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HomeMy WebLinkAbout9004-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupency THIS CERTIFIES that the building located at .~.( .0...h~.~..~..D..'?..~..O. ........ Street Map No ...... .--w. ..... Block No.-w ........ Lot No ...... -?-. ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... B.}:~... [~., 19.7.$. pursuant to which Building Permit No..~..Q..f.)..cf dated .......... .D..k.~(.~ .... t.~.., 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 is .. ~...~. ~. [ .~g.T~.. f . fj~/. E ..... Et) !.~1. [~. :r ..... Ih. ¢! .~..1.. ¢/j¥...f~w.. ........... The certificate is issued to ...'.~. ~..~..~..ry. ~. ....Iq..O..~fi..~ ._~. ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .h[0.~...~..Z., ]~777..P..~.e..~...~ 2?.o. 7. (Y..? UNDERWmTERS CERTZFmATE No .... M. ~.'5...7. ~. ( ..~ ........................ HOUSE NUMBER .... F). I. ¢ ....Street ...... \/~.,...~..~...~...~...~.: .O ..... · .~..~. ?..~.~T SouT~p~ ~,t. y. Building Inspector TOW. 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°. 900~ Z Permission is hereby gronted to: . . .T. . .~. . Ij. . F,. , . .v. . .~ ........ .f. . ! .o. . ~. £ .~. ....... .~. . b~. . .~. ........ ...%......~.~.~:.~. L.0....~..~.q.~.,..~......~..~..~. ~. ~..o ...................................................................... ,~.O.~..~..t)..¢~.t,.,b,: ............................................................ pursuont to opplicotion doted ..................... ]~.......D...~...~?_ ............ , 19..7...~..., and opproved by the Building Inspector. Fee Building Inspector ~:1 THE NEw~,YORK BOARD ,OF FIRE UNDERWRITERS EIIJREAU OF ELECTRICITY ': F-- ,: ',i ~ 8~ JOHN STREET, NEW YORK, NEW York 10038 THIS CERTIFIES THAT~ ' ' /' ~ ' mdy the etectrica[ ~qu{pmen~ ~s described be~o~ ~nd ~nt~duced by ~h~ applicant named on t~e above apptlcatlon number ~n th; p~mi~es Of Taurus~Homes~, ,wabasso S~. (Hiawatha Path IO0'S/~ Southold L.I~ ': 1 smoke detectDr ' - GFCI This 2ertificate must not be altered in any manner; return to the off;c~ of the Board if incorrect, lnspedors maybe id~tif~b~iols; TOWN OF $OUTHOLD , Building Department Town Clerks Office Snuthold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions 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, 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 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 c~pplicabJe. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings end "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 /,9 New BHitding ...~.. ........ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Locato/n Of P'ro ert .~/..~ ,//I, ..~.! .r./~;,_ P y ..... ;~/->~. .3~, .....~. ~-~.:x-...-..~/.x,~,~-/~. ~,~ ..;e~,.,~ ............................................... Owner Or Owners Of Property ..///~.~./.~.,~..,~-.-~\/~'~/,~.,.~..~,x~..~. ...... ~ ............................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Health Dept. Approval ..... ~.~..0...'.{..~..~.. ................. Labor I~pt. Approval ................................................ Underwriters Approval .... .~-r~,~/~o.~.J./. ................... Planning Board Approval ........................................ Request For Temporary C~_ificate ........................................ Final Certificate .... ~ ............................. Fee Submitted $ ........ ~. ....................... Construction on above described building andJ~ermit meets all applicable codes and regulations. Applicant ...... ¢~...../, ~ .~,~. ...... Sworn to before me this (~/ ................ day of ............................................ (stamp or seal) ~ v 7 Notary Public ..................................... County 7-~c ~r/~ '7~ 2- TOWN OF SOUTHOLD ~/~-~ ~/~ ~ ~ ~ BUILDING DEF*RTMENT* ~ g~a ~/~ ~ TOWN CLERK'S OFFICE ~ '~ .~ ~ .~ ~ ~ ~ mUm. OLD, ,. v. ~ · ~ ~ ,* ~/~ ~ ~ ~ u~sapprovea azc .............................. ~ ....................................................... · . .~,1 ..~, ~ . ~ ~ ~ oh ~ x ::~ .... .~,.: ........... · ..................... ~.~-::.~.~ ................ ~...~ xed - -~ - _ . .... ~ (Building.~e~tor) _ ~ ~, ~,~. ~..~ ~ ~y '~, gk AP~L~ION F~R BUILDING PERMIT x- ~ '~ ~, ~ ~-~/ ~~te .......... Z...:...~..., 19-: ......... a. This application mu~be ~om~e~Jy,~iJled in by typewrl er o~ an su-m~ -d in trpJicate to the -'JD~o~h 3 set~ of p[a~ a~q~(a%-~J'bt plan to ~ ~~~ ,~ ~ . b... P~ ~l~n s~owin~ loco~o~ o~lot ~,~co~buiMin~s on premises~ ml~t~n~i~to ~djg~ ~remises or public streets ~. ~r~;~in; ~ de~oil~e~rih~ ~loyout ofptope~ must b~r~ ~nX~h~dio~ch is pon of ~his d. U~on o~prov~l of this o~plic~fion. ~he Buildin~ Inmector Will is~ue"o-Buil~in~ P~rmff to m~ ~pp~ic~nt. Su,~ p~mi~ shall be kept on t~e 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 Ce~ificate of Occupancy~ shall have been g~nted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building De~r~e~t ~rz*he issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southol~~t~Y~ and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additmn'''~ s or altera~ons, or~r re'oval or demolition, as herein described. The applicant agrees to comply with all applicable laws, ord~, ~ c~e, housing code, and regulations and admit authorized inspectors on p?b~i~s-~d ~iBgs for n~es~d~ insp~ ~c~T ' ~ ........... ........ ........................... (Signature of applicon, or qdme, if a State whether applic~n/t is ~ner, lessee, ent, architect, engineer, general (Addr of applicant) electr'~ ah, plur Name of owner of premises ................. 4\ ......... ; ...m.- ..................... If appli~cont is a corpb, tate, signature,,of duly'duthorized officer. ....... ,-'., (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ........... / ....... Electrician's Licens~ Other Trade's License No ............................................... builder. 1. Location of land on which pro,gosed work will be done. Map No.: ...................... .................. Lot No ......................... , , , , Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: c. Exisifing use and occupancy ................................................................................................................................ b. lnten use and occup ......... ~ .................................................. 7 .................................................. 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ................................................ ..., (Description) 4. Estimated Cost ..... ..~....~/...?.~..'.~... ............................ Fee (to be paid on filing this application) cy/¢~_~ J--~/~f t~ / , nl eac floor If dwelling, number of dwell~g units ....................;h.~..Numocr of dwelling u 'ts on n ........................... If garage, number of cars ~.~.~../?~..~. ;..Z:..~.~..-.....~.'~.~.'.C...~..?...~..~.~...~....~.?..~.~..~'/ ....................................... If business, commercial or mixed occd'pancy, specify nature and extent o~f each type of use ............................ '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 ............................ .....~7...?.. lx~mber of StorieSRear ............... '~/ '~ ............. Depth ...~/...Z 8. Dimensions .~...°f' ~re new construction: Front ......................... ~ .,,.f.L..,.."..; ........... .............. I / "' ¢¢*' Height ...... ..........Number of Stories .................... .-/.-. ....................................................................................... 9. Size of lot: Front .....~-......~:....7.. ...................................... Rear ....'.~.....~...~.. ......................... Depth ....J...~...~... .................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ........................................................... ~....' .............................. 12. Does proposed construc~ violate any zoning law, ordinance or regulation: .............. ~.~. .................................. 13. Will lot be regraded .....~.~ ............. Will excess fill be removed from premises: ~ Yes ( ) No 1 4. Narne of Owner of premise~../~...,~....'.~.~:~'.../~.....¢~.....~...~....~.d'.:. Address :.~.,.,~..~.~5',~..~,"~.~.. Phone No. N ...... - ,,,~h ................................................................................................. · .......................... Nome of Contractor-~..'~-~Z~.~.~..:~ -- .............. Address ...~,...t.~......~.'.~C.~...~.-~.... 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 Jot. t STATE OF NEW YORK, c;,llr;/~ COUNTY OF ................ ..%..". ......... .......... ~r.~....~.....~.~...~...0. ........ ~.C,~.~.~,~ .............................. being duly sworn, deposes and soys that he is the applicant (Name of individual signing contract) above named. ................ ..................................................................................................................... (Contra~r, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that ali statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the app~ filed ~ith. Sworn to before me this ~/ / / ~ / / ~/-- .................. o, ................................ II O.O TEST HOLE sood a grovel coQrse sond woter ~he se~a~e dlspos~l and water Supply facilities for thls location havo been ~nspe~ted by this do~,artmont and found be cngzneer j.~]~ Se~'vices NOTES JJ MONUMFNT ;) STAKE O:PIPE NEAREST WATER MAIN-3000'-+ SLJRV[ Y FOR EDWARD d. FiNcN RurH ~. F/NCH iBARANTEED lO CH/C.4~O 1'/1"££ INSUR,4NC£ CO. AT SOUTHOLD r°wN'°~ SOUTHOLB SUFFOLK COUNTY, N, Y. !~E~o~ YOUNG & YOUNG, LAND SURVEYORS 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK DATE' i SCA~-Ei,,= I NO NOV. 16,1977 t 50' 77-8'40 __ el,=14.0 N 84t Are¢ ;26, 7~8 sq. ft, Wil/ord H $chilfing SUFFOLK COUNTY DEPART/,AENT OF HEALTH SERVICES FoR APPROVAl OF C©biSI'iIUCTION ONLY DATED',: II' MONUMIeN O:$IAK[ O=PIPE NEAREST wATER~ MAIN- 3OOO'~ ANGELO.~> ~ JOAN · , ~ . ,.,,, SOUTHOLD ,o,.'o~ sOO ' ~ '"~ ~6~. O~ [R~NDER .AVENUE 7 5;; ~¢~ ~0't'N~W ~OR~ .........