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HomeMy WebLinkAbout9542-zFORM NO. & TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No ...... ~9..~.6.0.. Date . .D..e.c.e.m.b..e?...~? ............, 19.. THIS CERTIFIES that the building located at .2.~0..Kc~..o.$...R.o.a.d. ......... Map No ............. Block No ........... Lot No ............ ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...Noveraber...7. ...... , 19.7.7, pursuant to which Building Fermit No.. dated ...November..-? ....... , 19.77, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .P.r$.v~te. One. Feu~£1y. D~.e],l$~; ............................... The certificate is issued to ..... David .$,. &.. tlemine Horton .................... (owner, ~ ~'~Sf the aforesaid building. Suffolk County Department of Health Approval Se tember 18, ?~.T.8,... Robert A. Villa UNDERWRITERS CERTIFICATE No. N~056t9 HOUSE NUMBER .... ~.~.0. ......Street ........:~ .... .K.o..u?.o.s. ?..o.a.d. ............... ~i New. Suffolk~N', Y,, BuiIding Inspector County Tax Number 1000-117-6-16 (THIS PERM~IT Must B~ KEPT ON THE PREMISES UNT!k J: COMPLETION OF THE WORK AUTHORIZED) No. 95~t2 Z Date ......................... .l~V .......~ ............. , 19..,~c/.. Permission is hereby granted to: et 15remises located at '""~tO~'l~'~rtls"'BOr ............................. ' pursuant to application dated ~ ............................... i~'C~V' ......... ~., 19... , and opp~:oved by Building Inspector. FOI~M NO. 6 TOWN OF SOUTHOLD Building Delmltment 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 triplicate 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 disposol--(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. 13. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey aT 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 $1.00 y Date .~' ' ~ ~T,¢.....~...: ........ .~....~,,. ..... New Building ..................... Old or Pre-existing Building ............................ ,~acartt Land ............................ Location Of Property ... ~..~. ~:~:.,~ -- r~ ,~/-,,-/Z ~//.~Z .......... .). ~. ~,.~J¢Z..,~. (-~./~.~.~/),/~/,.... ~...~....~. ................... Owner Or Owners Of Property .~,../~..~//~,)...~...~.'.'-~ .~../..~..../../..~..~C.~..~,~.~.~Z'.~.. ....................... ................................................. .:.:...,ot ,o. House ,o' --. ,, ............. Subdivision Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporory Certificate ........................................ Fina! Certificote .......................................... Fee Submitted * .................. Sworn to ~fore me this Applicant ..~~~~Z/~.~~/Z~ ................ day of ............................................ (stamp or seal)~J~~7~~~ ~ Nota~ Public .................................... County THE NEW YORK BOARD OF FIRE UNDERWRITERS D~I BUREAU OF ELECTRICITY I~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CE~IFIES THAT David S. No~*o~, ~30 s/~ Kouros Rd.~ New ~exami~on Oc$obor ~. ~ andfou~tobelncompllan~wlthtAe~quiremefltsofthhhrd, .x..r _ o_ ~R~ ~T I m.m I s R v I ~00 CB MITfl X A.W.G. , ~w.o, I ~/0 I ~/0 ~a~boerd/s ~ 1-25cl r. l-4,SKW Hot Wafer Heater I-~O.K~ Heat Pumo I- t0amp, Blender Definer EL~c. ;o. P.O. Box 4~2 This ce~ificate ~d not be altered in any manner; return to the office of t~ ~ard if inmr~. Ins~ors ~y ~ i~ by their cmdentlals. COPY FOB BUILDING D~TME~. THIS COPY OF C~FI~TE M~ ~T '~ ~/~, TOWN OF SOUTHOLD /~ BUILDING DEPARTMENT/~-.'_~ ~ ' TOWN CLERK'S OFFICE ~UTHOLD, N. Y. D~pproved ~/c ............................................................ ..... , ............................................... ~ ........................ ~ ~ ~ ~. ,/~h~ ~,,.~z ....... ~. .................. . ,~.gZ...~ 1 NSTRU~IONS a. This applioatJon mus~ be ~ompletely filled in by W~wri~er or in ink and submitted in tripliaate ~o the Building Inspeo~or, wi~h~ 3 sets of plans, aaaura~e plo~ plan to scale. Fee aaaording ~o s~hedule. b. PIo~ plan showing Io~ation of Jo~ and of buildings on premises, relationship ~o adjoining premises or publia streets or areas, and~ ~iving a detailed desaription of layou~ of pro~rW mus~ be drawn on diagram which is part of ~his appliaation. ~. The work aovered by this application may no~ ~ ~ommen~d before issuanae of Building Permit. d. Upon approval of ~his applioafion, ~he Building Inspector will issue a Building Permit ~o the applioant. Such ~fmit sh~l be kept on the p~emises available for ins~afion ~hroughou~ ~he work. e. No bailding Shall be oa~upied or u~d in whole or in par~ for any purpose whatever until a Certificate of O~aupanoy shall have been~ granted by ~he Building Ins~ator. APPLIgATION IS HEREBY MADE ~o the Building Depa~men~ for the issuance of a BuJtding Permit pursuant ~o the Building Zone Ordinanee of the Town of ~u~hold, ~uffolk ~ounty, New York, and other applioable Laws, Ordinances or ~egulations, for ~he aons~ruo~ion of building, additions or alterations, or for removal or demolition, as herein described. The applJaant agrees ~o ~omply wi~h all applicable laws. ordinanees, building aode, housing aode, and ~egulafions, and to admi~ authorized inspectors on premises and in buildings for ne~ssary inspections. ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... .............................. _ : ............................................................................................................................ Name of owner of premises .....~...~.J~..L[[~ ........ ...~..'....~..~..'~.J~J ................................................ : ........................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~. Location of,an~ on wh!ch proposed wo~ wi, be don~.~ap No.: .......... : ......... ,ot No ..... Z...~.:.. ....... ~ ............. , ........ Street and Number../. ...................................................... ....................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......................... ,, ................. b, Intended use and o~upancy ................................................................... 3. Nature of work (check which applicable): New Building ...... ...{~..... ........ Addition ..................... Alteration ............... Repair ......................... Removal ......................... Demolition ........................ Other Work ....................... .:...~. ..... {Description) 4. Estimated Cost '..'~...~...p..(~/...L~.....~Z...;.....~. ....... Fee ...~.../.. ...................................................................................... (to be paid on filing this application) 5. if dwelling, number of dwelling units ...... I. ......... Number of dwelling units on each floor ......................................... If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify n/ature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ..~../..~.~JJ¢ ........ 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 ....~O..~ .............. Depth ...~. ..................... Height ....... I..~... .................................... Number of Stories ..........J .............................................................................. 9. Size of lot: Front ......... !..~......(~.. .................. Rear .......................................... Depth ...~.....~..~.. .................................. Height ........................... .J ....... /. ............ Number of Stories ...................................................................................... , 10. Date of Purchase .~...~z.~..x)/..~.~,... ...... .. Name of Former Owner..4,~,~jl~.m.~,{~......~.z~..~,~?~. ................. 11. 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 excels ~ill be removed from premises: [~Yes [ ] No 14. Name of Owner of premises .. I~....~.U..J,J~ ...... .~.....~J~i..~..~.' ................................... ..~.~.~..~..~...OJ.l.~. ........ (Address) (Phone No.) Name of Architect ..................................................................................................................................................... (Address) (Phone No.) Ne me of Co ntractor ... ~,~...l~t;~...i.~.......~....; ....-}1~.... J~.3~2..(~ .......................................................................... .'. ......... {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 wheth- er interior or corner lot. STATE OF NEW YO~, ~, ~z'~ ) cou, ..... ........................... ~.~..~.._~_~....~'._~.~.:.?:.'. .................. being duly sworn, deposes and says that he is the applicant above named. (Name of individual~i~ing contract) ~ _ He is the ....................................... ~.~.-. ......... .:...~..7...~ ................................. ; ............................................................. {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. //~/ ............................. ............. ........... ...... / ' $1./VF. CO D~'PT. OF HEALTH e,~:RylCl~ ~'rATEMENT O~ INTENT .... ~ ' ~" FOrt APeROVAL OF CON~U~ON H. 6, REF. NO.: ~ ~ /~ 5TANDA~D~ OF SUFFOLK CO, OWN£N: SUFF:.. CO. ,HE*L~"a, O~~r.,, *~PeOV*L. NEW ~o~ ~v~. ~ ~ 8EP 1 8 1978~~. ~ ~ .~~. The ao~,age dis~okal and wvtop : inspected by t:~ls ..... ',-~ K 0~;0 ~ x~ ~0~0 , ,, ,.:.~7~, ~ ~.~-s~,-..~ '- ~ ~ ~[k--~' ~DE~CK VAN TUYL, P, C, FOR APPROVAL OF CONffi~UqlON' ONLY DATE,' OlS~L ~YSTEMS FOR THIS RESI- DENGE _ WILL CONFORM TO THE ~'~'~'(~ STA D~RD~ OF SUFFOLK CO. DEPT H.S. REF NO.: ~ .... : APPROVED: , : ~ APPLICANT O~ f ' i d NOTEi APPROVr'D AS ...... , DEPARTMEN; AT I t , I k~, ~>~¥ E.