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HomeMy WebLinkAbout10478-zFORM NO. 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No 9.8.06;~ ............ Date ...... Deoemben .26 .............. 197.9. THIS CERTIFIES that the building ................................................ Location of PropertyHouse' ' 57.7.0No..Ifes.~; .M:I.~i .ROaat ..... '3't/obi .......... Fla~tgi~uok. 'h3,/~/b~ County Tax Map No.'1000 Section . .I06 ....... Block . 0/5 ........... Lot ...94. ............ Subdivision.. XX .......................... Filed Map No...X ..... Lot No. X ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated · .NO.v.e.B~¢~'. fl. 6 ...... ,19 7.9. pursuant to which Building Permit No...10.~.7.t~ .g ........... dated .... ~ ..... [7o.v. ember..16 ...... 1979., 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 ......... ................... Boa.~ .$~conage. l~ildtng .................................... The certificate is issued to ....... I~tt:ii:uok. tialdin;g ..'CO-.~. · ·., ...................... (owne~t) of the aforesaid building. Suffolk County Department of Health Approval . lq/t{ ..................................... UNDERWRITERS CERTIFICATE NO ...... i~/R ........................................ Rev 4/79 tlUllfflng inspector FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT OKI THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) /v v N? 10478Z Dote ........................................................ Permission is hereby granted to: ..... ./J,.¢.~..L?..(..!..~ ............ ~.¢~.~.r?.r..~ ..... ¢o ....................... .~ ......................................... //? ~ at premises located aT .................................................................. ~ ........... ' ............................. ~ · purs~ont tO application dated /XJ~/J/' /t~ 19.-~...~.. and approved by the Building Inspector. Fee $ ........................ Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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- tor 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- ttons, 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 Aprit 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing alt 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 informa- t~on required to prepare a certificate, Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copv of certificate of occupancv $1.00 $5.00 Date /.~.,-~,-~ ~..~./Z..~. J ........ New Building i~/4,~J Old or Pre-existing Building Vacant Land 57?0 rr.;t/ Location of Property ................................................................... House No, Street Ham/et Owner or Owners of Property .......................................................... County Tax Map No. 1000Section /~, .'.~.: .~. ~ Block Lot. Subdivision ................................. Map No ............... Lot No ............... Permit No./.0..~/-.~. ~..~-.. Date of Permit, ././.~../.~/~',~pplicant..,~,'~..~/'..7~.~.~, .~,...~.~ ./..~.~.~'.~.~...~.'.~..'.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval . .~//~ .................. Planning Board Approval ...................... Request for Temp~ary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building~rmit meets all ~pplicable coq and regulations. Applic .................. ~OL~ C~ 14 4~ ' i FORM NO.S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. NOTICE OF DISAPPROVAL ~ ~ ~o~,~ ,~, ~o~ ~,,~,,o~ ~ ............................. ~z.~... ,~.~..~ ~or porm[t to construct ........................................ ~r r~e premisos Ioco~od ot .................................... Map ........................ Block ................... Lot ................... ~. ........................... is .................................. ~ ~e ~ '~ returned herewith and disapproved on the follow, ng grounds ............................................................ ............................................................ .~...Y ................................................................ _, ~.~..~.~ ..................... ,~ ...... ~.~: .......... ~.~.~.~ ........ ~?..?..K.. ~.~. .. ~ ~:~?'..~.....~... a,~......~ ................. Building Inspector · 556 SEE SEC NO 099 199 A(c) 8 e4A{c} 13,2 % 9 I A[cl 14,2 i. OA[¢) 5 15 MATCH LINE --OR PARCEL I NO SEE SEC NO. 099_04_0234. I A RD. SEC N0~99 MATCH ~TLINE 9 15.2A(c) 108 * 2.0A{c ] t4*t MATCH TOWN OF ~g '~0 ?.t ~ [ct %20A(c) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved )~,, /(, 1~.~/. Permit No. /pt.~ -/~ Z Application No.( .~.c(. ~.~. ......... Disapproved a/c .... ~77~5~-. [ ~ :~.-.-.--.--....-. ...... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date [// /'l; 19.~..~ INSTRUCTIONS a. 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 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 of property must be drawn on the diagram which is part of this appli- cation. 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, 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) . .,2..>..,'.(..4/.:. ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ©.m~.~.~. ................................................................. Name of owner of premises .... P..~.~...~.. i 5~ ?.¢... ~.0./.0(./.c~.c] .... .~.o...: ............................. (as on the ta:~ roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .......... (Name and tffie of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No. ..................... 1. Location ofland on which proposed work will be done. .~. /. .~. .~. .~/: .7(.q.4. .'~. .~. !~. ?. · .~.~.~.{'.~.~...~°.°-.w ~ .... ~ ; d~ .o..:.. ~ ~o~ ~,,--~/~ , . ............. ~I~e' ~q~nber l~ir~i ~'/C~'/'~ ~' ~a/. Hamlet/~c..~,-TL~ .~ "j_)'.~'. .... County Tax Map No. 1000 Section ....... ./.~:~ . .~. .... Block ......... .~C. ...... Lot...../~ ........... ~ ... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~.q ~ ~. J'~20 ~ ~t.~. ~ b. Intended use and occupancy ..... ~.°..~...~....3.7..°..~. ~. ~..~. · · ·~ ..................................... 3. Nature of work (check which applicable): New Building .... X... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ...... ~1~. - · - · Other Work ............... ' ?J 'T,~50 (Description) 4. ' -- ~.(? O..o.O..~ Esttmated Cost ......... ; .............. Fee ...................................... (to be paid on filing this application) 5. If dwelling, numb. or of dwelling units ............... 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 type'of use. ~r~ :,.~-.. ~.'~. v.~. 7. Dimensions of existing structures, if any: Front ............... Rear .............. DePth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ......... ,.. ·, ......... Number of Stories ...................... 8. Dimensions~0f~eptire new construction' Front & 0 Rear ~, 1~ t Depth ~.0. t . Height ...~.~r .......... Number of Stories ... [ .................................................... Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated ..... .~... ~...o. ~ ;~... ................................. Does proposed construction violat~.i}ny zoning law, ordinance or regulation: ~../D~I., ....................... Will lot be regraded ...... ~ · ,t:J,'~0.: ~..,t..~.,;. ~',. Will exces.s fflJ b~.removec[ from premises: Yes Name of Owner of premises/ ~ ~r,'r~4t ~ t"~ ~..,~A~ldress ~'~.~[~.~t/ ~ * Phone No ~.. -. .......................... .. Name of Architect .. ~.. ~ ...... ~ ...... ~ ......(Address ..., .... ~; ..... , .....Phone No ................ SameofContractor ,J.~.~.~q t.?.~.g .~.: .... Address ~.,~.~.~.~.~, PhoneNo ................ 10. 11. 12. 13. 14. 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 comer lot. STATE OF NE.W ~)Rj~.. / ~tC S S COUNTY 0~..~... '~ , ...... ! .~?.'. ! !;*. 9: .~'~.....~.~ .~.~. '! .~ .~...~ .~.: ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. 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 tree to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application Fried therewith. Sworn to before me this ............. L ,~. · .~,....day of ..................... Notarv~ublic, . .............. ..,~-.~..~County . '~. _ ... ... .... ~IOTARY PUBLIC, Sti~ of Flew York r to:---*..-- e ',. ~.~ NO. 52-8125850, ~ County to~mtul~ o. appucan[i re~m Exi)ires MatLab '30, 19__ / / / / I I I I '~ ~Of / / I I I I Lot 35 N 87° 36'50"W YOUNG & YOt 400 OBTRANDER AVENUE, RIVER~ PLAN OF PROPERTY PREPARED FOR MATT[TUCK HOLDING CO INC NOTE 42 60' N 87° Wdham ~OSco/o~ dr' 00' /? / / 9 75 530 _ Lot 0 LOTS REFER TO MAP Of "SHORE ACRES", FILED IN THE OFFICE OF THE CLERK OF SUFF. CO. ON JAN. 3, 1914 AS FILE NO, 41. IS 89°4G'40"E.} = BEARINGS REFERENCED TO MAGNETIC NORTH IN DEED DESCRIPTION