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HomeMy WebLinkAbout10175-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. THIS CERTIFIES that the building ................................................ County Tax Map No. 1000 Section .... 0~.0 ....Block ...... .'~ ......Lot ..... ~'f ......... Subdivision ...... ~ ............... Filed Map No .... X~t No... ~ ... coaforms substantially to the Application for Buildin~ Pemlit he~tofor~ ~d in this office dated .... Aprt:L .17 ........ 19 .'~ pursuant to which Buildin~ Permit No ...... .'JOl?.~ ......... dated .... Apx~l~...16 .............. 19. '7~ was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this cartificate is issued is ......... ............. 1~;ty.~e. O~e. F. autll¥. D~el//ng ................................... T~ ~f~**, is ~ued to .. ~o~,~ .v.. ~,~. ~;o__.~,:~ ........... ........... of the afote~id building. Suffolk County Department of Health Approval .. 9-30--~O ....... 8/~O/7~ ................ UNDERWRITERS. CERTIFICATE NO.../~?O99 ........................................ Building Inspector ~OP~I NO, ~ TOWN OF $OUTSOLD BUI~.DIHG DEFARTME~T 'TOWN CLER[('S OFFICE SOUTHO~.D, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 10175 Z Permiss,on is hereby granted to: ~0, ,. .~:~ ...... .... ...... ..... m~.~.~<o.c.Z....~- ~ .... z~Zm.....~.....~..~- / ...... - ..................................................................................................~. ~}~ ~.~ ~ ~ ' ............. ~-~.~ / ~ -' ............ ~ .............. premises located ~t ......... ~ZZ.. ~.......~ ..... ~.~ ....... pursuant to application dated ........................................................ , 19....~..., and appr by the Building Inspector. / / ? ...................... ~.."""Z~';; ...... ~ .............. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southoid, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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. Commercia~ buildings, ~ndustria~ 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. 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 informa- tion required to prepare a certificate. C. 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 ............ Vacant Land ............. Location of Property .~..3-.~9.0...~9.z'.~.~..R.O.a.~.. ~.O..~.a.~r..~.e?. ............ .~.o.u.~.~.9.]..~.,' ?.'...~.o ...... House No. Street Ham/er Owner or Owners of Property., .~.o~.e.~.` ~.~....9...~.d..~.q .T'.O~.~.~..~..8~.o.~.~ .......................... County Tax Map No. 1000 Section . . .0.'~.0. ........ Block ...... ]...2 ....... Lot ..... 37 ......... Subdivision ................................. Fded Map No ........... Lot No .............. Permit No..]..0.~.'~.Z... Date of Permit . .~.-.~.~. .... Applicant . .G.e. qz'.g.e...A~. ,e?.s...~.~.~.d..e~..~.~.c... Health Dept. Approval ....8.-.~0..-7~. ............ Labor Dept. Approval ........................ Underwriters Approval ....8; .2.7. .~. ¢~..~. ¢2.~.Planning Board Approval .; .................... Request for Temporary Certificate ..................... Final Certificate ....~. .... . .' ............ Fee Submitted $. ~.o.0,~ ....................... Construction on above described building and per~m/j~jll appl~F/~ s~,afd regulations. App cant .... ............... Rev. 10-10-78 Memorandum from . . . . BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN H^LL, SOUTI~O~,O, N. Y. 11971 ~~ ~/~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18013 Examined... ,I9. Application No../©/. Zd--... .... Approved....~..'7.../.'7 .... , 19 .~Permit No../.~)../.Z-~.~7 Disapproved a/c ...................... ....... '/ ............... --~ .... ~ (l~uilding Inspector) APPLICATION FOR BUILDING PERMIT Date . .Ap~oil. 16 ...... , 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, }elationsh~p to adjoining premises or public streets or areas, and ~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 apphcation 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 authorized inspectors on premises and in buildings for necessary inspections. OIlOttOE. ~.~R~,. ~.BUI. hDER-,..iNC., ............. (Signature of applicant, or name, if a corpomtmn) 250 Col~ .l,alle.,..g.u~Cohogh'~.. No~q .York.. (Mailing acldress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... General..¢on.~.ac ~;o~. ................................................................. Name of owner of premises Rosel~. ~. arl(t .Doro~;hy. LalllOll.10 ............ : ........................... .~. (as on the tax roll or latest deed) If applic, a~t is a corporation, sjg~ature of duly au~orized officer. (Nt~Je ' rp ) Builder's License No...~.1. ..................... Plumber's License No. ~'7'02P .................. Electrician's License No. lBal~l~o, .............. Other Trade's License No ...................... 1. Location of land on which proposed work will be done .......... Nor.th .Road. to. ~ayvt.ew, · · .Dtst.~:[ot. 1000~..Seeti. on' 07Oi ' B.I. lf~ · 1~. 'Parc'el' 57 ............ House Number ~/~'~ Street namter, Southold County Tax Map No. 1000 Section SH$.~a .~,..T~ .~ock . ................. Lot ................... Subdivision .................................... Filed Map No .............. Lot ............... (N~e) 2. State existing use and occupancy of premises and intended use and occupancy of p~oposed construction: a. Existing use and occupancy ...I'Io1'1~ .... ~r~,X2 ~,-O.,t~771...Z.,~0 A~./_)..' ................................ b. Intended use and occupancy .Dw'ell,~.rl~ ..... .'~.~ ./~../~.~,~ ~.Z/~ .................................. 3. Nature of work iche~k which applicable): New Building '.. XX ..... Addition .......... Alteration ........ Repair .............. Removal .............. ' Demolition ....... _ ..... Other Work ............... _ ' ' ' ' ~Z'-- ~- (.Description), 4. Estimated Cost . .$52,a00,00 ........................ Fee .. /..~.. ~t.~, ......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units...~. ........... Number of dwelling units on each floor ................ If garage, number of cars . .'2.i .................................................................... 6. If business, commercial or mixed occupancy, specify' nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... l' ' ' Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: ,Front . . .60. g~, ..... Rear .... f~0. :f~, .....Depth . 45t 2s* ........ Height . 21.'~.. :f.'l;,. ...... Number of St~)ries..Orl~ .................................. ' ................. 9. Size of lot: Front . .J.O0~ .f~ ............ Rear .. ~1,~9,55 .;f~, ........ Depth .... it00..$~, .......... 10. Date of Purchase ... ltllklIo~ ................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated .... A ............................................... construction wolate any zomng law, ordinance or regulation: ...l~O ........................... 12. Does proposed ' ' ~ ' 13. Will lot be regraded ¥~.~ Will exce.~s I~11 be. rentoved from premises. ~ No 14. Name of Owner of premises . R, o~el'. LalIIOII~. · ... Addresss~[~..I~.. Phone No. ~'~/4' .~?705 ..... Name of Architect .. GO~.d~Ifl. dI~I~S ......... Address~,~l~l~tl~-~l~.u ......... Phone No. ~t5~-5/4~5 ..... Name of Contractor Oeo~.ge.lhl, ller~,..~hlt~l, de~Address-~'O'~ll~..~.? .... Phone Bio. '~'~*'~O'J.O ..... 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 corner lot. STATE OF NEW YORK, S.S COUNTY OF .................. · .l~OOI'g~ ./kl~el~8 ........... i ..................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. Contractor. ' He is the ,. , (Contractor, agent, corporate officer, etc.). of said owner or. owners, and is d¢ly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application ar6 true to the best of his knowlodge and belief; and that the work will be performed in the mann in the application filed therewith. Sworu to before m~ (Signature of applicant) 0 0 Lo?' I¸, ~,~N ¢. HAUI~ )i ;. TO REMOVE EXCESS FILL FROM ABCYVE pREMtSES BY REGRADING LOT -- DRIVEWAY CONSTRUCTION CESSPOOL CONSTRUCTION CELLAR CONSTRUCTION -- APPROVED AS NOTED 765-2660 gAM to 4PM FOR REQUIR. ED INSPECTIONS: 1. BEFORE BACKFILLING FOUND~ TION OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERIHG PIPES OF AN~ KIND 4. FINAL WHEN JOB CO~4PLETED NOT RESPONEIE)LE FOR DESIGN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST REQUIREMENTS OF N.Y. STAT~ COD~ AND TOWN NOUSiNG COD~ & ZONING · AECHITEC,5 & ENG:,N.ERS ) ~t~l Engineer, Ii Itle~l , vJsi~ t~ or ret ~s. of ~' , ,, ~ection 72~% Su~ivi~lefl,~ . ~ voids Seal and S~ture On m~ ' ,PT (~OU TIM,O L ~ N I~,/~ YO ~. + .... ~~ ~~ . - ....... ~ ~ ..... r I I ~"" f' ' " " ' '" ~ '- ' I " ~ ' ' ' , , , ,, ,, , ,,