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HomeMy WebLinkAbout9830-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Occupancy THIS CERTIFIES that the building .-.-.d.e.c..k..afl. ct..~J;.i.o.n. .............................. Location of Property 57.9.5. Nassau ?oint Road CuLchogue h3.se No: ....................... 'S't/e3i ....................... County Tax Map No. 1000 Section .. l 1 .1 ....... Block ... 1. .3 .......... Lot . .0.0.4. ............ Subdivision .N.a.s..s ~.u.. ~. 9.ip.t...C .~.u.b...P ?.p... ~..Filed Map No..1.5. .6 .... Lot No..3 .9 ........... Amended Map A. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... J.u.p.e..2.0. ........ , 19.7,8. pursuant to which Building Permit No, .9..8,3,0, ,Z. ............. dated ...... J.u..ly.. ~. 2. .............. 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...cl.e, qk...a.d.d. 5. ~.~.o.n...¢9..qr~ .e r.f.a.m..~.i~..d..w.e.l.l.i..n.g.. ............................. The certificateisissuedto HOUSNANG & ANNE L. MAHIN (owner, q~cee' ~r't~t~arrt) of the aforesaid building, Suffolk County Department of Health Approval ....... n.o..~..p.e, qu. }?.e.d. ..................... UNDERWRITERS CERTIFICATE NO ............... n. o..~. ?.e. q .u .i.p.e. d. ..................... Building Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Nm. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9830 Z Date .............. ,.T1J~L~'....'J ~. ......................... Permission is hereby granted to: ........ :~ar~l~..B.~..R~.~.e...~k..~on~..~n.o., ..... ........ ~ / ~. . , ,~a,,~.,,&. ,N~ , . . .Hou~ag. . Y~in to ... add,. de ak,..to,..a.. Dna..Fm~Ll~...D~cell in~ ......................................................................... at premises located at ............... 51.05...l~...a.P.~.a...'LA...?.~.*....~.d..? ................................................................ ................................................... Cu.teh~gue ,...New...Yo~k .................................................... ' ........... ........... Lo~...~....59., .......... Nasm au.. P.o~q.~..2~.op .............................................................................. pursuant to application dated ............. ~.l,J~l~. .......... 2.0. .................. , 19....'~..8., and approved by the Building Inspector. Fee $"'"%5'~00 ....... Building Inspector 1000-111-13-/* TOWN OF $OUTHOLD Building Department Town Clerks Office Southeld, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the following; for new buildings or new use: I. 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 aT 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 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 $1.00 Date ......A...u~.u...s..t.....1..5..,......1..9...8..3. ....... New Building .................... Old or Pre-existing Building ....D.~C~ ..............Vacant Land ............................ Location Of Property ............ ~7. D.5..&qa~s~u..~.o£n.t..R~a~,...~3u.~,~h~g.ue.,...N.,.~.., ............... Mr. & Mrs. Houshang. Mahin ~ Owner Or Owners Of Property .............................. ~ ......................................................... Subdivision L~s,~a~..Pmizzt..~R~p~ct..ie~...Lot No ..39 ...... Block No ............. House No ............. Permit No. 9830Z Date Of Permit 7..//..Z..2./.7.~Applicant Harold R. Reeve & Sons Inc. Health Dept. Approval ........ ~..o.~...~.e..qB.$~.qQ ....... Labor Dept. Approval ....... ~O.~...~.q~,~.d ............ Underwriters Approval ..... n.c~_..r~q~zir~d ............ Planning Board Approval ...... ~¢...~q~i~ed ..... Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. ............... ....................... Sworn to before me this // ~ ...... /~.. day of ..~.~.~.~.7~ FO~ ~0. 1 ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ...... J~l.y. .......... 'J.2 .......... , 19.....~.BPermlt No ...........~OZ .............. Disapproved a/c .................. ~. ....... ~ ........................................................... (Building Insp~tor) Application 1~4o ............. ~,.,8. ~..0. APPLICATION FOR BUILDING PERMIT Dote .......... ....... , INSTRUCTIONS a. This application must be completely filled in by typewriter off 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 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 port for any purpose wharrever 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, Jfa corpordtion) (AddreSs of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................ ................................ Name of owner of premises .......... ..~..Ik .~....~.~...~,~J, ...... L'~...C~..L~.~.)-~.-..~. !.~- ..~....-~.~t.~.l..~ .......................................... ~ x~ (Name and title of o~rporate officer) I~LlJJer's License No .........~..~ ..................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Location of land on whic,h.,?roposed work will begone. Map/~qo.: ........................................ Lot No....~...~ .............. Street and Number ..... ..L.~./.~.....~.X~t~.~.~2~....~.~.~..I..~.~..~...t..~...: ......................................... ..~--~...T-..~'~..'~.~..~.¢-~.... Municipality 2. State existing use and occupancy of premises~. Czz~and intended use and ecc~l~ancy of proposed construction: a. Exisitin, use and occupancy....~.....~..~.l~%..~....[..-~.)...C~.~· ....... t'r~x~'~L~'~.''~4~ .................................. b. Intended use and occupancy ............................................................................................................... ~.......r~.. 3. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration .'~ ............ Repair .................. Removal .................. Demolition .................... Other Work ~..'g~...q~..~,Lk4 .,,~...~,..cQ..~,.. (Description) 4. Estimated Cost ........ ..~.1.~...4~....~-.., ............................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... .J. ................. 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 tyl~e of use ................. ~ .......... 7, Dimensions of existing structures, if any: Front ...... .~..~. ............ Rear ..... .~....C~.. ................. Depth ....,~,..~ ........ Height ....... ~....~... .......... Number of Stories ........... ©..~.'~ ......................................................................................... Dimensions of same structure with ah'orations or additions; Front ...... ..~....~. ..................... Rear ...~..O ................. Depth ........ ..~..~ .............. Height ........ !...~ ............ Number of Stories ..~!.~/..%..~% ............... t 8. Dimensions of entire new construction: Front ......... ~...~. !. ................... Rear ....J....~. ................. Depth I-Jeight .................... -Nttmber of ~ ...... .~.~ ....... .~.~.~ ........................................................................ 9. Size of lot: Front .............. l...t~..) ................................ Rear ....... J..~..~ ..................... Depth ...,,~f~,,~ 10, Date of Purchase .......... .~..~...~:..J~ .............................. Name of Former Owner 1 1, Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ...... N..~:~ ........................................ 13. Will lot be regraded .....~J.~) ............... Will excess fill be removed f. rom premise~ ( ) ,.Yes (~N ............. No....:¢..4: ............. 14. Nome of Owner of premises J'~cJ~:~¥~J~ P~:JI.~ ..... Address .J~.)?~..~...g.......~.l/..V.i' Phone ~J Nome of Architect ................. ~1~...~-~.,...O-~...: ...................... Address ................................Phone No ....................... Nome of Contractor JtJJ~'(d~'~....(~--~..,.~.-...~. ~.~.... Address .~..LI~.~... Phone No.'~..~..?...~.."J.].,~ 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 STATE OF NEW YORK, ~ ~SS COUNTY OF~k,).~..}F~D..~.¥=...,,zz;..¢ '7% .................. · ~A~.~,~ ....... ~...~'.....-~.~,~...~..~. ............... being duly sworn, deposes and soys that he is the applicon, (Name of individual signing contract) above named. He is the .................................................. ....k~. ~..~7.L.~J..~.~..I'.~ ...................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to be~di~ me this /) , ....... day ................. , & Notary Public,. ........ ~~ ........ County ........ ~.....'~..,...!.,..~ ................. ,AMELA J, $cl-~,,'tflt~ [/ / ' ~ ~x \ (Signature of appl~ont)