Loading...
HomeMy WebLinkAbout9633-zFORMNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... g!OJ 5 ....... THIS CERTIFIES that the building ................................................ Location of Property .... ~.0. lXlo12th. ~.e~t. Dl~.:[¥e p ................ ~Ol,t~hol~t,p..l~l,~r.o... House No. Street Ham/et County Tax Map No. 1000 Section ..... 5.h: ....Block ...~ ........... Lot .... '} ~ ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .M..~r.~.~' .'1.~. ..........,19 7.~. pursuant to which Building Permit No...~..~..Z. ............ dated .... .M,~.~.9.13. J.6, .............. 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 ......... Addition One Family Dwelling The certificate is issued to ...... .lyI.~?,i..1y?l...d'. :..Q:[.1..l~.r.:l.~e. .............................. (owner, ~3v~X of the aforesaid building. Suffolk County Department of Health Approval - UNDERWRITERS CERTIFICATE NO ........ . 9.o.579 .................................. Building Inspector Rev 4179 FO~M NO[ TOW~ 0~; BUILDING TOWN CLERK'S SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 9633 Z Permission is hereby granted to: -5'n/ Ll-~,~.~ t.) to I~ O (), at premises located pursuant to application dated ~tl~ i¢ 'y 19..~?. and approved by the BuHding Inspector. iectbr 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~ tot 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 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 installa- tions, 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 survev of peopertv showing all property lines, streets, buildings and unusuat 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. C~,~ees: 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 Building ...~.~. ........ Old or Pre-e)c[st[ng Building ............ Vacant Land ,..~; ......... Location of Property Owner or Owners of Propertv... ~,~,t,~ .... County Tax Map No. 1000 Section .... .~"~.'/ .... Block .... ~.~ ...... Lot...~Z~ ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~ritersApproval.,........,..........,..~ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate , ,~ ................... Fee Submitted $ ,~ .~2 ........ Construction on above described bu ,lOing a~d pe~l ~7:s~l ~pliqable ~odes ulation,. THE NEW YORK BOARD OF FIRE UNDERWRITERS in the following location; ~ Basement ~ 1st Fl. [~ 2nd Fl. Section Block Lot was exa,ained on /k~t~~ ]_~ ~ ~.~ and fottnd to be in compliance witk the requirements of this Board. HXTURE FIXTURES RANGES :OOKINGDECKS OVENS DISH WASHERS EXHAUST FANS DRYERS OTHER APPARATUS: E R AW, G OF CC COND 2 V I C NO OF NEUTRALS 1 GENERAL MANAGER This certificc~te must n~ be o~tered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY I~OR BUILDING DEPARTMENT. THIS COPY OF C~ER~'IFICATE ~U~ALTERIKD IN ANY MANNER. FOI~M NO. 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ORDER TO REMEDY VIOLATION (owner or q(Jthorized agent of owner) (address of owner or authorized ogeflt of owner) PLEASE TAKE NOTICE therb exists a violation of: Zoning Ordinance Other Applicable Laws, Ordinances'or Regulations ............................................ at premises hereinafter described in that',~.~./.~...~.~. ~.~..~.~.~.z.~.J..~......~..~.......~/..~..(~?~.~.,.~.' ....~-- .... · (state ghoracter of violation~_~-- ........ ............................ (State section or paragraph of applicable law, ordinance or regulation) YOU ARE THEREFORE DIRECTED AND ORDERED to comply with the law and to remedy the conditions above mentioned forthwith on or before the ...................................................................... day of ............. ~..'~.~ ........................ , 19.~g The premises to weis~ this ORDERc,,T--~EMEDY VIOLATION refers are situated at ~,,,~g~....~.~'~:f..5~.~, ;~.~,,,,,,,~'.: ....... County of Sulfa k, New York. Failure to remedy the conditions aforesaid and to comply with the applicab~ provisions of Iow / may constitute on offense punishable by fine or imprisonment or both. / Building Inspector fl o to,,/ FOR~I NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Yo Exom,ned ................. ........ Approved .[ ............ [.[~'...{.~..., 1~.~ Permit No...~..~..~'[':...T ...... ~ii~ppro~d ~/c ........... .;.:~_. ,,~ ................... (Buildino Inspector) No. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 sche4ule, x. 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 apl~lication may not be commenced before issuance'of B~il~ing Permit. d. Upon approval of this application, the Building Inspector wdl issue a BuitdJng 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, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, a~lent, architect, engineer, general contractor, electrician, plumber or builder. General Contractor Mary. land G' l~ride Nome of owner of premises If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. 6.3 Plumber's License No. ~ ............................... Electrician's License No. ~ .............................. Other Trade's License No ............................................... Location of land on which proposed work will be done.Map No.: See ........................................ Survey Lot No. ........................ 16 Street and Number .~./.~.....O..f....Nq.r..~.h....~e.a.....D..z'...i..v..e..~.~.O...u.t..h..q.l.O.~...~.~.Y..~. ................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy ....... ~....-...F..~m.~.l...Y.....D~...e...1..1.:i..n..g.. ........................................................................... b. intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building,. ................. Addition ~ ......... Alteration ............... Repair .................. R, emovqt .................. DemoHtior ..................... Other Work .................................................... ~ (Description) $6~000.00 ~ ( ~ ..... 4. Estimated Cost ............................................................ tee ..................................................................................... (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 ar mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ...... ~..~. ................. Rear 34 Depth 24 Height '16 Number of Stories '1 Dimensions of same structure wit~or additions: Front ....... 5(~ ........................ Re(~i~..50 .................... ............................ Number of Stories [ .............................. Depth ....~., ,2. ........................ Height 16 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front .... ,'1.,O.O. ............................................. Rear ........ ~.0.0. ........................... Depth ......... .~.9. ............... : - 10. 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 ...NV. ................... Will excess fill be removed from premises: ( ) Yes :~ ~) No 14. Nome of Owner of premiseslVl~!~.d....~.~;],[~...3-.'.~t. ...........Address ................................ Phone No ....................... Nome of Architect .............................................................. Address ................................ Phone No ....................... Nome of Contractor ..~.~..3....~..~.~..~.,o~..,,~.~..~.....]:..~.~.... .............. Address .B..9..~....~,'1. Z~..~.~.z.'.l:~irte No...~.~.8...-.~.~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. ?~'A-r'E OF NEW Y, ORL<:,. .. ~ c c COUN'rY OF ...... ~.z z.~.o...a~........ ~ ................ ~ ............................................................ ..~.;~ ........... being duly sworn, deposes and says that he is the applicam (Name of individual signj,ng, cont;,racf) ~ abow,~ named-_ ~ ~ / ,, co :ac or He ',' the ......~. ~..~.L~., .~:':i~... ............................................................................................................................ ~((~ontractor, gg~nt, corporgte ?fficer, etc.) of said owner or owners, and is duly ab~horized to perform or have performed the said work and to make end file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the applicStion filed therewith. Sworn to b~fore me this ~ ~ ......... ......... ....................... Notary Pubhc~ .................................................... Coun~t ................................... ~..~ ........................ · _// ,/~ (Signature of applic~t~ MA RY//E. DAWSON I~OTARY PUBLIC, Stale o[ ~'~ew Yorl{ No. 52-4643721, Suffolk Cmmtv Term Expires Ma~ch 30, 19 O[~'l'. 1000~ :.5~¢'h. OG"t, 5locld ~, Lo-f lf~.