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HomeMy WebLinkAbout10956-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy August. 6 8~ Date ................................ 19... THIS CERTIFIES that the building .... O 9.c.~ ~95'gy7., ................................ Location of Property .....fl..~.25 ................ Q0C';v. ql..i..&v.q: .......... ~.egp. n.~9 ....... Mouse/ye. Street Hamlet County Tax Map No. 1000 Section .... .~.z~ ..... Block .......... 3 ....Lot ....fl.O ............ Subdivision ............... x ............... Filed Map No .... ¢:....Lot No ...... .x ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated November ? 19~.? pursuant to which Building Permit No. flO956Z dated... ..... November....................fl 0 19~.©. ., 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 ......... An accessory (s~;ora~e) structure. The certificate is issued to VIRGINIA WALTER HAIRSTON of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 , · BUILDING PER~ITi (THIS PERMIT MUST BE KEPT ON THE PI~EA {s~S UNTIL COMPLETION OF THE WORK AUTHORIZED) N? 10956 Z JLL Rev.. 6/30/80 F~ector Permission is hereby granted to: · . ........... ............ :.-.-i. ....... ,lzz~ ..c~,~o~.. ~. + ..,~. ................ ....... r. Ec~IC,...~. ~o ..:....~,u~,.~,..~rx..~..~,~.e,~.~...,(,~.C,o-r.~*.)-.-~.'n~-~ ................ ~ ............. ' ........................... at piremises located at .'1.~ .(~.~..~.~...i;....~ ......................................................... ...... : ......... i .............................. ~.~co~zc.,..~..~zo~r~...~,~ ~...: .......................... ; .......................... county Tax Map No. I000 Section ......... .7../f ........ ~. Block~ ~;,.;;....,]~ ........,Lot No. ........ .Jfl ........... pursuant to application dated Novei~be~ ........................ t ............ .:.....0 19.....q.., and ~pproved by the Buil611ng I~spector. FORM NO. $ TOWN OF SOUTHOLD B ~ olng Depar~m,e,n,~ Town Hall SouthoM, N.Y. 11@71 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Thi; ;¢plicaticn must be fined in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor wi~n ~he foNow~ng; for new buMdin;s or new use: 1. F~nai ~r.'ey of property with accurate location of all buiMings, property lines, streets, and unu~al n~tural er topographic features, 2. Fm~ a2urovat of Heaith Dept. of water supply and seweraoe disposat--(S-9 form or equal). 3. Acp~oval of e!ectricai installation from Board of Fire Und~riters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buMding~ and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. 2ubm~[ Planning Board approval of completed s~te plan requirements where applicable. Fcr existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" ~. Accur2~e ~¢/e,/ of peoperty showing all property lines, ~reets, buildings and unusual natural or topo~r2Dhic features. 2, Sworn statement of owner or previous owner as to use, occupancy 'and condition of bulldings. 2. Da~e of 3ny housing code or safety ~nspection of buildings or premises, or other pertinent informa- tion required to prepare a ce~ificate. / Fees: ~. Cer~H~cate of occupancy 2. O~rt~ficate of occupancy on pre-ex~sting dweN~ng or land use 3. Copy of certificate of occupancy $1.00 New Budding .~. ¢4~..z~c~d.. Old or Pre-existing BuMding(,'~) ........ =/Vacant Land -' ,oc ,,on of P,ooarty/ .TJ., ................ . Owner or Owners of Property .~ CcuntvTaxMaoNo..lOOOSection ...0,7.~ ...... Block .... ¢,~ ....... Lot .... ~.~ Subdiwsron,.~,¢ ............................ Filed MapNo...~', ..... LotNo. Pgrmit No /~ DsteofP~rm~t / 4..,~ph~n~ ................................. Hea~th De~t. Approval ........................ Labor Dept. Approval ...................... Under.vriters Approval ........................ PlannTng Board Approval .................. Request for Temporary Certificate . .Final Certificate - Fee Subm:t~ed S ......................... Construction on above described building and permit'meets all app~cabf~odes and regulations. R~. 10-10.78 Ii FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 , xamin ed .......19... Disapproved a/c ................ .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No.. (..~. ?. 5..~. ..... 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 buildings for necessary inspections. _ (Signature of applicant, or name, if a corporation) ........................ /~.. //M~,(Mailing- address of applicant) c- ~4-4-v~°r ~50 , ,. State whether applicant is owner, lessee, agent, architect, engineer, gener~co'~n r~ctor, el~i~i~ian, plumber or builder. Name of owner of premises ~.,~..F~:~...~-ff.~.~:~.~*g~W~cx~. · .'f' .~.~..-.~.. ~.~ .e~ ~-o~..~.<.' .............. (as on the tax rolg6r latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber s License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. ~9~ation of land on whjtcl~ proposed work will be done .................................................. ................................. ~,~', ~.~. ~. ~..., ....................... House Number Street ~ Hamlet (~ [ ~ County Tax Map No. 1000 Section .... .fl'..?..~. ....... 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 ~.~-. ~.~ -..~7¢:;..~4...~..: ................................. b. Intended use and occupah~y ...~.. ?~..,~.f~..-<....,~...~.~?..~.--:ff.~'.-~g..'~ 3. Nature of work (check which applicable): New Building ... ....... Addition .......... Alteration .......... Repair Removal Demolition Other Work .~...~. ~ (Description) 4. Estimated Cost ........ ....................... Fee ......... .~..~. 'i. ...................... i (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 altoration~ or additions: Front ................. Rear .................. Depth . Height Number of Stories 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Nttmber of Stories ........................................................ 9. Size of lot: Front . . , Rear .......... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction viola:re any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... . ................ Address ................... Phone No ................ Name of Architect ........... i ................ 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. ~ STATL OF NEW ¥;ORK, ., .~ _ COUNTY OF-,~.~! . ,, .____ , . ...... f~.J/~ ~. 7~.~. .... ~. ~../'.~...-('..2~..0. ~ ............ being duly sworn, deposes and says that he is' the applicant (Name of individual signing contract) above named. He is the ...................... i ................................................................... ~ (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 ;i that all statements contained in this application am true to the best of his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this ........................ day of ..... 19. Notary Public, . '... C L{NDA F. KOWALSKI N0 ^ y 0,,o ¥0,, ............ Nq. 52,4524771 Qti~lified in Suffolk County P~omrai~sior~ Expires March, 3ar 198t:~'x (Signature of a