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HomeMy WebLinkAbout11773-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 2,11083 ......... Date ....... JUllr. 15 .................. 198~. THIS CERTIFIES that the building ................................................ Location of Property .. 132.5. BI' ...... ~P.o&d.~i&l;ele~. Ilo&el ............ ~:.tlQgll.e ..... Houae No. Street Hamlet County Tax Map No. 1000 Section . 106 ........ Block ... 111 .......... Lot .Q 06, D.(I 7 ~ 0!0.~... Subdivision .l~&eel. u. Pt~,..Clulx .l.~r op. ae t;ie~iled Map No.. 156 .... Lot No.292~. ~ 291~E ~ 294 P Amended Nil) A conforms substantially to the Application for Building Permit heretofore Fried in this office dated ·.. ~Iune. ~ ........... 19 .Sapursuant to which Building Permit No...1.1.7.7.3...Z ............ dated .. J~tl)'. 3 ................... 19 .~2, was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is ......... .......... an. a,~ce~.o.r.y. ~.t,.qr. ~.ge.. ~ .h.e.d.: ....................................... The certificate is issued to ......... ~?.a.n..k..}/.....A.b?.e.q .a ................................ (owner, de~e~ e~nea~* of the aforesaid building. Suffolk County Department of Health Approval ..... r,/.a ................................. UNDERWRITERS CERTIFICATE ~0 ............. ~/. ~ ................................. Building Inspector R~v. 1/81 FOaM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N©. 11773 Permission is hereby granted to: ..... ~,f,~:....~./.. ............... ............ . ........ County Tax Mop No. 1000 Section ...l..~,.....~.. ...... Block ..... l..I............ L~ No. pursuant to appliccltion doted~ ............ ~ ....................... , 194~.~ and Building Inspector. approved by the Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD BUilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 ~ocation of all buildings, property lines, streets, and unusuat 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. 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 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 inspectiqn of buildings or premises, or other pertinent nforma- tion required to prepare a certificate. / Fees: 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 $5.00 Date . New Building ........ Old or Pre-exis,t_~i~g Building(X) ......... .a 'V_,aca and/'; ........... Location of Property .... !~,~ Hou~ No. Street ~ HamNt Ow.er or Ow.ers Of Property . S.bdi.~s~. ~ ...................... v... ..... F~d ~p N~ ..... .z .... L~t N~.'~ ~.~ ~:.~ ........ .~ ...... .. ~ .... . ................ Health Dept. Approval ........................ Labor Dept. Approva~ ......................... Underwriters Approval ........................ Planning Board Approval .................. ~ ,. ~ Request for Temporary Certificate ..................... Final Cartificat~ ....... - ......... - Fee Submitted $..~4....~:~. ~ ................... Construction on above described building and permit meets i),l~p~cabl~osles a~d regulafions. ~EL~INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL COMMENTS ADDITIONAL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved~ ......... ~ ............ , 19z~.,~ Permit No....~..Z:...~....~...~.~.....'.~.... Disapproved o/c ............................................................................................ APPLICATION FOR BUILDING PERMIT Date ............. , INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate to the Building Inspector, with 3 sere 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 drawr~ 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 Occupc~ncy 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 (S'g ature of applicant, or name,~f a corporation) ........ State whether applicant is owner, lessee, agent, architect, engin,e, er, general cJ~r~.'tnr, ~l~rtri~i~n,:i~b!um_her "~=l~ider. FEE: BY t ........................................................................................................ ]L" '; ................. N'OTU:~"B~I'I"D1 tUG"D~PA'r?~r~t~*~'.,~.'.~' ...... Name of owner of prem ses ......... 9 AM TO PM .................................... J~'~'li~'ggi]q ~"1~ ~Si:'Clq~F.rs': ....................... If applicant is a corporate, signature of duly authorized officer. 1. FOUNDATION - TWO RE~' FOR POURED CONCRETF ........................................................................................ 2. ROUGH - FRAMING A P~ (Name and title of corporate officer) 3. INSULATION Builder's License No ........ ~,..?. ...................................... 4. FINAL CONSTR!~ ..... BE Cr~MP! riTE F(~R C rq Plumber's License No ................................................. ALL CONSTRI.~CTION $'-'& THE REQ J RqMrNTS OF STATE CONSTRUCTION o Electrician's License No ............................................. CODES. NOT RESPONc Other Trade's License No. ~ . DESIGN OR CONSTRLJC~rlr~k' .............................................. ~ubaivlslon 1. Location of land on which proposed work will be done. Map No.: ,..,/...~.'..~ .......................... Lot No.~,.~/.~..~.,.2,~:.S...,.~...9~ Street and Number :.r...8.. ............ - ..... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................. ~.~,~.....~..~...~:.,..~...~C/..¢7......~.?.:~..~ b. Intended use and occupancy ................................... [~ ................................................................................. County Tax Map No. Dist. 1000 Sec'tJ_on. l(~Li Block I, Lot ~.©~ (./ [~ 10. 12. 13. 14. Locate clearly and distinctly property lines. Give street and whether interior or corner lot. Nature of work (check which applicable): New Building,. ................. Addition .................. Alteration .....~.......,% Repair .................. Removal .................. Demolition .................... Other Work ..................................................... (Description) (to be paid on filing this application) If dwelling, number of dwel, llng units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ...: .......................................................................................................................................... If business, commercial orl mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing.structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ......... ~...~...x~. .......................................................................................... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ iHeight ............................ Number of Stories ................................ Height /..~.....40r, ..... Number of Stories ........ (~...'~7..v~ ................................................................................................... Size of lot: Front ............... ' ......................................... Rear .......................................... Depth ................................ Date of Purchase ............... , ......................................... Name of Former Owner ........................................................ Zone or use district in which premises are situated ..................................................................................................... Does proposed construction ¥iolote any zoning taw, ordinance or regulation: ........................................................ Will lot be regroded ............................ Will excess fill be removed from premises: ( ) Yes ( ) No Nome of Architect .............................................................. Address ................................ Phone No ....................... Name PLOT DIAGRAM all buildings, whether existing or proposed, and indicate all set-back dimensions from lock number or description 'according to deed, and show street names and indicate STATE OF NEW YORK, il S S COUNTY OF ..~.~r~...~./..¢'. .........jJ' ' .... ~.,~/..~........~..~....~.Z~.£4~,/~.,,~.r.'.....~...~. .............................. being duly sworn, deposes and soys that he is the applicant , (Name of individual ~'igning contract} above named. He is the .............................. ; ....... ~ .......................................................................................................................... '. ............... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dbly 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 that the work will be performed in the manner set forth in the application filed therewith. Sworn to be. fore me this : Notary Public,~/.~f~/.,~..r~....~.~ ~ .... ~..~....~.~.~ ................. [ (Signature or applicant) ~ ' LINDA F. KOWALSKI NOTAh'Y PUBLIC, State of I~ew York No. 52'4524271 Qua)ff~e~ m 8uffel~ C6anty , ~ ~ . Commission Expires:Marcl~ 30~ J