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HomeMy WebLinkAbout10425-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office 5outhold, N.Y. Certi ticate O[ Occupancy No ........ Z10056.. Date ............. Jllly. 30. ........... 19.80 THIS CERTIFIES that the building ................................................ Locatmn of Property ..... ~0. B~y. RO~d Hamlet House No. ' ......... 'S't/e~[ ......Greor~Dol~.t.~..I~,Y., ..... County Tax Map No. 1000 Section . .0~. ...... Block .... 02. ........ Lot . . . 0JJ..-.. 0.~.~. · · S~t§division ............................ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. B. eDJ;elllbe~'. 2-~ .... ,19.79pursuant to which Building Permit No... ¢{)./42~Z ............ dated ..... OoJ;oher. 2 ............. 19 .~.~1, was issued, and conforms to al/of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ................. One Eemily..Dw.elling .wi.th ,at~ached..Gal-age ............... The certificate is issued to ............... ]~.eol/t. ]~1/~1{0 ................................ (owner. I~ of the aforesaid building. Suffolk County Department of Health Approval ............... 151/R ........................ UNDERWRITERS CERTIFICATE NO .......... ~,1'1(:].:1.1"1~; .............../~/......~ .0..~7.( ..~/ Building Inspector Rev 4~79 FO]~FI NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10425 Z . ~..~.5.:,2~....:~~ ........... : ....... ~. . ~o....~,:.~. >, .:....~,~.....~,~.~....~......,.~,,;:~.~.~ ~....~...-~,~~........:~ ......... ::...,: ............................................... ..? o, p rem ,~s , oco,ed ot : _z~z ~:-. . . . . . ~. ,:::~z ;. . . . . ~ .~. . . ;. . :.~. .. ~.~ ...... ~/~ ~ ~ ........ ~ .......... ~: ............. Building Inspector. Foe $.../.~,.. ............. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall SouthoSd, N.Y. 11971 ~,TION FOR CERTIFICATE OF OCCUPANCY Instructions in typewriter OR ink, and submitted in duplicate to the Building Inspec- ' buildings or new use: th accurate location of all buildings, property lines, streets, and unusual res. :~t. of water supply and sewerage dtsposal-(S-9 form or equal). ation from Board of Fire Underwriters. strial buildings, Multiple Residences and similar buildings and installa- compliance from the Architect 'or Engineer responsible for the building. oval of completed site plan requirements where applicable. to Apri~ 1957), Non-conforming uses, or buildings and "pre-existing" i ~ y showing all property lines, streets, buildings and unusual natural or ~ ~© ~ E r previous owner as to use, occupancy and condition of buildings. ~ ~ ~ ~ F~~ ~rsafetyinspectionofbuildingsorpremises, orotherpertinentinforma-~rtificate. ~ pre-existing dwelling or land use $5.00 ,. .~ncy $1.00 7,/~..~.~..''/~'''' / · Date .. ,; ........ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........................... ~..~. ............... House No. ~'~.~. ~ ~_~/~ · Stree~.f~._~ ~ · ~ Hamlet Owner or Owners of Property .~ .... .~. .................................................. County Tax Map No. 1000 Sect,on ..~....c~.. ~. ..... Block . .~.'~.. ....... Lot~.~../.'~...~./. ~.... Subdwision ....... ~ ........................ Filed Map No ........... Lot No .............. Permit No., ~.O..~..~'.~...~Date of Permit .~'J~/.~..~'~pplicant.../~..: :.~.~.~ ........... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval'~.~¢~'. .................. Planning Board Approval~ .................. Request for Temp.~rary Certificate ..................... Final Certificate ....................... Fee Submitted $. ,,..~ .'. ....................... Construction on above described buitding and perFnij)~eets all applicable codes and regulations. 5 3, iNSULATION 4. FINAt- - coNSTRUCTION BE coMPLETE FOR C, O, ALL coNSTRUCTiON sHALL REQUtR'f:M~N~'S OF THE THE coNSTRUCTION & sTATE RESPONSIBLE FO~ CODES. O~NS.[RuCTiON DESIGN A' OR USE IS UNLAWFUl. WITHOUT CERTIFICATE OFQ~CUPANCY FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18013 Examined~'~.....~.. ..... ,19.~p A pproved~..~....~ .... ,19. er mit No. ~.~. Disapproved a/c .......................... ~. .......... " ....... ..... APPLICATION FOR BUILDING PERMIT Application No..~. · .~..~..~..~.'. ..... 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 pre~nises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown 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 ~n 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 here~n 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 inspeq~'on,s,,~, ....... ....... (Signature of applicar~/Sr r~e, if a corporation) ...... ~' ~¢~a,ddress o f applicant) ~/' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .......................... .............................................. Name of owner of premises... ~..~.~-~...-~. ..... /~....~..~...~.. ~. ......................................... (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 ............... Plumber's License No ........... ~ ..... ~ Electrician's License No .... ~?..../.(~7.. ~m. ~ ~"~ Location of land on which proposed work will be done. Ho4se Nu~er 'Str~( County ~a~ ~ ~o. ~000 S~tm . ~¢~ ......... ~o~ ...0.~ ......... rot ~F~. r. ~Y~... Subdivision ................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occdpancy of proposed construction: a. Existing use and occupancy ....... /:../~../~. f... ~ .~..~4/~.'~.~;,2.2.~..;. 54 ......................... b. Intended use and occupancy .... ~..~..f ~ ~.~.. ".~.~¥.~."~/~.~ .~.~.. ~r~.2f~..~..'TT.~.: ............. 3. Nature of work (check which applicable): New Building .......... Addition...~...... Alteration ........ ',. Repair ..............Removal ..............Demolition .............. Other Work ............... i. Fee (perception) 4. Estimat~dCost .... ~,/..O~...'~..~ ........................ .............................. (to be p~d on filing this application) 5. If dwelling, number of dweRing ~nits ............... Number of dwelling units on each floor ................ If garage, number of c~s ..... /..~ ~ ~.. f. ~.' ........................................... 6. If business, commercial or mixed~ occupancy, specify nature and extent of each type of use ............ ~ ........ 7. D~ensions of existing st~ctures, if any: Front ~ ........ Rear .... ~ ....... Depth ,. ~.'. ........ , .... /.V ....... ..... ............... .......... D~ensions of ~ame structure wifh alterations or ad~t[o~ .............. Rear .~.. ~ .......... Dep~ .... ~:~ ............ ~. HeiSt . ~~ ~.. ~mber of Stories ...................... 8. Dimensions of entire ne~ constmc~ f~..: ........ Rear .... ~ ..... Depth , ~.~ .......... He~t ... ~. ~~~ ........... ~ .......... ,k. ~.__ ~.~ ~ ....... 9. S~.ze of lot~.t. 9 ................ Depth /.~ .................. 10. Dat~f P~e ........... : .................. Name of Foyer Owner ............................. 11. Zone or use district in which premises are situated .................................................... 12. Does proposed construction viol~e ~y zoning law, ordinance or regulation: ............................... 13. Will lot be regraded ~... g~~.' ........ Will exc~s fill ~ removed frqm yremises: Yes No. 14, N~e df Owner of ~e~ises ............... N~e of ~chitect ........ f ............ N~e of Contractor ~~. ~: Address~.~.~ ..... PhoneNo.~~2 .. PLOT DIAGRAM Locate deady ~d disfincflg ~ ~build~gs, whe~er existing or proposed, and. indicate ~I set-back dimensions from prope~ l~es. Give street and block number or desc~ption according to~d~, and show streot nines and indicato whothor inte~or or cbrner lot. cous .... ............. ~~__.>/~~ ........ being duly sworn, deposes and says that he is the applicant (Na~e oT ~vidual s~tract) above named. He is the (Contractor,.agent, corporate officer, etc.) of said owner or owners, ~d is du~y authorized to perfom or have peffo~ed the said work and to m~e and file this application¢ that all statements confained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed ~ the m~n~r set forth in the application filed therewith. ........ , SOTh~Y PUgLIC, ~ate of New[Yotk ~ / (Signature pf applicant) ] ~ ~2.~125850, Suffolk Co~