Loading...
HomeMy WebLinkAbout10641-z fORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No, ' .z.U36.5. . . . . . . , . Date.,...... .I?~.ce:;m~~.r. .~?........., 19 .S.~ THIS CERTIFIES that the bluldmg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property .. . 2.1-5 . Wor.thf ie.1d, Lane, . S.QlJthD.J.4 . . . . . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet County Tax Map No. 1000 SectlOn ,7.1........ .Block ........1...... .Lot , . .44 . . . . . . . . . . . . Subdivision. . . . . . . . ~ . . . . . , . . . , . . , . . , ' . . , .Filed Map No. . . ~. . . . .Lot No. . .X. . . . . . . . . . . conforms substan!lally to the Application for Building Permit heretofore filed in this office dated '" April, .30, , , . , , 19 aD pursuant to whi~h Building Permit No. .. +9!5.4,J,Z. . . . . . . . . . . . dated. . .. April. .30. ,. . , . . . , . 19 8.Q , was issued. and conforms to aU of the requirements of the apphcable provIsions of the law The occupancy for which this certIficate is issued is . . . . . . . . . '" - ,. . , . .' . .accessory, stora.ge. bU,j.J.Q.;Lpg. . . . . . . . . . . . . . . . . . ., . . . . . . . . . , . . . . The certlfJcate is Issued to .. .Mic.hae 1. Morr i.s , . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . , . . (owner, ~see-or-tenQnt) of the aforesaid bUlldmg Suffolk County Department of Health Approval .. .N! A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERT1FICA TE NO, , . . . . . . . . . !"/.~ . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 'b '171 6?= ' .. c, ~ 1J?:.... ~,. ":7..... Building Inspector Rev. 1/81 .. ~ , u. "I. FOR)\( NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10641 Z Date .+ft.I..t..,.........;l:Q..................., 19dO,: Permission is hereby granted to: ......bI..('.tY&c:.t.....da..ac.(~..7~.' .. ....Z~.YO.ll1#..i0:E'-Z,).... ,A...., ........ ~~e..=../.\..-,~,..., ...., . ! :~..::::::~~:~~~:~::~~~:~~:~7:...:::~..........:~~::::::~.~,~~~5:::::::.:: at premises located at::;;:f.(...d/~..,{k4~/.li:~....L;a4.............................. . ..................................,...........................,..........,...... .......................~c.<~L.R.=:;(.;,..7...~ ,................................................................................ ............................................................................... pursuant ta application dated ..+~..I...-......s:.a............., 19~:, and approved by the Building Inspector. Fee $.lO~...... , , -, - -, fORM NO.6 67rY ~ r C(1 TOWN OF SOUTHOLD Bujiding Department 1/?/82- ~ Town Hall Southold, N.Y. 1i971 cf! . APPLlCATIO;\J FOR CERTIFICATE OF OCCUPANCY -ccc'l ~~ 7 Instructions A. This application must be lilled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor "''11th the following; for new buildings or new use: 1. Final survey 01 property with accurate location 01 all buildings, property lines, streets, and unusual n3tur3! or tODocraohic fe3tures. 2. Final approval 01 Health Dear. of water supply ana sewerage aisposal-(S-9 form or equal). 3. Approval 01 electrical installation Irom Board 01 Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildi.[1gs and installa- tions, a certilicate 01 Code compliance from the Architect or Engineer responsible for the bu iiding. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to /\prll 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 prefl)ises, or other pertinent informa- tion required to prepare a certificate. / C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre.existlng dwelling or land use $5.00 3. Copy of certificate of occupancy S1.00 Date. . , .. .. N~.{ Duildi,,~ .,( if~.O " . Old or Pre.existing Buildlng(X) . _. .__ - ,. . IVacant land ....., ....., Location of Property .?"/ (., , . ..t!:.k 1-,(;-1:[: ~ !ff-fl. . . . . . . M; . . . . . . S:c.: d. ??~z;...f? . . . . . . . . . House No. Srreec Hamlet Owner or Owners of Property . ./':1.(~~n-E.~.",: .-.', ,,rUr./f..<<.J......................... .. County Tax Map No. 1000 Section .. ? I. . .. . .... Block ....../........ Lot. . .J... 1:. . . . . . . . . SubdivIsion. . . . Po. . .. . ., . . . . . . . . . . . . . . . . . . . .Filed Map No. .....,... .Lot No. ............. Permit No. (C?{,.y/... Da:e of Permit 0-~ .,. .A;;;okant ..(# :.c;!(:fJ .0.".?-: '" .... . " . .. . , Health Dept. Approval. . . . .. '" . .. . . . . . . . . . . . .Labor Dept. Appraval .... ..... ... .... ......\.. UnderwTlters Approval....................... .Planning Board Approval.............,..... '.. Request for Temporary Certificate. . . . . . . . . . _. . .. . .. , . .Final Certificate.. . " . . .'. .. . .. . " _ Fee Submitted S. .-}..o.. iK.. .')):1.41./.6: e(..... I Construction on above de~~ribed building a"d ~'> all appl.i,cabl~JJ,pdes and regulations. ApPI;c.:m~ .. ',' .,~~..,.. ..J,..... .J.......... R". 10,10.78 . r [), {36lf- ((0 +- C{ S~/AJY ..:" :':"'~'.~t~;}~':-t..;--:"" :.:' .,~ .~~ " " .. j' _.it iL " _ ~H~j)__~~~~~1~I~'i==~-"7..cf ":~~l=-==..c~.=-'='-c=c l;O:"L":l"l~=_ ~:''--.---====--=i ~'~ _".._._ _____ .J ~~ '~ ..- --- -1-----.------.--..----.--------'-----------'--'--.... :::j FOUNDATION (1st) ~ _-_--__-- __ 0 " N FOUNDATION ( 2nd) b) H,~ 2. ~ - !~ "I' ROUGH FRAME & z~ PO') PLUIvIBING , ~ (\ [j) '-I 3. q~ - (1) ~1 INSULATION PER N.Y. (1) m c+1\.. ~ STATE ENERGY t' CO:QE / , ~- f~ 4. 'Vzf!?'2, au :/ fMJ &I(/('D ()u.~c~(\ 1-' - / -- (1) c+ FINAL , ~~ . ~~ ADDITIONAL COMMENTS: , 8 --- \f\ - , ~, i1~ ~~ c+"'... g~ - f - ::r:: (1) .' J}) f-' c+ ~ . t:I . ~ I c+ , . 'j ;..~ " "'- .L~iI -", .. ~ .. ' . *' . fORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 &.mJ'"1:'~. 50., 19 .JP. Application No. . ./(1( ~/. . . . . . Approve . .'t:t:~0: . Sa. . " I~. Pennit No.!al?-?/ Z:- p ~ Disapproved a/c. . . . . . . . . . . . . . . . . . . . . .. ... ...... .. "- . . APPLICATION FOR BUILDING PERMIT Date 7it:d:-..J.d..., 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 Pennit. d. Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such pennit 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 Pennit 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. ~~~~ii; ~;';;;~ii';;).. .V.5.');L~:..<.. ,~4/ (Mai g address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ .c.P. (....c.<'~ ,~~!.':.......,.....................,....................................... Name of owner of premises .. ,#.(.''!-. t/.;{J-,?i'olC. . . . . . .tV (),/;(, ;<.(. J . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . (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, ......,.......... ... . Other Trade's License No. ....,........,.,..,.. I. Location of land on which proposed work will be done. . :?./.s'~.. .,d~/#h:4'~. '(~'" .S."f{/~..?? ..,....... .. ... ,..................................... ,.... ............ ..,........ ,......, House Number Street Hamlet County Tax Map No. 1000 Section .....'7/......... Block .. .1 . . . . . . . . , , . .. Lot.. .<? <I. . . . . . . . . . . . Subdivision. . . . . . . . . . . . . X~/. . . . . , , . . . . . . . . . Filed Map No. ,.x: y... y. . .. Lot .x:-.><;<,:,. . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occur. I)cy .of proposed construction: licP/V? ~ ~ ' ~. ..E'"'""'"~""_pm'y... ....:............. ... .. .. . .~............. b. Intended use and oecupancy ... ,),r&./!..h:F:--:....S; .4:':0...... .~K...... ~~P......... i , , , ~ ~cc..!';. scnrj . 3. Nature of work (eheck whicb applicable): New Building ~>~~-::: . . ! . . . . . .. Alteration .......... Repair .............. Remqval . . . . . , . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . #. : _ '~tfYCJ (Description) 4. Estimated Cost. . . . . . . .~r?. .~. . . . . . . . . . . . . . . . . . . Fee . ./ Q'. . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . (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, commereial or mixe<;l oceupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structur(js, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth......... .'. . . . . Height ............... NUmber of Stories. . . . .f.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear.. . . . . . . . . . . . . . . . . , Depth'. . .. .. . . .. " . . . . . . . .!. . Height. . . .. . ../ . :. ;fl/" " . . . . Number of~ories .. ., . .., . ~~/./.... ... 8. Di~ensions of .22tireJ~ construction: Fro.nt . . . . "e~< . '. " Rear . . ./?J.--#- ~. . . . Depth . Tr . '. . . . . . . . HeIght . .c;. .M fr7;,' . NUl1)ber of Stones. . . . . ./. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front.. . /.'ij-;': . . . .. . .. . .. Rear....1 ~.--: 1. . . .. . .. . .. Depth /. ~.r. .. .. . .. . .. .. . 10. Date of Purchase .... /.9.?t::................ Name of Former Owner. .(f,"v'19': .4':'(~(.~~...... II. Zone or use district in which pr$mises are situated. . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ... .~<P. . . . . . . . . . . . . . . . . . . . . .. . 13. Will lot be regraded ........ ~ . . ';../ . . . . . . . . . . . . . Will excess fill be removed fr9J11 premises: Yes No 14. Name of Owner of premises i!1. .r.r,,~&,f.r.f. . . . Address),Is.-.~I4V.~~';q.H4)hone No. ~J.'(.':~..s:?'. . . . . -Name of Architect .. . . . . . .. ................. Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . .. ................. Address . . . . . . . . . . . . . . . . . . . Phone No. ...... . . . . . . . . . PLOT DIAGRAM Loeate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-baek dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. " LJ <""'-- ?, r /- I-,II1.J_ J<:;{ ,..J;tJ....tfo- ~ I1PPROVE~ AS 'NOTED " U=.L. '~:re. - .."'n;!? :'#', .----..-- - --.---.---'-"'- . 'm~ !BY f ,NOTtFY I3vrwrN~ D&'ARTMENT AT ,). r6'5~J18012> ~',M.I\;I'O 4. I'M FO'R 11'-f~ n fOLLOWING INS~ECrJaNS:: 'hI Pi ,I. FOUNDATION ,- TWO Rl:QUAm> '\ FOR POURED CONCRETE' 0 ,~ ROUGH, FRAM: rNG & PWMBI'NG i :4 r' . tNSUI.ATION i I 'Pao t- I _ FINAL ' CONSTRUCTION M~T ! ~ BE COMPLETE' FOR C. O. ,. C\..: LL CONSTRUcflON SHAll MEET ""- ' HE REQUIREMEIltTS OF THE N. V I I ,;,. />TATE CONSTRU~rON 8. ENERGY !lot.{ 5 !of ' i.. tODES.. NOT ~ESPONSrBlE FOR ' ~ pESIGN OR CONSTRUCTION ER.R.ORS. ~ L ...,., -:1,.------.:. ".-''''-' , 1 3 ..,-':'-------.'.. -q f"/& IZ TIIF /6"L;) t rJ. . S.S .. 'flf." - . . . . . . . ~ . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant (Name of ividual signing contract) above named. : He is the . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dbly authorized to perform or have perfonned the said work and to make and file this applieation; that all statements eontained in this application are true to the best of his knowledge and belief; and that the work will be perfonned in the man~er set forth in the application filed therewith. Sworn to before me this . . .. ... .. . . 'f' ..ffl..p. . .day ~ . . . .. .., 19 PO NotnryPUblic,~.{}!.: ~ , ~. \ LILLIAN D COfH~N, Vork . . . .~ . . . . . . . . . . . . . . . . . . . . . . IN t P hlic $\i)!p 0 I' eW , o ,ry No '41..610695 ! () (Signature of applicant) , QUf1\lhcd In Queans co(r\\~\'I' 0..,1 C~"'miS5\Ort Lxplri;l5 March J, . ". ~ , ,