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HomeMy WebLinkAbout9503-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... .Z.~.l.[?_ ........ Date . .Janua.r,lr .2.2. ....... 19.8.0. THIS CERTIFIES that the building ................................................ /+560 Dee~ Ho;~e..Dlei.v.e. ................ ~li~.ttitu~k, Location of Property ~t'~s'e 'N'd .............. Street Hamlet County Tax Map No. 1000 Section ..... .q ~.5....Block ...... ~.7 ....... Lot . . 20% o..Of... 2 ..... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this off'me dated ·.. 0¢~.o.b. er..~7. ....... 19.7..7.. pursuant to which Building Permit No ..... .9.5.0~g ........... dated .... qq~,o,b,e.~, ? .7 ............. 19 ?T., was issued, and co~forms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Private One Family Dwelling Board cf Aopeal aooroval No. 2g~g October JM, 1977 t4a~ard and Ma.fy Larsen ............. The certificate is issued to ..................... of the aforesaid building. Suffolk County Department or Health Approval ...7.-80-127.. n., A..v.i.zl~. UNDERWRITERS CERTIFICATE NO .......... .N../4..6.1.6.7.2. .............................. Building Inspector Rev FOR~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9503 Z Date ....................... ..O..q.t. ....... ~.~. .............. 1 Permission is hereby granted to: How.ard & Mary. Larsen ................... ['~a.%t i.tu~k ....................................... Build new one family dwelling (a~roved by Bd Ap ea]s) to ............. :......: ............................................................................................................. ~ ....... . .............. at premises located at ...~.../..S.....D.~..e.p.....H..o..~.e.....D.?..~-e. ............................................................................. Nattituck N.Y. pursuant to application dated ........................... Q.c..~.....].~. ............ , 19...~'.., and approved by the Building Inspector. Fee $.(~ ~....~.D. ........... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall 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 Inspec- tor 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 natu rat or topographic featu res, 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 installa- tions, 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 informa- tion 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 / ?~..~..~. . . .o~,. d' ~ New Building ~t~ Old or Pre-existing Building Vacant Land Location of Property..~.,~,~:...~.~(?,~...~. · .-~., .~'...~'~'~/ ................ · .~..~../~ ~';~,~-'~ Hduse No. &' Street Hamlet Owner or Owners of Property .J..~..~.~...~..~..!.'~.~.4., ..~ .................. County Tax Map No. 1BO0 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Underwriters Approval..~j~..,~,..o?;../~.~. ,~..Planning Board Approval ...................... Request for Temporary~cC~rtific~te ..... .) ............... Final Certificate ....................... Fee Submitted $..~ ..... .~. · .~..~..~..~. ......... Construction on above described building and permit meets all applicable codes and regulations. Applicant....~..~.~~ ....................... Rev. 10-10-78 -~(~ ~ ~) THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICr'rY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CE~IFIES THAT only t~ ~t~ ~u~nt ~ ~,cd~ ~ ~ i~t~ by t~ ~t ~ on t~ a~ ~ numar in t~ p~s of w~exami~don Deoe~beP 21, 1979 andfoundtobeincompliancewithther~uirementsofth~. RXTURE RXTURES RANGES OVENS O~SH WASHERS EXHAUST FANS OtJTLETS SWITC, HES FLUORESCENT DRYERS FURNACE MOTORS FUTURE AFf'UANCE FEEDERS TIME CLOCKS UNIT HEATEII SERVICE D4SCONNECT S- E R OTH ARAT ]-G.F~C.I. ]-~m~ke Detector I C ~oward & ~4ary La~'sen 1-Box 90E-4660 Deep ~attituck, N.Y. 11952 This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified by their credentials. THIS COPY Of CERTIFICATE MUST NOT BE 1 Examin~ ............~......:2....., 19.~ ~plJc~i~ No. ~.~..~ .......... ,? ~ ~ ~ .~ ~ ~ > a. This a~lic~ion m~ ~ c~ple~ly fill~ in by ~wHter oe in i~ a~ s~ I I~tor, wi~ 3 ~ of p~s, ~u~ pl~ ~n ~ ~ale. F~ ac~l~ to ~h~ule. b. P~ot plan ~ing I~afion of lot and of buildings ~ premises, relationship to ~jo n ng premiss or public str~ areas, and givJ~ a d~aJl~ d~ripfi~ of I~o~ of~ must be drown on the diagram wh~h c. The work c~ered ~ ~ a~licati~ m~ ~ ~ comme~ before i~uance of Build~g Permit· d. U~n a~al of ~is a~licati~, ~e Buildi~ l~tor will i~ue a Building Permit to the a~li¢ant. Such shall be kept ~ the premi~ ~l~le ~r in~i~ ~ ~ ~rk. e. No building shall be ~upi~ or u~d in ~ole or Jn ~ for any pu~e wh~er until a Ce~Jficate of ~cu~ncy shall have been granted ~ the Building Insp~tor. APPLICATION IS ~EREBY ~DE to the Building ~ment for ~e t~uance of a B~ng ~it Building Z~e O~inahce of the T~n of ~thold, ~lk Count, N~ York, and ~her ~pllc~le R~u~ations, for the constm~Jon of buildi~s, a~iti~s or altemti~s, or for mm~al or ~litJ~, ~ h~in ~ri~. The applicant ages to comply with all a~licable ~, o~inanc~, bulldi~ c~, h~J~ admit authoriz~ in~to~ ~ premiss and Jn ~lldl~ ~ ~ J~tions. (Signature of applicont, or name, if a coq~oraflon) ~/.- ... ',~: ,~. . //?~' ....... ........ r./.. ........................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...................................... ~ ................... ~....~ ................................................................ 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. ~ Location of land on which proposed work will be done. Map ,No.: ..................... ....~,.... Lot ~ ..................... Street and Number .~..~..~..~.....~.~...~ ............ ;.......~...~).....~....~...:...../../..~..:...~.... ~ Municipality State ex. isting use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy ............ ~ ....................................................................... 3. Nature of work (check which applicable): New Building.. ........ Addition .................. Alteration ................. Repair .................. Removal .................. Demolition ....... : ............ Other Work ..................................................... -~ ,, / ~ "") r~ (Description) ~ · (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 .................. .~,ZC~,..~D ............................................................................................................ 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 ............. :~x..,~ ................ Rear ....... ~7..~. ............... Depth ,~./~..~ ........... Height .................... Number of Stories ....... ./.. ........................................................................................................... ]0. Date of Purchase ........ ~..2~.~.. .................................. Nome of Former Owner ..,~..~...,Z4-*.~'~ ....................... ! ]. 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 excess fill be removed from premiSes: ~"Yes ( ) No Nome of Architect .............................................................. Address ................................ Phone N~ ...................... 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 COUNTY OF .......... ~1~,,~O~..... f~'~ ................. ~1911~1~.I~..~ ................................................ being duly sworn, deposes and says that he is the applicam (Name of individual signing contracf) above named. He is the ....................................... ~~~ ........................................... i ........................................................ (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 thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..%'~t~ ............ day of ...... Ol~l.~ ..................... , 19..~..'[... Not,,9~/(,~.~.~_~~~u.blic, .,...uzz~..,d7. ....... Z~ ...... ,.~:~/.C°unty I[LIZABETH ANN NL~ILL~ HOYARY PUBLIC, State of New Yor~ Ho. 52-812§$§0, Suffolk Ci~.~-i~p (Signature of applicant) .... ~,, FOR APP~OV&~. O~ GO~U,~-F~ON ONLY '4~{ . H. L NSF. NO,: ~AND~ ~ IUF~ ~ D~. A~ROV~: ~ I (~l ,,, 'i / ;j APPROVED *AS NOTED REQUIREMENTS OF N,¥, STATE CODE ', AND TOWN HOUSING.CODE & ZONING ,,OV,,~IN~ P~F~S OF ANY KIN~ -4, ,~INA[ WJ'J~N JO] COMPLETED NOT A~PONSIBL~ FOR D~SIGN , ' / OR CONST~UCTIGN EAROR5 5, ALL CONSTRUCTION MUST MAS'TER, © z~. WALV, Ol kITE/ 'TWO oN L'I' iTEM GIRDER ----- -SILL -~[R. JO~STS CEIL-JO,S:FS RAFTERS ROOF SH:ATHffqG SIDEWALL " FLOOR " SIDING WIND" '"-i FIN WALLS LOUVERS ROOF SHINGLES RAKE O/H CORNER _P~' GARAGE CLG, NT. FAIRFi'ELD HOMES DWe, C4" .... - 4" LALJ-Y 6"?~oJ, FZ . U N £kCKVK'T E b 2..4 ' - 0" TOP OF, GARAGE AND MAIN FOUNDATION WALLS TO BE [.EVEL FINISHED FLOOR OF GARAGE TO BE 4" BELOW TOP OF,, FOUNDATION,WALLS. T WALL &EC'~I ON