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HomeMy WebLinkAbout8811-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Occupancy THiS CERTIFIES that the building ................................................ 2~5 l~al~ RO~d O~.~.en.~ .NoVo .......... Location of Property ..... -~ .~ ............................ House No. Street Ham/et County Tax Map No. 1000 Section ...O.~.T. ...... Block .... O.~ ........ Lot ... 0~.~ .......... Sub~n ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .. ~.~.~t.~ .~ ?..5. ........ ,19 .T..6. pursuant to which ~ Permit No... ~:~'J. Z ............ dated ....A.u.~. ~..55. .............. 19.7.;~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The oCCupancy for which this certificate is issued is ......... .................. ...................................... The certificate is ~ued to .... .O?.o.~..~'..ey..t:I. ~g.~. ....................................... (ow. or, ~xx of the afore~nicl building. Suffolk County Department of Health Approval .. ~N~R .................................... UNDERWRITERS CERTIFICATE NO.. l~.eR~ ,~qg ....................................... Building Inspector ~RM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PI~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 8811 z Permission is hereby granted to: ...... .......................................... Building~ Inspector pursuant to~ a~hcahon dated ........................................................ , 19 ........ , and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicatmn must be filled in typewriter OR ink, and submitted 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 featu res. 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 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 ex~sting buildings (prior to April 1957), Non-conforming 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 prewous 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 cert~fmate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date ...... J. ~.. ~.'.f..'T.O~.q .... New Building .. ~ ...... Old or Pre-exist~ng Building ............ Vacant Land ............. Loc,tion of Property... ~..~.. 1.~,.,~'...~'----~/~'~..,/~.. ~. ¢~).~.~. ........... ~../~.. J.,...W~.. .......... House No. Street Hamlet Owner or Owners of Property ~.~.. ~.~,~t/~..~.~.~.. ~/.~,[:~ .... ~.~.~.... ~.4/~./E~.~. .' .-~.~.,.¢.L .... County Tax Map No. 1000 Section ..~./.~. ....... Block ... ~.7. ....... Lot...~..~Jg..'-~...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. t~L~. 4//.~-~.. Date of Permit~ .~ 7~Applicant .................................. Health Dept. Approval ..... ~....----.. ............ Labor Dept, Approval ...... '-T.., 7 .............. Underwriters Approval ~ .Planning Board Approval ~ ' Request for Temporary Certificate ..................... Final Certificate ..... ~ ........... ,. r.-' -- Fee oubmitted $~ ~' ................ Con.,truction on above described bu,ld,ng a~eet?_~a p~_~le code. s ,and iegu lations. Applicant . . / -, Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS [3[r~BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.t,~ January 22, 1981 106441 81 THIS CERTIFIES THAT only the electrical equipment as described belo~v and introduced by the appt,cant rtarned on the above application number tn the prem~ses of (k~£frey ~gh, n/~ Ri:. ZS, 500' w/o V~llage in the folhswlng h,eation, [] Bo.~ement ~ l,,t FI. [] 2nd FI Section Blot'k Lot .XTURE FIXTU.ES .^N~ES OVENS DISnW^SHERS OUTLETS I~ECEPTACLES SWITCHES INCANDESCENT FLUORESCENT V~,POR 3 2 DRYERS FURNACE MOTORS SERVICE DISCONNECT 1 FUTURE APPLIANCE FEEDERS SPECIAL REC'PT TIME CLOCKS AMPS S E R V OTHER APPARATUS NO OF CC COND PER ~' ] UNIT HEATERS MULTI-OUTLET |DIMMERS SYSTEMS ]~ ---r~ ---- I c E awa NO OF HILEG awa ~NO ~LS~ AWG OF CC COND OF HI LEG ~F_ NEUTRAL / / Elec,, Rocm HeaCer/s:l-2.0l~ 'l~iore ~ohioff Orchard ~,c. Orient, I~.Y. 11937 Th,s cerhflcate must not be altered in any manner, return to the office of the Board if incorrect Inspectors may be den d~ed by .~r/credenhals COPY FOR BUILDING DI~PARTNIENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION (owner or authorized agent of owner) Box ;) ................ .Qri~zz~:.,...N.aw...Yom.!c ......................... (address of owner or author,zed agent of owner) PLEASE TAKE NOTICE there exists o violahon of: Zoning Ordinance ART. XIV Other Applicable Laws, Ordinances'or Regulations ............................................ at premises hereinafter described in that ......... ..B.~$.l..~..~.g...~..e...z~...~...~..~.~.!..J...~. ............................. (state character of violahon) .... ........... ..... ..... ..................................................................................................................................... ,n violation of .......... ~.~.:.~.R~.:~.~Z.~ ............................................................................................. (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the ................. .1.~.~.~. ............................................ day of ......... :D.~fLg;~b.ft~'. ......................... , 19..8.0.. The premises to which th~s ORDER TO REMEDY VIOLATION refers ore situated ot e..~...~.../~'...,~........~...~,,~~ ......... County of Suffolk, New York. Fodure to remedy the condmons oforesaid and to comply with the applicable provisions of law /.~, ~,/'~w~ a_y constitute an offense punishoble by fine or imprisonment or both. ui d,ng Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION TO ~-~...C~....t~...~.../...~..~..~. k./.. ...... .~.../'(.~....~./. ................. (owner or authorized agent/of owner) (address of owner or authonzed agent of owner) PLEASE TAKE NOTICE there exists a violahon of. Zoning Ordmance Other Apphcable Laws, Ordinances'or Regulabons .......................................... mt premises here,nafter described in that ....~..}.~....~'././.'~../¢..~.~.'...~¢. (&..~..~'.(¢..~.~...~...~...~......~Z.C~:..~...~..<..~ .... (state character of wolohon) zM...:~.~./../.~.C~....~;~.~.....:.:..:~..,'~.~.././Z, .... Zz-~xz'-.~....~¥~..<~.~ ¢, ©ccc¢,n~.¢_~.. ....../ -~;~ ................. iZ~ _ 7' ........ ' ...... ':_:;'-~," ....... ~' ~n ¥,olat~o~ of ....... ....~..~..C.....~..¢....O.....7....<..~.~ ..... ~...¢.O...: ............... .(... ............................................ (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply w~th the law and to remedy the condibons above menboned forthwith on or before the -- . ....................................... day of ....... ?../~.~..o./..¢~. ................... , 19....?../. The premises to which t_h. is ORDER TO REMEDY VIOLATION refers are s~tuated at .~.;Z/~-~--'- /~'~'.~ /r-~/oT-County of Suffolk, New York. Fadure to remedy the condmons aforesaid and to comply with the applicable prowsions of law may constitute an offense punishable by fine or imprisonment or both / ' Budding Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Sou'rHOLD, N. Y. Examined ....................... ~....~...,~ 19..~...~.. I 7__ ..................... rm,t,o ..... .................... Disapproved a/c .......... ~ .................................... / ........................... APPLI~,kTION FOR BUILDING PERMIT Application No ............................... ..~ INSTRUCTIONS a. This application must be completely filled in by typewriter ac in ink and submitted in triplicate to the Building Inspector, with 3 set~ 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 o~ 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 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. (Signature of applicant, or name, if a corporation) ........ ............... _................. .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................... ................................................................................................................................ Name of owner of premises ........... ...~....~...~.~..~....~....~......~....~....~.. .......... !.?...!....~......~.. ................................................................. 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 proposed work will be done. Mop No.: ........................................ Lot No ......................... Street and Number .................................................................................................................... /. .............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy . / '~' ..~../~-'zt/~ ! £ ~ ,.~A ..~. ~. ~'~TH ~ Z::>J~ / -/-/o . b. Intended use and occupancy ............................................................................ ..~. ............................................ 3. Nature of work (check which applicable): New Building~. ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... (Description) 4. Estimated Cost ............. .~...~...0....0. .............................. 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 ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ~.E~C I Z) . 12. Does proposed construction violate any zoning law, ordinance or regulation: .............. ~ ..................................... 13. Wil'l lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (~No 14. Name of Owner of premises ~" /-//G/+ Address Phone No. Name of Architect .............................................................. Address ................................ Phone No~ ...................... Name of Contractor ............. ..~.......~...~...O..~ ................... Address ...~..t~...t.~...~...-(. ......... Phone No~..'2'~. .....................- ~ 5' .~..~R PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~OR~,,/ COUNTY OF .~ ....... f'~"~ ................................................................................................ being duly sworn, d~oses and says that he is the applicam (Name of individual signing contract) above named. He is the ........... ~.~.~.~..~. ..................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to ~ke and file this application; that oil 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 fo~h in the application filed therewith. Sworn to before me this