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HomeMy WebLinkAbout9743-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z113.62 ........ Date .... D. eg.era, b.e.r...1.6.,. ............... 198.2.. THIS CERTIFIES that the building ................................................ Location of Property .. 2170. Gr.a~:hw.o.h$. R~I,,. ~q~w. Su.f.~o. ~..k ........................ House No. Street Ham/et County Tax Map No. 1000 Section . $~L.7 ........ Block ...... 2. ........ Lot ....1.3 ............ Subdivision .... X .......................... Filed Map No....X ..... Lot No ..... X. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... May..1.5 .......... , 197.8. pursuant to which Building Permit No...97.4.3. Z. .............. dated ..... MaT..2,3 ................ 19.7.$, 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 ......... The certificate is issued to .. Co. lxzin..Gragk~ohl ............................... (o wrier, of the aforesaid building. Suffolk County Department of Health Approval ... N/~ ................................... UNDERWRITERS CERTIFICATE NO. N/A Rev. 1/81 Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,o Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMiSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9743 Z Date ....~'vJj~.. ....... 2]~ ................................ , 19..."/.8. Permission is hereby granted to: ...................................... ro ..... ~'ut,,'Ld,..ce.lZa~...ta~1,e=...exla,+.,ln~..&,~el/.lr~ ................................................................ at premises located at ....... ~,~'.0....~-~I,t~Q~I~..ROB,0- ....................................................................... ........................................... l~lew...S~tf;f, olk,.. ,~., .Y., ............................................................................. pursuant to application dated ..~l,~k~. ....... .'J~ .................................. , 19.~.8.., end approved by the Building Inspector. Fee $..1..~ :.g..0. ........... 1000-117-2-1~ Building Inspector PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT DRIVEWAY CONSTRUCTION CESSPOOL CONS~ RUCIION CELLA?, CONSTRUCTI'ON OTHER FORM NO. 6 TOWN OF SOUTHOLD Building DeparTment Town Hall Southoid, 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 disposals(S-9 form or equal). 3o Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, industrial buildings, Mult p e Residences and similar buildi, ng~ and installa* lions, a certificate of Code compliance from the Arch tec{ or Engineer respons b e for the building. 5. Submit Planning Board approv~ 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 ~nusual 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. / ' 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 $5.0O New Building ............. Old or Pre-existing Building(Z) .._.~ --= ZVacant Land -. ............ Owner or Owners of Property .... County Tax Map No..1000 Section ..... ) )~ ...... Block ..... ~ ........ Lot... J .~ ......... Subdivision ................................. Filed Map No, ,,: ....... Lot No, ............. Permit No. . Date of Health Dept. Approval ........................ Labor DePt. Approval ...................... ,.. Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Cart f cate ..... Final Certificate - . ............ . ................ Fee Submitted $..~~ . .......... Construction on above described building and p..e4rr~it'meets all applt,'c~b,r~'~ ~-~-~.~ .~gu latio-. Apphcant . ~ ......... ,.~_~ ............. Rev. 10-10-78 TO,TN OF SOUT OLD OFFICE OF BUILDING INSPECTOR ' P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 This is to advise you tLha6 the job under Building Permit No. ' ~ ' a ri.~ai inspection ~as~ has .. ~ been done. ~o_i __ ._vted and In order to comolete . ~h_s file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form(s), return same to the above office 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 inspec[ion date. Thank you for your prompt attention. Very truly yours, Victor Lessard Adminis trR tor VL:ec Enclosures FO~ NO, ! TOWN OF $OUTHOLD BUILDING DEPARTM£NT TOWN C~L~RK.'$ OPPIGt~ SOUTHOLD, N. ¥. Approved ..... .~...~.~. ........ 2.~. ............... , 19.Z.~... Permit No ....... ~.~..Z}..~.~ .................. Disapproved a/c .............. ~_,..,~.._-~; .................................. (Building Inspector) Application No ..... 9,Z~.,~. .................. APPLICATION FOR BUILDING PERMIT °ate ........................... INSTRUCTIONS a. This application must be completely 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 at areas, and giving a detailed description of layout ofproperty must be drown 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 HEI~EBY 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~j~e, and regulations, and to admit authorized inspectors on premises and in buildings fo~ (Signature"~f appl~ant, or name, if a corpora~'Ton) 7B SUlZFOu I (Address of applicant) State whether applicant is owner, Jessee, agent, architect, engineer, general contractor, electrician, plumber or buiJder. Name of owner of premises ' ~/~ L V I h-I ~ T~/~ '-FI'I cd O (-i ~ If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .............. ..~...E...~......~..~....~....L....0...!~_ / L~O0 ..... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No ......................... Street and Number ........................ .~........-~......~.........~....~./s,'ff.~...~...0....H....k. ....... ~..~.. ............ ,.~....~....L~/... ,..~_..L!..~.E ............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ........................ i ....... :. ' ' ' ................. 9 ...................................... b, Intended use and occupancy ......... ..'~,...,/~..[.~..~,.~.:.',.: ....... ........... ................................... 3. Nature of work (check which applicable): New Building'. ................. Addition .................. Alteration ................ Repair .................. Removal .................. Demolition .................... Other Work ..................................................... 4. Estimated Cost C~../'~:~ ~) 0 ~ Fee .~¢00~,.,~ (Description) (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 structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Stories ...................................................................................................................... Height .................... Number of 9. Size of lot: Front ......................................................... Kear .......................................... Depth ...... ~...[. ........... i0. 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 lot be regraded . ........................... Will excess fill be removed from premises: (~Yes ( ) No f4. N~me o¢ Owner o¢ premises.¢~A Name of ~rchitect .............................................................. ~ddress ................................Phone ~o ....................... Name of Contractor ~O '~y~O '~ Address ~ ~J ~¢.¢< Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, 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 /o~ ~ LVIN ........................................... 5.Zl ................................. duly sworn,~pqses and says that he ,s the appl,cam (Name of individual signin¢ contract) above named. / ,s ,h. ................. ................................................. ................................................................................... (Contractor, agent, corpor~/e officer, etc.) of said owner or owners, and is duly authorized to perform or ~ave performed the said work and to make and file this application; that all statements ~ontained in this application are true to the best o~ knowledge and belief; and that the work will be performed in the manner set fo~h in the applica~ filed therewJ~/ Sworn to before me this ~0 fi2-8125850, 8uffelk Te~m Expires March 30.