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HomeMy WebLinkAbout9781-zFOltM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No... ~..9.Q.8.0 .... Date ..... June .... 22 ............ , 19.7.8. THIS CERTIFIES that the building located at .1530...Tke~.esa I)~'~.~r.e, .... Street Map No .... /~25.6. ....Block No ........... Lot No ..... 7. ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...Jun.a .. l~ .......... , 197a. pursuant to whi~eh Building Permit No.. 97alZ. dated ...a'una.. ~./,. .......... , 19..7.8, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... Prl~IYATE .ONE..FA~IILY. D~&EI,LING. ~,ITH. ADDITION. (IIECK.) .......... The certificate is issued to ...... Howard. & .Car'ollna .Fle~c¢laer. ................... of the aforesaid building. Suffolk County Department of Health Approval ............ N/R .................... UNDERWRITERS CERTIFICATE No ..................... I~/.~t .................... HOUSE NUMBER ..... 1.530 ..... Street ......... Thene~a. D~ive .................. Building Inspector FOl~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTILFULL COMPLETION OF THE WORK AUTHORIZED) Ne 9781 Z Date .... ~e ........ '~/',. ............................. , 19.-78. Permission is hereby granted to: ........ Hewe~d.. &...~ot..~-m.. ~.t®%~e.r, ......... to ....... add,..ont;o...a.~rJ..vat:.a..One...E'emLllt...Dwelling ......................................................... at premises located at ..................... .1,~30..~he,res~r. Dri. ve ............................................................ ......................................................... Ha~tl.~uoks...N. ew...Yo~.k ................................... ?:::::~. .............. pursuant to application dated .... '¢Tune-'"'l~ ................................ , 19~,8..., and approved by the Building Inspector. Fee $.1.5.,00 ........... 1000-115-1z~.2 Building Inspector FOI~M NO, S TOWN OF $OUTHOLD , Building Department Town Clerks Office Southold, N. Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Insfructions 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 u~se: 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 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 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey.of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation 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 ........................... -.....~.. ............ New BciJldJng ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Health Dept. Approval ............................................ Labor ~t. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........ ~.~ .............................. Request For Temporary Certificate ........................................ Final Certificate L'/" Fee Submitted $ *~' ~ C onst ruction on ab ave descri bed buil d~ng~~~regulations. Applicant/.~ ............... t.~..,,~. ........................................................ Sworn to before me this ................ day of ............................................ Notary Public .................................... County (stamp or seal) / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. Examined ......................................... 19... Application No ................................. Approved J~q~e 1LF 19...~.8.. Permit No. 9781Z Disapproved a/c ..................................................................................... (Budding Ir~pector) APPLICATION FOR BUILDING PERMIT ...... ........... INSTRUCTIONS a. Thls application must be completely filled in by typewriter ac 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, ~ilding code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings fg~e~e.s,,s6ry inspections. ~, ¢0.~ /j / ...... .-~..------ -- -~.,-. -_-- / F;innntu r~ ' n f' 'nn b/'ie~nf, '~ ;' '~;'~';;' 'i f' ';' ' ~';j~;';~'~ i ;~ ........ .............................. ................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~/...~.?..~(..~..~. .Z~...~. ........................ .~ ......................................................... ~ ...... ~.. ....................................................................... iName O? owner Ot premises 1.1..:'. .................... .~,. ......... t~.~...../,t ......... ¥..~ .................................................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, ~ffi~e~r,)h~ ......... mullaers License I~0 ............ ~;;..~..7 ............................. Plumber's License No ................................................. Electrician's License No ............................................. ~..~o ~ ~L~4 Other Zrade's License No. M L~ ~/~" ~ ' Location of land on w~hich proposed ~orkw I.I be done. ap No.: ..,.......;.;...,,.. ....................... Lot No ...... Z ................ .................. , ............. :,: .................. :4...,. ................. ............... , .... 7.. ....................................... Municipality State existing use and occupancy ore,premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy .... /..~.,.~C~. .............................................................................................. b. Intended use and occupancy L/../..~..~. ............... 'c.- ~,...~...~-. - ..................................................................................... 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration Repair .................. Removal Demolition .................... Other Work ~' ~.~ Z' ~..~..~_~ (Description) 4. Estimated Cost ............................................................ Fee .......................................................................................... (to be paid on filing this ~pplicotion) 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 occu~hcy, specify_ ~nature and extent of' each ~pe of use ................ 7 .......... 7. Dimensions of existing structures, if any: Front .......~...f....~. ........ Rear ........ ~.~.L ............Depth ...~Z .......... 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 ........................ Height .................... Number of Stories ...................................................................................................... ? .............. OD ' 9. S ze of lot: Front .... ~ ...................... : ......................... Rear .............................. .;~ ...... Dep~ ..... ',vP ............ 10. Date of Purchase ...r[.~.,....Z;.....(.~'..~.Z'~ ~ ................. ~me of Former ~ner ,.~--, ~_ ~-- -4.._~L~(;~...~eZ~....~.Z ..... 11. Zone or use district in which'~' premises are situated ...~.~.(~.~.~:(~: .................. ~ ............................................... 12. Does proposed constructi?.,/_ violate any zoning law, ordinance or regulation: ...~ ............................./~ .............. 13. Will lot be regraded ....~.~ ............... Will excess fi~ be removed fram premises: ( ) Yes ( ~No '~O~- ' ~ [~dre~ .... i~ D~t~r¢~ ~ Phone No. ~ 14. Name of Owner of prem,se,,z ........... ~ ...................... ; ...... ,j~),~..~,. ..... ................. Name of Architect .............................................................. Add~ ................................ P~ No ....................... Name of Contractor ............................................................ Address ................................ Ph~e No ...................... PLOT DIAGRAM Locate clearly and distinctly all buiIdings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Iol. duly sworn, deposes and says that he is the opplicanl 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 th s app cation; that all statements contained in this appJicatio, l~ are true to the best of his knowledge and belief; and thaz the work will be performed in the manner set forth in the o~plication filed therewith. Sworn to e.l~.o.f re me this ~ ~ /~ ...... / day, f ....... ......... , ' ' ' Nota~ Public,....~... ~, '~/~.~~~ ....................