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HomeMy WebLinkAbout10285-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...Z.96..~9 .......... Date ... Set2temhe:'. ~g ............... 19 .T.9 THIS CERTIFIES that the building ................................................ Location of Property ... q. 9.0.0..I~. ~.~.:~W. ,I~l:'~.y.e ........................ .~a~;.~c~-14ol~. House No. Street Hamlet County Tax Map No. ] 000 Section . .~I.Q? ....... Block ..... ? ......... Lot ....... 2.1 ........ Subdivision ............................... Filed Map Ho ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~..1~..e..~.~. ........ 19 '/9. pursuant to which Building Permit No ..... 10~_J55Z .......... dated .... .O'L~. ~. ~ ................. 19. ?9, 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 ......... .......... .~.~ .m~..~.ng..ppp~, ~.c.]~q~ ~.~..t~r. ~..r.e~.e .............................. The certificate is issued to ...... I~,..ar~I. Iv~$ ...~J.].:L;Lam. Bec, Rex' ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO..~../-~..2.0.~.2. ................... .H/ ............... / Building Inspector R~ I~OB~ NO. ~ 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. 10285 Z Permission is hereby granted to: .~.cc...~::..~.~.,~ ............. ~.~..~...c.-.~. ............ ................... ( ~ ~.~.~.~.:..~:.~ :..... ~,z..~..: ............ ..................... ~..w...z.z~.c~..~../...!..~.~..~ to ...... ~.~:.(.~..~. ............. fit ....... .~..~..t.~..~..Z.~LC~... .......... ~.~.~. ........... ~....../~.~.-. ................. ..... .~..~..c..t:..e.~.~ ......... t~/..'z.~t ........ ~ ....... ~.c.-..~E';.. ................... , ................................................ at premises located at ........................ ./...?...~....~. ........... ..~.....~..~...~....~./..~.:....~... ....... ..~....~.../.~:."~.. ................... ................................................................................ ~...A:... % .L .'C~L,'..~ ............. &/..% .......................... pursuant to application dated ................................. ..~.../ff...t~...4T.......~.., 19..-~..~.., and approved by the Building Inspector. F.e s...J.~.~ ........ PERMIT INCLUDES APPROVAL Building Inspector TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REGRADING LOT ~l~dpRl¥ EWAY CONSTRUCTION OOL CONSTRUCTION CEdaR CO~S'rRUCT~O~ OTHER THE NEW YORK BOARD OF FIRE UNDERWRITERS ~- p~ BUREAU OF ELECTRICITY ! 8B JOHN STREET, NEW YORK. NEW YORK 10038 July 1979 THIS C~I~IES THAT only t~ e~t~al ~uip~nt ~. & M~B. Becke~, Wes~view Hd., Browe~ & Woodclef, Mat~lguck, L.I. in the followlng location; [] 8.se.~nt [] ~st rt. [] ~,d rt. outside s~tio, m.¢~, Lot 1.~ 7 9 and found to be in compliance with the requirements of this Board. 16s RANGES SPECIAL BEC'PT. R OUTLETS ECEPT LES SWITCHES ~Rcu,m COOKING DECKs OVENS DISH WASHERS AMT. K.W. A~T. K.W. A~T. K.W. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET V I C (Swimming Pool) This certificate covers compliance ~t ~he date of inspection only. Because of unusual envirorm~ent, s it £s advisable to have frequent test and/or repairs made by a qualified person. DRYERS I FURNACE MOTORS [ FUTURE A~A~E ~RS AMT. K.W./ OIL H.P. GAS M.P.I A~T. NO. A.W.G. OTHER A~ARATUS: EXHAUST FANS ~MMERS OF NEUTRAL Glenn H. Bradley Horton Ave. Mattituck, N.Y. 11952 L1c.1227 This certificate must not be altered in ony mannerr return to the office of the Board if incorrect. Inspectors may be COPY FOR BUILDING DIPARTMINT. THIS COPY OF CERTIFICATI MUST NOT BE ALTEBED IN 11/ their credentials. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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 foUowing; 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.O0 Date ...J.q .ly..6,.. 7~) ............ New Buildi~W,~,m, ?. ,o,o,[, .... Old or Pre-existing Building ............ Vacant Land Location of Property ..... ~.e.s, ~¥.~ .e.w..D. ?.~y.~. ~. ~.a.~. ~.o.t.~.q [. ................................ House No, Street Hamlet Owner or Owners of Propertv M.r... · and. ,Mz s....wi.l.l.i, am. 'B'e cke~c ............................ County Tax Map No. 1000 Section 10.7 .... .7. · .2].. · Block ............... Lot ................ Subdivision ................................. Map No ............... Lot No ............... Permit No.. 102.85 · Z. Date of Permit 7. .3. -7.9 · · .Applicant 'Mich~t lc' '~nd' ~ 'Bec'~er ....... Health Dept. AtgCf~wel-.-.~-~ .................. Labor Dept. Approval ..................... Underwriters Approval..T.o · Fo.l. tew ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... K'~XXX×~X ........ Fee Submitted $ ..... .5...0,0. ................... Construction on above described building and permi{i~/~t,s a'~t'~PpJ~ble cq~and repletions. ~,,~, ....... ~ .t' !~ ~'~. . . (~~. ......... ~ ' ~temorandum from BUILDING INSPECTOR'S OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, S. Y. 11971 765-1802 CB k k F o'~< ~e9 L 'r r 0'~ Examined TOWN OF SOUTHOLD BUILDING DEPARTMENT ~v ~ _, ~ TOWN CLERK'S OFFICE ,~/~ o~ SOUTHOLD, N.Y. ~ 19....J... Application rqo. f.......;..~ ..................... Approved ' '/ ,z-..--.. Permit No ............. ; ................. -" : Disapproved a/c ...................... '~,.~...'.i ..................................................... (Building Inspect'or) APPLICATION FOR BUILDING PEIU~IT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildina 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 ofproperty must be drawn on the diagram which is part of this application. 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 perm t~' shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in port 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, dr for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and t~.~ admit authorized inspectors on premises' and in buildings for necessary inspections. ............ ........... (Signature of applicant, or name, if a corp~oration) Yrl State whether applican( is ownerf' lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ If applicant is a corporate, 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 ............................................... Location of land~n ~hich proposed work will be dQ~e. Map No.: ......................................... ~;~':~:~;~..f~ff~ ~~~. . Lot Nq..,.... ....... / ........... Street and N~/~,~:~~';.5,,..;:~......:~L,f,!~ State existing use ond oecup~ncy of premis~nd intended use ond eccuponcy of proposed construction: ....... ...................................................................... b. Intended use and occupancy ................. !lI · TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY, LOT hq DRIVEWAY CONSTRUCTION CESSPOOL C©NSiRUCTiON __ ;_ CELLAR CONSTRUCTION 3. Nature of work (check which app icab e): New Building.. ................. Addil~ib~n ....~.. ......... Alteration ...~....,./. Repair .................. ~moval ..................Demohho~ .................... O e Work .~:~ ......................... .~ ................... It ;t'. (Desc~tion) 4. Estimated Cost ..... ~.......t.~.~..~. ........................ Fee ........................ ;;, ............................................................... (to be p~id on filing this application) ~ ,j~ f 5. If dwelling, number of dwel.lina..~nits ............................ Number of dwel,l'?g units on each Ioor ..... , ...................... If~orage, numbero{cars..(..[.~. ............................................................. ~.} ................... 6. If business, commorci~l or mixod occupancy, s~ci~oture..~ ~-- and ex'on 7. Dimensions of exi~tin~ structures~ if ~ny: Front ............................ Rear ................................ Depth .................... Hei0ht ........................ ~umber of Stories ........ ~..,~ ............................................................................................. Dimensions of some structuro with ~lterotions or odditions: Front ....................................Root ............................ Depth ................................ Heiflht ............................ Mumber of Stories ................................ 8. ~imensions of entire new construction: Front ................... , ............... ~oor ...... :.~ ................... Dopth ........ d.... .......... 10'~ Dote o~ Purchose ....... l. ................................. ~me of Formor Ownor ........................................................ 11. Zone or usa district in which premises ore situ~tod ..................................................................................................... 12. ~oes proposed construction violate ony zonin0 Iow, ordinonce or regulation: ........................................................ 13. Wffl I~t bo reor*ded .[D.O...~ ....... will oxcoss ,[11 bo removod *rompromisos: No 14. Name of Owner of premises .I/4~...~.l.~l.~....~tz}...~.~. Name of Architect ............................................... ~ ............. Addre~ .....; ....... 7'"'"'""?"' Phone No ....................... Name of Contractor ....'1~;,,...~.'.,2..;~......:.~:.:,..:.,.,~...:_, ...... Addres~,.,~,~.>., ............ .. Phone ....................... ~ "~ ' 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 NEar' Y~I(// ~ IcS/~ COUNTY OF ~l[~r:~-~-,~K~.~....~'~'"(~/ ...................... u,y sworn, deposes and says that (Name of individual signing contract} above named. He is the ........................................................... .~; .......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have ~ the said work and to make ond file this application; that all statements contained in this application a~'~true to/tl~e best of his knowledge and belief; and that the work will be performed in the manner set forth in the appl~tion filed therewith. Sworn to before me this A , / /~ , ........ of .............. ............... , '///// Nota~' P~blic, . ................ . ......... ~.....~un1'y .~ ",'"' ~'/'~' '"': :":z .......................... ~ '~'"- ........................ (,~,,~ ~,,~,,~j ,~.~,.~,~ ~.~/'/ (Signature of app!~?) I~qTTAI~Y PUBLIC, State of New YMk No. 52~8125650, Suflo[l(