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HomeMy WebLinkAbout8394-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. g.1.1.~¢7 .......... Date ...... ~. ? .c.e.m.b..e .r..8. ............... 198.2.. THIS CERTIFIES that the building ................................................ Location of Property .. 1 .~3. .................. B..~.a~..~..vg.n.q? .......... L.a..u.rp.J: ........ House No. Slreet Hamlet County Tax Map No. 1000 Section .. ! .~ .6 ....... Block . .. 0..8 .......... Lot ....0.0.6 ........... Subdivision ...... .X ........................ Filed Map No. × .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. .8 .......19.7.6. pursuant to which Building Permit No....8.3.9.4..Z ............ dated ... ~.a.r.c. ~..1 ................. 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 ......... ...... ~.. p.r.~.v..a.~.e..~.a.r.a.~e... ...................................................... The certificate is issued to ......P.h. 5:. ~ ~p..d. :..&..H..e.a.~.h.e..r..L.O.r..L.a ........................ (owner, lesa~ ~m')' of the aforesaid building. Suffolk County Department of Health Approval ..... g./.r. ................................. UNDERWRITERS CERTIFICATE NO ............. .n/.r. ................................. Building Inspector l~ORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTN~ENT TOWN CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COA4PLETION OF THE WORK AUTHORIZED) N? 8394 Z Permission is hereby granted to: ~¢r~ :;at oremises located at ..J~...~ ...................................................... ~-' --~ ............................................................ ~!lt~l ....................................................................................... FOEM NO. 6 TOWN OF SOUTHOLD , Building Department Town Clerks Office Soutbold, N. Y. 11971 APPLICATION F0K 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 s~mHar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and 'pre-exmting" land uses: 1. Accurate survey of property showing all property hnes, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condihon of buddings. 3. Date af 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 $1.00 ~, ~ Date ...... O.g..t,~.~.e.~..~..,1,.g..~.~ .......... New B~ilding .... .x.....~.u..~.. Addlhon ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ...... E/.5..B~.~v..A.~e~iH~.,..L~.e.1 ................................................................................ Owner Or Owners Of Property ...... .P..h.,~..~ .......................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No ..83~.~Z ........ Date Of Permit ..3/.$/.7.6 ...... Applicant .,g,l~i.l,i,p,.ba~4~.,&..W~.~.e .......................... Health Dept. Approval ............................................ Labor Dept. Approval .............................................. Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FmaJ Certificate ......................................... Fee Submitted $ .~...~..J.(~:.~..~..../ ~ ~ q Construction on above described building/~N~.e~ni.t., me~)al, .applicable codes and regulations. Applicant ..~..~/~7. ...... ~.~ ............................................................ - P~ILIP ~ORIA Sworn to before me this ~, ~ 22nd dayof October, 1982 (stamp or s~l) ~~ No h2-45C'CTZ9 ~ ~ TITLE NO. 72-~-Z0475~ .... ./ erohon or a~cJlhon ~o fh~s su~ey ~s c v~c~al,o~ o~ the Ne~ ~c,b S~o:e Ed'~cct,on Law NOTE: · z MONUMENT L©RIA SURVEY FOR PHILIP O. ~ HEATHER LAUREL TOWN OF SOUTHOL D SUFFOLK COUNT¥~ N.Y. SCALE: I':=' 40' SEPT 15, 1972 GUARANTEED TO' CHICAGO TITLE INSURANCE COMPANY RIVERHEAD SAVINGS BANK PHILIP J R. HEATHER LORIA LAND SURVEYOR N,YS LIC. NO 28725 RIVERHEAD~ N. ¥. Proposed One Car Garage $ 18, x 24, ) Frsme Philip J & Neather Loria Bray Avenue ,Lattrel Southold Town Construction Details Foundation: Slab 5" poured concrete Footings 12" x 36" Concrete mix 1-2-4- Grit Fr~ing Detail~ Plates 2-2x4 Studs 2x4 on 16" Centers Halters 2x6 on 16" Centers Collar Besm~ 2x4 on 48:, Centers Sheathing 1/2" C.D.X. Throughout Ceiling Joists 2 x 6 on 16': centers ( for storagel Walls 15 lb Felt Asbestos Shingle Roof 15 lb Felt 240 lb asphalt shingle Details: 1. one 9 x ? five section wood overhead garage door 2. one 2 x 6 by 6,8" side entrance door ~ frsme 3. Two double hung sash (Located as per owners ordersl gx'7 o.H. ........... Disapproved a/c ..................................................................... ~ /~_~l~...~ n {Building ~1 r~fl:~'tor) ................ /, APPL~ICATION FOR BUILDING PERMIT Date ...E.e..l?~'..~.n....~....l...8. .................. ,19~.§ ....... INSTRUCrlor, IS a. This application must be completely filled in by t~ewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 set~ of plans, oct _umt~ plot Plan to acale. Fe~_ according to schedule. b. PIo~ plbn showing location of-lot {and a{ building~ o~premJ~, relofionslsip to' ai~liotnlng premi.~-~ or ~Jbli¢ ~'r~ atoms, and gi¥ing a detailed d~:ription of la,out ofpra~ must~l~ drown on th~a~grom-~:h is por~ of this ~lication. c. The work covered by this application m~¥ not be commer~:ed be{ore issuance of 8uildir~ Permit. d. Upon approval of this application, the Building Insl~:tor will issue a Building Permit to the applicant. Such l~rmit shall be kept on the premis~ m, ail~ble {'or in~ecfian .~raughout fl'~ ~ork. e. No building shall be ocoupled or used in whole or in l~rt {or any purpase whot~ter until a C~rl'ificc~'~ of Occupor~/ shall hc~te b~en granted by the Building In~ector. ^PPLIC~TION IS H£R£BY MAD£ to the Building Department {or the issuance of a Building Permit pursu{mt to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, dncl~,other aj~pllcable Lows, Orclinances 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; ¢:mcl to - - (Signature o~ppliccl'nt, or name, if a corporation) · .- '(Aaaresso a~nlicant)d~ f I t 0t State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricion, plumber or builder. ...................................... .9.~....e~.. ................... ~ ................... Z.L..,..:....:,,.~.....~ .......... ............................. ~ ..................................... Name of owner of premises .......... .~.~.~...~..t...~.~L~.a.~.~...e~...~.~'~g: ....... : ............................... ::: .................................... If. appl cant is a corporate, signature of duly autl~rized' officer.: (Name and title of corporate officer) Builder's License No. ~el.~ Plumber's License No." : Electrician's License No ............................................. Other Trade's License No ......................... 1. Location of land on which proposed work will be done. Map No.: ........................ ................Lot No ......................... Street and Number ......... ~.~.~r..,~.l[r.~l~...,.~..e...~[..JLl,~l..J~i~.~...~,.Clou.~]:L.~,a~g~ ................................... Municipality 2. State. existing use and occupancy of premises and intended use and occupancy of p~ construction: a. x s ,ng use ond occu n ....................... b. Intended use and occupancy .......... .~.~...e.....o....a~....~..~......ag.q...J.~.l~...~..~..l~l~.). ................... , ............................ 3. NatUre of work (check which applicable): New Building, ........~.. ........ Addition .................. Alteration ........ :...,:.4~, Repair .................. Removal .................. Demolitio~ .................... Other Work ................................................ . (Description) 4. Estimated Cost ......... .~..~...O..0...0..e...O..O. ............................... 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 ............. 0~,~ ......................................................................................................................... 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 .~.t ................. Height ........ .~.[. ...... Number of Stories ................ Q~.e. ............................................................................................... 9. Size of lot: Front .................. ~.~;; .............................. Rear ......... .?..5.;~ .......................... Depth 10~ ~ate of Purchase ....... ~.~..;./....~...'~..J. .......................... 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: ........... .~...O. ........................................ 13. Will lot be regraded ....... ,~.0. ............... Will excess fill be removed fr_om pren~.ises: ( ) Yes ( ) No ~r~' AVe 14. Name of Owner of premises ~I,~,~...~T..&..~[fL~,t~Z'...~Z'~ress ....La, t~.e,], ............. Phone No.~.~.~.~.~ .... Name of Architect ...~....'. ............... .~. .................... ,/--(~,~,'g~Address ................................ Phone No ....................... Name of Contractor ............. ~,1~. ..................................... 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. STATE OF NEW YORK, lc c COUNTY OF ................................ ~'~'~ ................................................................................................. ~eing duly sworn, deposes and says their he is the oppliconl (Name of individual signing contracO above named. He is the ..................... ~...~.. ................................................................................................................................................ - · · (Contractor, agent, ~c~rporate. officer, etc:) of said owner or owners, and is CIuly authorized to perform or have performed the said work and to make and file this application; that all statements cpntalned i~ this ap~licat~on:ore tEue to the best of his knowledge and belief; and thor the work will be performed i~l9 the manner set forth in the application filed therewith. Sworn to before me this ~// .... .......... day of ............. , Nota .ub ic, ............... -- ........... County ......... ' ........ .............................. (Si~'nature of applicant) rea, 52-4050425 . Surf°~ ~ew TO~