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HomeMy WebLinkAbout10157-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...~.10A94 ........ Date ...... ~l&y. ~ ................... ,19. B.1 THIS CERTIFIES that the building ................................................ Location of Property ~t~s~'do?76''' t 02'5' H~a~ha's · ~ i ..... Sou'~hoid','' fl ~ ~'"~ie~ County Tax Map No. 1000 Section . 07B ........ Block ... 0~ ......... Lot ... 0~3 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pe~it heretofore filed in this office dated ...Apv~Z .9 .......... ,19.79pursuant to w~ch B~ding Pe~it No ....... ~ 0.1.57. Z ....... dated .... a p ~tZ .9 ................ 19.79, was issued, and conforms to a~ o f tho requirements of the applicable provisions of the law. The occupancy for w~ch this certificate is issued is ......... The certificate is issued to .... .T. homa~ .l ,..~agg~.~g · .. .......... . ...................... of the aforesaid building. Suffolk County Department of Health Approval ..... ~dR ................................. UNDERWRITERS CERTIFICATE NO .... Pend~.ng .................................... Rev. 1/81 Building Inspector Forum NO. 2 TOWN OF SOUTHOLD BUILDING D£PARTMENT 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? 10157 Z Permission is hereby granted to: ..... ....:~ .Z~...~ .................... ~. .................................. ; ....... ~ ....................... ; .................. pursuant to application doted .............. .~'...-m..~ .......................... , 19..7..~, 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 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- 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 .,~..~. I .~....~.~). J.?.~.~ .... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .......................... House No, Street Hamlet Owner or Owners of Property :~../.~..~, .~. }~...~....~.%t'O.~.,~.~...~..7'~.~...~..~'~. ~,~.'..7',~. ....... County Tax Map No. 1000 Section ............... Block ............... lot .......... ~ ...... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No/~.X/~.~.ZDate of Permit .~.'."~.~.~.~..Applicant....'~.~ .~.'.~...~..~.. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ........ i'/ .......... Request for Temporary Certificate ..................... Final Certificate ........................ Fee Submitted $ ..................... Construction on above described building and permit meets a~ appJicable codes and regulations. Rev. 10-10-78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 Thomas A. ~aggart P. 0. Box ~49 Southold, New York Dear Sir: This is to notify you that Building Permit No. issued April 9, 1979 to same will expire on 10157z If more time is required to complete the Certificate of Occupancy, you may apply, six (6) month extension. job and obtain a ~y letter, for a If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, GEORGE H. FISHER Sr. Building Inspector 8? TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 1197! TEL. 765-1802 November 5, 4980 Thomas A. Taggart P. 0. Box 249 .. Southold, New York 11971 Re: B.P.#10157Z Dear Mr. Taggart: The above permit was issued to you April 9, 1979. This permit has expired~as of October 9, 1979, unless you write to this office for an extension of six (6) months. If the work has been completed con.tact this offi.ce for a fina. l.inspection in order that m.ay issue a Certificate of Occupancy' and finalize the job. Ve~ t~l~ yours, ~ ~ ~ GEORGE. H. FISH~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application o .... ~,· / ....... ,isapproveda/c..._. .... ............ ...... ........... , ......................... APPLICATION FOR BUILDING PERMIT Date .~P~.~,I. 9 .......... ,19.7.9 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 g~ving 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 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 admit authorizedinspectorsonpremisesandinbuildingsfornecessa~,.,t~ j y~~v~-~- · . .~-~-~-~. ~v, ..... ~. ....~'"' · 3-",,,~,~~'¢:'~ ' ' -- i --. .... (Signature of applicant, or ~'ffn/~, ~f a corporation) · .v:.o.:~. ?.x. ??. ?.,..s..~.e.h.o.~.¢,. ~.z. .............. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder~, Name of owner of premises . .~"..[1~.. ~ e~,~. A.:..'~.~..Clv~ .°OC.' .~ ..... ~..-- .~7..~k..O~..' .~.~ .~'.~.c&.~..~ .... ,~ (ahr~h the tax roll or latest deed) % ~--~ '~ If applicant is a corporation, signature of duly authorized officer. { (Name and t~tle of corporate officer) Builder's License No ...................... Plumber's License No ......................... Electrician's License No ..................... Other Trade's License No ..................... 1. Location of land on which proposed workwillbe done..~,-.~.~.Oa~.~.x~...~. ~ ................ ........ .......... ............. House Number Street Hamlet County Tax Map No. 10(J0 Section ...c?~..,~..~. ......... Block . .Cfi. ~ ............ Lot...~.~ .~. .......... Subdivision .................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 10. 11. 13. 14. property lines. Give street and blockl number Nature of work (check which applicable). New Bmld~ng .......... Ad&tlon .......... Alte~at~°~t~: ' 't, ...... Repair .............. Removal .............. Demolition .............. Other Work...~.~.~.[ ...... .~..~.O~.. ~5/4_ ~. (?escription) Estimated Cost ............................... Fee .: ~ ................................. (to be paid on filing this application) If~dwetling, nu.mber o f dwelling iunits ............... Number of dwelling units on each floor ................ If garage, nhmber of cars ........................................................................ If business, commercial or mixeg occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of. Stories ............... · ....: .................................... Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i ',' Height ....... : .............. Number of Stones ...................... Dimensions of entire new construction: Front... ~ .~. .... 7: Rear ...~...~. ........ Depth ..~fJ¢..~. lteight ...~ .~-3 .~... Number of Stories ........................... : ......... '..."2 ................ Size of lot: Front .......... : ........... Rear ...................... Depth ...................... ])ate of Purchase .......... [ .................. Name of Former Owner ...' ................. . .....' ..... Zone or use district in which pr~mises are situated..~-~o .~/¢~ t, .~. ......... ; ........ , ....... ""*' '~" .... Does proposed%ofii-t~tfction rio!ate any zoning law, ordinance or regulation: . t~'t~ ................... .~, Will lot be regraded .. · '~'~.~i ...................... ~-~ Will excess fill be removed from premises: 'Yes Name of Owner of premises. :?~.~/~¢.~2_~ Address ................... Phone No .......... ~ ..... , Name of Architect ..... .~ ?~,~'... Address ..... , ............. Phone No ......... ~..' ..... Name of Contractor .... ¢¢ffT.~.~,/rj~./..: ..... Address .................... Phone No ................ PLOT DIAGRAM Locate ~ clearly and distinctly al! buildings, whether existing or proposed, an& indicate all set-back dimension~ from or description according to deed, and show ~treet names and indicate whether int~or or&orner lot. STATE OF NEW. yORK, , . ' S S ...... , ..... ~;,.>(..4~ .~ ', ,, .... . -.~'?~%..~: ....; bern: dulv sworn, deposes and says that he is the applicant ' ' ' ' (Con~actorragent, cOrporate officer, etc.) of said owner or owners, ~d is dqly auChorized to perform or have perfomed the said work and to m~e and file th~s application; that all statements con~ned ~ this application are true to the best of his ~owledge and belief; ~d that the. work wffl be perfomed in the m~n'er set forth in the application filed therewith. Sworn to before me this 19 Nota~ Pu~c, .~'. ~.../ ..... j. ~g[ .... FI/ ........... County FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 ,19 './72 .... ............... Application No./(..~/~ .:.. Examined Disapproved a/c ........ ...................................... (Building Inspector) " APPLICATION' FOR BUILDING PERMIT Date&l~..l.l, .9 .......... ,19 .?.9 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 tot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property m~st 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 avalhble for inspection throughout the work. e. No building shall be occupied or used in whole or in part for'any;purposo whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depa~tm~ e'Rt for the issuance of a Building Permit pu~suarlt to the Building Zone Ordmance of the Town of Southold, Suffolk Coun~,, New York, and other applicable Laws, Ordmances or Regulations, for the construction of buildings, additions or alterations, or'. for removal or demolition, as herein d'e§cribCd. ' The applicant agrees to comply with all applicable laws, ordinanc, e~, building code, housing code, and regulations, and to admit authorized inspec{ors on premises and in buildings for necess~ary inspections. ·. ,~.~j~j~,~,,~.:~. ~ : ·..~.~-,.7~,~/~r~_:? .......... ./: :~S[g~ ~a[ur~of apt~t~caht,'~r tariff a ciSrporatlon) 2¢9,, ~ (Mailing address of apphcant) : State whett~er applicant is owner, lessee, agent, architect, engineer~ general contractor, electrician, plumber or builder· ..................................... c -- ...... i ................... Nameofownerqfpremises''~'~'~'~ ..'rTvL'~<;~','g'c' .A...~TQer,~t~f~..:...~7,L..~.,.~.,,...,.~;,c',~. ~.~.~ ~" '~' '~'" '~ (hs.~,~tiS~ t~.x rot! or latest deed) ' .~ ~,~ If applicant is a co~oration, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No .... , .................. 1. Locati0n of land on which proposed work will be done. ''[''~.[~:)F~-,'~[~'i~'~i''~'~ ................ House Number ~ ~, County Tax Map No. 1000 Section . .~..~. 0~. ......... Block ... ,~: .~'. ........... ,Lot....~).-.~.~.3~. ....... X'' Subdivision .................................... Filed Map Nb ............... Lot ............... 2. State existing use and occupancy of premises and intended u~e and occupancy of proposed construction. a. Existing use and occupancy '~ b. Intended use and occupancy .......... ~ ......... ~ ............................................... f 3. Nature. of work (check which applicable):, New Building .......... . . Addition .......... Alterati~l~.,2~ ...... Repmr .............. Removal .............. Demollt~on .............. Other Work.. ~-tq{~,.:t~ ...... 4. Estimated Cost ............................... Fe ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling[ units ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure With alterations or addltmns: Front ................. Rear .................. Depth ................... '... Height ...................... Number of Stories ........ 8. Dimensions of emtire new construction: Front · . .~),t~ ......... Rear . ~ .......... Depth . Height . . ./~..~2. ~.... Number of Stones ....................................................... Size of lot: Front ...................... Rear ...................... Depth ...................... Date of Purchase .......... ! ................... Nam~ of Fo, rlner Owner ............ i ................ Zone or use district in which p~emises are situated..~ .~/-a.~. ~. ...................................... Does proposed construction violate any zoning law, ordinance or regulation: . Will lot be regraded ...,a~?.. I..~,~ .,,, .,,-~ .~ ..,~---r ..... Will excess fill be removed from premises: Yes Name of Architect .... . .~..~--ft::::~ ./.... Address ................... Phone No ................ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, 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 homer lot. \ STATE OF N~OI~j o . ' ..~~~~ ......... being duly sworn, deposes and says that he is the applicant , (Name of individual ~ co~ract) above named. He is the ' (Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is d~ly author~ed to perform or have perfomed the said work and to m~e and file t~s applicaOon; that ~1 statements contained work will be performed in the m~n~r set ~h ~ the application filed therewith. Sworn to before ¢~is ' / ........ , .... _f ........ , ~otary · .....