HomeMy WebLinkAbout8196-z~"~ ' FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
Z10~01 Deodmber 15, ,19 80
No ........ : ......... Date ...................................
THIS CERTIFIES that the building ................................................
Location of Property ....87.~., .0r.c.h..ar.d' .~.~;r.e.e.~., ...... . ......... O.r..~.e.~.~. ...............
House No. Street Ham/et
County Tax Map No. 1000 Section . . . 0~.~. ..... Block .... 0;~ ........ Lot .0'~ ?..Q03 ........
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
..... S ep~.ember..15 ,., 19.7.5 pursuant to which Building Permit No... 8.1.96. Z ............
dated . . ~.e.~l~lb.~l?...~5., ........... 19.7.5, 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 issued to . .~.j.~[1.~alla..~Y. 8OCR], .&. ff.O]t¢.e: .~'~07-.~. ....................
(owner~
of the aforesaid building.
Suffolk County Department of Health Approval ...I~I./.R ....................................
UNDERWRITERS CERTIFICATE NO. 151~ .............................................
Rev 4/79
FOP~Vl NO. :~
TOWN OF SOUTHOLD
BUILDIHG DEPART,~ENT
TOWN CLERK'S OFFICE
SOUTHOLD, N~. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
8196 Z
Permission is hereby granted to:
...~:...~y~o~i~. ......................................................
............. .~r£e~t ....................................................
to .~l~..an..a~d.l:bi~...on..~,.a.tJ~n~;.[ae~e~s oz:br...t lo~L:J.i~g.....f~,..~ ....................
........ .~lt~;~e.t i.o~..on..ez~J~$..ons...i:ami:Ly...aweZLlzLn~ ................................................
at premises located at ......0F~a~[...S.$~;e.~ ............................ ~ .......................................................
............................................................. .0r.£e~.t ...... ~i..Y.~ ................................. .. .................................
pursuant to application doted .......................~.¢¢~:.~ .......... .~. ........ , 19~.~....., and approved by the
Building Inspector.
Fee $...L~.Q0 ..........
Buildin~ InspectoI
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, 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 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.
B. For 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.
C. 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 ....D.e..c.e.m?.e..~..'].~.~...'1~.~.0...
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property .... ~.~..~.~. ........ ~, ~..Zz~.C,h .y~. ~7~ .~Z ............... ~. A'~ ~ .~.~:¢Z.
House No. Street Hamlet
o~,~r or o~,,~ o~ Pro,,rtv .. ~.~: ./.L ~ ~ ~. L,. ~ ~ ~ '~''~'' ~ ~
Co..t~ T~ Ma, No. ~000 S~ctio, .. P.~ ......... ~oc~ .... ~ ......... Lot .... ~.~: ~.~...
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. ~'~/.~,~ .................... ,~ Date of Permit C~//.-~:'/7--~.Applicant ~Z'~-~'''~ ."~'.! ./~... ,~..~, >~"-~,~ '
Hearth Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate X
Fee Submitted $ .... ~...0.0. ....................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant.. ~-.'/~'//¢~ .~..¢~.."~. . ~/.~..~.. .......... ¥~,..
FORi~I NO. ~
TOWN OFSOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
ORDER TO REMEDY VIOLATION
Date Novezaber ~6 19 80
TO .......... ~.~ !. ,~. ~ ?...~.....~.~'.~ ,o..c, .~ ~ ............................
(owner or authorized agent of owner)
................. .9.~.t...e.~.k:..,~.e..~., ~ .o..~ .........................
(address of owner or authorized agent of owner)
PLEASE TAKE NOTICE there exists a violation of:
Zoning Ordinance
ART. XIV
Other Applicable Laws, Ordinances'or Regulations ............... ~:. .................. .:. ........
at premises hereinafter described in that ......... ..~.~.J:...1.~.i...~.g...?..e....z~....~..'g...~....8.!..?.~ .............................
(state character of violation)
,.~R~.?.~. ...... ?.!.~../..?..~ .......... ~..~...?...z,R..t.~.e..~.......,Z.o.~...,~.~.e....~.e...~.t.~.~ ~...~.o...~.~.~:LT.,. Z.n~...~ .....
new permit.
in violation of .......... ~.e...q.:.].g.9. r.!~J..~ .................................................................................................
(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 ......... .~..~.g..~b..~.E ......................... , 19..~.0..
The premises to which this ORDER TO REMEDY VIOLATION refers are situated at
,..~./.r.~,.~..,. ~' .................. of Suffolk, New York.
Failure to remedy the conditions aforesaid and to comply with the applicable provisions of law
may constitute on offense )unishable by fine or imprisonment or both.
....
Examined ....... ~. J..C ........ ,
~oprov~d .............. .'.! ....... ./..~.~ ........ ,
FORM NO. I
,ow. o,
BUILDING DEPARTMENT
TOWN CLERK'S OFFIGE
~UTHOLD, N. Y.
Disapproved a/c .............. ...:~~
a. This application must be comp[etely filled in by typewriter o11, in ink and submitted in triplicate to the Building
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according.to schedulq.
b. Plot plan showing ecat on of [at and of bud ngs on premises, re, lafionshlp to adjoining premises or public streets or
areas, and giving a data ed descr ption of layout of property must be drawn on the diagram which is port 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.
No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shell hove been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment 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 bu ld ngs, additions or alterotiop~, or for removal or demolition, as herein described.
The app[ cant agrees to comply w th all applicable laws, ordinances, bUilding code, h6using code, and regulations, and totoq
admit authorized inspectors on premises and in buildings for necessary inspections. '
(Address of applicant)
State whether applicant is owner, less~, agent, arch~ect, engineer, o,er~eral 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 ............................................... "~
Locat on of land on which_.proposed wor~ will b~ done. Map~.,~,.,../~,, ..Z...: ................ Lot ~o ..¥~., .
1.
Street and Number .....~.'.....~ ........... ............. ~~;~i~'i'l~i~ ........
~.~.(....~-:.~
2. State existing use and occupancy of p4:emises and intended use and ~ccuponcy of proposed construction:
...... ...... ....... 4 ...... ........ ......
/
3. Nature of work (check which applicable); New Building'. ................. Addition .................. Alteration ................
Repair .................. Removal .................. Demolitior ..................... Other Work ....................................................
(Description)
(to be paid on filing this application)
5. If dweilih~, number of dwelling units ....~......Number of dwelling units on each floor
If garage, number of cars .............................................................................................................................................
6. I~- bus ness, 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. Si:ce of lot: Front ........................................................ Rear .......................................... Depth ................................
10. [)ate of Purchase ...................................................... ~.~a~['~o.r~_ro~of Fo er
Owner
] 1. Zone or use district in which premises are situated .. ,~. ....~.! _.. .. _.,.. ....
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be regraded . .......... ...~...,..~.. ..... Will excess fi. II be removed frorRpremislts: ( ) Yes
Name of Architect ................... V...?. .............. Address ........... Z.~ .................. Phone No .......................
Name of Contractor ............................................................ Address ................................ Phone No .......................
PLOT DIAGRAM
Lacate 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.
.................... ,~4~.,..'.,~//,.b~T../~..~r:rR..r, cY.~ ................................. being duly deposes and soys t~t he is the epplican~
(~ ~i~ ~i~ contr~c~ sworn,
above n~med.
He is the
(Controctor, ~ont, corporote officer,
o{ s,id owner or owners, ond is duly outhorized to per{otto or havo performed lbo said work ~nd to moko ond file
th~s ~pp~cotlon; thor o~ stotomonts coBtoined in thi~ opplicotion ore true to the host of his knowlod~o
th~' tho work w~ll be per{ormod in tho m~nnor set fo~h in the opp~icofion {i~ed thorow~th.
'. Sworn to before this ~ - ~ ,
............ ......... .........................