Loading...
HomeMy WebLinkAbout9669-zFOB,~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificnte Of Occupnncy THIS CERTIFIES that the building located at 390. Her~y.'.~. L.aB9 ......... ~ Map No../~18.~ ....... Block No ........... Lot No ........ 33 ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated . Apr1~ .. 2 ........... , 19~.8. pursuant to which Building Permit No.. ~ 9~69Z dated . Apr~ ... J.l ......... , 19..78, was issued, ~d confor~ to M1 of the requ~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ...... : ~r1~a2e. One. ~'~ily. ~.~t~ .~. a~i2ion ............... The certificate is issued to ...... Jo~. Skab~ ..................................... (owner, ~ of the aforesaid building. S~olk County Department of Health Approval ............ N/~ .................... UNDERWRITERS CERTIFICATE No. N~072~ HOUSE NUMBER ~90 Street Hen~' s L~e Peconic, N.Y. B~lding Inspector Co,tM T~ Map .~ q000-7~-2-~ FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT~4OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9669 Z Date ~ ~=TF/r ! / 7~ ......................................................... 1c) ........ Permission is hereby granted to: ~o ..... ~...~..~. ........ ~..~. ........ .E~ ........ ~....../~ ........... '.4.. ............. z ................. : .................... :...: .................. at premises located at ............................................................................................................................ ..... ~.e.z..3~7 ............. ~.C9~Lc..&(e..~ ~ .CC.~ ~7 ~.e pursuant to application dated. . IL . ~19, , and approved by the Building Inspector. Fee $.../.C.~ ....... Building Inspector FOI~M NO. 6 TOWN OF SOUTHOLD , Building Deportment Town Clerks Office $outhold, 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, end unusual natura~ or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal--(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 19§7), Non-conforming uses, or buildings and "pre-existing" land uses: ]. 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 $§.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 .............. ........... New Building ................ Addition ................ Old or Pre-existing Building ................ Yeoant land .............. Locaton Of Pro err' ?0 /-/,/~'~/~y~ /~ ......... ~ . ~-; ' ....... Z'Z'"'"2'"~'~'~'~T"2' ...... t .............................................. .2... Subdvson ~C0~t~ ~ D~C ~ at ~ ............................. ~ .................... ~ ....... L No...~. ...... Bilk No .............House No ............. .~.~.~.~ ~ ..q:./> Z~ ~,,oa., ~0 d~ ~K~~ p~,~ ~o. ...... De,~ o~ ~,~ ........................................................ ,... ............. Health Dept. Approval ............................................ labor Dept. Approval ................................................ Underwriters Approval ................................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ......,.~..',..~..,0. .................. Construction on above described building a~~e~~ca~e,, codes and regulations. ......... ................................................... ................ day of ............................................ Notary Public .................................... County TEL. 765-266D TOWN I-IF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN CLERK'5 OFFICE 5OUTHnLD, N. Y. 119'71 ]:7 Z.: ~ ~ ..Z-h"£ P~ ~ '--r ~ ~/'V" THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-- 85 JOHN STREET, NEW YORK, NEW 10038 YORK ,,,.,,,2z,,1 7 .*.,,,,,,.,,,,n ,,'o. o,/,,. 7 s4o N4072 3 TI-IlS CERTIFIES THAT on~x th~ elec~ical pq.ipme~t~de~Fribed be~w q~d introduced by tt~ appiiEanLn~rned on t~ abo~e ~pp~i~tion number in the premises ;.Turin ~K~D~y, 3YU Iteitl~y'~ J.,4111e) ~'~C0111C, .L,,.L,. in the followlnR Ioc=tlon; [] Bo~ement ~ lst FI. [] 2nd Fl. Section Blue& Lot ,,~ e..,,.~d o. OCcober [ 9,1978 ..a /o.~a to be in compliance with the requirensents of ). ! 8 2 :t .DTRY' ."w. OiL FU .RNpACS OMO~TORS H. ,. ~TUT, AI~U~AoNC' A.W. GI~R$ COMCING OECKS I OVENS I mSH WMRS TIMECLOCKS BILL UNIT HEATERS MULTI-OUTLi SERVICE DISCONNECT I NO. OF [ S E EXHAUST FANS R V I C E OF CC. COND, O~ NEUI~RAL John Skabry 390 Henrys Lane Pecon:Lc, L.l. 11988 11 Per This ce~if~ate must not ~ altered in any mannerr ~urn to the office of the ~ard if incurS. Ins~ors ~y ~ idemlf~ by t~r Credentials. ~ ~ ~ ~I~eWM. THru COPY O~ CERTIFI~Ti WT~T U ~T~_ IN APPROVED AS NOTED DATE, N~ ~J TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. ,~proved .................... ..~.../.~.......(.L, 19..J~..~Permit No ..... ..~..~....4.Z.~,.. Disapproved o/c (Building Inspector) Application No ........................... ..~.....~.~./. APPLICATION FOR BUILDING PERMIT Dote ............................................... , ] 9 ............ 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 o Certificate of Occupancy sha{~ 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 laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necess?y insP~cti)?ns. .~/(Signature of ~ppllcont, or name, if a corporation) ......................................... /. ....... ,~, ............... / ....... ,Z ...................... (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. .................. i~i~;~e and title of'corl~'orate officer) ........ / Builder's License No ................... .~ ................................. 7 Plumber's License No ................................................. Electrician's License No .............. : .............................. Other Trade's License No ............................................... /.// Location of Iond on which proposed work will be done. Map No.: ........................................ Lot No ......................... 2..f..O: Street and Number ...... ...... ........ ,.. ............................. ........................................................... Municipali~ State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: a. Exisiting use and occupancy ..... ~.~(~ .......................................................................................................... b. Intended use and occupancy ....... ~..~.C....~...~.~..C....~C~,~ ..................................................... 3. Nature of work (check which applicable): New Building. ................. Addition ...~ ...... Alteration ............... Repair .................. /Removal .................. Demolition ............... :~. Other Work ................................................ ..- ~ /- (Description) · 7~'~c, (~)~ ~ Fe / 4. Estimated Cost ..... .~.7.(~.~ .......... r .................................. e .......................................................................................... (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 car's ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of, each type of use ........... ~.~, ........... 7. Dimensions at_existing structures, if any: Front ...... ~.~.. .............. Rear ....... .~...~. ................... Depth ...?.. ............. Height ....... Y ........ ~ .... Number of Stories ................................................................................................................. Dimensions of same structure with allerations or additions; Front ........ .,~,.,8. ...................... Rear ......~..~.. .................. Depth ~ ~ Height .......................................................... / 8. Dimensions of entire new construction: Front ...... ;/ .......... ~. .............. Rear ....:./..~.. ................. Depth .../..~.. ................ Height ......~. ............ Number of Stories ......................................... :.~......,.. ................................................ ~, .............. 9. Size of 1at: Froat .......... 4..0~..~...~ ................................... Rear. ........ ~.....~.....~. ...................... Depth ....~?...Z:.~ ................. ]0. 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: ....... ..~..i.~.. ........................................ 13. Will lot be regroded ...........~....~. ....... ~.... Will excess fill be removed from premises: ¢~Yes ( ) No 14. i',ame 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 Io1. 0 17' 17' STATE OF NEW YOP, I(, lc c COUNTY OF ................................ ................................................................................................ being duly sworn, deposes and says that he is the opplicenl (Name of individual signing contracf) 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 ~he best of his knowledge and belief; and that the work wilt be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ dayo, ............................................ ,19 ........ Notary ' , ................................. ty Public Coun ' ........................... .............. .............................