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HomeMy WebLinkAbout9915-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No.. ?~9605 .......... Date . .ffu.lV..27 ....................... 19.7.9 THIS CERTIFIES that the building ................................................ Location of Property .1.000 ........... Pr&vat~ Rd.. ~1 e~t, · ~{yat.b .Rd,...-*.. Sout~e~m]~c~ House No. County Tax Map No. 1000 Section . .Q5/3 ....... Block . .1 ............. Lot :1 ................ Subdivision ...... ~ ....................... Filed Map No.. XX .... Lot bio. ~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... fi.u~, · 22 ..... 19 7a pursuant to which Building Permit No...991.5~ ............. dated ....... &ug,. 2/* ............ 19.7EL 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 ......... .... A..nri¥~te. one. f~ly. ~ell~ng ......................................... The certificate is issued to ... Rein. Narma ..... [o~tn'e'r,~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ....... 8~S~-,98,..A~r~..26,..1979,. ~obm~.t A Vill~ UNDERWRITERS CERTIFICATE NO..4~.q 0Bq ......................................... Building Inspector Rev 4/79 N? 99i5 Z BUILDING: 'PERMIT (THIS PERMIT Must BE' KEPT ON THE PREMISES UNTIL FULL COMPLETIOi' OF THE WORI< AUTHORIZED) Permission is hereby grontbcl to: 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 ~ocation of a~ buildings, property lines, streets, and unusua~ 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 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. B. 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 featu res. 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 3, Copy of certificate of occupancy $1.00 New Building ,..~ ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... lO. ~.~. ..... .~.~. ,~...~'T~-. ~.(~., ~ [~....~..~. ~...'~..,. ~r~...~. 0~..~/~[~ House No. Street Hamlet Owner or Owners of Property ...~.1 ........ County Tax Map No. 1000 Section .,, ,O~'.L~- ....... Block ,, ,j~ ........... Lot,./ ............. Subdivision ................................. Map No ............... Lot No ............... Permit No.~..~ I .~.... Date of Permit .......... Applicant..1~, ~ .... --~¢.f~J~.~ ...... Health Dept. Approval .~..% .~.~..~. ,~'~. ........ Labor Dept. Approval ........................ Underwriters Approval..~1[,. ,(~.~.1 ........... Planning Board Approval . R eqL~est for Temporary Certificate ..................... Final Certificate. ~ .~',' iii ii Fee Submitted $.. ,L~. ,. ~..~, ................... Construction on above described building and permit meets all applicable codes and regulations, Applicant ..... ~ .... ~.., ...................... Rev. 10-10-78 ~;~, THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICiTY ~" 85 JOHN STREET, NEW YORK, NEW YORK tOO38 ..,. ~p,-f~ 23. ~79 ~.,,~..o.~o.o./,,~ 99~o4~ N431081 THIS CE~IFIE$ THAT ~ t~fMi~in$ ~ation; ~exami~on Ap.il 1~, 1979 a~found~incom~ia~witht~uire~ntsofth~. ~YE~ ~ACE ~TO~ ~ 3 ~ ~ ~0 ~ ~ec~ ~V~ ~HN~ ~*~ S E R V I - C E ~ ~0~ C~ ~ 2 ~/0 2 4/0 OTHB~~ lo20lk il This certificate must ~t ~ a~r~ in any ma~ner; r~urn to the office of the ~ard Jf i~orred. Ins~ ~y ~ i~i~ by t~ir c~dentials. coPY FOR TOWN DF E;DUTHDLD OFFICE DF E~UILDtNG INSPE(~TnR Tr'IWN CLERK'S OFFICE SOUTHOLD, N, Y. 119~1 ' ~EL. ~6S-~660 Folr~ NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~proved ........................... S.....~.~, 19.~. rmit No. ~¢/~ 7 Disapproved a/c ................ ~ ..................... ~ ...... .................................................... ........... (Buildin~ Inspector) APPLICATION FOR BUILDING PERMIT Dote ............... INSTRUCTIONS 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 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 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 on premises and in, buildings for necessary inspegt~s. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer~~ectrician, plumber or builder. ~omo of ownor o{ promisos ........................................................................................................ I{ *p~licoSt is ~rporote, sion~ture o~duly outhori~ed officor. (Name and titlEof corporate officeff Plumber's License No. Electrician's License No ............................................. Other Zrade's License No ............................................... ~. ©5 5t Location of land on which proposed work will be done. Mop No.: ....'~.~.~.1..' ' :...J.~..~..O. ............ Lot No...~. .................... Street and Number .................................................................................................................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use end occupancy ............ ~.~../~./~..~.....T. .......................................................................................... b. Intended use and occupancy ........................ ~ .................................. ..~.. ............................... : ......................... 3. Nature of work (check which applicable): New Building' .......~ ..... Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work "~'~'E ........... iD~'~'ription) 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 ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same st~cture with alferations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories .......... ;....i ................ ..w ro., ...................... .................. ............. Height ~ , Number of Stories ..... ~ ......................................................................................... ~ ........... ~" ize of .I.aa .............................................. ............................. .... 10. Date of Purchase ..... ~ ................................................ Name of Former Owner ..... ~ ............................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... ~.~..~ ........................................ 13. Will Jot be regraded ..~ ................ Will excess fill be removed fro~ ~re~i~es; ( ) Yes ~No ~4. N~ o~ Ow~ o~ p~ ..~...:..,.~.....~.~ ........... ~ ~..~.#m.. ~'~ No ....................... N~ o~ ~t~ ..~d.~._.~.~. ........... A~ .......... ~.~.~ ........... ~,~ No ....................... PLOT DIAGRAM Locate clearly and distinctly all b~ildings, whether existing or proposed, and indicate all set-~ck 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. I STATE OF NEW YORK, ~ c c COLJNT~ /g F..~.... ......... ~ ............... .............. V...CL..~......L..~-~9~.8.~.~..................... being duly (Name of individual signing controc~ sworn, deposes and soys that he is the applicam above named. He is the ........................................... ..v~...............~. ............................................................................................................... k(Contractor~ agent, corporate officer, etc.) of said owner or owners, and is duly a'1:~..._~r~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 perforg~ed in the manner set forth in the~pplication filed therewith. Swam to before me this / J / ~ Not~ P,b,~, ...,.~Z~. 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