Loading...
HomeMy WebLinkAbout10064-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou/hold, N.Y. Cerfificnfe Of Occupancy Date t~g R ! Y 19 J-~ THIS CERTIFIES that the building ................................................ Location of Property 2~00 45A Iq .DY I~[~C Iq ~DA~ c-'~Fe E £ 1,4 ~Ot~T County Tax Map No. 1000 Section .... Y!'i~. .... Block ....... ~ ...... Lot .... ~ ........... Subdivision ....... -~'". ...................... Filed Map No...'~. ..... Lot No..~.~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~ [..~... 519 .~.. pursuant to which Building Permit No. f OO (,)~ .~. ....... dated ................. ~5.~ .C .... -[.. 19 .~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... The certificate is issued to I4 E (owner, de~e~:oi' of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ]I~T? ~00(~Z] Z Date ...; '~.,~......7.. ...... , 19..~ Permission is hereby granted to: ~ ~ ~./ ,~ /~' / ~_ / ~ .~ // . ..... ~c....~~...~.q~ / ~ ...... ..... ,~~...~~ ~ ~ ~ ~ ~, ~ ~__z....~...~..5.~ ....................... ~. ............................ .................................................................................................................... ~~~':....~ 7 pursuont to opplic~tion dated ......... ~....., 19~ ond opproved by the Build[n~ Inspector. Fee $.~...i~. .......................... ~.~;~ i'.~g~i~L .......................... 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 natural 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, Multipte 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. 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 .I..,:"~.. ....... Vacant Land ............. Location of Property ....... ./.~.,4'~./.¢.)-~/)~.,4 ~'z~.... ~'4 t//~...~.'. ~?~.~.C{~'..~?. ~). ............. House No. Street Ham/et Owner or Owners of Property ..... //~/~. ?./... ~...~. ·z¢..~-, .............................. K~ ~. ...... Lot . ,~. County Tax Map No. 1000 Section ..... ~.z//.~. ......Block .................... Subdivision ................................. Map No ............... Lot No ............... Permit No./C~)Q~..~.'?.. Date of Permit/~../.~.,,,,~_,~.~.Applicant..~.~/~.~....~..~Z'~/~....~.7'/.~'.~.,~¢~,~.. · · · 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.. '~ ,'~.. ~'.~..~..-;~. ~..~-~ .........................  TEL. 765-1802 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 Long~eek Homes Applicant a(~c^P~.ie~e Yacht Basin Inc. Owner: H~D~y E. Pierce Manhanset A~e~& Beach Rd. Greenport, Newark 11944 Dear Sir: ~~ /. On December 7, 19~, building/permit # 10064Z was issued for an addition. Your p~t pl_an~/~and inf~o~rmation did not indicate that this building was in ~he ~lllage of Greenport, so the permit was issued. This building, according ~o our ass.essors records is mn' the Village of Greenport. Th~ town lmnes cross your property. I have voided th'/spermit # issued January 26,~979 to ~ierce 4186 paid the building permit fee of The receipt # 15320 was Basin Inc. whose check # 5.00. I am ref~:ing the $15.00 fee in ~. truly, Sr. Bu ~Inspeotor ~CEIVED FROM THE BUILDING INSPECTOR, GEORGE ER,~ TOWN OF //SOUTHOLD, $15.00 CASH AS REFUND OF VOID BUILDING PEP~T #10064Z ISSUED TO PIERCE YACHT BASIN. __X~ FORUM ~qO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT' TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..~/,~.......~.. ............ 19Z..~'.. Approved ./~. ........ .~, ........... , 19.~.~.~ Permit No./...~...,~-).....~....~..,..~. ......... Disapproved a/c .................. ;;,..,~_~.~,..(~ ............................... ~ .... Application No. ~..~..~....~.....~.. ............ ~ APPLICATION FOR BUILDING PERMIT Date ....... ~,...~.~......~..~.Z,~ ...................... , 19..?...~.' .... INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~c- 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 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 a Building Permit pursuant to the, Building Zone Ordinance of the Town of Southold, Suffolk Cou.n. ty, New York, and other applicable Laws, Ordinances or TM Regulations, for the construction of buildings, additions or alteratmns, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signor, tire .of apphcant, or name, Lf a corporati~n) __q ................... ..~...;~ ............................... L~ .../...~.'. ~T; ..... J (Address of applicant) / h /"¢/~ ~J//.~---.,4~.' .v~----~ State whet er applicant~ ag~er, general contractor, electrician, plumber or builder. Name of owner of premises .......... ~..~..~....~.....~..........~...~..~..~..../~..:~ ..~...i..~ .'~'...~_~....~.... ...................................... ;ii;iii;iii'i.;; . , ·- Bu,lders L,cense No .......... .~ ........... ...j~ .................. Plumber's License No .... ,~&~......~'~,~ ....... Electrician's License No .... ~./. .......... Other Trade's License No ............................................... 1. Location of land on whic~h proposed work will be dene. Map No.~b. .....................,,~ ................ Lot No ......................... ,, - Street and ~NumDer .~...4.:..:~(;4r/~ .......................................................................................................................... Munlcipali~ 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 .~ .... ~ ....... ~ ........................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... /,-~.. ~Y:~ (Description) 4. Estimated Cast ........... .................................. cee ................. .................................. (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 egch type of use .............. 7 ............ 7. Dimensions of existing structures, if any: Front ...~....~.~ .............. Rear ......~2...O.....- ............... Depth .,..~...~.. ........... /2.- Height ........................ Number of Stories ............................................ .~] ............................................. ~ ............ Dimensions of s/gme structure with alterations or additions: Front ............ ~ ....................Rear ......~... .................... Depth ..... ~..~.. .................... Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction; Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear ...... ~ ................................... Depth ................................ 10. Date of Purchase ........................................................Name_..~f Former Owner ........................................................ 11. Zone or use district in which premises are situated ............ .~...~.~../....~'....~'.~..~ ................................................ ; ............... 12. Does proposed construction violate any zoning Jaw, ordinance or regulation: 13. Will lot be regraded' ......~ ............... Will excess fill be removed from premises: ( ) Yes (v~ No 14. Name of Owner of premises .~....~.....~.~..~../../...~'-.~...~....~]..'/-- -- .............. Address ....'~....~.~~'--- ........ 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. STA'TE OF NEW. L, YORK, COUNTY~-~ ..................... obove 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 will be performed in the manner set forth in the application,f, iled therewith. Sw°rn t~re ~n:ytho~S~-~ ~ ,19 : ........... .:., .... .............. Notary I~ublic, . ............... ~ ......... Coun~ ........... ~ .................................. t,~ ................................... " ~" ~' (Signature of applfcont) ~ ~~ BABETTE C. CON~qOY ~O~ARy ~U~LIC, St~lto o[ Ho'~V Yor!~ ,*. Su~lk Co~ty ]No. 52-5792800 .~ , %,,. K4AD OF' LAND HENP~Y PIECHINSKI '~ ¢' (~ I~ ¢_. IF.. NPOf~T TOWN o1= SOUTFtOLO, N.Y.