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HomeMy WebLinkAbout7892-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ..... / Date THIS CERTIFIES that the building Location of Property ~ ~ .,6-.)- House No. Street County T~x Map No. lO00 S~ction .../. ~..~....mock Subdivision ............................... Filed Map No.....-~--....Lot No .............. conforms substantially to the App~cation for Building Permit heretofore fried in this office dated ............. ./~..~ 7~ ..~,, 19... pursuant to which Building Permit No ..... .7..~. ~..~...-~. ...... dated ............... .~...~.....~. .... 19 .~.~.. ,~-as 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 ................ [~ '~n~,'l'~'dr't~n't) ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... /v -Y~2 7o~.~ UNDERWRITERS CERTIFICATE NO ................................................ Building Inspector Rev. 1/81 FOB3[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON TH.E PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 7892 Z Permission is hereby granted to: ....... ~.~....~ladel..O= ............................................ ................ Y~L~er. haac~ ......................................... ~o..I~Ll~.~..£rmt~..eat~...~ad~tt~n)...aa..ex~t.t~..baXla~ ......................... at premises located at ..~/..~..~..~adaJl~.....~.(~P~).o$,l,~a..,~tl~...~,~l.). ........................................ ......................................................... ~.~l~.e~ ....... ~.,. ........................................................................ pursuant to application dated ................... ...K~..~. ....... ~. ................... , 19...~.[~., and approved by the Building Inspector. Fee $...:1.~,,~ ......... B~ildir~' inspector I ............... 'FO~,3 NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office 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 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 applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "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 New Building ................ Addition ....~". Old or Pre-existing Building ..~/.. Vacant Land .............. Location Of Property ...~../~. .......... ..~./'~.../..~..../.~...~.........~.,~...~:~.~..~.;;. ....................................................... Owner Or ~ne~ ~ Pr~e~y ..... ~.~....~:.~.~..~ .................................................... ~ ......... Su~ivision ................................................................ Lot No .....~.... BI~E No .............House No ............. Pe~it No..2.~.~ate Of Perm,t' .......... ~ ~ Apphc~t' .................................................................. Health ~pt. Approval ............................................ ~bor ~pt. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this .... ,~...~... ..... day of ....... ~.~ .............. ./...~..~.? Notary Public ..........~....~....~....~...~., ......... County (stamp or seal) .Robert FI. Militscher, Nc}. 52 451]]10 ~otary Public, State of New Yorl~ Q~,alified in Suffolk County ~ty C~rnission Expires Mar. 30, J. ¢ It.,: THE NEW YORK BOARD UNDERWRITERS ~' BUREAU OF ELECTRICITY --85 JOHN STREET. NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT ten ~zer, ~n R~. opp. Bray Ave. ~ueeL, L.L in the follmelng /~ation; [] Basement [] IstFI. [] $nd FI. Section Bloek I~ot and found to be in compliance with the requirement~ of thi~ Board. DRYEI~ FURNACE MOTORS HXTUII~ ~ OVE~ EXHAUST ENMMBIS SERVI~ DISCC)RN~T S E ~' R V " I .1. 350HC~ : ~arren R£=zer Rd. This certificate must not be altered in any manner;, return to the office of the Board if incorrect. 11 ~~ BUILDIN~ ~IP~. THIS COPY OF crdmRCAT!I ~ !~)~T ! 1~01~ NO. $ TOWN OF $OUTHOLD , Building Deportment Town Clerks Office 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 Inspector with the fallowing; for new buildings or new use: ]. 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 farm 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 far the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), No~-conforming uses, or buildings and "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 New Building ................ Addition ...... ~... Old or Pre-existing Building ....~.,.. ...... Vacant Land .............. Location Of Property ...... .~../5 ....../'.~.~.~./.~.....Z(~.......~.~.~...~..~:~..~.....~... ..................................................... Owner Or Owners Of Property ...... .~..~..'~.~'.Z~..~...4~....Z~..4 .~.,~.~ ............................................................... Subdivision ................................................................ Lot No..~.~ ......Block No ............. House No ............. Permit No...~..~'...~.~- Date Of Permit ..~..~...~./~.'..~plicant .................................................................. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ FinaJ Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicab~ codes and regulations. Applicant ......... ~2 ............................... Sworn to before me this ...... day of ..... ............. /.F..Z.? Natal/ Public ....... ............ Cou.ty (stamp or seal) .Robert H. M;litscher, No. 52 451]~10 ~]otary Public, State of New York Qualified in Suffolk County M~'C~rnmission Exp!res Mar. 30, 1 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved 192: ..~. Permit '~ ~(~' ~' ~"~- Application No. Disapproved O/~ ..... ~ * (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plon showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or 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 opplication 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 port for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY N~,DE 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, o~name, if a corporation) o applicant) ~ ~, ~ '~ .... State whether applicant is owner, lessee, agent, architect, engineer, ~neral contract~r,~lectrician, plumber or builder. ................ ............................................................. ..................... I{ opplic~nt is ~ corporote, si~n*ture of duly ~uthorixed officer. (Nome and title of corporate officer) Builder's License No. ~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... ~ x/. Location of land on which,,il~?~sed W~l~//will b~e don.~ Hap No.: 7'"'~ ......... ...~...Z~.. Lot No ..... ./..~. ............... Street and Number ~,,~.. ./.....~_~ .~...c...~ .... .~....~~ ............................ ........ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ..~..~.J/..~...~,. ...... .~.../~'..~,.~.d~ ...... ~--....~.~. ..... J'~....~..~ ...................................... 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior. .................... Other Work ................................................... ~ ----~ (Description) ' Estimated Cost .........~....~..1~, ..................................... 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 & t ,i '1 · ,' ~ ................................. Rear .../~ ........ & ............ Depth ....~.. .... ~..~.~../ Height ....~.~. ........... Number of Stories ..................................................................................................................... 9. Size of 'lot: Front ..... ~./...~1~..~ .................................... Rear ....... .?..~....: ........................ Depth ....... .~...~..~.....~.. .......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..~...~..~...~.:~..~.,~.,~ ....................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ....~....~. ................. 13. Will lot be regraded ....~.....~...,$ ........... Will excess fill be removed from premises: ( ) Yes (~ No Name of Architect ... Address ~' Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ~1 buildings whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and bl~9F. number or description according to deed, and show street names and indicate whether interior or ~~ STATE OF NEW YORK, ,. COUNTY OF ..~....~b.b ................... ~ ......... ~ ..... ~~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing c~trac~) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicotion are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ...... day of ............................ , ............... ...... ............... ~' ~ ~//'~, ~ (Signature c~rapplicant) ........... ~ ~' o .