Loading...
HomeMy WebLinkAbout10414-z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z10098 Date ....A.~.gl3..~.t;..2..2 .................. , 19 .~.0 THIS CERTIFIES that the building ................................................ Location of Property .......a~.O. 0. Maple Lmae Oreepl~.o~tL, .}I,~r., .... House/vo. ' .................. ~'r'e~ t' .................. Hamlet County Tax Map No. 1000 Section ....3.~.o.Ofi....Block .... ! .......... Lot ..... .1.~...H ....... Subdivision..qr.° .s.oe.n.~.. B. qh.: q.o.n.d.o.m.il3.i..u~..Filed Map No...6..~ ....Lot No.. IJll. t,t}. ' .. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... 8..0 .p.g.o.~.b..o?..1.T.., 19 .7.9. pursuant to which Building Permit No ..... ,'1.0.11! 4~ .......... dated .... .g.O.p. }.o.ra.b.o..~..~.0. ....... 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 ......... . .o.n.? .~..~..i.x.~...s.~ ~.o..n.~.x...w..~.x.~i..n~..~./..s.o~,. ~..n.~.d..p.~?.o.h...n.~.v.~.~,..~.o..~,. wi~h glass The certificate is issued to Oha/'les (}uhl & wf, . . ...... ?o¥.'~;,'~s'sW Jr't~'~'O .... of the aforesaid building. Suffolk County Department of Health Approval ........... N../~. ............................ UNDERWRITERS CERTIFICATE NO .................. 1~../~. ............................ Building Inspector Rev 4/79 FOKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTklORIZED) N9 lOg14 Z Pete .... ~>. ...... , Permission is hereby granted to: ~...~..~.~c¢ ......... ~.~. ?,~r ,a ..c~...~.....~~...,,~:~_L~d.~,,~.~' .......... ...... ......... ~~...~~,....~~_z ............................ ~ ....... ~ ............... 7 .................... : ....................................... ....... ~..z~: ............................ ........... pursuant to application dated~~ ......... ~.~. ........... , ]9.Z.~, and approved by the Building Inspector. 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 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 featu res. 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 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 ....V~... ...... Vacant Land ............. Loca~ of Property (~ ~ ~Ce~ ~ ~ House No. Street Hamlet Owner ~r Owners of Property .............. County Tax Map No. 1000 Section ~- ~J Block f Lot~ /~ ~ h~i,i,i ~-~ ~ ~iled Map No. ~.~ .... LotNo.~T../ 6 h] Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ................. Final Certificate . ~ ........... Fee Submitted $... Construction on above described building and permit meets all applicable.c,,gcles and regulations. Rev. 10-10-78 Al} DI"FIr_]/xJAL C d~ l,._A IV',, ~_. l,u'T'.~ ' '' FORM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ... TEL.: 765-180:3 Examined 19??.._ ............. Disapproved a/c ...................... ../~ .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No..~(Y. ~.g ~. ........ Date 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 th~s 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, build/j~g code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary ~c~ _ (Signature of applicant, or name, if a corporation) ·..4.5..~/l~r;k~e. Place.. ~e,~. ~arion .N ~Y.. .... (Mailing address of applicant) ~1939 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Ownsr ........................................................... Name of owner of premises ........ .~13~. 1.e.o.G.'4hl. &..~i~o .... (as on the tax roll or latest deed) If applicant is a corporation, s~gnature of duly authorized officer. (Name and title of corporate officer) Builder's License No... ~J. ~.~-~...~] ............... Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ..................... 1. Location of land on which proposed work will be done..I~.~.P. 1. 9..I(.c~..e.(.O.~e..s?.e.13.~...B?'.a. 9.h) .................. East ~arion N.Y. ll~ House Number Street Hamlet County Tax Map No. 1000 Section . ~.'~:~'.-. S. ! ........ Block / ~t~.~?. g.~. ~ Subdivision(~)p_c3.r:t,z,a;TT./~O;,~.~...(~ .~.t~.~.,~ !~.~Filed Map No...~..~. ........ Lint....~.¢ .... ?.~. · · (Name) 2. State existing use and occupancy of premises and intended use and occt/~ancy of proposed construction: a. Existing use and occupancy ...Sg.a. ~. 9.n.a.1., .s.wqm...e..r..b.~a. 9.h..qo. ~.d.O~ .n.~..~.. [ &12.1?~..~.~.. '¢ .o. ~OY.,..~ ~'¢ ) b. Intended use and occupancy . . .8..a~. 9.~..w.J:..~.h..a.d..d.ifq~qrl' .o~. ¢l~.e.k. ~rxck .aeraenod. &n. po~.ctla ....... 3. Nature of work (check which applicable): New Building .......... Addition... x ...... &Iteration .; .~ ....... Repair .............. Rembval .............. Demolition .............. Other'Work ............... (Description) 4. Estimated Cost ,. :~. ... .......................... Fee . ]9. ............................ (to be paid on filing this application) 5. If dwelling, number of dwelling~ units ...... ..~.: ...... Number of dwelling units on each floor ................ ' number of cars If garage, ............. . ............................................................ 6. If business, commercial or mixed occupancy, specify,, natgre and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front...~..t~ ......... Rear . ~,, ......... Depth ...~g~ ......... Dimensions of same structure With ~dditions: Front .. ,..,.. ~..9 ...... Rear ./.~ ..... .~.., ..... 8. Dimensions qi'gntire new constrUction: Front :,.. ~'.~. ......... Rear .../:~.'~ ....... Depth . .-(..~.'. ........ 10. Date of Purchase . 6/~0/.78.I ................... Name of Former Owner J~,la,~. P,o..Kave~rl~&t~ ........ 11. Zone or use district in which p~emises are situated ..... ,~1 .~ ............................................ 12/ Does proposed construction violate any zoning law, ordinance or regulation:.4~lmuf.:pi, eiolI1 13. Will lot be regraded ..... No. i .................... Will excess fill be removed from premises: ~es l~o 14. Name of Owner of premises . ~t:l~:~:t'to{~ .~uh.1.. .... Address '45' ~?..,~0':ine...P1 .... Phone No.. '4'77-0~ .... Name. of Architect .. t~on~ · · 1 .................. Addressy%£flar~Ola. lq.Y. · [Z9.3~hone No ................ Name~ of Contractor ...... it0~tlo ............... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. G~ve street and block number or description accor&ng to deed, and show street names and indicate whether interior or corner lot. 1 b ' 6 lme, n~ion STATE OF NEW Y~RK, S.S COUNTY OF...~..~... being duly sworn, deposes and says that he is the applicant above named. He is the ........... ~'L~ ................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dtfly 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 ~e performed in the mannbr set forth in the application filed therewith. , Sworn to before me this i ~ / .day of .... ,19 N~v~Pllblic, ...;..~ ..... ~:" <~i,' '~'2~c°unty ~ __ ~ . .