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HomeMy WebLinkAbout9396-zFORM NO. t TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z9230 Date September 28 19 78 THIS CERTIFIES that the building located at . 1. .16.0..N..o.r.t.h' .P.a.r.i.s..h..D.r.,... ~ Map No ............. Block No ........... Lot No .................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .... 9. ...... ,19..7.7. pursuant to which Building Permit No .... .9.~.9.6. Z dated .... August .... l0 ...... , 19..7.7., 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 ....... ?r..iy.a.t.e...O.n.e...F..amily Dwelling Dorothy Matthews & Arlene Maga~ The certificate is issued to ........................................................ (owner, ~~ of the aforesaid building. 7-30' 109 Suffolk County Department of Health Approval .................................... N40286~ September 22, 1978 UNDERWRITERS CERTIFICATE No. 1160 North Parish Drive HOUSE NUMBER .............. Street .......................................... Southold, NeW York Building Inspector BE KEPT CQMPLETli bF ' THE WORI~ AUTFIORIZED) N? 9396 Permission is hereby gronted to: ~)uild new one family dwelling ;r at premises located at,,..~./..~....N..O..~..~.l~...:?...~.?...l'.~"h'Ji~'-.~. -...-:,. ..................................................................... , 8outhold ;...;.;~.: ...... ; ............... , ................ ? ....................................... pursuant to application dated .......................... '},.::;;/,~,~...,...{~I...[....., 19~/.~.:.., 'ond'opprov, ed by the Building Inspector. ,Fee TOWN OF $OUTHOLD , Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This applicatioa n-,Jst 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 dispasal--(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: I. 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 / Date ........ .~.~ ~0../..~,.s. New Bqilding ................ Addition .......... · ..... Old or Pre-existing Building ................ Vacant Land .............. · .......... ........................... Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No...~.. .ZDate Of Permit. .2,~pplicant ... ~...~....~...'..~..~.. ,. Health Dept. Approval ..... .~ ..................................... Labor ~t. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ....................................... ./~tl, Certificate .......................................... Fee Submitted $ .................................... ~~~~~ ~ Construction on above describedA buildinglican,//~'~and~it ~z/..~~es~/~/~,..~/~.~..~and r~e~ations~' ' ................ day of ............................................ Notary Public .................................... County (stamp or seol) ......... NEW ¥ORK-~':' ~:'--OA--,!B RD O-F':FIRE' UNDERWRITERS ~: ~! , £~- BUREAU OF ELECTRCITY i," : : , . :'' 85 JOHN STREET NEW YORK NEW YORK 10038 ~ ock~ eas~, North~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE '~-'~-~' SOUTHOLD, N.Y. ~ ~ ~ E×om,ned ............ /....0.. ......... , '~.~...?. ..... ~' ~-~ ^pp,cot~on $o.~ ~'~ ~ ,N)proved ............. '.! ......... ~..0.. ........... , m.3.~.F'ermitNo. ~ ~...~ ...... ~... ~ ................. ;i ....... ..7... .................... APPLICATION FOR BUILDING PERMIT Dote ................................ .,~ ........ INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate to the Buildlng'~ 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 jbremJses, relationship to adjoining premises or public streets 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 Inspectd~ will issue a Building Permit to the applicant. Such permit.J~ 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 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 oil applicable laws, ordinances, building code, housing code, and regulations, and to~ admit authorized inspectors on premises and in buildings for necessary inspections. ...... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~...~.~¢.~.~'~:..:L.......~...~..~iz.~.~...,~..~....~..l~F/?.~....~......~.~ ...................................... If applicant~J~'~ corporat~ signature of~uly authorize~ officer. .. z. ~ ~.~'~L~-~-~L~/~, Builder's Lice~qse No ..................................................... /c~oo -~ '7f ~['- ~?~ plumber's Ucense No..~..~....Y.L~f~,~....~.~r" Electrician's License No ....... .~,. ~"'- Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......... ~ ,~ ~ ~ ;~i. ~,,~ o, ~,-,~o, $ , ~ ................ Street and Number //~i ~ .~/~' .~..,.. :~...~. ........... ~.. ...... ,~.~... ~%~'--J~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy Of proposed construction: o. Exisiting use and occupancy use and occupancy ...... O..~..,~.....~ ,~.~.....~.~.Z~ ..~.. ......................................................................... b, Intended 3. Nature of work (check which applicable): New Building~ · ....... Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... (Description) 4. Estimated Cost .............................. : ............................ 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 ..,~J~..~.J..~..~.?.. .......... Rear .....~../~...~..~. ........... Depth .~.R.~. ................ Height ....;~. ........... Number of Stories ....I.~...~... ....................................................................................................... 9. Size of lot: Front ......... ~//',~.~...'~. .................................... Renr ......... ./..~ ........................ Depth .../..~ ................... 10. Date of Purchase ....~ ........................................ Nome of Former Owner ........................................................ 1 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 regroded .......Ir/.~... ............ Will excess fill be removed from premises: ( ) Yes ( 14. Name of Owner of prem.ses ..~.l}/z.~....~.. ................ Address ............... ~./~..i~.~.t ..... Phone N~. Name of Architect .~... ...................................................... Address ............................ ,.... J~one No ....................... Nome of Contractor ...~..~..~..~...~.. C)..~::..~..~. .: ............................................................ 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, ~c c COU NT~z-~F,-- -- ,-, -- , ,:'""'""'~""~ "~ ............... ~~..~.:..,~.~..H ........................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) 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 application are true to the best of his knowledge and belief; and that the work wilt be performed in the manner set forth in the application filed therewith. Sworn to before me this ..................................... Notary ~ubl~/ ....... ~ ............. ~ ........................ Coun~ .~ ....... '......;~.: ............... ~. ............................ ~- ~......~ .......... NO. 52-464372[, Suffolk Ceuun~_ Term ~ires March 30, J9 OWNER: $.7! ,~ , C:~iTle[. I I STAMP . ,~ ~A'~Mt~'NT OF i NTirNT ~ su~. ~co. ozs. ~ H~X v , ........ , ....... /~ , ~Ej WAT~ SUPPLY AND ~EWAOE have be ...........