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HomeMy WebLinkAbout10677-z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT T own Clerk's Office Southold, N.Y. Certificate Of Occupancy No.... .~,1.QQOp...... Date....... .;r~lX ,1..................,19 .8? THIS CERTIFIES that the building. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LocatIOn of Property .., ?-.Ei~?, ~,q~. N,~C:~. \i.~.~d. , . . . . . . . . . . . . . . , . . M~.~~~ ~u.c:~! . !'T...Y ~ . House No Street Hamlet County Tax Map No. 1000 Section ... :1.1} . . . . .Block ....97.... . . . , .Lot . . . . . . . .q~? . . . . . Subdivision. . . . . . . . , . . . . . . , . , , . , . , . . . ' . . .Filed Map No. ....... .Lot No. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated . .. .. .~i3-y.. 17. 80 .. 106777 , . . . . , 19 . . , pursuant to which BUlldmg Permit No. ..................... dated .... .~ti1y. .~1. . , , . . . . , . , . . , , , 19 .~C?, 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 . . . . . . . . . ...............", f{,o,q.f~~,-.qy~~, .~~~~? .'?~.. .E;~~~.~~~~, ~w~~~.i.~~,.............. The certificate is issued to .,.,....,.. .wrp..j,E!~. A.'. .J;.t~~~~~:. . . . . .. , . . . ., . . . . .. . (owner, I J of the aforesaid building. N/R Suffolk County Department of Health Approval ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . , ' , . . . . . . . . . .~/~. . . . . . . , , . , . , , , . . . . . . . . . . . ,...C~...~~......... Building nspector Rov 4/79 ! .,_.1: 'n~' . > , FORIII NO. 2 TOWN OF SOUTH OLD 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? 10677 Z Date ........MAy..........df.....,....,.., " 19tfO. Permission is hereby granted to: .........Wt.lI1.8.~....4....Lt,N.VS~.....;1Z ....<<.c..d.:F...........c.(l.~..i.I.;;.(;...k;.,.., Ii; .c:J.&R ....../dA>U.-r.:/X.<:.-k....",..../.,).:/..... .. , 1 - - t:"" - - J"- to ..(JQ.iY.?,(/,(.(.;..fd.,.......'<;a.or.:ER...t:2"v.Z'a.., ../:.;,.c.t/. .....Cu,<..,..jf;V.t'ST./.1!.J.7"..'...."... .. .. ..7.'.t.v..?/It.&i;;)', ...;;.... ..~:.......,..... '....i.....'..... ..,......... .........,...... .............. ......................, .........."., at premises located at d6d.~.."....CQ.i'f.....W.E:.C,{.......A~.P....................................,..,.. .......................................................".....,.............. .. ..........,.. ..............MAIII.J.::i:.","'.iLI/. ' ,................................................................................ " .......................................................................... pursuant to application dated ..M.4.y......I5:........, ..........." 1~,.., and approved by the Building Inspector. ,"5. .c- Fee ...........=:........ .. i ,. . . FORM NO.6 TOWN OF SOUTHOlD Bu ilding Department Tawn Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructians A. This appllcatian must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspee- 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 dispasal-(S-9 form ar equal). 3. Appraval 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 appraval of completed site plan requirements where applicable. B. Far existing buildings (prior to April 1957). Nan-conforming uses, ar buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural ar tapograph ic featu res. 2. Sworn statement af owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any hausing cade or safety inspectian of buildings or premises, ar other pertinent infarma- tion required ta prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate af occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 D~te r' ~.~ ~.~ .'I. Kq.. . . . New Building............. Old or Pre-existing Building ~.. Vacant Land............. Location of Property P.\ <.odS. . . ~ 1l~. .~,J,... . . . :"YJ.\.~Jl; . . . . . . . . . . . . House No. Street Hamlet Owner or Owners of Property ... .'1<.J~. a...X ~f:.................... County Tax Map No. 1000 Section ............... Block ............ . .. Lot................ Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , .Filed Map No. . . . . . . . . . .Lot No. ............. Permit Na. ;.0 (Po? 7. . . Date of permit'f.Y.)''1-15, 1 \i~licant W~. .6... ct' ~~. :f. Health Dept. Appraval . . . . . . . . . . . . . . . . . . . . . . . . Labar Dept. Approval ........................ Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .Planning Board Appraval . . . . . . . . . . . . . . . . . . . . . . Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . r:. . . . . . . . . . . . . . . . . . . Fee Submitted $. ... .:i...Qt;J,.................. Constructian an above described building an~it meets all applic~~le cades and regulations. A","", . A~,~tll~7l:.P p. p. p. p... Rev. 10-10.78 (!. .0. t....llJTtJ t '7/;/ 70 f!.-IJt:.. :# ~ 67 <f tCe~1F/'1~ , .0' j Jk .', FIE~D INSPECTION DATE COMMENTS - 'lj ~. , ~ -----;. ~ .1.. . -- I::i'o. --~~~~-------------- HI "-J >-:1 ._.~~"';~ ".! -YOUNDATIQN (1st) 5 ~ ~ - - ---- . '- N I ~ c:: FOUNDATION (2nd) m ~ . ill I 2. -- ROUGH FRAME & ~~ p~ PLUMBING l{ S\ 3. ~~ - !~ INSULATION PER N.Y. - ~ STATE ENERGY CO:QE - ~ 4, It/U1 lie,(! d ~ ~fi-/ ~ 11/ ,/ (J- ~'V - , ill, < IT 17 1,( .4. ./,~ , FINAL f/ /' -- . ~ ~~ :3' - ~ ill Y-~ ADDITIONAL COMMENTS: 'i, ~. .- '" ---'--- . ~ , -- , ~, rs-~ 'i", !IJ _ IT'" 1-" ':xJ 0' , :3 " 1 - - ::c: ill ~ ~\ t:J ~ IT . , j "\1< ",,' L .1\.. ".." ~ , ,- 1 . . , , / 'I}, ~~~ r ~ ...... f ~ +- ~. / }' 1~ tJJ- '-~--'~"""'t'-" , 1.,,11I,tll'\'" ~:~ /- '{,':It., lP1ii~ \' ,'I"j'" _" l'~H: f'-' ,~;, I r ";,}~!~~1t,, ~~, ( ';1,~!,\},j{('1 t , '\ " ,;,,} .\<, '., ~ ,,,._,,,;-.,'\t"'l""# \Y :','~'~,~N,,:;;V'j. . "f':;'),'I\{~~~ -'>11 ,~,~' P'\'tP,' jl-.,-,jr.' -fr.;<~", j~ -\-q ~^t~:~\1 - ;_...:~~}~\, Q ,~"_, !i, ." ,j"O . n , ".~.""""~ ~ ffI:!f1~! ' ' .1.JMU ' \ }I .' _r,t::;:' ""~ ft.-='> ..,.. ",,,,~f~1<;i '4>f" " -,' .. 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'/ Z -I Ir -CJli Zr: .-- -----~ DC :)' " pjiJi -ill ry ~~~ \ 1':<' C,{ , r A vi I r,' ,< - 71" h 1!1 ~ H -<1 (II '" '" 7: J1 ~z Z 'If' O~ r-...._ 1> ~ lJ ;. ~Q " tj IJ) ~, I~I } l ' >- l ~ ... -1'1 I -" , ~ \() - , ,>"' 'r' ~ ~G 1" :u~ ' ' , " . ~ v ~~ pI (:0 $. "'t .. r- '1J. ! <11' ': ' - q, r u - _rJ ~ ~ ~~., '-. -~--/ ()) UI' n' ." /..-.....- 1 -.. j .-.--..,.-~--.J .: IF.' '0 L~ , I L 'I)' ~," ,>' \' ~...,' ",-'" '" ! _. . ---'___ _~ _,," ~ _ !~ .">!:::~ ~'", t ..---" " .. L -- J ........._....,-'__... L _:L" r t i ~ :rp N ,'. " x .. -'rtJ(/~ { , " \~~. _ __ _ .~___ _ .... .__ . . -- -.- - '-" n,_ __ , .-.'.-. ,. - ..- .. ---.- , 'e 11/1/(;"11\(\\' 1 ,f " -'."'-," ,. ~~'. ~l ... FORM NO.1 TOWN OF SOUTHOLD , BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ExaminedlflAV. .dl...., 19&) Application No.lo.t. 7.7 . .. ... . Approved H.';;;~f. d ( . . . ., 19J<1. Pennit NO/O( 77.-? - ~ D"'"~,,, * . ................ .~...... . , . ...........................,.. ..... . ..... ... . . ................. .~~~ (Buildmg Inspector) APPLICATION FOR BUILDING PERMIT Date. .. . . :?:v.J.~ .15. . ..,19 .r.(). 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 shaH 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 Penn it 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 buildmgs for necessary inspections. . . . (S~~~lj~t:: =e~~ta~;~;)' . . . .~c..<?-.s:.~.?l~'~'j'%~' (Mailing address of app icant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,...,.....~........ -,..... -,.......................................... ,.... .,..,. .,. ... Name of owner of premises ... .tv~. a.',J(:'s:~'~~it;~li~~i~t~~t'ci~~d)"""""""""""'" 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. .. 7.C!.f. . if +. . ~ ~ I. Location of land on which proposed work will be done. ................................................. .,J,~';.5:. . , . ..... ,&.??~..~e!-,.......... ........,.., ,.....,.. ............, ,.......... House Number Street Hamlet County Tax Map No. 1000 Section, . .II. j3i'. .. .. . .. . .. Block. q 7.. . . ... .. . . .. Lot. 9.Q.~. . , . .. . .. . . 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 '2' .@.U-R. F/?1-!/.(;7.. . ~7i;-II./'Mrf';. . . . .. . . . .. .. . . .. . .. . .. . . .. .. ~JO;::~! ~ b. Intended use and occupancy a:zr~., ,~ . .,o./?/.?.f.I.1. 9. -!<rI. . . . . . . , . . . , . . . . . . . . . . . . . . . . . . . . . . . . . 1 1. ~. "- J. !.ol! ~ . " 3. Natu~e of work (check whicp applicable): New Building. . . .: '.' . .. Addition. . . . , . . ... Alterat~n .., .:'..,'. . . Repatr .............. Removal . . . . . . . . . . . . .. DemolitIOn .............. Other Work . ~. , . . . of' ~ _= (Description) 4. Estimated Cost. ./. .~ P.Ci . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . Fee .1:::>.7""::'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling, number of dwelling pnits . . .~. . . . . . .. Number of dwelling units on each floor. . ~ . . . . . . . . . . If garage, number of cars .....:... (r.'o'oJL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commereial 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. Di~ensions of entire new const~uetion: Fro.nt .' . .I.t. ~" . . . . .. Rear . /.f. (h. . . . . . . . Depth ./.'I:..fb. . . . . . . . . 9. Height ... ~~" . . ~m,ber of Stones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Size of lot: Front.. .1.90. o'.;.. .. . ...... Rear... (PC;>.~,.... ... .... Depth ..!~............ 10. Date of Purchase '>>1 .";./1.,,/''-7.1 . .. . . . . . . . . ., t'lp.:rep Fonner Owner 'ZI).......a , \Io:t.r.1. '~.. ... II. Zone or use distriet in which premises are situated. . . . . . . . . . . . . . . . . . . . . 'Afi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ... '?: . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Wi11lot be regraded .... ~. . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Y es ~B9 14. Name of Owner of premises 1JJti!-..a..cX~#<. Address ~/11~ .~tI. ;1J?ftlf.-Phone No. ..;l.<J(~.'If.~.... Name of Architec,t .. ~. ~. . . . A(1dress~. . . . . . . . , . . . Phone No. .. . . . . . . . . . . .. . Name of Contractor . . ;. .' ..... Address . ..~~&~ne No. .,,;1..f.O.~ ..f!I'!t;,. PLOT DlAG RAM Locate clearly and distinctly aU buildings, whether existing or pr<~posed, and, indieate all set-back dimensions fram property lines. Give street and block ,number or description according to deed, and show: street names and indicate whether interior or corner lot. ' I Sc>' J1foJ. i I .~ ~ l' "" IS 4- j , pool '{~"t" -? ~D 1> ~ \ i -f <7 &0-> j "" I{, '\' { STATEOFNE~SS COUNTY OF . . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '. . . . . . . . . . . . . . . . . . . " being duly sworn, deposes and says that he is the applicant (Name of individual sighing contract) above named. He is the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~IY authorized to perform or have perfonned 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 perfonned in the manner set forth in the application filed therewith. Sworn to before me this I ...... ./.: ~ .o.y ~f....~...' 191':9 No'"" P,bli" .... . ."7'--"-; k" . .. . , .. . Cooo1y u.1 tJ k l 'ICE M SKWARA ~. NOTARY PUBliC, SI"ls or New Vork ................... .~ .............. No 5? 460'34:91 Sig ature of applicant) Quollhod In Suffolk !County Corrlml5~I0I1 EX~lr(>s ""\0I'9h 30, 198a...