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HomeMy WebLinkAbout10978-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z10564 Date July..gs .............. 198.1· THIS CERTIFIES that the building ................................................ 3440 ganhan~et Avenue ~, ~ ~o? 's'~;e;,° ...... Location of Property s .Woo~ .~ane, .......... v~enpo.~g ~ - N~W · ~o~k Hamlet County Tax Map No. 1000 Section .... 043 ..... Block . 0.4 ............ Lot .... 027 .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Pemit heretofore filed in t~s offi~ dat~ ... No.v.~mb~. 18 ..... ,19 89. pursuant to w~ch Balding Pe~it No .... ~9~.T~[ ........... dated ...~gY.~gK .~ ~ ............ 19. ~P, was issued, ~d conforms to a~ of the requirements of the applicable provisions of the law. The occupancy for w~ch t~s ce~ificate is issued is ......... ..................... Pv.~va g~..One~EamiZg. D~lllng .......................... The certificate is issued to ...... P.e.~OP. ~l~YXag~..gg~..Rq~gP.~ .................... (ownerx~~XX of the aforesaid building. Suffolk County Department of Health Approval .......... ~ ~$~/.~ ~*. ~.~9~?. ~.'.~ ~ Y~.~ P' ~' u~vs~w~Ir~s c~r~Ic~re NO .... ~5 ~ 9.~ .................................... ildi Rev. 1/81 l~O~ NO. ~ Town o~ ,O~T.~i ~ BUILDING DEPART/~I TOWN H.~LL ~, SOUTH'OLDi N,. Y. BUILDING (THIS PERMIT MUST BE KEPT ON THE PREhilS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) N©. 10978 Z Dote .... ~.5~..~.~.~.r~.,::~...; ............. , ~%.~' Per~issio~ is hereby granted to: ...... ~Q ~~¢.~... ~...~.~.~..~....~, ............... .~ ,o....C.o.~.m~.c.t......~.~- ...... c~.~...~xZ~.~ ..................................... ......................... ~..:~ ....... ~.....~.(~.~.~.~.~.'~...~'.~ ~ ............... ..................................................... ..... ....... %"~v ,~x ~op ~o. ~oo0 so~o~ ..~.~ ......... ~o~k L..¢.~ ~ ........ ~[°~ ~o...~.~. ........ pursuant to application dated ~;~~....... ~'~ r: 19 and approv~ by the Building Inspector. ~e ~...Z... .~ .... Building Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 disposel-(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. 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 New Building ....~... ....... Old or Pre-existing Building Location of Property .. ;-..~: ....................... House No. $5.00 Date. 7.~;~, .'~. · · ) ............ Vacant Land ............. Street Ham/et Owner or Owners of Property .~.~.~. ;~. ,~'.'~ .~.-.~ ...... i~. '.~?.~;: {~~, .... ~,.A, ~g ~ ~'. ~ ) ;~.'}~) .~ ...... County Tax Map No. 1000 Section . ~;~ ........ Block...~ .......... Lot.. ~;'~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. .......... / Permit No., , te of Permit H. / ...... Applicant ...... ~ ...... ~ ~'T,~ ~<~ [g' (~ ' Health Dept Approval ~ '~ "~' Labor Dept Approval ...... ~ J ........................................... ¢? ~riter~ ~pCro~al ..................... ~annin~ Board ~p~roval ................. ~oquo~t for Tompomrg Cortificate ..................... Final G~rtifieat~.. ~ ......... Feo Submitted $..~ ~ ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~ ' .... ......................... Rev, 10-10-78 COMMENTS FI,ELD INSPECTION !. FOUNDATION FOUNDATION 2. ROUGH FRAME& PLUMBING (2~) INSULATION PER N.Y. STATE ENERGY CO~E FINAL ADDITIONAL COMME~S: UNIT HEATERS ¥1U[TI-OUTLET DIMMERS ~S¥STEMS ' ' NO. OF FEET t I~e 'Idqniifled rcr~lenfials. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examine .?. .... Approved 19 . Permit Disapproved a/c ........................... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 wilt 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. .I .... .~. co,o.~ Te, ..c~...re.e: ................. (Signature of applicant, or name, if a corporation) 5(o...~%.c.~.,, a..~.~-.., ~ .e.¢. i¢.c.~., ~..~.: ~.t .s~ 4... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .'~..~..~. ~ .~..c-. ~ .................. Name of owner of premises ~ t~ii'. . .~.'. . ~.'. . ~.~_.~. ~"lft~. I~.~..l,l V. ,.~.TIJ. . .'t-. I. .~. .~.o. ~. l. .... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. Builder s License No .......................... Plumber's License No... 7..~1~. 4....~. .......... Electrician's License No...1~../.?...~. ............ Other Trade s License No ...................... Location of land on which proposed work will be done. /~.'{.....~.~.....-~.?. ?.?.~..~..f~.~...'~. .... .O~...~.~...~.~. ....... ~ .h . . ~. ...................................................... ~. .~. . ................ . ..... House o Street Hamlet County Tax Map No.-'~T-000~ec~ion . . .~..~..~ .......... Block .... .~. ............ Lot . . . ~[.'7 ............ 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 ....~. ~....~..~..~...~. ~ . . . .Q4.Q.'I~ .......................................... b. Intended use and occupancy . ~). ~ .~..~......~....~'~. ).U..~/. .... ] .~. ~.4.~ .~...~.....~.. ..................... 3. Nature of work (check which applicable): New Building ...... Addition .......... Alteration ..... Repair .............. Removal .............. Demolition .............. Other Work ............... ~..~. 7.~..~' (Description) 4. Estimated Cost .~1.,~. ~.O.O.~l_~t~ ........................ Fee., ............................... (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 .q~.~..t~ 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 . I~ ............ Number of Stories ..... O ~.~ ............................................. 9. Size of lot: Front . .~.O ................ Rear ... I.~.O .............. Depth ... ].~. ~ .............. 10 Date of Purchase Name of Former Owner H. Zone or use district in which premises are situated.. ~2~g *~2>.~-.~'~. ~ ~. ................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: . ..~. ~ .......................... 13. Will lot be regraded ..... ~4~:}I ................... Will excess fill be removed from premises: Yes 14. Name of Owner of premises ~ .,Ol.o.t../.V. t ~.~.~$ ..... Address~..~'..~..~pp....~.1-.~?~..~: . . Phone No.~/'~,.&~.F..~)/.-~ .~'~'~. Name of Architect/,.'.T~.~J.'/'.~ !'~.~ ............... Address ~.~.,.?.4.~..~)..~ .... Phone No.~'4'.7.:L~.g.~. ..... Name of Contracto~"lv.~.o~:,,,,~'W~. e.~a *,.4a ....... Address~ ~,o~¢~ .fi~t. t~-~,Phone No. ~.'~:-.~. ~.LI ..... 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 NEW~X~RI~,a ~ g 'S S ·. ~[ .... ~-q 1 .k, ~,-.X. ~, ."~ .... W~.~, ~ ~*. ~ ............ being duly sworn, deposes and says that he is the applicant (Name of individual sigaing contract) above narned. He is the . .~.~. ~: .~..'...~..i.~. .... ."~.....~f~......C~.....~...~,.~. t' . .t~...~.. ?.; ............................ (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 cont~dned 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 Nota_rg-,P, ubl!c, . ...... ...~ ..... i~,.,,¢x}~. County ',~ z