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HomeMy WebLinkAbout10844-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z t014h Date September '11 19.8.0 THIS CERTIFIES that the building ................................................ Location of Property ..... ~.7.0.~. W.e.~.t. C~'.e. ek. l~Oa~d, ............ C.tltchogtle,. N.¥ .... House No. Street Hamlet County Tax Map No. 1000 Section .... ! ? .0 ..... Block ...0.5. .......... Lot..0.0.~. ............ Subdivision ............................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · . .A..u .~.~*~..2.0. ....... , 19 9.©. pursuant to which Building Permit No...'I.0~./4~..~ ........... dated .... ~.'gg~..8.~., ,2.1., ............. 19..~.0, 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 ......... ........ D,¢9.k .4~.d¢~.o..n..t.q..a..O.n.e.. F.~.~y. ~w..ell. gr~g ........................... The certificate is issued to Robert Latham ................ ..................... .... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. / 4/79 N©. 10844 FOB~ 'NO. a TOWN OF: ~UTS~ BUIL~IN~ blPAR~! TOWN HALL SOUTHOLD, N~ Y: BUILDING; P,E~I/ dULL (THIS PERMIT MUST BE KEPT ON: THE PRE~ S~S UNTIL COMPLETION OF THE WORK AUTHORIZE0) ~ 'i Permission is hereby grar~ted to: tO at premises located County Tax Map No. 1000 'Section~./..~. ......... ~. BIo~,~, ,.~...;. ...... . pub,an, to ~,,c~,o~~-~ ...~....:.~.0 ........ .~ ........ . ,d B0jldlng Inspector. ~ ~ j ~ Lot No..(,,q.~.-~, ........... and approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or rand use 3. Copy of certificate of occupancy $1.00 $5.00 Date ~. .'~.~. :.~. (~. .~. ¢.¢. .17..,. .I.?.~.. ~ . New Building ............. Old 0r~,Pre-existing Building ............ Vacant Land ............. Locat,on of Property.. ~ ........ House No. Street Hamlet Owner or Owners of Property ,~be.( ~ ..... ~ .ff~ ~.~ ............................. County Tax Map No. 1000 Section .. /./~ ........ Block . .~ ......... Lot..~ ........ Subdivision ................................. Fded Map No ........... Lot No .............. Permit No./.'1~,~;~'..~. ,~.. Date of Permit .¢',~.~. .... Applicant /~, ,/~/'),~. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .... J.'~ .0. .................. Construction on above described building and permit meets all applicable co_des and regulations. Rev. 10-10-78 FIELD I~SPE~TION DATE COMMENTS FOUNDATION ( 1 st ) FOUNDATION (2~d) -- ~ou~ F~ ~ PLYING STATE EN~GY CO~E FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examlned/ .. . ...... Approved Disapproved a/c .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.,fi.(] .~.~. .~( ......... Date . .~/.* .~Dj ........... , 19~.0 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 Bmlding 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 braidings, 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 prermses and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) · .(q .. ................ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............... Co ~ p~.q.c..~...~. ............................................................. Name of owner of premise~-O .......... .~..O..~.~'..~...~. .... .~..0..~...~?.~. ....................... (as on the tax roll or latest deed) If applicant ~s a corporation, signatm'e of duly authorized officer. (Name and title of corporate officer) Builder's License No....c~..6.../ ................ 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 ...O....b.~-. ~ ......... Lot....~.O. ~.~ ......... Sub&vision ............................... Fried 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... ~....~ ......................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration. .......... Repair ......... : .... Removal .............. Demolition .............. Other Work...~..~-~./.~ .... 4. Estimated Cost ~ fC'~l~) ~ /~,,____~ (Description) ...................................... Fee .... .~. ................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ It' garage, number of cars ........................................................................ 6. It' business, commercial or mixed occupancy, specify nature and extent of each type of use ............. ,, ....... 7. D~mens~ons of existing structures, ~f any: Front.. ~4'Z,-,,~'. ......... Rear .............. Depth...~.,5~'. ......... Height ............... Number of Stories ........................................................ Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth .................... i. · Height .......... , ........... Number of Stories ........... ~ ...... .~... 8. Dimensio~toft entire new constr~ction: Front.. ~.~ ........ Rear ............... Depth ~., .-. Height .. ~ ............ N,u~ber of Stories .' .................................... .~,.,,.-, ~, ............. 9. Size of lot: Front ...... ~.O...: ........... Rear ...................... Depth . ].~..~. ............... 10. Date of Purchase ........... . .................. Name of Former Owner ............................. 11. Zone or use district in which pr6mises are situated ..................................................... 12. Does proposed construction wolate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ ....,.~ ............... Will excgss fill be removed from premises: Yes N_o 14. Name of Owner of premises .,&~.~./~/$. ~ ......... Address C~?~.~. ~>.~ ~.~... Phone No...~',~.~.~..~-~..~... Name of Architect ...... ,'....//~ ........... Address ....... Phone No. Name of Contractor .~..C~15/O.[~-. .... ~.Z'~/2-ZO. Address .~; .' .~)i( .~. ..... Phone No. i'~..~.Y'.'~..~..~.i~.'. PLOT DIAGRAM property lines. Give street and block number or description according to interior or corner lot.~.~ ~ ~.2----ff/~ Locate clearly and distinctly all,buildings, whether existing or proposed, and. indicate all set-back dimensions from :leed, and show street names and indicate whether STATE OF NEW(Y~RKa~ ,, ,~d .~ ~ COUNTY OF _~.. '~'~_ ,.,.,'~, ' .........~ '(N~a ' '~~i'~ing i'~n~i~" . .[3o*.~rr.x,~.. .i ........... above named. being duly sworn, deposes and says that he is the applicant He is the .................... (~f_~-4~ ................................................. (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 .......... ~-~.//.~ .~/. ..... day of ....... ~..., 19~. Notar~L Public, ........ ~ ..... ~.. d/ /[U~'8~" ~,£¥ILLE ~ '~ ............... mOl:'::app ,c n,,'--1]ra NOTARY PUBLIC,State of New York No, 52-8125850, Suffolk Cou~ _ Term Explre~ March 30,