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HomeMy WebLinkAbout10897-zFORM NO. 4 TOWN OF So[JTiqOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z ~0316 Date December 22 19 80 THIS CERTIFIES that the building .............................................. 5400 Main Road, Laurel, N.Y. Location of Property .... ' ........................................................... House No. Street Hamlet County Tax Map No. 1000 Section 12~ .Block 3 .Lot . Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... $.ep.~o.~..b.e.r....29.,.. , 19 .~O. pursuant to which Building Permit No ........ ~.qa. 97..Z. ...... dated ...0.9 .~.°.'q~C. ~.' .............. 19..~.0, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ~ddition to ~ccessory (G~rage) Structure Frank Carlin & The certificate is issued to ..................... [o~'n'o'r,'~:~~ ................... of the aforesaid building. Suffolk County Department of Health Approval ...N/:R .................................... UNDERWRITERS CERTIFICATE NO...N../.~ ............................................ Building Inspector Rev 4~79 FORM ~0. TOWN OF. BUILDING SOUTH'OLD, BUILDING P,ER~IT* (Ti-IlS PEP, HIT MUST BE KEPT ON THE PP, EMI$~S cOMPLETION OF THE WORK AUTHORIZED) UNTIL EULL N©. 10897 9...rko Permission is hereby grot(ted to: '. ~ ....~ ..q~.:!:..~..~ ....~..-. ........... :i ............. "''~ ...... ~ir,..~.~,...a~x..llS2,.,...! .................. Mattituck, New York 11952 to ....................... Q~2.Q..A ....... o ~TLT~E ............................ at premises located at . .5.1 O0 .~azg..R.o.a~, ~aur.e.~.,...~..~ ..~...o...'..~...r L County Tax Map No. 1~00 Section .... .J.,.2.~, ............ Block ..... ~.,,~. ........... ~Lot No ........ J.~ ............ pursuant to application doted .... ~.~:p..~.e~b.f~,..~ ........... :..;.~;.....,~ 19,.~0,, and approved by the Building Inspector. 10. O0 . Fee $ ....................... ReV. 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southotd, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th'is 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 s~te plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildin, gs end "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- t~on 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 $5.00 Date .. Dec1 17, 1980 New Building x Old or Pre-existing Building Vacant Land 5100 ~,~ Mai~ ~p~ LAurel Location of Property .......................... ~ ...... ~ ................... House No. Street Hem/et Owner or Owners of Property ,..~:F{~, C{9~,3.:~. & .~f ..................................... County Tax Map No. 1000 Section .... ~.2..~ ........ Block ..... ~. ........ Lot ..... 1.Z~ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 10897 Z Date of Permit c~z/.2.~./.~Applicant Mrs. Ca.r. lin Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...X ................... Fee Submitted $...~.. ,0.0 ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant.~..-~..~......~..~ ..................... Rev, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .......... ,19 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 Pem~it 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 in.~pections. ~ ., · '(Signature of applicant, or name, if a corporation) .Te'. eL . . . . .o./. /lt. . . . (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ................................................................................ Name of owner of premises .F./~.../~. ??....d??.~...~./'../~ ................................................. (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. Plumber's License No ......................... Electrician's License No ..... . .h~.'..v~.. ........... Other Trade's License No ...................... Location of land on which proposed work will be done .... ~ .~.~.~..~...../~..A~..//.~...]2..~..~..~...~ .~.~?~ .~. ..... , .................................................................... House Number Street Hamlet County Tax Map No., 000 Section .... /..~...~... ...... Block ..... 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 ..... ..~..~..~. ~.Z'.~. .................................................. b Intended use and occupancy .... ~j'~tt ~. ~5~-~JZ'~,~ 3. Nature of work (check which applicable): New Building ....... ,... Addition .......... Alteration .......... Repair .............. Removal .............. 4. Estimated Cost ...... 0 o Demolition ...........· t, Other Work ............... (Desc 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 ....~?.~.L.....~.~..~..~.... 7. Dimensions of existin~g structures, if any: Front...,. ~../:T~ ...... Rear .... I..~..~..~- .... Depth.. ]..~...~..~. .... Height .. ,/. ~*../.~ .Ti ....Number of Stories ..... ] ................................... . Dimensions of same structur~ w~th alterations or additions: Front .... ~.~./~...T7 ..... Rear... ~.' Depth .... L .~. ~. ........ '.. Height ...[.~. 1~.. T~. ............ Number of Stories ...................... 8. r)imensions of entire new construction: Front ... ~ .~...~.T ..... Rear ...I../4..~.-tT. ..... Depth . .I. otc .]:q..~.. .... Height ../.~,. ~ r ..... Numberl/f Stories ....... / ................................ ............. 9. Size of lot: Front ..... 1.9..~, T'...rC ..... Rear..."./.~/~. (~...f~'. ......... Del/th .~z.~..~..)~. :~.7~ .'~.]..'~f/. 10. Date of Purchase ,. [, ~t.~. . (o,- .; ....... iiii ...... - Name of Former Owner ...~J~..~-.hU.~....Q,J~..tr-~t/.¥. ..... 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction vie!ate any zoning law, ordinance or regulation: .... /.~..O ........ ........ 13. Will lot be regraded .... ~-~..~..' ................... Will excess fill be removed from premises: Yes. (~ No./ 14. Name of Owner of premises J~...,~-g~'~.....~-~.~..L?/Y'... Address . .~...~.~../-v. .......... Phone No. l~,.~. ~.'..~.~./..nt~.. Name of Architect .......... , ................. Address ................... Phone No ................ Name of Contractor ......... . ................. Address ................... Phone No ................ PLOT DIAGRAM t: fl'~" Locate clearly and distinctly all,'buildings, whetherexistingorproposed, and, indicateallset-backd~r~m prope;rty lines. Give street and block.number or description according to deed, and show street names and, kfdicate whet~er interior or corner lot. ' .e,'~¢' ~ ~ ~ COUNTY [ S.S contract) above named. J .......... being duly sworn, deposes and says that he is the applicant He is the ..................... ~ ...................................................... (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. Sworu to before me this ......... c~.6~.,~ ........ day of~..~.., 19 , ("/ ELiZaBETH ~Ji~ ~IEVILL£ .................... tt0TAR¥ PUBLIC State 0[ New ¥0r~ (Signature ~f applicant) ~o 52-81258511, Suffol~ letm Expires March 30, 19~-,''~