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HomeMy WebLinkAbout10530-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ....gg~?, ........ Date ... E~..r~..~.rY...2.! ................ 19 .~.0 THIS CERTIFIES that the building ............................................... Location of Property .,...~.~Q~...~,g..5~. ~ .o.~.. ~. y.~.~.~. ? ...................... M..a~.5~ ~..l:lp~.,...N: t~ouse rye. Street Hamlet County Tax Map No. 1000 Section ....10.6. ..... Block ....6 ........... Lot ....... '1.6.: .2 ...... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....D.o. 9.~.m.~.e..r' .2.7.. ..... 19.7.9. pursuant to which Building Permit No .... .'1.0.5. ~.0.Z. .......... dated .. D.e.c ertlb.o.12.. 27 ............. 19.7.9, 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. qt.d;[~.O..n..g.o...0.n.c..~.o~. %.l.y..D~..o. 1..l%.n.g.. (G~,een~ous e') ........... The certificate is issued to Barbara and Gerard Goehrln..g.e.r. ............ ..................... /oYn'o;, .... of the aforesaid building. Suffolk County Department of Health Approval ........... .~./.R. ........................... UNDERWRITERS CERTIFICATE NO ................... N/R Building Inspector Rev 4/79 FOI~M 1~0. 2 TOWH OF SOUTHOLD ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P[~EM[SES UNTIL FULL CO, MPLETION OF THE WORK AUTHORIZED) N? ]0530 Z Permtss~on ~s hereby granted to: ......... ..z~.~.~........~./.~.~/V~z/ . ..... ~.~.~ ......... ~..:..7.'. ........ ~.) ........... at premises located at .[..~. .......... ~.~/~...~ ............................................ .................................. ~ ............................................. ~.~/z../~.~ ....... ~....:/ ...................... ,.~.~...~c~ ............... ~.. ~z ........................... g~.~....zf.~.=z.4 ......... pursuant to application dated .?......~ ......................... 19.~. and approved by the Building Inspector. Foe */..6Z...~. ...... 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- 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 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, occupancv 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. 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-existing Building ............ Vacant Land ............. House IVo, ~' ......................................... ~ Street /9~ Ham/et Subdivision. Haalth Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval .... ~2x5 ............. Request for Temporary Certificate ..................... Final Certificate .... v. .................. Fee Submitted $..: .~.../~/..tr~. ................... WINDOWS * (;tIDING DOORS. ANDERSEN CORPORATION DAN CARROLL ANI)ERSEN~''' PERMA-SIIIELD® UNITS - l~0~, COMMERCL PERMA-SHIELD® WINDOWS GLIDING DOORS' SHUTTERS PRIMED WOOD WINDOWS GLIDING DOOFIS FInD INSPECTION · DATE COMMENTS FOUNDATION (Is~) FOUNDATION (2nd) ROUGH FRAME & PLUMBING STATE ENERGY ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTI~ENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 Application No. ff.O...~.--.'~..~. ·©. ...... Disapproved a/c .............................. · (Building Inspector) APPLICATION FOR BUILDING PERMIT Dat~.(.~. .2..7 ......... 197.9 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 authoriz ed inspectors on premises and in buildings for necessary i~n~on~s.4v.Q/~__~'h~//~y~w (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ) Builder' License No.....~..~-~. ~ .'3~.. · ............. / Plumbers License No ..... //' ' ~ .... e~ ......... J Other Trade s License No ................ / ..... Location of land on which proposed work will be done .................................................. ldo. ............ ...................... ............. '/~'/~' ' ' ' ' ~ir;;i Hamlet House Number . County Tax Map No. lQ00 Section . . .../~ff-a .......... Block .. ~ .............. Lot..~. :-~ ~ ........... Subdivision .~..~..~./~..~'..~m/~e/2~d?.'-"' ...... FiledMapNo....~.~.. ........ Lot.~/~ .... State existing use and occupancy of premises and intended use and occfipancy of pro~9.p.t:~ construction: a. Existing use and occupancy ..... ........... .1. ............................................ b. Intended use and occupancy. . ~..~.J....'~...~.,e~. ~.-~...~.. ...c~. zeStY. / .~(4-7-4~__t:Y: .~ ~ ~'~ ~ ~.~. .... ._~-~..,.. . ............ 3. Nature of work (check which applicable): New Building .......... Addition ......... Alteration .......... Repair .............. Removal .............. Demolition ............ Other Work ............... 4. Estimated Cost ............................. Fee ............................. (to be paid on filing this application) 5. If dwelling, number of dwelling cnits ............. Number of dwelling units on each floor ................. If garage number of cars ' 6. If business, commercial or mixe~ occupancy, specify nature and extent of each type of use .................... 7. D~mens~ons of ex~stmg structures, ff any: Front ........... Rear .......... Depth ......... Height . ~ .......... Numlber of Stones ................... ,~ :/~ ................. ~,,~./ ....... Dimensions o~ same structure with alterations or additions: Front ...~..a. ........... Rear,. ,~..a, ............ Depth .. .d.~Z'vgr.r-:. ...... Height .................. Number of Stories .................... 8. D~mens~ons of entire new construction: Front ....t/~. ........ Rear ...a~. .......... Depth .. ~. ........... Height ............... Numlber of Stories ...................................... '--~2 .............. 9. Size of lot: Front ... ~f.~ .... i ........... Rear .... .4f. ~ ............... Depth . ,:;3....~. ............... 10. Date of Purchase ........... ii ................ ;O _Name of Former Owner 11. Zone Or use district in which pr,emises are situated..,...,~.. ............................................... 12. Does proposed construction, violate any zoning law, ordin'ance or regulation: .~.' ........................... 13. Will lot be regraded .... /t~'.~.i ~ ................. Will excess fill be removed from premises: _.)'es No 14. Name of Owner of premises . . .,,Y~.~;. ......... ..Address .... 0"*/'~.~. ........ PhoneNo...~,~..~.-fi/,~..~... Name of Architect I N ........................... Address ................... Phone o ................ Name of Contractor ..... !. Addres~, ............ Phone No ......... Locate clearly and distinctly all property lines. Give street and block interior or c'orner lot. PLOT DIAGRAM buildings, whether existing or proposed, and, indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEV~OR,~ COUNTY OF~,.~fi~,.~.O.tr/~.,,~x. · ~'~ ...... ~.¢.r'..a,.r'.O( .... ~. ~} ~,~..*'/tO ~r .......... being duly sworn, deposes and says that he is the applicant (Name of individual sign:ing contract) above named. He is the .. O. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duty authorize, d 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 thc work will be .performed in the manner set forth in the application filed therewith. Sworn to before me this ELIZASETH ANN NEVILLE NOTARY PUBLIC, State of New York No, §2,8125850 Sufto k Couaty.,,. Term Egp res March 30, t~ · County . ~~ .. · .... ...... ," '