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HomeMy WebLinkAbout10069-zNO. 4 TOWN OF SOUTItOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy No.. ~.9./?.0.© ..... Date ....J.~.~.~.a.~. ~..2~ ........... , 19.79. THIS CERTIFIES that the building located at ...'1~30.. ?.h.e.~.~.a...D?., ....... ~ Map No .... 4256 .... Block No ........... Lot No ........ 6 ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated . .~9.v.e.~.~..cF..2.~ ......., 19.7.8.. pursuant to which Building Permit No...17.0..~.9.Z dated . .D. ~.o.e.m.b..e.r..'~.D ........ , 19.7..8., 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 ........ fl. az'age. ~dd±tian .............................................. The certificate is issued to ...... ~.c..h?.Z.a.s...~:...1~..e.t.h?..eh. ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ............... .N./.R. ............. UNDERWRITERS CERTIFICATE No .... ~.~ ....................... I~.T./,.R. :.... ........ HOUSE NUMBER .. J.6.~ .0 ....... Street ......... .T~e.:c..e~.a..D..r; .................... ............................................... .lyl.~ ~ ~ .-t:.u.~.~.,. ~,.¥: ............... Building Inspector County Tex Number 1000-115-14-3 FORM NO. 2 TOWN OF SOU?HOLD ? BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 10069 Z Vote .~,:~.-r,Z~.....z.~. ........ , Permisslon is hereby granted to: ';. ' ::': ........................ ~ 7'"'"~ ........................ ~ ' - at premises Ioca~d ~t~.~C~~~-..~ ....... ~~~y. p,~,,,~ ~o ~p~,,c,,o, ~ ..~...~.Z ........ , ~.ZZ, ~,~ ~pro~d ~ ~h~ Building Inspector. Building Inspector FOF,~I NO. $ TOWN OF $OUTHOLD , Building Department 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 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 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 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: 1. 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 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 Dote ./. ........ New Building ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..... ~..~..!~..~.'......~..~.~'~..~.~....~ii~.'./...t.....';~.t'~..~, ...... .~.~..~..~.?].-..~.~...~..~.?/.~.~..c.; ....................... Owner Or Owners Of Property ~/¢ c'^! ~/' /~//¢4 ~ )~ S~ /c~[£_- 7 ~ Subdivision ................................................................ Lot No...,~,,i.... Block No ............. House No../.~..i,~,.~. Permit No../.~..c2.~..~..Z Date Of Permit .................... Applicant ....'~.../..'..c.../'.~.(~:,s.'...~./.~:~.~.~..'~..~...~.~.¥i ............... Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval ............................................ Planning BOard Approval ........................................ Request For Temporary Certificate ........................................ Fincd Certificate .......................................... Fee Submitted $ ~ c~ ................ day of ............................................ Notary Public .................................... County Construction on above described building and permit meets~z~l[ applicable codes and regulations. A ,ic · ......... pp ant .................................... .~. ................................................. Sworn to before me this ~~[~'~O ~'~ (stamp or seal) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 November 29, 1978 Mr. Robert L. Corwin Colonial Homes Jennings Road Southold, New York 11971 Dear Bob, I received your list o2 construction material. Building Permit application states under Instruction "a", the applicant must submit 3 sets o2 plans. These do not need to be architect. The plans 2or a addition must show the adjoining rooms so we can approve the proposed work. For example, to show that you are not reducing the window area less than the required 10% o2 21ocr area. That you not having a door between a bedroom and garage etc. A cross section o2 the construction should be included showing depth o2 2oundation, pitch o2 roo2 etc. Sr. Building Inspector G F/pjs ~* FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. E×am,ned ............. , Approved ............ , ..... Disapproved a/c .......................... ;'"'"4~4~..u~"',~ ........................ "J' ................ (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter orjin ink and submitted in triplicate to the Building Inspector, with 3 sere 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 Ihe 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 o 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 lows, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in, buildings for necessary inspections. ..........(~'"' 'r~'~'~'r~''fl ........... of~appi icon,t,'~or .............................................. name, if a corporation) (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 .............. ~..,.~,)i ...................... Plumber's License No ................................................. Electrician's License No. //{/~ ~/<~,'~'~',c Other Trade's License No ............................................... 1. olon~l ~[ome Improvement Company Roof lng $1Jing Alterations Location of land on which proposed work will be done. Map No.: .....'~...~..'..~..-~' ........................ Lot No. ~ Street and Number ....... /..~w~.......~..~.:(~..]'~..~..~[[~.:~:~L....'.~..)...~.~.~ .................................................. .~..~'Jt?..~...?~ff~..~..~.. Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ....... ; ........... y ......................................................... ~ ........ . ....... ~ ................................. b. Intended use and .... ~__~; ........... ~ .............. ./. .................................................................................................. 3. Nature of work (check which applicable,): New, Building ...: .............. Addition .................. Alteratioj~ ................. Repair .................. Removal .................. Demolition .................... Other Work ........................................ ..'k ....... ~' (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 ~ ...... .e..f.~ ......... Rear ..... .'?...?. .................... Depth ..... .~.. ............ Height ........................ Number of Stories ......... .~...x.~..~.: ............................................................................................ Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ...... ..'-:?.~: ................... Height ....... ./....Z; ............... Number of Stories ......... J. ..................... 8. Dimensions of entire new construction: Front ..../..~'.i .......................... Rear ........./..~. ............... Depth ..~.&.,.~.. .............. Height ...... ../..Q..I. ...... Number of Stories ..... ./ ................................................................................................................ 9. Size of lot: Front / o ¢,/ . Rear .../...~..~.r...~.~.. ..................... ;.. Depth ..wc~..?.......;..: .............. J0. Date of Purchase ..... ~.~....-7..~.. ............................ Nome nf 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 excess fill be removed from premises: ("~Yes ( ) No 14. Name of Owri~r of p~Ifti~i~tk.~..~?..'(....../..~../i.6[7...7..~C/.~--- -- -- ......... *~' /2~m'/~v~'~q-/J Phone No. ~aaress ................................................... A rclql~l~r ovement C.o...m. panT. Nome of Llo.~.~......S[~i~.~ ..................................... Address ................................Phone No ....................... Name of Contractor ~:Jjo~ti~e~ .......................................... Address ................................Phone No ....................... [16~.~9~ ~. ~gT~.][~.O~. , PLOT DIAGRAM Locate clearly"~nd 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. .~'~- ~'~ /P~7)~/ct~-~ d~//~,~,~/,/ ~-PPROVED AS NOTED ~IT AT REQUIR- NDA- ,,,.: ~,~. O,,V~,,L~,, ~,,. ANY KINb ALL CO?;J';'~.bC'FPDN MUS1~M~ET .............. J AND 'gOWN i4OdJJi~G COD~& ZONIHG (/~ I~, , ~,, I STA'I-EOF NEWrYORK, , ,,, Icc COUNTY OF ~,-~';'~ / . ..................................... ~ .......... ;.; ........ z......~:~; ..................... being duly sworn, deposes and says that he is the applicam (N~me of individual signiKg contracf) a'bove nome.& He is the ................................................. ~.~ ...................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 fo~h in the application filed therewith. Sworn to~efore me this ~ ~ ........ ~ ....... day of~~......, 19.~ Not - P,b,¢, , ...... Co.. .......... ,y .... ~ ..... ~ .... ] ................. ~.- (Signa~re of applicant) 't I APPROVEI} AS NOTED NOTIFY DUILDING DEPARTMENT AT 765-2660 9AM to 4PM FOR REQUIR- ED IHSPECTIONS: 1. BEFORE BACb'FILLING FOUNDA- TION OR START FRAMING F, CZ-oS 481-0" t f [ r: