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HomeMy WebLinkAbout10450-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z9729 Date 0otober 25 19 79 · . with this chimney addition THIS CERTIFIES th~lLt~ b)~ldmg .. ~. ............................................ o>~u uregon ~oad & Location of Property ....9..99.~. ?..ly.Et. hfl...Lg.n..e. ........._...: ............. .C. utoh.ogue0. N.Y. Mouse tvo. b'treer Hamlet County Tax Map No. 1000 Section ...~.~. ....... Block ..... ~. ......... Lot ....... 7 ......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .O.ctober 16 19.7.9. pursuant to which Building Permit No. lO~Og. dated . .°.e.~. 9.~.e.r..2.~ ............... 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 ......... ............... p. r.&v.a.~..e..O.n.e...~..~.~..~y...r~..~.~.~.~.n, g ................................. The certificate is issued to ........E.uJ[e.n..e. ~ .urg.a.n..&...c..a~.~..1.1.e..y... ~u. rg.a~.. ............ (owner, lessee or tenant) of the aforesaid building· Suffolk County Department of Health Approval .................... .I)1[.I:[, .................. UNDERWRITERS CERTIFICATE NO ............................ .1}I/.R. .................. Building Inspector Rev 4/79 TOWN OF ~UTHOLD BUILDING D~.PAKTMENT 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. 1045O Z Permission is hereby grOn'md to: ........... ..................... ............... /..~.Z..~. ......... ~~......~... ~ ...... ~.D..~. ............ .4.. ....... ~.~..~.~.(~.~..-,:. ............. ~.L~....~:.Y. .......... ~ .................. .............. ~ ..... o ~.~. .......... ./..~.!,~. !.L..:/.: ............... ..D....U....~..~..L.../..~.~ ............. ~ ~._,.,~,,~,. ........... ~.~.~....o.. ....... ~:~.c.~../. ....... .,..m..~..~.~ .......... ~ ...................... ........................................................ , 19 ., and approved by the Building Inspector. I~ll~ir~i Inspector FORM NO. 6 TOWN OF $OUTHOLD 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. F~nal 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 ~nstallation 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 Aprd 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 $I.00 $5.00 New,Bu:!J:;;~ .......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ./, .~.¢...~. .............. .O~.~.~.~..J./'?. ./~.~.: ............... House No. Street Ham/et Owner or Owners of Property .~.../¢...~ ,/.¢'.~.~.~. '...~':.-~.. '~G.~../~Q .~.'~..-~..-~.¢-~: .~'(..~. ~. ~ .' ........... County Tax Map No. 1000 Section .... ~ ''~ Block ~ Lot Subdivision ................................. Map No ............... Lot No ............... Permit No. ] ~,/~..~. ¢~- Date of Permit I.~.-~/¢..- .7.. ~,Applicant d'~. .¢'.~. ,~. ~ .... 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 p~t meets all applicable codes and regulations. ~ppdcant..~, .T~: ...........~'. T.~ ..................... ,._,o.,. / BUILDING DEPARTMENT {~----~ ~)~'~--~ TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ........... '. .... ,19... Approved ................. 19... Permit No.., ...... ':.. Disapproved a/c ..................................... (Building Inspector)' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No../.' ............... a. Tins 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 Occupanc y~ 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~l admit authorized inspectors on premises and in buildings for necessary inspections. (Signatur4,6f applicant, or n~6ne, if a corporation) ~te././:,. ~,~ ./.c.,..'~.a..c ,.,'"r~_ ~.~ ~. ,,.,,xt.~ .x-: ........ ' (Mailing addreSS'of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... .47..q~. ~. :4 ............................................................... Name of owner of premises .... ~..-'.O..c¥~.~(... ]3. q.~..~ Q?. ............................................... ~/(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 ..... /?..~ ................ Plumber's License No ...... .t~.. ~. .............. Electrician's License No .... .~..~. ............... Other Trade's License No .... ./??. .............. 1. Location of land on which proposed work will be done.. ~...d.~..-(..~... ?. ~ .c?...O. ?..../7].0..~.~ .~ ................ .... !..6,..?..~ ...... : .e'..,x. r.,8 ?.~..R'.¢ ..................... c?.?. c.~,, ,,.1t ~ .-r., .................... House Number Street Hamll~t County Tax Map No. 1000 Section ...... ~.C. ....... Block ..... ~. ........... Lot... :.~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~sting use and occupancy ..... ~..~. F.~ .t.of. ~.~ .c.~ ................................................ b. Intended use and occupancy .... .~.c. ~ ./..~. f.~...{'..~- ................................................. i 3. Nature ofwork (check which appllcable): New Building .i-'7--. ..... Addition ...Z ...:.. Alteratlon ~-'7. ..... Repair --'""-'" Removal , Demolition .... ":-. .... ~ .... Other Work .f2 ~t.l.~ ,~'.~. (Description) 4. Estimated Cost .......... .~. i. jO. ...................... Fee ....... ~ ........................ ~ (to be paid on filing this application) 5. If dwelling, number of dwelling hnits...O. './'q .~. ...... Number of dwelling units on each floor...O..~..&-. ........ Il' garage, number of cars ..... 77..o~..O. ............................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .... .~?. t~. 7. Dwnensmns of existing structure~, ff any Front... & ~' ......... Rear .,g~r.t. ........ Depth .~. ~ Height ...... /( .e/,gdr:.... Num:ber of Stories .... ~/~...t .............................................. Dimensions of same structure wtth alterations or addmons Front .. ~J~/',~ ~ ....... Rear . ./¢,,4,..~ ......... Depth .. .... ~.. ~ ........... ~.. Height ...... M/~. ............ Number of Stories ... t~,~'A ............... 8. Dimensions of~i}tire new construction: Front .... ./g'...'&.. ...... Rear ..... .¢~/. ('3; ....Depth './:k/.~ .......... Height ...... r.v. ~ ..... Num:ber of Stories ....... ~../'7-.: ............................................ Size of lot: Front .... /..~....: ........... Rear ..... ,t.5-(2. ............ Dept ...................... Date of Purchase ·/. q. 9..3 ................. Name of Fgrmer Own~er . ,f~q .q'?.~. ~'~.~o~z-~/,~, ......... Zone or use district in which prdmises are situated... ~.e.3 .~. 0,(x a,~././A~.( ............................ Does proposed construction violate any zoning law, ordinance or regulation: ..../,V..O. ...................... Will lot be regraded ......... tS~ 9 .....~, .......... Will excess fill,be removed from premises: _ . Yes Name of Owner of premises . }~-t~ 0.~'~..l'.,5.u.r~.t/~.., Address ~.~/. ,Z'.~ ?~}.(.~,Tc/c~,~,°.%, Phone No..~t: .~(4rT?. ..... Name of Architect .. ] .... ." . . Address .............. .".... Phone No ................ Name of Contractor ......... ~ ................. Address ................... Phone No ................ Locate clearly and all! buildings, whether existing or proposed, and, indicate al/set-back dimensions from ~tion according to deed, and show street names and indicate whether 10. 11. 12. 13. 14. property lines. Give street a interior or corner lot. STATE OF NEW YORK, i S.S COUNTY OF .................. , t ......... ' ......... ' .......... i .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigt~ing contract) above named. : He is the ..................... i ................................................................... (Contractor, agent, corporate officer, etc.) of said owher or owners, and is duly authorized to perform or have performed the said work and to make and file this application l that all statements cont¢ined in this application are true 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 ........................ day of ...................... 19...