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HomeMy WebLinkAbout10147-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N,Y. Certificate Of Occupancy No ..... Z. 'J..0~.6.9. ...... Date .... .N.O.V..e.m.b?..l?...25., ............... 19.8.0 THIS CERTIFIES that the building ................................................ Location of Property 620 .R. qg.e.r.8. R~ad, ................... .S. okl~o.],(J.,. ]bJ.~¥, .... ~/~S~ HO. ' ....... Street ' ' Ham/et County Tax Map No. 1000 Section 066 .... Block 07 .Lot 035 Subdivision.. J3.e.~ .x~.d.O.1O. ~.'~ .~g. ......... Filed Map No ......... Lot No. · . 3 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · . .IyI.aT.e. tl. 5.0. ........ , 19.7.gpursuant to which Building Permit No..%0~ ./47..Z ............ dated . ~17¢]a..~0 ................. 1979., 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 ......... Addition to Private Dwelling The certificate is issued to Rev, Canon John W. Da¥is ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... N44885 ~ UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev 4~79 FOEi~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10147 Z Permission is hereby granted to~,, ...... ~.:......~. ..... ....... ....... .... t ................... ~ .................... ) ...... , .......................................................................... ~' ~.. ' ....: ........................ ~..~ ................... r ant ' ' '/ p~,, to ~pp,,~,o. ~t~ ................. ~....~.~ .................... . ~.Z~ ~.d ~pp,o.ed b~ th~ Building Inspector. Fee $ ................ 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: I. 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ali 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. 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 . ~.. . House No. ~ ~ Stree~ ,~ ~ Hamlet Owner or Owners of Propert[ ~ .~?~?x,,: ,~'~ ~....(.~.~~.. ~ ~,-. ~ .... co,,~v ~.~ ~.. ~o. ~000 s~,,~o, ,2C4 .......... ~o~ .~ZZ .......... Lot. P~J:~'. ...... ................... ....... ....... ........... Perm t N~ .......... Date of Permit ~/P~/,.t .... Applicant . ¢t¢~. % ......................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate . .~¢~. i .................. Fee Submitted $ ............................. Construction on above described buildin~g;~,_~pe~.~nit meE t~,.al, I ap?ic~b,~e co~es and regulations. Applicant ~;~'. (~ ~'~'¢¢, ~z~ .................. '1 ...... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY o.t. ~epCembe~ 12, 025333 THIS CE~IFIES THAT o~ t~ e~t~cal ~uipment ~ ~c~ ~ a~ int~ b~ t~ oppl~t ~ on t~ a~ ~n ~m~r in ~ p~m~ of in t~ foll~ing l~atlon; ~ ~ement ~ 1st Fl. ~ 2nd Fl, ~tlon Bilk ~t ~.~o. ~p~mbsr 10, 1979 and found to beln compliance with the ~uirements of th~ B~rd. o.L/,, .!..c:.o,!..' L._!.c. AMT. K+W, OIL H.P. GAS H.P. A~T, NO. A.W. G+ SERVICE DISCONNECT j NO. Of l S METER HO, O~E~C#COND. 6.8 EXHAUST FANS DIMMERS OVENS IDISH WASHERS V SYSTEMS NO. OF FEET C A. W.G. NO, O~ HI-LEG NO. OF NEUTRALS A, W. G, OF CC. COND. O~ NEUTRAL E..oodl... / //? ~/ad~n~ l~/vertN.Y. 11792 t ~' / Per '~ /. -- ~ .Th2s~.ce:ificat_.e_.mu...~_n.o~,t b: a2t*ce~ ,,:. ac~mznncr;, reCu:::oCh: o~icczfch: ~ard if incorrect. InspeOors may be i,e~~ COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN AN~IANNER. TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, N. Y. 11971 TEL. 765-1802 August 1, 1980 Rev. Canon John W. Davis 217 Peninsula Blvd. Hempstead, N.Y. 11~0 Dear Sir: ~his is to notify you that Building Permit No. mssued March 30, 1979 to Davis, J. will e~'~ird on ~ap~emb~r 10147Z If more time is required to complete the job and obtain a Certificate of Occupancy, you may apply, by letter, for a six (6) month extension. 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 5. APP~OV2D AS NOTED DATE:=~(. NOT~F¥ BL:JL"~,,'~G gc~-ART~ENT A~ 765-2560 ~.,q~ fo 4~A FOR REQUIR. 3. BEFORE COVER~G P~?~S OF ANY KIN~ FINAL W~EN JO~ COb~PLETED NOT EESgONS~SLE FOR DESIGN OR CO~STRUCT[~N ERRORS ALL CONSTRUCTION h~UST A~.EET P-,EQUIP,,EMENTS O~: N.Y. STATE CODE AND TOWN HOUSING £ou b^ T / ,PZ,41V $/4 ~ itV. ~Ovf~ £L6db, T'io~'u Examined ................ ,19... ^ppro ed :" --.>'".::t ...... 19.r:PermitNo /..q<'/..: : .../.. /Z --- .. .... "'-""'2 r'""'""' (Building Inspector) APPLICATION FOR BUILDING PERMIT :-:o Date .................. TOWN HALL SOUTHOLD, N.Y. 11971 TEL: 76~1802 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 giving 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 authorized inspectors on premises and in building~Qa~ necessary~sp~tions. ,-~ LE., .................. ( ~(~nat~ of appl. icant, or name. if a corporation) (Mailing address of appli a ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. 2q'~,~.':":..'K?-~-~.'.'Q~.Z-~.~/.~: ...... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .... .~..~.~ ......... Block ...... .°.7. ........ Lot.. ~'~ ~ O;fS- Subdivision .... ~. ............................... Filed Map No ............... Lot....~. .......... (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy~.~/K'~oee-~.. ........................................ b. Intended use and occupancy ............................................... 3. Nature of work (check which applicable): New Building .......... Addition . ~.. ...... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... j (Description) 4. Estimated Cost... ?/.O..~.~ ............................. Fee /.3~..'~~. ................................. (to be paid on filing this application) 5. If dXwelling, number of dwelling units ....... /. ....... Number of dwelling units on each floor. / If garage, number of ears ........................................................................ 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 ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... _..~7_a- --~.Number of Stories_o ........... ~ .......... - ~' ...................... ~ .fi..O~.-~ ' "':' ' ' 9. Size of lot: Front ... .,<..~ . ~..b~. .... Rear ..... ~ .... '~ .,.~.' ..... De~h ........ 10. Date of Purchase ~/,~.;.~' ',; 272. /'. .~. ~... ............... Name of Former Owner ...~¢~,-~..~tT__ ............ 1 ~ Zone or use district in which premases are situated ..................... ,. ............................. 12. Does proposed construction ~p~a,tffany zoning law, ordinance or regulation: ...... ././.o..' ................. ~..~ 13. Will lot be regraded ......................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect .......... · ................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 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 NEWI OF. , / ~UN~? .~.~. ........ being duly sworn, deposes and says that he is the applicant ~.,~/.~b'b~)~ f individual signing ~ontract) fibove nam ed(.NI He is the ..&~~ .................................................... · (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the Work will be performed in the manner set forth in the application filed therewith. Sworn to before me this /'~, . .......... .......... Notary Publi . ............ A' ./testy. .