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HomeMy WebLinkAbout7436-zFOll~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's O~[ice Southold, N. Y. Certi~icnte O~ Occupnncy THIS CERTIFIES that the building located at .. ~/.~...J99~0~/, .O~..D?.i.v. 9... Street Map No...X$. ......... Block No. ~ ....... Lot No, ~f-Y.~ .... .8.°.u.~.hg.l.4... ~.'?~; ......... conforms substantially to the Application for Building pe~mlt heretofore filed in this office dated ............ .JULY...2.~, 19 .~.1~.. pursuant to which Building Permit No. ?.~.3.6.~... dated ........... ;I..u%.y...85.., 19 ?.~., 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 i~ .~.r.%.v~.~...~?~.p??.~...~.t.~. :~:e..n?.,..a..~?.~??.~.~ .................. The certificate is issued to .I~.~...&~..r.~....~.l.l.i. ~..~.e.r.. ~. ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~i,~. ,R., .............................. UNDERWRITERS CERTIFICATE No. ~.8~.7.9.~. .... , .~.]p.~., .1..1., .!77.)+. ............. HOUSE NUMBER ....2.50 ....... Street .J..c~..k?.y...0R .D. ?.iy.e. ....................... Building Inspector IPOu-M' NO. ~g 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? 7436 Z Permission is hereby granted to: ...... .2.5'.q..~.a~..Z~. ................................................. ................ .c..~.~..o.~ .......................................... ~o ..~5 ~.?.~.~.. ~.~. Y...~.~?..~ ~.~....s.~.:~:..~L~..;~.?..°.~...C ..~ ~..e..~..s..°..~...s. ........................................... ~outho~d ~.k. pursuant to application dated ............... :.....~T.~.~L~'.....2.1f. ................ 19~7...Lt...., and appraVed by the Building Inspector. Fee $.1..~.*...0..0. ............ THE NEW YORK BOARD OF FIRE UNDERWRITERS 8.~ BUREAU OF ELECTRICITY THIS CE~IFIES THAT w~ exami~d on a~ f~nd to be i~ ~mplia~e with the r~ui~ment~ of th~ 1 2O COOKING DECKS OVENS DJSH WASHERS SERVICE DISCONNECT NO. OF S R V I C E o~8~q~Ml~g Pool) ~hts oertlflcate eover~ oompltanoe at the date o~' lnepeotlon only. Beoause off unusual env/~onments it is advisable to have f~equent test and/or l~epatra made by a qualified pel~on. EXHAUST FANS DIMMERS Ellis TerrT, 230 3ookey C~eek Drive, Bouthold, L.~r. 11971 COPY FOR BUILDING APPLICATION FOR CERTIFICATE OF OCCUPANCY IllenlCflOee ^. 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 dispasal--(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 "pm-existing" land uses: 1. ,~ccurate 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'. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: i. 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 ~o ..~.:/..~..:..7..,,?,,. .............. New Building ..... ~ ...... Addition ......... , ...... Old or Pre-existing Building ..~.......~., Vecant Land .............. own,, o, owners Of ................. Sul:~li¥islon ................................................................ I~ No ............. Black ~o ............. Hou~ No.~.. Permit No ..................... Date Of Permit .................... Applicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary~C',~ertificate ........................................ FinaJ Certificate .............. ...~.h ...................... Fee Submitted $ ...?.... ............................. Construction on above described building and per~mi/1;/~m?s, all al~l;L~able codes and regulations. ^,~li~on~ ~ '"._-.'; ................................................... ............ ,? / , - ,~6 TOWN OF SOUTHOLD BUILDING DEPARTMENT O.,~_ ~'~,L"~ ~ TOWN CLERK'S OFFICE Exam~n,d .... [~. ............ , 19. Approved(.~ .................................... , 19 ........ Permit No..~..~..~...~J.~ ......... Disapproved a/c ..~,~ ................ ~~ ..................... ~'~- (Buildino Inspector) APPLICATION ~:OR BUILDING p~.RMIT Application No..../-~.....~..?.. ............... Date .~.g.~Z...~..~ .............................. , 19...?..4. ..... 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 lot and of buildings on pre,raises, rela}ionship to'adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty 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 Inspe6tor will issue 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, gene,;al contractor, electrician, plumber or builder. Build er Name of owner of premises ....l~,~.,-...6;...~t"~,~.....T..e'~.'~ ......... /.~.~..~...~..'~Z.~. ............................................................................... If applicant is~ corporate, s~gnature of duly authorized officer. (Name aJ~l title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number .... ;~.~O...~f. mc~Jf,v....Q~.e.e, lf....g..~.~.~.e.,...~.g.~Jl.e.~.~ .................................................................... Municipality State existing use and occupancy of premises and in~.ended use and occupancy of proposed construction: a. Exisiting use end occupancy ............. ~.~.~k~.:Ll~l~ ................................................................................................ b. Intended use and occupancy ............. d.w,.l,l.i.~..~...~.i.~m.t,~.~...l~OO.l......g..~ .- .~..~..%..: ................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work ...~.?.$..~..~..~IL.~.P..~ ................... (Description) 4. Estimated Cost ............................................................ Fee /~. ................................................................................... (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 .................................................................................. 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 ..................................................................................................................... 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: ...N..9. ................................................. 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ..~.~.~.....~....g.!.z'..~......?..e..~?.. ........... Address SouCho]L~t Phone No. Name of Architect . ............................................................. 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 whether interior or corner lot. SEE ATTACH~. . . . . . . STATE OF NE~Ag~[[[~,],,]( t ~ ~ COUNTY (~F° ~.'~'",Alf l;i~'ff ~ ........ ................................................................................................. being duly sworn, deposes and says that he is ~he applicant (Name of individual signing contract) ~bove named. H~ is th~ (Contra~tor~ ag~nt~ corporate off~cer~ of said owner or owners~ and i~ duly authorized to per~orm or ~ave performed t~e said work and to m~e 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 perform~in the manner set forth in the application filed therewith. Sworn to before me this I /~ ~ ~ ~/day of ~ , 19 .~ ' ............................................................................. .............................