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HomeMy WebLinkAbout10100-zTOWN OF SOUTHOLD BUrr.BING DEPARTMENT Town Clerk's Office $outhald, N. Y. Certificate Of Occupancy No. . ...........Z9530 Date ......~ ..ay. .................. THIS CERTIFIES that the building located at .. -500. Center. gti~ee¢ Map No ..... ' ........ Block No ...........Lot No,, ................................. conforms substantially to the Application for Building Permit heretofore filed in lhls office dated .. J. anuar~' ..... 8. ..... , 19. ?.~ pursuant to which Building Permit lifo...'[0, J0O dated .. J. anua~. .... .JS. ..... , 19..7.$, was issued, and conforms to all of the require- ments of. the applicable provisions of the law. The eccupancy for which this certificate is issued is ........ .P.r.~.v.a..~.e...On.e...F.a~..i.l.y...l~,..e.l.l.i.n.~ ................................. The certificate is issued to ......... .~.e..o.P~.e...Du.l~.r.e.e' ............................... (owner, of the aforesaid building. of Health Approval 8--S0-151 May 7, 1979 Suffolk County Department .................................... Robert A, Villa UNDERWRITERS CERTIFICATE No ..... N/~]27~7. ............................... HOUSE NUMBER ..... 500 ......Street ....... .....¢ erl.~er .~l;r~et .............. . ./.--// ............................................ . .... ....... Building Inspector County Tax Map Numb.er 1000-2-123-19 FOI~M NO. 2 TOWFl OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI,. Yo BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 10100 Z Permission is hereby granted to: ~_____~,/'~(j~/~, ~ ..~.....~.~... ~~ ............. ,.~....~....z~.~ ................................. .... ~~ ~>...~.:..~. ..................... ~o ...C~.~-~i...~..~.....~.z~.~...o.~...f.--~..~.~//~... at premises located at ....... Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Buiiding DeparTment Town Hall SouthoJd, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This app/ication must be filled in typewriter OR ink, and subn~itted 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 unusua~ natural or topograohic features. 2. Final approval of Health Dept. of water suoply and sewerage disoosal--(S.9 form or equal). 3. Approval of electrical installation from Board of Fire Underwrit'ers. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and installa* tion~, 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 buildlnos 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 $1.00 $5.00 Date New Building .... ~ ...... Old or Pre-existing Building(X) ......... =/Vacant Land¢~ ............ Location of Property . .. .......... , .... , :- , Hou~ No, Stree[ Ham/et · .. _ ..... ....... Subdivision Filed Mao No Lot No ' Health Dept. Approval ~:J'~/~'/ Labor Dept. royal ...................... ,.. Unde~riters Approval..~ ~ ~ Planning Boar proval .................. ,..~ ......... d Ap Request for Temporary Certificate ' ...................... Final Certificate ........ - ......... Fee Submitted S ............................. ,YORK BOARD OF FIRE UNDERWRI 25 JOHN STREET NEW YORK NEW YORK 30038 ~nly t~ el~tr cal e~u p~ent as gesc~b&d ~elo~ ~hd ~nt~uded [ t~ a l cant na~ on the above Uomes, .$¢¢ qCn~er St.,, 254' w/o Bungalow Lane, Matt tuck L. ~ XTURES ~; r RANGES r :OOK NO DECKS , OVENS ~ iH WASHERS EXHAUST FORM NO, 6 TOWN OF $OUTHOLD 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 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 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 $1,00 $5.00 Date..,~:~'?:'. ~.~.. :'~. ~ 2 ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ~...D..~! ............... .C: ./.~..~.. ?./.~..~ ............ .~...'.'.~..~..'~./..Y.~.~..~?~ House No. Street Hamlet Owner or Owners of Property .~.' ./.~..~./.{ .~../~ ..... !~..q../,~,'~../~./..~. .......................... County Tax Map No. 1000Section 2, Block /..~.~ Lot. "'-" ~.. Subdivision .... ~ ................ ,~/~( ......Map No ............... Lot No ............... Permit No/~./, ..... ~,Date of Permit j/~,/~,~,.Applicant ,.. ............................... Za or ........... U nderwriters Approval j~,, ,/'/. 7~..'~. 7 ~..Tf _/..../.Planning Board Approval ......... iiiiiiiiiiiii Request for Temporary Certificate ..................... Final Certificate .. ,~. ................ Fee Submitted $ .~..'. ~ .................... Construction on above described building and permit meets all applicable codes and regulations. R~v. 10-10-78 FOI~,M NO~ 1, ~ TOWN OP $OU~O~, BUILDING DEPARTMI:NT TOWN CLERK'S OFFICE ~UTNOLD, N~ Y. Examine ~f~' / ~ ~ ' d~'""~" .............. , 19Z..~. - Application No./~/~ ............................... ~ . ~P ~.~ ............' .................. , ly~..~.., rerm~r ~o .............. :...., .................. Disapprove~/c ................ :':::~ .............. ~ . ~? ....................................... ........................................ .................... ................. ...... ' ~ ' ' ~ sp~toH APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter Orr'in inl~ 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 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 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 pumose whatever until a Certificate of Occupancy shall have been granted by the Building nspector. 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, NewYork, 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, build ng code, housing code, and regulations, and to admit authorized inspectors on premises and ir~ buildings for necessary inspections. ................................................ " ........................... (S gnature of applicant, or name, if a corporation) ...... ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber Name of owner of premises ~..~C~-/~, 9 [:~-'' f'/'P ~"~: '~" If ap~nt is,.e'~porate, signature of du4v. outhorized officer. ....... .... ¥ (Name and titler of corporate officer) Builder's License No ..... ./....~....0.....~...../.~...~... .................. Plumber's License No .... .~.....~.,...7.......~... .................... Electrician's License No ..... ..~.....~.../....'~..-'~.... .................. Other Trade's License No ............................................... Location of land on which ropo ed work will be don~e Map No ' Street and Number~ .. ,~ .... Municipality State existing use and occupancy of premises and intendedr~use and occupancy of proposed construction' a. Existhng use and occupancy . b. Intended use ond occuponcy ............................................. 3. Nature of work (check which applicable): New Building' ......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ................................................. ... (Description) 4. Estimated Cost ..~..~...~)..~.. ....................................... Fee (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 additions: Front ....................................Rear ........................... Depth ................................ Height ............................ Number of Stories ................................ Rear ..~..~.. ................. Depth ~..~. 8. Dimensions of entire new construction: Front ....... ~,~...~. .................................. Height ...... /...~..( ..... Number of Stories ....~'.. ............................................................................................................... 9. Size of lot: Front ..~'.~...~. .......................................... ear ...... ...~..~......~... ............. __z'"'¥~,,zDepth ~ .~.,~. ................ 10. Date of Purchase ...~..~...~Z. .................................... Name of Former Owner ...~.....?5....~.d.,~.,.;?,.'.~ ............................. 11. Zone or use district in which premises ore situoted ..................................................................................................... 12. Does proposed construction violate ony zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded' . ....... ~.... Will e~xcess fill be removed from premis~s: (r-~es~ ( ) No 14. Name of Owner of premise~'.~....~...~.~... Address Name of Architect ............................................................. Address ................................ Phone~ l~lo. ! ..................... No, a of Contracto .. . ...... 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 end indicate whether interior or corner lot. -" - ~-~'~- ~¥ ' deposes and soys that he is the opplicanl ......................................... ? ...being.duly sworn, (Nome of individual si~q~infl controof) , ' above named. He is the ....... ~~'"-'~~~:,"~;~["~¥f[~¥r"'~'~/ /~~- ~ .(C. , , g , p ' , , ........................................................... "' ' of said owner or owners, and is duly authorized t~ perform or have performed the said work and to make and file this oppl cation; that a I stoter~qnts contained ,in this ,application ore ,true to the best of his knowledge and belief; and tha~ the work_wil. J be performeF~r~ the manner set forth in the application filed therewith. Sworn tf~bflZ~s~me .......... ~.~lgnoture at appucant/ , 550 ,~ ' ,: b 'B' B,, FOR APPROVAL OF GONST~UGTION ONLY ~ ~ DATE , .,H.S.REF. N~I ~ APPROVED~ THF ~'IATER 'L'PP,Y AND SEWAGE DISPOSAL SYSTEMS FO,~ TH'~ RESiOI:NCE WILL ~NFORM 3~) 'FHt~ STANDARDS OF THE 5UFFDLK ~NTY . DEPARTMENT OF HEAETH SERVICE& ' , ELEVATION OF TH~S PROPERTY NOT SHOWN, EXCEPT AS INDICATED. DENOTES STK. PLACED ELEV. $1DNEy.'.B..'BOWN~: & SON LIC, PRO,.,'ENG'R 8< LA'ND SURVEYOR' ' JOHN C GREGG NO, 25093-CHEST[R C. KELS[Y NO. 36~23 MIN ..~. SCALE 1"= ~/~/~X/ MEAS ARS GUARANTEED TO DRAWN BY'//-~ CHECKE~, BY~:~K~ OR¢3ER NO ..... TITLE NO '-~©o /00. O0 Testhole Pool )ATE ' '~s.-6' ' '~_ I Story Frame I Gar, 68.8 THE WATER ,~U[)PLY AND YEWAGF DISPOSAL SYSTEMS POR 'Fills ~DENCE wirI,L CONFORM TO STANDAI~I)$ ()F TIlE SUFFOI. K DEPARTMkNT OF ttEAt,F~I APPLICAN~I ELEVATION OF THIS PROPERTY NOT SHOWN, EXCEPT AS INDICATED NOTE: STRUCTUI~ LG~&'TEO ~ MEASUI~D I~B. 2~, 1~1~. CHIMNEY & CO~C. PORCH NOT COMPLETE. FINAL APRIL LO( SUFFOLK COUNTY GUARANTEED DRAWN ~Y~ CHECKED BY SIDNEY B. BOWNE & SON LIC. PRO. ENG'R & LAND SURVEYOR JOHN C. GREGG NO 26093-CHESTER C. KELSEY NO, 36923 MIN Y. RD A [)F~ JOT[:'% %] ', PI, AC ~ I) 00.00 F l [' V ' ~IsuFFIoL~ ~UNTY DEP'T. OF HEALTH ,%ERVICE~, FOR AP~OV~ ~F CNSTRU~TI~ ONLY ',U' r~tl[ STANt~A~DS OF' THE 5UFt'ULK ~NTY ELEVATION OF THIS PROPERTY NOT SHOWN, EXCEPT AS INDICATED. FOR .<?~"'"'-'~'--~:~--~'~'/~/~-~-~"~', SIDNEY B...,.I~OWNE & SON ~, ~:_.¢~z~/;_~ uc. PRO. EN~"~ LOTS '. _ -';Y3_.~ ~c~I~-~.F{T J~ ~ JOHN C. GREGG No,MiN~A~:26093 BLOCK. -- _~LL~ - ~ ' ~ ~' ..... ' / ,I..' 1~ /(",.. "¢ ~ , ~, -' uY~'/~- ,~ .,. .' , .' .1.'; .I' t LL .ATE..__ 765-2660 9AM to 4PM FOR REQUIR. ED INSPECTIONS~ 1. BEFORE BACKFILLING FOUNDA- TiON OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERING P~P~S OF ANY KIND 4. FINAL ~/HEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCT/ON ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y. STATE CODE AND TOWN HOUSiHG CODE & ZONING 1