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HomeMy WebLinkAbout10102-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No... ~..c).[3~p ......... Date ....~.e.~..~2..~.~r.... ? .'1 ................. 19 3~.0. THIS CERTIFIES that the building ................................................ Location of Property . ?.7..5. ~.v..n.~.c.~.. '.L.a.o./.5..~.~..~.r;gp.n.~..s..P.a.~..I3 ..... .Sg.u.~..hg.2..d' ,...El...Y.: House No. Street Hamlet County Tax Map No. 1000 Sect Jun .... ~,.0 ......Block . . .~. ........... Lot ..... ~ ~ .......... Subdivision. ?I.a..1T~. ?.s.~..I-,{o..ra.o.s. .............. Filed Map No. ,5~.~.7....Lot No..2..I .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .d'..a'.~.ll.a..rT..~. ........ , 197.9. pursuant to which Building Permit No. fl.O.~ 0.2...Z. ............. dated . .ff.~...n.u.a?.y...1.7. .............. 197..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 ......... ................ ?r~.v..~.t?..o..n?. ~ .~..~.~.y...~..,~..~.n.g. ............................... The certificate is issued to Willitlln H. and Johanna C. Grim ..................... ?o;,;.;;, ~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ...8/fi.~./.7.9.... 9.-.S. 0.-..'1 .... R. :. .A.,. . V. .J...]:~. .... UNDERWRITERS CERTIFICATE NO .......... ~. ?.. /4. ./4 ./4.7~ .............................. Rev 4/79 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BI:: KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ............ ....... ......................................... ...~...~........~.~-c~.~.~...~.. ....... ..-. ............ ~.q~..~.~....-.....~.-..~ ......... ~...:&..&.k.: ....... ~.~.~..~.~....~7..~......-........X.~....~.../... ......... pursuant to application dated ........................................................ , 19 ........ , and approved by the Building Inspector. Fee $.. ~.~-.~.....~.7...~... 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 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. 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 $5,00 3. Copy of certificate of occupancy $1.00 Date ~.~.~ .~. ...... '/. .... .~. ?..~'.O... New Building Y Old or Pre-existing Building Vacant Land Location of Property z/ ?~ ~f~,~,//-¢ J-,~,9~-- House No, Street Hamlet Owner or Owners of Property ~'//~ /~'/ o ~.q~...~..~?.~..~. ........ .... ? ......... .... Subdivision ~.~..~.~, ..~ ........... Filed Map No, .O~,',~,~,'~,,,Lot No. 'i~iiiill .... Permit No./~../?.~2, .~,. Date of Permit . ./.~. ~,~. .Applicant ....~./~'/..~.,.../~.../~..' ................. Health Dept. Approvalr~),_ ~'~ ~ / .Labor Dept. Approval Underwriters Approval ........................ Planning Board Approval . ...,~ ............... Request for Temporary Certificate ..................... Final Certificate ....................... v/ Fee Submitted $ ............................. Rev. 10-10-78 Construction on above described building and permit m~ets all applicab),e codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 ..,e ^u~.t 6, 1~79 ,~,,,,,,c.,,o.~,o.../,,. 0;~9~ N 444474 THIS ~E;IFIE~ THAT ~ly t~ e~t~al ~uipment ~ ~scdb~ ~ a~ int~uc~ ~ t~ ~pl~ant ~ on t~ a~ ~i~n numar ~ t~ p~m~s of '4. O~i~, n/e/c Jernlck i~ath & OriEonis La., Southold, N.Y. ~...~do. August 1, 1979 and/oundtobeincompliancewiththerequlrementsofthaB~ra. FIXTURE I { [ RXTURES m RANGES ~KI~ DECKS m OVENS m ~SH W~HERS EXHAUST FANS 16 ~ ~ lq 16 , , anvils I ~U~NACn ~mons m m~u.~ A~A.c~ ~n~ns SP~A~C~, .~n~S m mm ~ ~um~u~m ~s S){vmc{ BlaRNEY m NO. 1' 150' C~ x , OT ER P~ATU: ~-Smoke De~e¢ ~o~ , · Fu~ume Appl[anae Feede~/stlT2~lh,~l-2912, 1-3~8 Four t:rolnt Electric Inc. 350 L~ke Ave. Nesconset, N.Y. 11767 Llc.30?-E This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N.Y. T,mPOR R¥ Certificate Of Occupancy No ...... ~., .......... Date ...... A~lf>~st. 21~ ................. 19 "79 THIS CERTIFIES that the building ................................................ Location of Property .... N~/~I~. Co,~-:nc~x'. 0:e~lioh · Lane_s&. Gr. ig0r~i ~ s. ~a-gh. .... ~o~ld. t~ouse tvo. orreet County Tax Map No. ] 000 Section ... ©.TO ..... Block .... ~ .......... ]Lot ..... ''1G ......... Subdivision J-[~,.,~.~.r[~. HOJ~Q8. ,~ b¢~.~ ..... Filed Map No .... ~.. ,,.T..Lot No... 2.'1. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... T~:oll.~:m.f..~.7. .....19 Y/.9 pursuant to which Building Permit No ..... .'10~t(9~ ........... dated .. ,.I~,B~,I~.p~..'1~/ .............. 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 ......... ..... (.'Per~po:c.'~.r5r.) · Prd,v~.t e..o~e..~.m~cZM .dwe.~.3:i:ag ............................. The certificate is issued to ...~gi'.[:t.L~rrt. Ho.. &. ~oh*an~a .C.. By. ira ....................... of the aforesaid building. Suffolk County Department of Health Approval . :c),,S0-.'1....~,~lg~.a-~..'1.~ f · .19.7.9 ............. UNDERWRITERS CERTIFICATE NO... d~.~,lf~lg.'~, .~ j..'1¢79 .............................. Rev 4/79 Building Inspector """"""""""~o L.~ C& H ¢,.5 APPLICATION FOR SUtLDING PERMIT /~ . INSTRUCTIONS Date~.:.....~.... .............. , 19Z..~..... a, This application must be completely filled in by typewriter ar 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. Plat plan showing location of lot and of buildings on premises, relationship t.o. adjoining, pre. raises or. pu?ic et.r. eet.s o) areas, and giving ~ detailed descrlptian af layout ofproperty must be drawn on the d~agrarn which ,s par~ at this appllcatxon. 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 an the premises available for inspection throughout the work. e. No building shall be occupied ar used in Whole ar in p~rt far any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depacment for the issuance of o 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 atl applicable laws, ordinances, building code, housing code, and regulations, and to uthorized inspectors an premises and in buildings for necessary inspections. (Signature of applicant, or r~ame, if a corporation) (Address of apphcant) State whether applicant is owner, lessee, agent, archffect, engineer, general contractor, electrician, plumber or builder. "' '-'% .c' !Namoofawnerafpremlses ~/i/ll~m ~ ~ ~ ~/~ 1~ If applicant is a co,orate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. yr~aO ot=' /'//ae~e*l/ Other Trode's License No ............................................... Location of land on wh, ich proposed work will be done. Mcp No.:~..~)¢~---./-;-.--tT?.--~-.%-...-/~-.n?.~(-'%ot Ns.. 5treat and Numbe~'~ ...... k.~'1~.(L.(~....>&%.~(~e....~J ............ ~ .................................... I ............ F ............................ MunicipoJi~ State existing use and occupancy of premises and m..nded use and occupancy af proposed construction: a. Exisifing use and ~cupancy ............................................................................................................... b. Intended use and occupancy ..~; ........................ F ............................................................. '~' ................................ 3. l,~_.ture~of work (check which applicable): Nevi Buifdmg - Add~tton .................. Alteratlgn ................. Repair .................. Removal ..................Demolition .................... Other Work ................................................ ..... (Description) 4. Estimated Cost Z 2~..O.....O..0. : ........Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .... ..~...../~/..-~.~.. ........... Number of dwelling units on each floor ...{~....~'..J....~.~. .......... IF garage, number of oars ....... .~. C/~./~ ~ ................ 6. IF business, commercial ar mixed occupency, spec,fy natu,e 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 odd;tians: Front .................................... Rear ........................... Depth Height ............................ Nun b-r of Stories '° ' " ' Depth.. 30 8. r};mensigns of entire new construction: Front ~, ...... ~ ~ear ................................................ Height /. b Number of Star es .~. / ~/.-~.- ................................................................................ 7 .............. ,-~ Rear ...................... De th ............................... 9. ¢;ize of o,. Front ..... .'7.. ........... P 1 1, Zone or use district in which premises are situatea .~c.~.~.~ ....... x ............... ?. ........... . ..................................... 13. r Name of Architect .............................................................. Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions fror property lines. Give street and block number or descrip,ioe according to deed, end show street names and indicot whether interior or corner lot. / COUN'Dr' CF ..%JrfZJ/'JL/~..'.kd..~;....-zTr~ _ ......... J,. ....... , ...... }.~.~_~.~ .................................................. being duly sworn, de;~ses ~nd s~ys that he is the (N~me of individual signing contract) ~bove ..... ........................................................................................................................................ (Contractor, agent, corporate officer, etc.) said ~wr. er or owner% and is duly authorized to ~erform or hove performed th~ said work and to ~ke and fi ~his appl;cction; that ali stctemen~s contoined in t~is appl~cstion ore true to the best of h~s knowledge and belle~; tha~ the w~?: will be per~orme~ in the manner se~ fo~h in the application filed therewith. Swam to ~his // ...... · 7 .................. Noto~ ~}~r4~ ~' ....................... ~m~~r4. ~~ .......... ~ ............. (Signature of applicant) SUFFOLK CO. HEALTH DEPT. AIqIROVAL H.S. NO. ,~ STATEMENT OF INTENT . THE WATER S~LY AND ~ DI~ ;~F~M TO ~E ~AN~R~ OF THE ~IcANT ~FFOLK COUNTY ~. ~ ~2TNDL~'. SERVICES -- FOR APPROVAL OF ' CO~RU~ION ONLY H. S. REF. ~.: ~-' ~VED: , , OWNERS ADDRE.: ~'~N PIPE --- - ~': ' ' "" o~ ~s su~v~ ~,~ NOT VAN TUYL. P.C. L~D SURVE~RS GREEN~RT NEW YORK t '0 ~FF~C ~ H~? NO 535Z 9'9: JAN 2, AN,,. D~ ' - LK:EN~,.D LAND sURV ~EE~RT NEW YORK H.S. NO. __ ~T&TI~NT OF INT£NT THE WATER ~JPPL, Y AND ~A~E Dm~AL ~E~ F~ TH~ R~IDENCE WILL c~F~M ~ T~ ~AN~R~ OF T~ (S) ~ C NT sUFF~K ~oUNTY D~T, OF HEALTH SERVICES -- FOR APPROVAL OF co~TRUCTiON ONLY / / H.s..E~. ~.: ~- ~ ' / ~FFOLK CO. TAX ~' DI~. ~CT. ~L~K ~L. OWNE~5 ~x ~ TE~ H~E ~A~ ~AL · De.e'l. ~u-r~OVAL D[~']~ _~ H,S. NO. ,")~ 15,5 · I ; THE WATER SU~L~C~A~ DIS~AL, ,.~ -~. , SY~EMS FOR THIS R~IDENCE WILL r './~',~ ~- --~, CONFORM TO THE STANDARDS OF THE ,- '~ - , ~ SUFFOLK CO. DEPT. OF HEALTH SERVICES. '- - SUFFOLK COUNTY DEPT. ~ HEALTH ;~, ~'T-, ~., SERVICES -- FOR APPROVAL OF ~','. ~ .... -~.,~ · ,..,, ........... C~STRUCTION ONLY DATE: H.S. REF. NO.: ~- 5~- I ' ". ~,/ SUFFOLK CO. TAX MAP DESIGNATION: / DIST. ~. BL~K ~k. / ~ ~,~ ~ 19~0 / L'J'~..*O~N DEED: L. N A P. A~EA~ ~- ~ O~O ~"~, ~' :, _ ..... · ,~ TEST HOLE ~ ~ TO ~ A VALID IRUE COPY. IS PREPARED, AND ON HIS ~HALF TO T~ TO THE ASSIGNEES OF THE LENDING INSTI- ROD ICK.VAN TUY~.C. . LICENSED LAND SURVE~RS GREEN~RT NEW YORK ALBEP,.T .A 54~¢¢0 ~,., QOI2.DON K.. ,8, HLED,.co 54G5or' MA~H P...OAO, ~OOTHOLO, N.'I' I'q'/I APPROVED AS NOTED 7/ q , NOTIFY BUILDING DEPARTMENT AT 765-2660 gAM to 4PM FOR REQUIR- ED INSPECTIONS= 1. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERING PIPES OF ANY KIND 4. FINAL WHeN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y. STATE CODE AND TOWN~USING CODE & ZONING F:IR~T FLOOR PLAN ' FDUNDATI 0N PLAN P.E A R.' ELEVATION 't ELEVAT1 ON