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HomeMy WebLinkAbout9977-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.l.'l..4.5.2 .......... Date ....J.a, .n.u.a.r.k;..2,6 .................. 198..3. THIS CERTIFIES that the building alterations Location of Property ...q ~.0 ....... .B.a~. Water Avenue . . Southold House NO. ' ............. 'S't/e3i .................. County Tax Map No. 1000 Section ....0.7.~ ..... Block . .Q¢ ........... Lot ... 9.2.2 ........... Subdivision ............................... Filed Map No....X ..... Lot No...X. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .O.q .tg.B. qr...q .1 ..... , 19.7.8. pursuant to which Building Permit No...9.9.7.7...g ............. dated ... 99.1~9~.%r.. q. $ ............. 19.7.8., 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 ...... new cellar and alterations to an existing one-family dwellinq. The certificate is issued to .... .N.&N.C.Y.. $....G..R.I.S.S. ! .N.O. .......................... (owner, le~,,~ or-~w~-arrt) . of the aforesaid building. Suffolk County Department of Health Approval ...n./.a .................................... UNDERWRITERS CERTIFICATE NO. N 439274 Rev. 1/81 Building Inspector FO~M 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 (~OMPLETION OF THE WORK AUTHORIZED) N? 9977 Z Permission is hereby granted to: ..~.~.~..¢..;F. .............. ~ ....... ~.~.!..~../..~/o PI:RMIT INCLUDE:,; APPROVAL-- TO REM©v~ EXC~S~ i FROM ABOVE PR~:MIs~:~ g F REGRADFgG L T DRIVEV,~y ON 7R~)CF~oN CEL~R FORM NO. 6 TOWN OF SOUTHOLD Buiiding Department Town Hail $outhoid, N.Y. 11@71 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 wi~h the following; for new buildings or new use: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or topograoh c features 2. Final approval of Heatth DepT. of water supply and sewerage disposa --(S-9 form or equal}, 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings Multiple Resdences and sm ar bu dings and nstalla- tions, a certficate of Code comp ance from the Architect or Engineer responsible for thebuiiding, 5. Submit Planning Board approvai 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 features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Cate of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. / ' 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(X) Location of Property ,.,. ............................................ ~ ....... -.~- House No. Street Owner or Owners of Property County Tax Map No..1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate ........ - ......... Fee Submitted S ............................. Construction on above described building aod permit'rnee~e all appl-i,cable_.codes and regulations. ~tioant .: ..; ................... /Vacant Land Ham/et TOWN OF $OUT~OLD O?FICE OF BUILDING INSPECTOR ' P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 1 TEL. 765-I 802 T,,is 10 ~o amv~se you that the ~ob ns=~ m,,~ lnai inspect!on nas~ %~as noL~ been done. In order to complete this file, it is necessary that a Certificate of Occupancy be issued Please fill out ' enclosed form(s) ~ return same to the above ~ = o~._c~ with a check for $5.00 payable to the Town of Southold. Please indicate to whom the Certificate of Occupancy is to be mai!ed and arrange with this office for an inspecfion date. Thank you for your prompt attention. Very truly yours, Victor Lessard Adminis~rR tot VL:ec Enclosures TOWN OF $OUT OLD OFFICE OF BUILDING INSPECTOR ' P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. ! 1971 TEL. 765-1802 - Applicant ~ .T~,is l~ ~o amv~se you that the Job under ~ni]~4n~ - - ~ . . ~. ~s comml~ed and a flnAt inspection has~ has noz~ been do~e. In order to ~+ ~ ' com~e ~hzs file, it is necessary that a Certificate of Oc~,,~ ~ ~ancy be issued. Please fill out the enclosed form(s) , return same to the above ~r4 ~ o~._c~ with a check for $5.00 payable to the Town of Southold. Please ' indicate to whom the Certificate of Occupancy is to be mailed and arrange with this office for an inspection date. Thank you for your prompt attention. Very truly yours, Victor Lessard Administrator VL:ec Enclosures TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN r, LERK'G OFFIOE GOIITHOLD, N. Y. 11971 TEL. o E TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .x?' ,/ . . Examined ~ ' ' / .................... :::':'i""T/".' · ? / Approved .................................. :....., 19 ........ Permit No ..................................... Disapproved o/c ............................................................................................ PERMIT INCLUDES A..P..P..R...O.,,V.A.L' .... 10 REMOVE EXCESS FILL FROM ABOVE PREMISES BYApp REGRADING LOT DRIVEWAY CONSTRUCTION CESSPOOL CONS~ RUCTION CELLAR C~)NS'J'RUC] tON OTHER Application Bio .................. ./ .............. .......................... : .......... ........ (Building Inspector) CATION FOR BUILDING PERMIT INSTRUCTIONS Date .................................. v../. ........ , ~i'" 'l:~iS"appJ'~(~ On ~u~{ J~e cor~plef~ly'filled in by typewriter or~ 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 of property 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 inspections. ...... :.':,: ,, ; . . . . ; ............................. (Signature of applicant, or name, if o corporation) · .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. (>.'.ez~ .~.~ ~:~. ........................................... . .................................................................................................................. Name of owner of premises c - t ,.~-~ / If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No..,,//.7,-,.ZL,6'.,L~...~/.Y//..~.'/./. i'o aa Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot .No ......................... Street and Number ............. ./'...~....C..~. ........ ~'~..~.~.....~...//..~...~ ........ .~....~?k. .............................. ~ /' ~.,t..~(~...(.~ ....................... Municipality 2. State existing use and occupancy of premises and inCended use and occupancy of proposed construction: a. Exisiting use and occupancy ...../~,.....~..(~.~.~,./.~.~.Z~.~" ' ....................................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ....~..'....' ..... Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... Z~Z, /,/ ~ ~/j, (Description) 4. Estimated Cast ...~.....~..;;.~...C. .................................... 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 ...... /~/.~..4,?..~: .......................................................................................................................... 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 ..~.'..~,.J ......... Height ...../..~.. ............ Number of Stories ...... ././.'.,~¢.. ................................................................................................... Dimensions of same structure with alterations or additions: Front ..,~x..-?.,'~.~. ...................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...~./~.~..~- .................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... ....... /..~,-~.,.~, ..................... Depth ~, ~.~.'..'..~. ............. 9. Size of lot: Front .......... ,~.~.:.~.[ .............................. Rear t ' ' 10. Date of Purchase ....................... &..~ ./..]....%.~. ...... N me of Former Owner ...~...<~.,..~.'~'/~\~'e..~.~/~. .................. 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction wolate any zoning law, ordinance or regulation: ..,~/.,f?......~... ............. ~-, .................. 13. Will lot be regraded ....~..4-! ................. Will excess fill be removed from premises:( ~Yes 14. Name of Owner of premises'/' "'¢~..~/¢.~....~..,..~"./~/...'S.~.//~.~? ...... Address ,¢~'4c~4¢~,~,..1~Z.~... Phone No. Nome of Architect ..~]~ ......................................................... Address ................................ Phone No ....................... Name of Contractor .T.J ........................................................ 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. .... .)..~'..~.,~.~,.(~.~?....~.~.x~...~./2.¢1~.t¢;..~. ................................ being duly sworn, deposes and says that he is the applicam /(~ '(Ng~ of individual signing contract) (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 ~ ~ /~ .... t~gnarure or applicanT)