Loading...
HomeMy WebLinkAbout9411-zFOl~l NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ?~.../. ~., 19..~f pursuant to which Building Permit No. dated ............ ~( ...... , 19. ., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occu~l~ancy for xwhich this certificate is ,~u~ ,~ .... ~ ............... ~ ............... ~, *~ ..... , ......... ~ ............... The certificate is issued to... ~ .(:~.~l..~..~.:.., ./.*~f,(~: ~?.-~.~..~.-~ ....................... (owner, lessee or tenant) of the aloresaid building. Suffolk C .... ~ ~' ~ ~ ~' r~' .................. ' .....'/' .......... l:il.)U;~ INUI¥1~ o;1~ ......... · .: .... ~l;ree~. ~ ....... ?,:., .,~/~ ,. ..................... Building Inspector (THIS PERMIT MUST BE KEPT ON THEPREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? §~11 Z Permission is hereby gronted to: ............... ~.~...~ .......... c.~.~..~. ................... pursuant to application dated ................................ .~.~.....~.~- ....... , 19221., and approved by the Building Inspector. I~OEM NO. 6 TOW~ OF $O~THOLO Building Depai~ment Town Clerks Office Southold, bi. 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 alt 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 fram 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), blah-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing aH 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 3. Copy of certificate of occupancy $1.00 $5,00 ,, ? -? Date ,...., ...... ;.,,....~...., ..................... New Building ...~.: .............. Old or Pre-existing Building ............................ Vacant Land ............................ Location Of Property ' /'--,c, -. / ) ,4 ' .... .,J:;/ Owner Or Owners Of Property ................................ ,~ ....... ,~.v.x ............ ¢. ............................................................ Subdivision ................................................................ Lot No, ...r; ....... Black No; ,,.2 ......House No ............. - ~(./.. ,~c . ~ ,,: . Permit No...c..M, .... x. Date Of Permit ...~...'.: ........... Applicant ..... ~ .......... d ............................... Health Dept. Approval ............................................ 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, Applicant ,. ,.-/ Sworn to before me this /' biota Pub,,c ............ Co.n,y ' T~rm £xpires ~rch 30, ~9..7_~ : (stamp or seaJ~] THE NEW YORK BOARD OF FIRE UNDERWRITERS L.% BUREAU OF ELECTRICITY 8S JOHN STREET. NEW YORK, NEW YORK 10038 1',,'~ December .')7, 1977 ,pvli,-,,,i,,,,%.o,.fit,~ 93"04' o~n~3~z N 3700,1,7 THIS CERTIFIES THAT Carol HaloiD, Robinson (s/e/c West Champling), GreenDort, L.I. ~c.~ex,,,.i,,,~,l,., December22, 1977 FtX~'URE jRECEPTACLES~ SWITCHES ~ FIXTURES OUTtETs I IIncaN~c~NI ~tuo_~e sci,~T _ · I, I .7 DrYErsI FURNACE MOTORS ' ~UtURE ~""['ANC~ ~IESDERS ,SPECIAL REC'PT~ T~ME~L~KS] BE~ UNIt HEATE~ DI~ERS ~1 , S~VICE OlSCONN~T ' NO, OF ~ S E R V I :C E I 10~ CD ~ ~ I I G.F.I. : ~ I Smoke dete,£tor 227 East .. , / ~ I TO ~ ~ vAu~ r,,u~ a~ ~ Nov. t'7 ~ /977 FOEM NO. 1 BUILDING DEPARTMENT /~ _ TOWN ~E~K'S OFFICE 5'~*~7 SOUTHOLD, N. Y. ~ ~~ ......... ~ :.,,., ....... Applicatio~ No ................................ Approved ........................................ , 19 ....... ./Permit No...I......l...L ...... t. TZ....~.¢~ ....................................... :';5 .................................. p~R~IT 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, relationship to adjoining premises or pubhc 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 Inspector will issue a Buildingr¢ermit 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 pa rt 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 all applicable Jaws, ordinances, building code, housing code, ~nd regulations, ~nd to admit authorized inspectors on premises and in buildings ~or necessaw inspections. ...................... ~i~noturo of oppHc~nt, or nome~ .................. ....................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................................... (Name and title of corporate officer) Builder's License No ........... ~..../. ................................... Plumber's License No ...... .z~:....~.../.:....,.~.. ...................... Electrician's License No../~...~..?.....~ ............... 1. Location of land on whichDroposed work will be done. Map No.: ...................... '......~.~,.~ ..... Lot No....¢..xq:: .......... Street and Number .~4-~'~.......~-.~ .............. ~ ............................................. Municipality 2. 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 ................ .~.~ ......................................................... b 3; .Nacre of work (check which applicable): New Building ..~.. ........... Addition .................. Alteration ...:...i..'....~... Repair .................. Re, oval .................. Demolition .................... Other Work .................................................... ~ L[ 0 (Description) E' t ' ~ t ~"~'~" ~ q~l, ~'"'--' 4. sT'ma ea bos ............,,4.~.~.~..~. .................... 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 ~,tire new construction: Front ...... ~.~. ..................... Rear ...... ~..~). ............ Depth ...~:~.~.. ........... Height ....~.~ ..... Number of S~ories ......... ./.. ........................................ .~. ............................................................. 9. Size of at Front ........ ./..(~....~. Rear ........... ~..~.. .................... Depth ..... /.~.~..-- 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ~ ~. Zone ar use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ~ ................................... 13. Will lot be regraded ..../~.. ............... Will ex,cess fill be removed from p?~mjses: ( ~} Yes (X) No 14. Name of Owner of premises ~--~....../.4/~ .................. Address ~-~,~.~hone Name of Architect .............................. ,~ .............................. Address ................................ Phone No Nome of Contractor.,~,~..~ ....................... Addres/~... Phone No.'9.~..~...~'J~....~(~. 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, IS S COUNTY OF ..~..~.:~.~P.~,~; ............... ~' ' .......................... ~.~.zt~..~J.c~.'c. tt~.~n~ .................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing contract) above named. He is the ..................... ..~cJ.~..~.~...~.9.~'...q.O~q~.~,.~gf~ ........................................................................................................... (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 fife 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 before me this ........... ~,7..~'t... day of .......... A~l,cju.~. .................... , 19...7.7. ~,.,~,,v~,,~Z ~'~ x2,,~.~..~_..___~'~-/ ~f~ ~/~ //J~,,~, Notary Public, . ................................ S.g.f,f,o,l,k.. County ..tg...~'.~....:.z..'.w..r,~.c..~..~...,rm, c~...r....~....,r..%r~.....i · ............................... x~,~~ Z.~'~ fx~,~. '~ .... j~ 3~; (Signature of applicant) Office Of Gordon K. Ahlert, P. E. except by sional Engineer, Sedion N. Y. Stogie [~uc~flon Low. Office Of Gm'.~ou K. Ahlere, P. E, "Atteraficn of i'hl~ t~Jment ext~l b~ ~ LIc~ns~d Pmfes- S.e,~-Iion 7?.09, Subcllvlslon N. Y. Slot~ Education Lnw. '1 ~ordon Offt~- O!~ K. AhlsrI, P. S.