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HomeMy WebLinkAbout10407-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ...... Z99.0.6 ...... Date ..... .M.a..r.oh .2..6 .................. 19 B. 0 THIS CERTIFIES that the building ................................................ Location of Property ~s'e 'IV'o. Street Hamlet County Tax Map No. 1000 Section ...!35 ...... Block ...0.~.. ......... Lot ...... .OhO ....... Subdivision ............................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~,e. lT~9~l,b, elT. ,'1,/4:. ,, 19 79, pursuant to whtch Building P~rmit No ..... ,1.0,/407Z .......... dated .... $.~'l;~]a.e. z7..'1 {~. ......... 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 ......... ........... A~.¢.er..roof....~.ct..t.z~.a.~.~,. v.e.n.~. ~.cl..e. lsyk~h'~e ...................... The certificate is issued to ........... l~L~,c~eql..V. (owner, ~'-;'t~TGi~ ..................... of the aforesmd building. Suffolk County Department of Health Approval ........ .N/.I~. .............................. UNDERWRITERS CERTIFICATE NO ............. ~..~6..2.9.6.~. .................. Building Inspector Rev 4/79 TOWN O~ $OOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 10407 Z Dcte~-~/~-...../..~-~. ........ Permission is hereby granted to:2/ .~, .'~./../~....~z...,C~.. ...... ....... ....................................................................~ ~~ ~ } .................................... .~ ................. ~....~ ....................... ............. ~.~'~. ...... ~~..~.~ ....................... Building Inspector. 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 thc Building Inspec- tor with the following; for new buddings or new use: 1, Final survey of property w~th 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. 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 featu res. 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: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-ex~sting dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building ............. Old or Pre-existing Building J Vacant Land Location of Property . .I.~..~..~ .... ~'~ ~ L" '~ ................. House No. , ~ Hamlet Owner or Owners of Property . ~, .~.,..~ .................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Fded Map No ........... Lot No .............. Permit No. J.~.~..b'.7...~-.. Date of Permit ~ .~./l?j.~.~ .Applicant .~. {~'.; ~.~ Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval .. ?..~..el. ~. ~ ........... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $...~..'.~.. ..................... Construction on above described building and permit meets all applicable codes and regulation~s~ Applicant . ~ J~.,. ~ ........... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examin . ./. ..... ,19 ^pp,.ov Disapproved a/c .. J. :'~:-5..~ ............ ~ ...... ff.. ...... ...... ....... (B~ilding Inspector) APPLI~ATIOH FOR BDIkDI~G PERMIT INSTRUCTIONS ,,, ~, a. This application must be completely filled in by typewriter or in ink and submitted in triplicate, ~ the Building~ Inspector, with 3 sets of plans, accurate plol~ plan to scale. Fee according to schedule. ~ ~1: b Plot lan showing location of lot and of buildings on premises, relationship to adjoining premises ok;public streets~ · p . . . . . ~ . . ~,~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is pa~ of this apph~ cation. ~ c. The work covered by this application may not be commenced before issuance of Building Permit. t ,x' ,~ d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applichn~, Such permit shall be kept on the premises available for inspection throughout the work. ~3 ' e. No building shall be occupied or used in whole or in part for any purpose whatever un3dl a Certificafe d~f Occupancy shall have been granted by the Building Inspector. '~' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit p~rsuant to the Building Zdne Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, O.xrdinances el Re lations for the construction of buildings, additiot~s or alterations, or for removal or demolition as herei~described. The applicant agrees to comply with all applicable laws, ordinances, bulldlng code, housing code, and regulat~xns, and tc admit authorized inspectors on premises and in buildings for necessary insp?ctions. ~\ [ (Signature of applicant, or name, if a corporation9 Mill Creek Drive~ 8outhold~ N.Y,, 11971 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Agent Nmne of owner of premises Mildred V, Sohwiebevt (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No..~.~7.)°~ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ..................... 1. Location of land on which p reposed work will be done. }.0.7.5. ~l.i.l.1, ?.~?.k. py~.v?.~..~.o.u.~.h.o .1.d !. ~: Y.: ........... House Number Street Hamlet County Tax Map No. 1000 Section 135 Block O} Lot..0..b~. .............. Subdivision ................................ Filed Map No ............... Lot ............... State existing use and occupancy of premises an~4~ntended use a~ proposed const~c~$~: a. Existing use and occupancy .......................... ~Y ................................... Residential b. Intended use and occupancy ................................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration , g, ....... Repair .............. RemoVal .............. Demolltlon (Description) 4 Estimated Cost ~1~100 Fee /..~...-~? ..................... (to be paid on filing this application) 5 If dwelling, number of dwelling t)nits 1 Number of dwelling units on each floor If garage, mmaber of cars ........................................................................ 6. If business, commercial or mixed, occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front...0.~.o.5. ........Rear ....8.2.o~. ...... Depth .. 2.8 ........... Height ............... Number of Stories ...1.~ ................................................... Dimensions of same structure with alterations or additions: Front . .u.n.c..ha.n.g.e.cl...Rear Depth ...................... Hei~at ...................... Number of Stories ...................... 8, Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Number of Stories ....................................................... Size of lot: Front ....1.2.0.~. .............. Rear, .1.9.2.~ ................. Depth ...1.6.0.I ............... Date of Purchase ....... J..u.n.~...1.9.7.7.. ............. Name of Former Owner . .H.i.]..d?...g.u.l.d ................ .... ' · · Zone or use dastrlct an which premases are situated ................................................... Does proposed construction violate any zoning law, ordinance or regulation: . .No. ......................... Will lot be regraded ......... ' ................... Will excess fill be removed from premises: Yes No Name of Owner of premisesM. ,.V. ~.~qh.w.:l:.gb.~.e.%..' . . .... Addres~i.!.l..0.rp.e.k.D.a'.,..gp.u.%.hpllt~lone No....67~..1.~p2 ..... Name' of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor ......... ~ .... Address .S.o.u.%.h.o.l.d.,..~.o.~.o ..... Phone No ............. 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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 corner lot. STATE OF NEW YORK, ,S.S COUNTY OF. SY, IP.I~OLK ....... . ................... ~'.cJ~qtq .~..'fi:. ~.'.~...~°./'~;~..~& .T~... being duly sworn, deposes and says that he is the applicant (Name of individual signling contract) above named. ~ He is lhe ...................... ' ................................................................... , (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 filed therewith. Sworn to before me this · .14tk ..... day of.,. Saptemhel~,. · 19.7.9 ................ , (Signature of applicant) mO: o n3' Z~5 ~ C, ~ rn Z ©