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HomeMy WebLinkAbout9906-zTOWN OF $OUTHOLD BIm'.r~l~G DEPARTI~.NT Town Cl~k'e Office Southold, N. Y. Certificate Of Occupancy No. Z94.2h~ ...... Date ...Fe'bz~uaz7 .... 2 ........... ,19..7..9 THIS CERTIFIES that the building located at . ~p No... f.W.? ..... B~k No ........... Lot No .......... ??.~. ~. ?.!S. ............. conforms substantially to the Application for Building Permit heretofore filed in thi.~ office dated .. Au~s.t... 21 ......., 19.7~ pursuant to which Building Permit No...99~5Z dated .. Augus.t... ~ ........ , 19. ?~3, was issued, and conforms to all of the require- memts of the applicable provisions of the law. The occupancy for which this certificate is ~u~. ~s ...... .&d.d.~.e..~.on..to., .A.~.~..e.s.s.o..~..s.t.o.r..~.e...~s...! .dS..ng. .................... The certificate is issued to ....... .F~..e.d.e..r.~.c.k...T....ff...a~..L....ff. ~..e.s.1...t~I~ ............. ( owne~, of the a~oresaid building. Suffolk County Department of Health Approval .......... ~T/R ...................... UNDERWRITERS CERTIFTCATE No .................... ~R ..................... HOUSe. ~'~S~R .... ~..~? ....... St~t .......... ~..~.~?....~.?......~ .............. . .~ cu~:,ho~. ?.,. ?..~.. ¥or.~. ....... Build4ng Inspector FOR1V~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) pursuant to application dated Building Inspector. Fee $.../..~....,,~..: ........ 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 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 instella- 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 . .3.~p_. ~.~.t'.y....Z.9.,..~..97.9. ..... Add'n t~ access.,stora, ge.bldg. New Building ............. Old or Pre-existing Building ............ vacant Lano ............. Location of Property ...3..3.5..(B...o.x..5.6..B)..L.~..1.a.c..~ .aF.e.~' ......... .C.u.t..c.h.o. gu..e.,..N.Y. ~..1.1. 9..3.5. Housa No. Street Hamlet Owner or Owners of Property . . . .~.r.e.d.e..r:~.c.k.. T....~I . .H.a.r.y...L:..~..~..n.e.s.l.~..i)g ................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision Nassau Farms 1179 115 & 116 ................................. Map No ............... Lot No ............... Permit No. 9906Z Date of Permit B/21/78 .Applicant Mary L. Ninesling Friedberg Health Dept. Approval N. A o .Labor Dept. Approval N.A. Underwriters Approval N.A. .Planning Board Approval N.A. Request for Temporary Certificate ..................... Final Certificate ... XX Fee Submitted $...$ .5...0.0. ..................... Construction on above described building~xox ermit m_.~all, a~p.~p2ica~b~..co_des and r~egulations. Applicant ~.~..~. ~ ~~-z.: .... ~0~ 'To /-.p-F ,¢//6 FOB, M~ NO. 1' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Examined ~ -7_./ , 19..Z...~ Approved il;;i~.i;ii~iil;;;;il;i, lgZ...~.. Permit No.....?....~.....~...~......~.. ..... Disapproved a/c ............... ;:~ .......................... ./ ............... .......... ..... ....................................... (Bu ~'ding Inspector) Application No. ~'~// APPLICATION FOR BUILDING PERMIT Date a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building 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 o~ 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 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 laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors premises and in,~"' i '~''Z'{'~''''~/~ . /~'"1--~~ ,~ ..~..../..~...~ on buildings,for necessary inspections. ...... ~i~'~re of ap~icant,'~,t~ ~m;~"if a co;l~;';~i~) ...... ......... (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ..~...~...~..../~....~.~..../~..(..~..~.C....../....~......~......~.~/...:....~...(..Z~./~_~.~..~.~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .............. 4,~%~..~ ................ Plumber's License No .............,~.....~.....'. .................... Electrician's License No ....... ,~.....O.. ......................... Other Zrade's License No .......... ...~......~.. .......................... 1. Location of land on which proposed wor~ will be done/Mop No.: ~...~....~....~......~........~....~...~t_~Jg.... '.~'.../...~.... Street and Number ....~.....~...~...~........~.../...~....~...~...~.~-Z.~'~': ................................................. .~.~2¢::,'.'-'-~'~';4~..~..~.,. Municipahty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Ex,s,t,ng use°nd occupa,cy ..... .............. - -. b. Intended use and occupancy .. ~...'T., ~.. ......... ~.~.../. ........... Repair .................. Removal .................. Demolition .................... Other Work .................................................... ~ ~ ~x~ (Description) 4. Estimated Cast ............. '.....~,..(-~..f~. ............................ 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, specijy nature and extent of,eoch type of use .......................... 7. Dimensions'of e,~,~ s;bru,ctures, if any: Front ....../..,.~.....-...,'~.. ....... Rear ...../.....~....~.....~.. .......... Depth ..4:~'-~..~....;...~...' Hei ht/ ~;~'~l~mber of Stories. ¢~...~.....~---7.. ................................................................. g ..... ...... ...... Dimensions of same structure with olteration~ or additions: Front ...~---.¢-~. ...................... Rear ...¢.,,,,.~¢ Depth .....'~.~...~.....~.. ....... Height ......~.....~... ~'-- -=,Number of Stories ..... ~-~ ........... 8. Dimensions,cC entire new construction: Front ..L...~rZ....~....~.~L, ................ Rear ..~...~....'.~.. .......... Depth ~....~...~....~.- .... Height ......~.-.~...O..i... Numbej~ of Stories ............. ~...,~......~%....: ...................... i ............................................................... 9. Size of lot' Front /47/0 ......... Rear /'...~...~. .... ~, Death ..... .~......~...~.. ........... 10. Date of Pb;chase ::::::::::::::::::::::::::::::::: ............. Name of ~Fo~r~,,~f~,/Owner ~..(:~...~......~./.¢/~/~./..~,.¢. .................. 1 1. Zone or use district in which premises are situated ........................ /...~/ ....................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation: .............. (..L~..~..~ ......... .7' ............... 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes (r) 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, STATE OF NEW,.'~,ORK. ~ ¢ S COUNTY OF .~s~..'.~..../~. ,.~.~.¢-¢,/~.....f ~' ~O~ ~/~ ~ - ~ ' deposes and says that he is the applicant ~....~ ................. , ................. ¢.~d.~..~¢Z¢.~ .............. being duly sworn, (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 tha~' the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this~, ..................................................... Notaw Public, . .................................. ~~ Coun~ ............