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HomeMy WebLinkAbout8584-ZFOB,~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z?~l.5 ..... Date .... F®hru~r~.. 1.1.r ........ , 19..7.? THIS CERTIFIES that the building located at S/.S. l~$n. Road ............ Street Map No... XX ....... Block No .... XX .... Lot No ....... XX ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated . Nay. 10., ............. , 1g.76. pursuant to which Building Permit No. 8~8~Z.. dated .Nay. lb~ .............. , 19. ?~, was issued, and confoms to all of the require- ments of the applicable provisions of the law. The occupancy fqr which this certificate is issued is .. l~aek, add~.t$oll, ta .pri.~ate. ~ .fa~ly. dwelling ................. The certificate is issued to ... Raymolld .and .Nol~a .g~lle~ ........................ (owner, ~ ) of the aforesaid building. Suffolk County Department of Health Approval ... Ny~R ............................. UNDERWRITERS CERTIFICATE No ........ N/R .................................. HOUSE NUMBER ~9~ 0 ........ Street. ][~i~. ~.oad .............................. (THIS PEIVAIT MUST BE KEPT ON THE I~,EMiSES UNTIL FUII COMPLETION OF THE WORK AUTHORIZED) 8584 Z ..., ...... ~6.....Lon~..~tr~e.t ......... Itunt4~&ton St~o to ...~ReLu~14..~..e~l~e..~4Ls ~Lr~;..~ch..~Lo..~ - ~eck ................................................. at p~ laemed at ,~/.,~...Y~..~..;~l ............................................................................................ .............................................. E~ &t,..l~a~n....~. ,~., ......................................................................... pursuant to application dal~ed .................... .~:.....1~1 .................. , 19.~.6.., omi appm~ Building Insi~ctor. t~*OmM NO. 6 TOWN OF SOUTHOLD , Building Depmtment Town Clerks Office Southold, H. Y. 11971 APPLIGATION FOR CERTIFICATE OF OCCUPANCY Instructions E to he Building A. This application must be filled in typewriter OR ink, and submitt 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 ...¥..../.../.. Data ........ ?.. Z.7.. ................ New B~ilding ................ Addition /~ (~ ~'OId or Pre-existing Building ..~i.... Vacant Land /%__ Location Of Property ......~...~..:.....~...~../.~,1:~....~..~....:~......~..~....~...~.../;.~ ................................ Owner Or Owners Of Property ~.~../~.~..~.~.~:~..~..~..~.~..~/~./...~.~.~...~.....r~....~.~/..~..(:.~ ..~...l/,~/...~... ................... Health Dept. Approval ............ ..,~'...Z..~... ................... Labor Dept. Approval ........... ..'~..//...~/. ....................... Underwriters Approval .............. ~../..~.... ................. Planning Board Approval ..../~../~/~ ...................... Request For Temporary Certificate ........................................ Final 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 FO~M_ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT ~ Z.~.. TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ====================== Dote ~ 10 INSTRUCTIONS o. This application must be completely filled in by typewriter or 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 plan showing location of lot and of buildings on premises, re at onsh p 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 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. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o 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. (Signc~ure of appl cant, or name, if a corporation) 26 Long Streett iiuntington Sra. 11746 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................. ....... Name of owner of premises Raymond d Norma ~.lller 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 ............................................... 1. Location of land on which proposed work will be done Map No ~ ............... Lnt N~ XX Street and Number ~/~ ..azn ~,oad - ~;/ Dam rand ~ast l.:rlon h.~ . Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy dwellimg b. Intended use and occupancy S-3.,~,,O with deck ~cl:iltion 3. Nature of work (check which applicable): New Building.. ................. Addition .....~.....~ ....... Alteration .... ~ ...... Repair .................. Removal .................. Demolitior ..................... Other Work ........ ~....: ................................... . .... / (Description) 4. Estimated Cost ......................................... Fee .~.~.0O. ..... (.~ck..~d~ ................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~J'l.~ .............. 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 ................................ Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated .L.~!!..~.4,.~,¢ ......................................................... Does proposed construction violate any zoning law, ordinance or regulation: ............ 1~O ....................................... Will lot be regraded . ........ ~O ..............Will excess fill be removed from premises: ( ) Yes (X) No ~mt. S~a ~f.5~. Name of Owner of premises ..~a.~no~d..~..,Wo~ma,..i%£.~.l.e~,ddress .2.._~...L4~n~...,%t......Z-Pr~one No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. 9. 10. 11. 12. 13. 14. / / STATE OF NEW YORK, ~ ~ ¢ COUNTY OF ..... i~.~:~.o~1~ .......... f ~'~ ................................................................................................ being duly sworn, deposes and says that he is the applicom (Name of individual signing contracf) above named. He is the ............................ ~-~r~e~,. ........................................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owner~, and is duly authorized to perform or have performed the said work and to make and file this application; that oll statements contained in this application ore 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 ............ ~]r ......................... , 19.~.6... Notary Public,. ...................... ~.1~1~,~'.Q ~ ............ C~,u nty .... X ...... ;....~i .................... ;..; ............ :..., .................................... j~t:~f ~ "~ (Signature of applicant) ~U!I~ING ~I~AlrrMINT Approved ............'./'..~....~...~.~.. ........ , 19~....~.. IPermit No..~. -.~...~.....~...~ Application No ............. ~ ........... (Building Inspector) APPUCATION FOR BUI~ING Date i~y 10 1976 INSTRUCTIONS a. This application must be completely filled in by t~ewriter or in ink and submitted in triplicate to the Building Inspector, With 3 ~ of plans, accurate plat plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pub c streets or areas, and giving a detailed description of layout of PraPert~ must be drawn on the diagram which is part of this application. c. The work COvered by this application may not be commenced before issuance of Building Permit. d. U.pon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shall I~e Kept on the premises ava lable 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 Occupancy 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 the iuild!n.g. Zon,e O .rFlinance of t. he Town.o.f. Southol.d/. Suffolk Cou.n. ty, New York, and other applicable Lows, Ordinances or ~geU~ar~.o. ns, tor the construction of buddings, add,hons or alterahons, or for removal or demolit on, as herein described. e 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 ir"',~pections. (Signcflure of applicant, or name, if a corporation) 26 Lon~ Street~ Huntington 3to. 11~+6 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~...~ond ~ ~ormn Miller If applicant is a corporate, signatu, re of duly authorized officer. (Name and title of corporate officer) ?Builder's Licefme No .................. !..~.....~....../..~.. ............ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work w be done Map No .... ~. ............ Lot No.....~.... . Street and Number ..~./.~..~..~..o..~...~.....-....~.../.......D~......~...o..n..~........~.~..~.~....~.~..~.~..o..~.......~..:.~... ............... Municlpalit~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy . b. Intended use and occupancy .~e wit.h, deck addition 3. Nature of work (~:heck which applicable): New Building.. ................. Addition ~ , ~ Alteration ZZ , Repair .................. Removal .................. Demolition .................... Other Work ........ 4...:. .................................. . .... - / (Description) 4. Estimated Cost ............................................................ Fee .1.~.QO...."(.(~J~IaCI~..~I..) ................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... 4~ .............. 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 ................................ Dimensions of entire new construction: Front .................................... Rear ............................ Depth ....... ~ ................ Height .................... Number of Stories ...................................................................................................................... Size of lot: Front ........................................................ Rear .......................................... Depth ................................ Date of Purchase ........................................................ Name of Former Owner ................. ; ..................... ~ ................ Zone or use district in which premises are situated ....!!~!!..~.4.~. ............................................................................. Does proposed construction violate any zoning Iaw, ordinance or regulation: ....... i....~O. ...................................... Will lot be regrnded ......... 1~O .............. Will excess fill be removed from premises: ( ) Yes (Z) No Hu~t. S~a N.Y. Name of Owner of premises ..JJa,~raioi:tcl...&..~o,r. laa,..JC:J,]..l~L&ddress ~q~..[,~Tt.~...~.t ....... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ 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. 9. 10. 11. 12. 13. 14. STATE OF NEW YORK, [ ¢ ¢ COUNTY OF ..... b%t~f.a~ ir .......... ~.~ ................................................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract0 above named. He is the ............................~)'~ae~ ........................................................................................................................................ . (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 application 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/~efore me this day of ............ M-~r ....... ~ ................. , 19~.6... Notary Public, . ...................... $.1~ ............ C~unty (Signature of applicant)