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HomeMy WebLinkAbout9619-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13743 Date August 12 1985 THIS CERTIFIES that the building.., gDD.~ T ~3~ ................................... Location of Property . J.3.8.0...BAy. b..er.r.X Road .C.ut.c.h. 91g.u.e' House No. Street Hamlet County Tax Map No. 1000 Sectinn .... 1.1.~. ..... Block ........ .2 ......Lot....1.2. ........... Subdivision .~.R~.V. ?.~. :..C.l.~.b.. ???.p...~.n.q .Filed Map No.7 .~? ...... Lot No..1.1..8 ......... conforms substantially to the Application for Building ?ermit heretofore filed in this office dated ..... 7=.h.. :~ fi ........ , 19 ? 8. pt~suant to which Building Permit No...9.6. ~. 9 ~ .............. dated .... r.. ~ .b.... 1. 6 ................ 197. ~.., was issued, and conforms to all of the requkements of the applicable provisions of the law. T~e occupancy for which this certificate ts issued ts ......... ..... ~.~.~ J, .~.~.o.~. ~.~.o..a. j?. ~. ¥.a.~.e...o.n.e..~..~.~.~.~.~..~?.e. ~..~.~.n.g: ...................... The certificate is issued to MARGUERITE F. MULLEN ~o~er, ~ ReX, apX& X X of the aforesaid building. Suffolk County Department of Health Approval ............. .N./?. ......................... N/A UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9619 Z Date Permission is hereby granted to: ...!~.:./.:....4. 5~.!:..~..,~q.~../:;.~.. .................................... ...,/.~. ....... .~......~.,..,..*..u::..~ ............................. ............... C.¢..Z..~.,:?...%r?...c!~. ................. / pursuant to application dated ................................ ~..~.....~.e., 19..~.~ and approved by the Building Inspector. ~ee ,...../.~. ....... FOF~M NO. 6 TOWN OF SOUTHOLD ~uiic~Jng Dapar~men~ Town Hall Southold, N.Y. 11971 APPLICAT]O;',J FOR CERTIFICATE OF OCCUPANCY instructions A, This ~221icatfon must be filled in typewriter OR ink, and subr~itted in duplicate to the Buildina Inspec- tor ,.'/~n the fei!o',ring; for new buildings or new use: 1. Final su~,'e,/ of property with accurate tocat¢on of all buildings, property lines, streets, and unu~al 2. Final 233ro'/al of Heaith Deer. of water suDoiv 8nd sewerage disposal--tS-9 form or equal}. 3. Acaro,;al of e!ectricat installation from Based'of F~ro Unde~rkers. 4. Commerci3l buildings, industrial buildings, Multiple Residences and similar build~ng~ and installa- tions, a c~r~fscate of Code compliance from the Archite'dt 'or Enqin~er resoons b~e for the b~iiding. 5. ~u,,,,.~,, I~n,.mg Board approval of completed si~e plan requirements where applicable. B. For existin~ buildings (pr~or to April ~957), Non-conforming'uses, or buHdincs and "pre-exisdn~" 1. Accurate su¢zey of peoper~ showln9 ail prooerty tines, ~reets, buildings and unusual nature or ' 2' Sw°rn sratoment °f owner or previous owner as to use, occupsncy end cond~tlon of buiid~ngs. ' 3. Date of an,/ housing code or safety inspection of buiidines or premises, or o~her pert(neat informa- ticn required to prepare a ce~ficate. /' C. Fees: 1. Ce~ficate of occupancy $5.00 .............. occupancy on pre-ex~sting dwelling or land use $5.00 3. Ceph' of ceruficate of occupancy Date ...... ~' ........... Old or Pre-existing Building(X) . _[ ...... = /Vacant L~nd Location o!Pro2erty . e]2~2 .~ Owner or Owners of Property . .~:¢~¢~¢ ~, Ccun~vTax MaD No..1000Section .~8-~-~ Block 11'8 Sub=¢,z,sion . .Nassau Poin~ ........................ F;~ed Map No?89 ....... ;.Lot No. 118 Heatrh O~,,,. Approval ........................ Labor Dept. Approval ..... Unden.vrhers Approval . ,Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ........ FeeSubmi(t~d~ ~,00 ConstructJon on above described build~ng and permit meets all aPPficabl~odes and regulations. TOWN OF OF?ICE OF BUILDING INSPECTOR · ,,OX 728 TOWN H,\LL SOUTNOLD, N.Y. 1197! TEL. 765-I 802 ~ ~ Applicant · ~nls ls to advise you ~hat t~e · ~ . =n oF!em to complete this file, it is necessaFy that a Certificate of Occupant- ~. enc!~oed ~ ~ . .~y be issues Please fill cut '' ~ ~C,m(s), return same to ~ - ~n~ check fop $~.00 payao!e to the Town off Southold. Flease ina~ate to WhOm the Cern e~cat or Occusanc is - . Y to be man!ed, and arpanse 'with this office fop an inspecgion date. Thank you fop your prompt a~t~nbZon. VL:ec EncloSUres Very truly yours, Victor Lessard Adminis ~r~ tor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL[RK'S ~UTHOLD, N. Y. Examined .,. ................... 9 ..... Disapproved a/c ........................ ~:.~ ................ :~'"" ........................ (Buildin~ Inspector) INSTRUCTIONS Application No. a. This application must be completely filled in by typewriter o¢ in ink and subm tted 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 m 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 o 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 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 applic~~'~'~i~'~ ........ ........... ...................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................. ~u,Z/~.~ .................... . ............. Name of owner of premises ......... Z~...~. ¢/~. ....... ~.~.~/~/ ................................................................. if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ '..' ....... ~..~...~..~..?~' Plumber's License No ................................................. Electrician's License, N©. Other Trade's License No. ~: ............................................ 1. Location of land on which proposed work will be done. Map No.: ............................... ]55 ..... Lot No..../../..~.., Street and .................................... Municipality 2. State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction: o. Exisiting use and occupancy ................... ./.'.....~.z/~/~'~.~.~.. ~.,L...~..~.Z;¢~'/ ,v ~.~ .... .,.-~..,,ffz~ ..................... b. Intended use and occupancy ............................................ 3. Nature of work (check which applicable): New Building .................. Additionidi.,.... .......... Alteration ....... ~ ........ Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... '/ (Description) ' ~ 4. Estimated Cost ..... u-' .'~).. ~' ' ..................... this (to be paid on_filing application) '~. If dwelling, number of dwelling units ............................ Number of dwel[ing 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 ..... 7;'_~..-.~ ........... Rear ................................ Depth ..~..~(~.. Height ~' -' c z ................ .~ .................. Number of Stories ... ~/);,, , Dimensions of same structure ~Jth aherotions or additions: Front .................................... Rear ............................ Depth ....................... ~ ........ ~eight ............................ Number of Stories ................................ 8. Dimensioas of entire new.construction: Front ......... >~;~..~, ............... Rear ............................ Depth .~./.~ ........... Height ,../~ ............. Number Stones ........ ~ ...................................................................................................... / 9. Size of lot: Front .................. ~. .................................. Rear. ......................................... Depth, ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....... ~u.e,:¢,.~ .................................. 1 ]. Zone or use district in which~remises ore situated ............................. /)/ZZ,:;../~....y¢~,~/:~% ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............. ~(~ ...................................... 13. Will lot be regraded ........~.t .............. Will excess fill be removed from premises: ( ) Yes ~ ) No 14~ Nome of Owner of premises ~tt.~f.,Mt .................................. AddressZ~,pr.~.,[...~j~.... Phone No ....................... Name of Architect ............................................................. Address ................................ Phone No ....................... Nome of Contractor .~V~..~..~i/~gt.~).~..~,~.~, ........ Addres~.~,f,F~'..4~,~,~ ...... Phone No,~.~,¢..,..~ ...... PLOT DIAGRAM L.oc~te clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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 Io~ STATE OF NEW YORX<, Icc "~-B' /¢l,,~d ,~/~¢oL~ COUNTY OF .,.~.0~ ........ 7...f~'~ ................... ~.~...~.~.~ ....................................... being daly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. contractor 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 the best of his knowledge and belief; and tha~ the work will be berformed in the manner set forth in the application filed therewith. Sworn to before me this / ..... ~ ..........day of .....~t~.~t~ ..................., 19.~.. ,, ..~. ........... k / ' Notaw,, . Public,. ................................ , -~'~9'~'; CounW .............................. (sgnatute of a u'i'"-' "~'"'-:"-~"" ................................... Term Expues ~4arch 30, 19 tt8- hq1 ~, p OF LA,ND .Scc~ !~e: 4-0 =', AT