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HomeMy WebLinkAbout8860-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... .Z ?.0.4.'( .6 ....... Date ..... ?.p. ~ .~.1..1.5., ................ 19.8.1. THIS CERTIFIES that the building ................................................ Location of Property .... 230..H l ~ P.q4 r' 9 rn.e., p r j..v.e., ......... S. 9 .u .g.h.q 1..d ~..N.: ¥: ......... House Ale. Street Ham/et County Tax Map No. 1000 Section ..... 6. .6 ..... Block ...... .2 ........ Lot ......... 2.5. ...... Subdivision..~.e.~x.e..d.°.n..~.s?.a.~.e.? ........... FiledMapNo....1472 ..... .LotNo. ............9 & P/o 8 conforms substantially to the Application for Building Permit heretofore filed in this office dated · .fie p.t.e.n~[~or.. 16 ..... ,19..7.6pursuant to which Building Permit No ..... .8.8.6.0...Z .......... dated . . .S..e p.~.e.a.t .b .e.r.. 1..6 ........... 19..7.6, 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 ......... Accessory Storage Buildin~ ~ The certificate is issued to Robert A. Taylor, Jr. ~ Jeanne A. Taylor (owner, tender-or mt?~tfl - - - of the aforesaid building. Suffolk County Department of Health Approval ...... .~/?. ................................ UNDERWRITERS CERTIFICATE NO. N / R ...... :'..~...' .... ' ....... ~..~'2..~ .~ .'.~ ...... Building Inspector Rev. 1/81 FO~.~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Z ~. ~ Ne. 8860 :- Permission is hereby granted to: Date ................ 8a~p.'~......1.6 ...................... 19..7.6.. Bober. t..&.. J:e ~a~me ..... ~a:~lo~ ......................... :~ ............ ~o~t~h~ ............................................. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application 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 buddings, 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 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. F'or existing 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 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 informa- tion required to prepare a certificate. 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 New Building .. ~.(.s.t}.e.d.)... Old or Pre-existing Building ............ Vacant Land ............. Location of Property !..'~.....~.i~.~) .o.d.r.o.m..e..D.~. J:¥.e.,..S..o.u.t:1? .o.~.d/...~.e.~..¥o..r~ ................. House No. Street Hamlet Owner or Owners of Property .R.o.~.e. ~..A.;. ?.a.~.]: .o.~.,..~.~.o..a.~.d..J.e.a..n.~.e...A....~.a..~,.1.o.~ ......... County Tax Map No. 1000 Section ...6.6. .......... Block .... ~ .......... Lot .... 2,5. ......... Subdivision .~.e. ~.x.e.~.o.~. ?.s..~.a?.e.s. .............Filed Map No..1.4.7..2 ..... Lot No..9..&..]~./.o...8.. Permit No ........... Date of Permit .......... Applicant .~..u.d.o.Z.~?.. ~.o..~.rF.e?.:..~.s.q .. ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . ?. .................... Fee Submitted $..5.; 0..0 ....................... Construction on above described building and permit meets~l~'l~plic/aD, l~ co~es ~/~c~/r~_~lations. % lJt Ru.o-ph~ Brue r/- BUILDING DE~,.~RTMENT ~'~//~L~ /~//)T~r,I? ~/'~/?? ~ ~OWN CLERKS OFFICE ~UTHOLD, N. Y. ~proved .............. ~.~ ......... ~.~. ........ , 19~.. Permit No..~..~...~... D~pprov~....~~..L~.~....~....~ ............... ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. TI,s application must be completely filled ~n by typewriter or in ink and submitted in triplicate to the Buildi 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 areas, and giving a detaded description of layout ofproperty must be drawn on the diagram wMch is part of thru applicatir c. The work covered by this application may not be commenced before ~ssuance of Building Permit d. Upon approval of this application, the Building Inspector wdl issue a Budding Permit to the apphcant Such pern 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulaho.ns, for the construction of buildings, additions or alteratmns, or for removal or demolition, as here~n describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. i ' Southold N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricmn, plumber or build.- o1~ne r Name of owner of premises Robert & Jeanne Taylor If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......... .o....l~...e...r. ............................... Plumber's License No ................................................. Electr,cian's License No ............................................. Other Trade's License No ............................................... Block Location of land on which proposed work will be done. Map No ..B.a..x_i...d..o..n .................. Lot No .... ~ .............. St,eat and Number ........ ~.iO~IQf]~.Q~...~.~. .............. ~..9..~.~.~.0..~..~. ..................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construchon: a Exisiting use and occupancy .,~...~..e..~.~.~.,~ ...................................................................................................... b Intended use and occupancy same with storage (accessory) shed 3 Nature of work (check which applicable). New Budding ~ Addihon Alteration Repair ................. Removal ................. Demohhor. .................. Other Work ............................................... (Description) ~ 10~00 ; EsHmated Cost ................................... , ....................... Fee ................................................................................. (to be pa~d on filing th~s applicahon) 5 If dwelling, number of dwelling units ...... .O..~...O. ............ 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 .......................................................................................................... Dunensions of same structure with alterations or addmons: Front .................................... Rear ...................... De[~th ................................ Height ........................ Number of Storms ............................... 8 Dnnens~ons of enhre new construction: Front ......... .~. ........................ Rear ..... 8. .................... Depth .......1...2. ......... H~ight ................... Number of Stones ....... Q~. .......................................................................................... 9 Size of lot' Front ...~. .............................................. Rear ........ .~.~. ............................ Depth .1...~..1. ....... ~ ............. 10 Date of Purchase ..................................................... Name of Former Owner ...... ~..~'..,~..:..~.~ 11. Zone or use distr,ct in which prem,ses are s,tuated ......... !!..A.~l....~..s..~. .................................................................. (/ 12 Does proposed construction violate any zoning law, ordinance or regulation: Eta 13. Will lot be regraded .... ..~..O.. .................. Wdl excess fill be removed from premises: ( ) Yes ( ) No 14 Name of Owner of premises ..~..~;..J...~.~'].OZ'. .................... Address ...... ~..q~.~9,~,~, ....... Phone No ..................... Name of Architect ................................................ Address ................................ Phone No ..................... Name of Contractor .............f~'te.~ ................................. Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~stmg or proposed, and indicate all set-back dimensions fro~ property lines Gwe street and block number or descnpt~on according to deed, and show street names and indicoi whether ir~tenor or corner lot /© STAT OF N EVVn~I~I~,~ ~ ~ c c COUNTY OF ....~..~?.~.."..t~.. ............. .................... ~.e...a....z~...e....~.~..~..o.~ ........................................ being duly sworn, deposes and says that he is the apphcar (Name of individual s~gnmg contract) above named. He ~s the ...................... owrzez'- (Contractor, agent, corporate officer, etc) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and fil this applicahon; that all statements contained in this applicahon are true to the best of h~s knowledge and behef, an that the w:)rk wdl be performed in the manner set forth in the apphcahon filed therewith. Sworn to before me this ................... '1...~.. day of ................. .~..ep.t,.... ....... ..... ..... ............ NO[ARy PU~LIC $~afe at New York N. 52 ~I25850