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HomeMy WebLinkAbout10429-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ...... 7:'77.'1.0. ...... Date ....09.~.O.l?gT. fi.~ ................. ;19..7.9 THIS CERTIFIES tha~ the building ................................................ Location of Property ...5. ? .5...~...r'.~.s...P.Y.~.q e. .............................. .P.e.e.O~.C... House No. Street Hem/et County Tax Map No. I000 Section 67 ...Block 0/* .Lot 018 Subdivision..P.e.c.o.n..J.?..~..o,r'.e.~.. 7..~.e.c. ~;..2..Filed Map No. .~.~?.....Lot No .... .1.0.~. ...... conforms substantially to the Application for Building Permit heretofore fded in this office dated .... .07.~.o.~. ?.~..~ ......,19..7.~pursuant to which Building Permit No ....... .q.Q~29~ ........ dated 0c2ober' /~ 1979 , was issued, and conforms to aH of the requirements of the applicable provisions of the law~ The occupancy for which this certificate is issued is ......... ............ .o.n.?, .~?~.~. ¥., .~..e.~.~.~.n. ~..~.~.~. ~)..c.~.~.o~., .&~.~..~.o.n. .................. The certificate is issued to . ...L.u.o.~..3_.a..L.:. ~.u.2.~..~9. .................................... (owner,/~~C of the aforesaid building. Suffolk C~unty Department of Health Approval ............. ~ ./.~ .......................... UNDERWRITERS CERTIFICATE NO ..................... ~..~ .......................... Building Inspector Rev 4/79 I~ORM NO. 2 TOWN OF $OUTHOLD 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) No. 10~29 Z Permission is hereby granted tol ~/ ..... ...~.:....:.~, ..... ~ ......................... · at premises Iocate~t ~.~ ........... ~...~,~.-~..-~,~2'--~~ pursuant ,to application dated ...~~...~. ................. , ]9~ and approved by the Building Inspector. 6(_/"' ' ' ~Building Inspector FEB 2 6 1987 February 24, 1987 Southold Town Building Department Southold Town Hall Main Road Southold, New York 11971 Dear Building Department: Enclosed please find Application for Certificate of Occupancy along with MJH check in the amount of $5.00. Please forward a c6py or-this C.O. to our office at your earliest convenience. Our files indicate that it should be under #Z3494. Sincerley, MICHAEL J. HALL by, Beth Lademarm :bi FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 2. _Ce~rt!ficaz~ef-~ccupanc;,-e[Lpr. ec~xisting dwelling or land use ~. ~opy of certlhcate of occupancy --'~ $'~ - A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec, tot 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 certdicate 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, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informao lion required to prepare .a certificate. Fees: 1. Certificate of occupancy $§.00 Date .,FebrD~y 24, 1987 New Building ............. Old or Pre-existing Building(Z). _. Y~. ~ ~/Vacant Land ............. Burtis Lane Peconic Location of Property , .. .... Strew Hamlet Hou~ No. Joan Leavitt and Dolores ~arberi Owner Owners of Property .............. or 067 00 ,04 00 018 000 County Tax Map No 1000 Section ' Block ' Lot ' Subdiwsion ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ...................... Underwriters Approval ........................ Planning Board Approval .................. ~.. ~ Request for Temporary Certificate Final Certificate - Fee Submi~te'd $ [-,~,, ,5, :0.0. ..................... Construction on above described building and permit'meets all app~cable~co.das and regulations. Applicant .; Michael J. ,Hall~ ~ _ Rev. 10-10-78 Existing Certificate of Occuancy. ?~349~. ' 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 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- 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 ........... New Building ............. Old or Pre-existing Building ............. Vacant Land ............. Locat,on of Property ...... Z ..... ,...~.-~ .~.~. ....... ¢..~.: .................... Owner or Owners of pHrOoU~r tN;,..~..~: . .~..~ ..................... County Tax M_ap No. 1000 Sect)pn ... ~ .......... Block , .~.-.J...f.. ..... Lot.../. ,O. ~. ........ Subdivision ,~,~ .~. · ,~, ',~,",, . F lied Map No.~.~,~, ..... Lot No.. ]~, .~ ...... Permit NO /¢-~.~.~ '~---Date of Permit Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .., . .~/~... .............. Fee Submitted $, .. ~'~ ('/, ?. ................... Con struction on above described building an~)~ r~rn~itF~e, ts all ~/~li~ c~d~s~? ~e~gu lations. Applicant, ~.. ~., Y.t~.~Y ................ / ' APPROVED AS 765-1~09 9 AM TO 4' PM FOR TH FOLt.OWING INSPECTIONS: 1, FOUNDATION - TWO REQUI~ED FOR POUR~D CONCRETE ~. ROUGH - FRAMING & PLUMBING BE r~'~'qm F~-F ;q~ C O. I ALL C~c'~RliCTloHI SHALL MEET T~E RFn~r~A~C.S CF THE N.Y, ~A~ COblc~RUCTION & ENERGY ~ESIGN OR CONSTRUCTION ERRORS. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..4 ...... ,1977 ^ppli0ation No. ...... ^pproved© ..'-Z ..... , ,mee=, Disapproved a/c 2" 7.~.....~ ........................ APPLICATION FOR BUILDING PERMIT Date. ~..~ ......... , 19 ~ INSTRUCTIONS a. Th~s 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 constructmn 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) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises '),'~.U. ~ I..~.~.0. ,.. !,1..~. &. !.4.51 ..................................................... (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. ~..~.. t .~. ....... Plumber s License No ...................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done... ~3a~e.k. o£..0.~/~qe~.~.~. ~I.o.~ e ...................... ......... 515 .................... B. urt,.i$. Place ........... ~eo.anic,..iqe~. X. oz'k ............... House Number Street Hamlet County Tax Map No. 1000 Section ...O.K7 ........ Block ....~. ~ .......... Lot .~..~.~..~..--./..~.-.~,..~.o. Subdivision...l?.e.q .o.nJ_.q .S...h9.~.~ ,..~.ee.~..i.o.r~. ?.w.q.. Filed Map No..6~5./4:. .......... Lot . ~.0.14 .......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy..~-.n.u.s.~d., .ep.q 1. 9~?.d.. ~.~y.cl.~.n. ...... ~ .~... b. Intended use and occupancy .... C. ar~.po¥~: ......................................................... 3. Nature of work (check which apolicable): New Building .......... Addition ,. oX ...... Alteration .......... Repair. RemoVal Demolition Other Work (Description) 4 Estimated Cost ....... ~ Fee ..................... , (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... 1. ......... Number of dwelling units on each floor .... .1.., ......... If garage number of cars ' 6.' It' business, commercial or mixed occupancy, specify nature and extent of each type. of use ............. ~ ...... 7. Dimensions of cresting structure~, if any: Front ..... .~..~. ...... Rear ... ~. ....... Depth....~..~ ......... Height ..... ~.~. ....... Number of Stories ............................................. ~ ........ Dimensions of same structure width alterations or additions: Front .... ~ ........... Rear .. ~.. ........ ~ 7. Depth .................. He ................... umber of oriesL .................... 8. Dimensions of entire new construction: Front .... ~. 6.~. ...... Rear .... ~. ~.'~. .......Depth .]. ~-'. Height .... ~ ......... Number of Stories ..... ~. .................................................. 9. Size of~lot: Front ._..]4.5. F.~; . .j ........... Rear ... ]45 .F/; ............. Depth .~0...?/4.F~c ........... 10. Date o f Purchase ~.~.~.~gX~.~...1. ~ 5.5. ......... Nature of Former Owner .... xzc ...................... 1 I. Zone or use district in which pr~mises are situated ...... [~..: ........................................ 12. Does proposed construction violate any zoning law, ordinance or regulaUon: . ~ ....................... ...:~ 13. Will lot be regraded ..... ~ ................ Will excess fill be removed from premises: Yes 14. Name Of Owner of premises .L. ffe2.].~. ~.o..l¥1ul;1A. oAddress . B.ox. ~Z2 ......... Phone No..76.~,..~7~ ..... Name of Architect ........... i ....... Address :~: ~.: ~. Phone No ............... Name of Contractor...~. ~.'. i~ Address Phone No. ~..~...':..~..~ .~ 7 PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and. indicate all set-back dimensions from property lifies. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. ~ ~) ' I STATE OF NEW ~IDRK. -- i'- - ........ ~.~4~.c~4'7~..~.~...~........'M..~A-~.. ~. being duly sworn, deposes and says that he is the applicant : (Name ofindividuai sig~ing contract) above named. I He is the (Contractor, agent, corporate officer, etc.) of said owner or owne~ ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file this apphcation; that ~1 statements cent,tuned m th~s application are tree to the best of his ~owledge and belief; and that work will be perfomed in the m~nOr set forth in the application filed therewith. Sworn to before me this .. .......... .,,~.,.~ ..... day . /: Nota,a~u>~ic, ..... ...~ .~ .... ounW '":' ....................