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HomeMy WebLinkAbout10952-z TOWN OF '$OUTHpL~D BUILDING TOWN HALL SOUTH'OLD, N~ Y. BUILDING: PERMIT (THIS PERMIT MUST BE KEPT ON THE P~E~IS~S COMPL~ION OF THE WORK AUTHORIZED) UNT L N©. ~ 0 9 5 2 Z gate Permission is hereby granted to: pUrspant t:o application doted ........ Guild'riG lispector. Fee $ ........ ~ ............... Rev. 6/30/80 . ...~.339 .0.~3..w.~. &v;~,...:... ........... 801~HOLD It.Y, 119~1 Build I/a aw~i~ pool ~ e~ ~ ~ fenoe . ~' o ~w~ A~ ~ .., . ..... at premises located at ..........~.~ ............... , ............. - .......... ... ........... ~ ' ~O~HO~ 'N.Y. 11971 .................................................................. *, ............................ ~,, ~ · ,t~. ,, ~ .... . ~ ':: ...... ...... .~ ..... ............................ Co~ T°x ~op No. ]000 Soction ..~ ..... ..... Bock ~ ..~: ...~ ........ ~-ot No.~ ........... ~. ....... ~1 , (~ '19:~ and ~pprov~ by the FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hail 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 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 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 ~ertificate. 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 . .-Augu._s~c 5, 1982 New ~;'.d;.g . .(~. ,-~. .... Old or Pre-existing Building(X) ..........=/Vacant Land - Location of Property .4330,-Dak1~w.a .Avenue. ;F~l;e~s~,on ~. S~ul;lao.J,d, · ................... House No. Street Hamlet Owner or Owners of Property E.li.~abeth A Nevill. e County Tax Map No. 1000 Section ...... ?'0 ....... Block ....... ,9. ...... Lot .... ' 3.4. ~ dnd'-~' Subdivision ....... Permit No. / ~ ..... ate of Permit ..... Applicant ................................. Health bept. Approval .~/A ................... Labor Dept. Approval ~/.,~ ................. ,.. Underwriters Approval ........................ Planning Board Approval .~T/. ~ .............. ~ ,. ~ Request for Temporary Certificate ..................... Final Certificat~ . .%~:~ .- ......... , Fee Submitted $ .... ,~. ,.00..r-4~. ................ Construction on above described building and permit'meets all aPpl~cable~codes ~).d regu~'ations. (j,o. [ l l S"o "', "dY ...... - .......... - ..... THE NEW YORK BOARD OF FIRE UNDERWRITERS 85 JOHN STREET, NEW YORK, NEW YORK 10038 Neville, 4330 Oaklaa~ in the followir~g Iocatlo~ [] Basement FIXTURE FIXTURES and foutrd to be in compliance with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS R V I C AWG. OF CC COND, NO OF HI LEG A, WG OF HI ERG Pool) This certificate covers CUal~liance at ~ ~ce of ~C~ ~y. ~ of ~l ~~Cs tC ~ ~le ~[= ~ ~d/or rep~m ~ ~ a ~!~i~ p~. Phil Gordon 12 Dem~ St. Port J~.fferson Stat/~h N.Y, 11776 L/a.ll01 g Pen This certificate must not be altered in any manner; return to the office of the Board if incoqect Inspectors may be identified by COPY FOR BUILDING DEPARTMENT. THIS credentials. ~5o.a I~O~M lqO. 1 TO~NN OF $OUTHOLD EUILDING D~:PARTMI~NT TOWN CL~K'S OFFICE ................................................................. ....................... ~.:¢~...~~~ ......... ~ (Buffding Inspector) APPLICATION FOR BUILDIh~G PER~v~IT Date .......................... .......... 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 m 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 wJJJ issue o 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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. ..... ar ....... .... g.9..u..c.~.e.~.~A~.~.t.p.~.q.k.~.~.~".~c.~3~.~.t..~7.~7.~.8. ....... : ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................................... ~.~.~. ............................................................................................................ Name of owner of premises Robert Neville If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........ ~.$. ........................................ Plumber's License No ......... ~../.A ................................. Electrician's License No. llO:].E /o o- 70 Other Trade's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ....... .6f..3..~.O.....O...a,k.~..a.~....A..v,.e.,.q~.e...~.~.~.;,,. ....... ..S..o...u.[,b:...o.~.,d. ...................................................... MdnJcipality 2. State existing use and occupancy of premises and in,~ended use and occupancy of proposed construction: o. Exisiting use and occupancy ............. ..o..~.,.~.,.?...~..?~...]:~/'....~...e..s..i..~.e...~..c,...e. .................................................................. b. Intended use and occupancy ............. ~g~`~Qk~t~[~:[~TAg~`~.~.~ ............. property lines. Give street and block number whether interior or corner tot. 3. Nature of work (check which applicable): New Buildino,. ................. Addition ....~....)~. ........Alteration ................. Repair Removall Demolitior, .................... Other Work XX  (Description) 559 . O0 .......................................................................................... 4. Estimated Cost .............. .~ ........ ~ .................................. Fee I (to be paid on filing this application) 5. If dwelling, number of dwelli,ng units ............................ Number of dwelling units on each floor ............................ Jf garage, number ~f cars ..... ~ ....................................................................................................................................... 6. If bbsiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structu~'es, if any: Front ............................ Rear ................................Depth .................... Height ........................ Numbpr of Stories ................................................................................................................. Dimensions of same structure'lwith alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ B. Dimensions of entire new con,ruction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of Jot: Front 1'~0~ 150~ 1§0~ ................... , ..................................... Rear .......................................... Depth ................................ 10. Date of Purchase ................... ~ .................................... Name of Former Owner ..~,.i,,,q,h.A~.d....~,~...°-~A.t3.e,.~ ................. 11. Zone or use district in which p?emises are situated ..................................................................................................... 12, Does proposed construction viol,ate any zoning Iow, ordinance or regulation: ................. Ale .................................. 13. Will lot be regrdded. ...... .Ye~..i .......... Will excess fill be removed from premises: (X) Yes ( ) No , .] A . Suth , ~ 14. Name of Owner of premises ..... ~f~b.f~r.~.,~.~.~,~,.~,f; ............. Address .k~,~.Q..O.a~,~,~c~..'~one ~o....~..~.~=Z0;~. Name :of Architect .......... ~J/.~. ............................................ Address ................................Phone No ....................... Name of Contractor ....~.9/;J-~..~J~g....~.O.Q~,$, .................... Address .~0.~.~,..~,~ ......... Phone No..~.~.Z~-....~.~OD... PLOT DIAGRAM Rocky Point Locate clearly and distinctly oil buildings, whether existing or proposed, end indicate all set-beck dimensions from or description according to deed, and show street names and indicate See Attached Survey STATE OFINEW~ y~ORI~, . . [ c ¢ COUNTY OF ..... ~, .q.~..~.g..L..~. .......... ................. l,~,l~,);'.e~...~.Z.q~.~, ............................................. being duly sworn, deposes and says that he is the appJicanl (Name of Jndividuo s gn ng contracf) above named. He is the ............................................... ~.~,~...~.....~... ....................................................... ................................................ (Cbntractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work end to make and file this application; that all statements contained in this application are true to the'best of his knowledge and belief; and thor the work will: be performed in the manner set forth in the application filed therewith. Sworn to before me this ..... day ......... ............. , / . Noto Pub c,.. .......... c · ' ..................." (Signature of opplica~ti' ........................ PETER C, Notary Public, State of New Yo~ No. 52-4612312 ~Q~tualified in Suffolk CounW onE×~Jres M~rch 30,19 , >~OO'9 E~ ,,91 x,~ ~,~ S35,~1r~0::) g Z <1: .J I1. Z I