~- .... 1..~.~.. .~...:.~...~ .................................... Builder s License No....~ .............................................. Plumber's LiCense No ....... ~L~ Electrician's License No ..................................................... Other Trade's License No ................................................... Cap%aaa F,:l. dd ES~Ooe 1. Location of lend on which proposed work will be done. Map No ..............................................Lot No..~...~...~...~....~.. Street and Number ........ ~......]~....~R.. .................................................................................... tla.t,:bS~l~k ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............. J~ea:[d~toe .................................................................................................... b. Intended use and occupancy ........... ~lrl. f. ll~[~l&..R.c~L.az~.ffal~e~ ......................................................................... 3. Nature of work (check which applic~): New Building ....................... Addil~ ..................... Alteration Repair ......................... Removal ......................... Demolition ........................ Other Work .B~damtng.~.g~nn ......... ( Description 4. fistimatsd Cost ....... ~.~., ........................... ~ee ..... Z. ......................................................................................... (to be ~aid on firing this application) 5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor ......................................... If garage number of cars ............................ 6. If business, commemial or mixed occuoancy, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..... ]1~ ........... Rear ..~ .................... Der)th .30 .............................. Height ...2.4 ....................... ~..,;...~ ..................... 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 ......................... Rear ............ Depth ........... Height ................................................. Number of Stories ....................... 9. Size of lot: Front ......... ~,7.,¢, ...................... Rear .~.'~,~. .................................. Depth ..... ?~.. ......................................... 10. Date of Purchase ..... ~=?: .~;~..3,92;~ ........ Name of Former Owner ..~1.~....~.~.~ .................................................... 11. zone or use district !n which premises are situated .................... .~ .......................................... : ................................. 12. Does r)roposed c6nitr~etioii'violate any zonin~ law, Ordinance or regulation: .~'f};~ ..................................................... 13. Will lot be re~raded --5~ ............................ Will excess fill be mmoved frorn premi_ses.'_[z]~Y~es [ ] No 14. Name of 0Whet ~f premises ...b,;~..~-,~Z.]..~.P-~ .......................:Z~ ........... ...~,..~.. ~ .: ... [ .P'~'~'~'~'~'~'~'~...L ..~. ....... ~ .............. (Address} (Phone No.) Name of ' ' Archttact ................................................................................................... ~ ................................................ - (Address) {Phone No.} Name of Contracto. . .... .~:~ ..]~t~. P,(~t],~,. ,.T~Ib~-. ....................... (~.ddress) ............................... · "~ ............................... {Phone No.) PLOT DIAG RAM Locate clearly and dt~th'efly ~11 butldtfl~,.whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and,blec~ ~ br I~cription according to deed, and show street names and indicate wheth- er interior or corner lOt. STATE,'O~ .NEW YO~K .... ) 'cOuNTY OF ) ............. ..~,I~.~..'...~.:,.....~.'t~c.L[t~06 ........................................ being duly sworn, de~s aod says that he is ~e appli~nt above n~d, I~ o~i~b~,~l si~in~ con~act) He sthe .e.~.~%~ ~ ~G~ ( Cont~ctor, a~t, co~te of said owner or o~ers, and is duly authoriz~ to moorm or have ~ormed the ~id~ to make and file t~ application; state~n~ ~ntained .in this appli~tlon ~re true to ~t forth in t~ apPOrtion filed t~mwlth.' ..... "; ....... "7'";" ~- ................ ~'~. ~ ........ ,ot,w uo,,c. ............. ........... ........