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HomeMy WebLinkAbout10955-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. 7.10327 Date December 30 ., 19.8.0. THIS CERTIFIES that the building ................................................ Location of Property 1235 Factory Avenue Mattituck County Tax Map No. 1000 Section 1 2;> Block 02 .Lot 018 Subdivision....X?. ......................... Filed Map No....X.X....Lot No. · ..X~. ......... conforms substantially to the Application for Building Permit heretofore filed in tiffs office dated October 29 19.8..0pursuant to wiffch Building Permit No. 10955 g dated Novembex~ 10 19 80, was issued, and conforms to all of the requirements of the applicabl'e provisions of the law. The occupancy for which this certificate is issued is ......... a private one-family dwelling with addition Louis Stokes The certificate is issued to ..................... [ohJn'o'r,';'/~'go'o;d'r'c'b'~bit) ...................... of the aforesaid building. Suffolk County Department of Health Approval nog required UNDERWRITERS CERTIFICATE NO .... P.~. ~.d.i.~ .~ ...................................... Rev 4/7g FOE~ NO. TOWN ON BUILDING :D£PARTMiNT TOWN HALL SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL dULL COMPLETION OF THE WORK AUTHORIZED); Date ........... N? ~0955 Z Permission is hereby granted to: ................................ ~ ................... ?.. ............... ~:. to ..... ~,: ............................................................................ , 't ..... at premises located ~ ............................................... :, ................. ? ............. ' ........................... pursuant to oppli,otion d,tod ...~.r ~ . ::~:~, 1¢....¥..,~ ond approvod by the Building Ihspector. ..... :'"'"":~':' ~,'~"-'~;~'5~;~i;; ........ Roy. 6/30/80 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 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 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 New Building ...V.... ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property.../.~)'..~..~..~'....)~..~.%'.o..R/.. ~./~.~., ...... ./~. ~.'~../~..~.(;..j~: .~./..~?.'~../.z)./?.~ .... House No. Street Hamlet Owner or Owners of Property .......................................................... County Tax Map No. 1000 Section .. f..~.'77. ........ Block .... ~.. ......... Lot .... /..~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./..O.?.~.-.~... Date of Permit ././~.~/~...Applicant....~?/~....~.~..fi? ./~.~..t~.. ~ .......... Health Dept, Approval '- . ................. Labor Dept. Approval . .-. ..................... Underwriters Approval ..... .~. ................ Planning Board Approval .-7- .................... Request for Temporary Certificate ..................... Final Certificate ....~... ................ Fee Submitted $ .... -.~..~..O.~ ................. Construction on above described building and permit meets all applicable codes and regulations. Applicant ................................................... Fi~LiT~INSPECTION FOUNDATION (Ist) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY cope FINAL ADDITIONAL COMMENTS: N/O/F MARY ROACHE ;~ IV. 71~' 54'E. 217.92' N/O/F FRANK HAUPT Unauthorized alterat,o, or add,hon to tbs su~ey ,s a v,olahon of / ~~A~g secti°n 7209 °f 'he'N°w Y°~k'~Z/° EdJcoti°n Liw ' ' / ~'0 ~ SURVEY FOR LOUIS gi F~UTH 5TOKES A T MA TTI TUCK TOWN OF $OUTHOLD SUFFOLK COUNTY, N.Y. SCALE: I"= 40' OCTOBER Il, 1978 REF£RENCE~ .,~UARANTEED TO: SECURITY TITLE & GUARANTY CO. LOUIS El RUTH'STOKES LAND ~URVE¥OR N.Y.$. LIC. NO. ES?'25 RIVERHEADI N.Y. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1801~ Examined ...... ~..v'. ,~.o.., 19 .~.. Approved ................ , ... enmr r~o ............ " Disapproved a/c ................................ (Building Inspgctor) APPLICATION FOR BUILDING PERMIT Application No. '! ,~.r~J ~'~b- 7 Date ......... r.~. 7.L?..719 .~.. INSTRUCTIONS a. This application must be completelz 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 i~ 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 buildings for necessary inspections. (Signature of applicant, or name, if a corporation) 5.W... .7. .... (Mailing address of applicant) State whether applicant is ow.~_~ner, lessee, agent, architect, engitl~er, general contractor, electrician, plumber or builder. ...~¢.~..v~ ~. ~... ,c, 9.:.,..~...~. ~., .'.( .~ ~ .~..~... } ........................................... Name of owner of premises .. ~O.q. [~. ..... ~.~.~.c?..t'[ .~. ,.~. ............................................... (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 .... .~ 9.0.~...~..~J ........... Plumber's License No ......................... ~ //~,_ Electrician's License No. '~' '~ ~ '~ ~7~. ~ ...................... ff0~, Ca~ ~ 2;/,5 w'v~9 Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. · 1~.3s- .v.~.c..7-.~. ~/.h%, ............ .m...et...TZ,..~,~. House Number Street Hamlet County Tax Map No. 1000 Section ...... ./..~'., .'. ,"~.... Block ........ ~ ...... Lot /- Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....................................................................~S, b. Intended use and occupancy ..... 3. Nature of work (check ~hich applicable): New Building .......... Addition. .. Alteration .......... Repair .............. Rem6vai .............. Demolition .............. Other Work ............... ~i~ : (.~. (Description) 4. Estimated Cost... ~./..O.~..o. :.o..o. ...................... Fee ................... ............... (to be paid on filing this application) 5. It' dwelling, number of dwelling units .. 7FF?..'?... i .... Number of dwelling units on each floor..: ............. If garage, number of cars ............ ~ .................................................. 7. Dimensions of existing structurei, if any: Front...1 .x~. ......... Rear .., ] .......... Depth ..... Height ~ ~[ Number of Stories LO.~. . , Dimensions.of same st, ructure with alterations or additions: Front .... [?. .......... Rear...[.'~ .......... ~... Depth....~..~..-'.. ~. ........ :.. Height ...~[~...~ ............ Number 0~f Stories ~}, .(~C?~. 8. Dimensions. of entire new construction: Front . . ~.~ Rear . I..~.' .. Depth . [.t~ ....... Height .. ~[;~. ...... .~... Number of Stories ..... ~.Q?.' .................................... t' ........... 9. Size of, lot: Front . .~J_..O~ .~..._.,~ ...... Rear .... .o~.O../~;..o..~. ........ Depth . .?1./.~. :..R~. ............ 10. Date of Purchase .~..'~.: .I.l,~. [.~.~. ............. Name of Former Owner .............................. 11. Zone or use district in which pr~mises are situated....~...~...I.?.cl.~.'].~ .................................. 12.' Does proposed construction, violate any zoning law, ordinance or regulation: .... .~.?. ................. 17 .... 13. Will lot be regraded .... ~.? ..................... Will excess fill be removed from premises: Yesg' No 14. Name of Owner of premises . .~.o.w.~.-....~o~.~?. ..... Address ./..~.~f. ~(.~r. ~ .~.~7'~.~./( Phon~ No..~.~.~. - g ~.~.° Name of Architect . .T.,.ox...~ .h..~..t~ .L~.~ ........ Address i i~i ~,i~. i i.~¢'~ '~'c~' ' Phone No...-'/ Name 6fContractor . .~..ore....~.~..~.t.e-.~..~. ......... Address xJ}a~t~-~'~ ...... Phone No....'2..&. : 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 humber or description according to deed, and show street names and indicate whether interior or corner lot. COUN~I'Y OF ................. :S.S ............................. ' .................... bling duly sworn, deposes and says that he is the applicant (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 0r have perfo~ed the said work ~d to m~e ~d file this application; that ~1 statements conthined ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the manne~r set forth in the application filed therewith. Sworn to before me this t. ........................ day of .............