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HomeMy WebLinkAbout10680-z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy 210072 Date . . . ..1<J.l1W$:t. .J.Z, . . . . . . .. . . . . .. " 19 . ao No,...",.."...... . THIS CERTIFIES that the bUlldmg . ............................................ . Location of Property.. .~~9. r..~p.t9n.~ .J?9;!.:qi; .13.9.8:4. . . . . . . . ~.8:i;t:j.:t)..\QI!:.. iii")'\\'. rp.r.~. . . House No. Street Hamlet County Tax Map No. 1000 Section ... .1.15. . . . .Block ... l1. , . . . . . . . .Lot . . . . .020. . . . . . . . . Subdivision. . . . . . . . , . . . . . . . . . . . . . . . . , , . . , .Filed Map No. ....... .Lot No. ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated . . . .~~Y. .?~~. .. . . . . . ., 19 .I?~pursuant to which Building Permit No. .. .1.q~?9. .~ . . ... , .. . . May 19th 80 . . dated .".,.,... .. ..."",..,... 19 . . . , was Issued, and conforms to all of the reqUIrements of the applicable provisions of the law. The occupancy for which tlus certificate is issued is .. . , . . . . . . . . , . Gr.~Einl;1ous e, Ac.cesso.r.y . Building. . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , The certificate is issued to ........,...,.., ~.~,?~~.e. .f:: ~ . ~.:!':r:<:i. . . . . . . . . . . . . . . . . . . . . . . . . . (owner, l~li1I1IlXXX of the aforesaid building. N/R Suffolk County Department of Health Approval ,............,..,.............,.,.,....... UNDERWRITERS CERTIFICATE NO. . . . . . . . . .,. .~/13-....................."..... .... ....,~~ >/~ ,. ~.~.................. Building Inspector Rev 4/79 f., Il , ~ FORIII NO. 2 TO~N OFSOUTHOLO BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10680 Z Date ....HCJ.7'-.......LY,..,.............., 19Jb Permission is hereby granted to: ......fi.r;.';!.(.;<ij€........ ..(!:.. "../;;/..~r.t? .....~r..9~..f.Y.r.a.~3... ./d:,. .....H.-fl.I.I.I..I..(/..c.&.:::-:..........:.~.:. , <:: Q U$T/lv..c.T (f,' ,-; =- u.t':-I (.{."':~ .' t::;,;' ~O~7 "[;1 t;?(;. . to ....... , .... .. ..... ..... ...........v.Z~=.(i . .... ,C/. , .;.?. ......./.;l.J;.~ .....~.... ..",.. '....'..'.........'7. .. ~.~.~:~~;:~:.;~~.~.;~~..~;. .:::;y:;;Q::::::2~Z;;;;;;;;:::/3;~:;:::::~;;;;::::::::::::::::::::::::::: ..,..,.,............................................................:....,...". .......,...................Mf.7iJQ(,I..:~..&/.:.1 ................................................................................. .......... ............................................................. .. pursuant to opplication dated .../.#6?.y.:.....,..9"......,............, 19.dt?., and approved by the Building Inspector. 10 ee.J Fee $........................ . ..... ...................................................... Bui (ding Inspector , Ii , FORM NO.6 TOWN OF SOUTHOlD Building Department Tawn Hall Sauthold, 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- tar with the fallawing; far 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 appraval of Health Dept. of water supply and sewerage disposal-(S-9 form ar equal). 3. Approval af electrical installation from Board af Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Cade compliance fram the Architect or Engineer responsible far the building. 5. Submit Planning Baard appraval af campleted site plan requirements where applicable. B. For existing buildings (prior to April 1957), Nan-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or tapographic features. 2. Swarn statement af owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code ar safety inspection af buildings or premises, ar other pertinent informa- tion requ ired ta prepare a certificate. C. Fees: 1. Certificate af occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 Date. . . . . Aug1.ls!;. .1.1,. .1.5180. . . New Building. . . . ;x; . . . . . . . Old or Pre-existing Building ............ Vacant Land ............. Location of Property 490. J:.upto;ns. Po.i.nt. Road. . . . .. .. . . . . . .. . . . Mat.tl tuok . .. . . . . . . . . . House No. Street Hamlet Owner ar Owners of Property ........ ?~.~~I?~. .~ ~ . !3.i.~~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No. 1000 Section ............... Block............... Lot................ Subdivision. . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. ......... .Lot Na. ......... .... Perm it No.1.o680. . . ., Date of Permit 5/19/8.Q .Applicant . . :Qeor~o;) . C.. ~lrd. . . . . . . . . . . . . . . Health Dept. Approval.!\1.O.t . needed. .. .. .... . . Labor Dept. Approval .... ~Qt. n€!ed~p. ... . .. . Underwriters Approval. . . . .not. needed. . . . . . .Planning Baard Appraval .., .n9t. need13.d. . . . . . . Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate,. . . .~. . . . . . . . . . . . . . . . . Fee Submitted $. . . . . $5...00. . . . . . . . . . . . . . . . . . Construction on abave described building and e it.me~~s all.~~r~~~I~~i~~~.. . . . . . . . . . Applicant. . . . Rev. 10.10-78 . I , ,."..,- .. ,,:.3, , ii. I. AI ,~ ~ - '<i'W -7 !: J . '" LLlpi 0 V1._f> ? CH~"\ \- Ro(!..d...- <f- I ()O. _.----:.....> _r- ~:;.> t I~ i , , , LJ ~...~ , ~,5" I~' ~ ....<- f Co-v q......r<:"...' e... -.!. u.> . oN (J), " -..--. ~ . ys' IV ~ 0&1(91 <q ree()hc:JU5e.( qb.~!'.) .../ -'j~ . ...~ /~J~--1-~ ~':.-=1r.i~o ' . -- ... > ~;>...~ ~ /.;J,5 " - ------ ~ L ii , FIE~D'T~SPECTION '! D~,TE II CONJ'TE1\:TS ~., - '"' '1:1 - . - - . . 0.= C~ I - - ~ 1 . ~ ~ HI :>. f-j ~-~_.. _....--" ~~---- -------------- ~ FOUNDATION _ ..J.1~ ~ 0 - - - ,- . ['.; -- I~ FOUNDATION (2nd) ~ 0 ro-..J;, I 2. . ROUGH FRAME & ~{ Pe:p PLUMBING t'-.. , "\ (j) ~, 3. qt - CD '" CD INSULATION PER N,Y. IT~ ,,' STATE ENERGY ~ COpE 4. 7#,) 01:. ~ C .r) ~ I ~~ I-'~I - /7 ~, / , FINAL - ~ ~. ::J:-< CD ADDITIONAL COMMENTS: >j~ , "I -. ~ , ~~ Ii" P>~ IT"'.. 1-" g~ ? - ::r: ro .'. ~ I . . ~ IT . I , " J!~~~f:~ "*' . , , ,. ii~ > " , fORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEl.: 765.1802 Examined #-:<It- f. 7. . . . " 19 m Application Noja f~. . . . . . . . Approved (:(1!Y .1 '(.. . . ., IfJ!b. Permit No.I.QC:; ,fc?.-2 D;M""~'" 'J< . . . . . . .C H H H H ~ ..........;....................!..."k. "'I'~ ., ....',.................... (Bu'ilding Inspector) , APPLICATION FOR BUILDING PERMIT Date.... .M~ .9.......,1980. 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 Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupiea 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, bUi~g code, housing code, and 19U1ations, and to admIt authorized inspectors on premises and in buildings for necessary ins ~~ions. ~ ' { . . . :-.~: . . . . . . . .. .. . . . . . . . . . . . . . . . . (Signature of plicant, or name, i orporation) . r...qL J3.~'" .n5... .~.t.t:~~)l~.~! . ~~.~. ~?;r:~ .;~952 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , , . . . . . . . . . . . . . . . . .owne.I! . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises ....... ,Geer!';e .C.. Bird. . . . . . . .. ... .. . . .. . . . .. .. .. .. .. . . .. . . . . . .. . . .. . . . . (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. ,.. .eel.f. .. . , . . . . . .. . . .. Plumber's License No. .............,.,..,..... Electrician's License No. ..". .none. . . . . . , . ' . . . Other Trade's License No. ....,....,........." 1. Location ofland on whIch proposed work will be done. ......... ~ . . . . . . . . . . . . . . . . . . , . . , . : : . . , . . . . . . . . . . . . . . , .49Q . , . . . . . . , , . . , . . :r..:Ul?to~.s. . ~o~~~ . ?o~~ . , . . . . . . . . . . . . . . .~~~,1.t:'!-~~. . , . . . , . , , . , . . . . . . , . House Number Street Hamlet County Tax Map No. 1000 Section .,.. .t.(~. . . , . . ., Block.... /(. . . . . . . . ... Lot,.9.?: 9. . . . . . . . . . . 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.. . (JJ'kc.r.4H.((..;I. .. .~.?,?;il/4""""""""""""'" b. Intended use and occupancy ...,........ .~~~~~~<?'\1!'~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . j , ^L _ ~ 3. Nature of work (check whicl1 applicable): New Building. . . .;1(. . . . . Addition. . . . . . . . .. Alteration .......... Repair .............. Rem6val . . . . . , . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . (Description) 4. Estimated Cost......... ~..~~9~~.~................... Fee..... .1.~~?P........................... (to be paid on filing this application) 5. If dwelling, number of dwelling ",nits. . . . . . . . . . . . . . . 'Number of dwelling units on eaeh floor. . . . . . . . . . . . . . . . If garage, number of cars .....'..........................................................'......... 6. If.busir~ss, com~er.cial ormixe? o.ccupa.ncy, specify na~ie and extent of each tYl?e.ofuse ...........;......... 7. DnnenslOns of eXlstmg structures, If any. Front. . . . . ? . . . . . . . . Rear ..... 7.11: . . . . . . Depth . . .!!-D. , . . . . . . . . . Height' ............... Number of Stories. . . . . . . 9!11:~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear.................. Depth. . . . . . . . . . . . . . .. ..... Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front..... .9'....... Rear.. .9~.......... Depth. .6............. Height 7.'. .to. ~tiak. . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front ./.Q9';. : _. '. : .. . .. .. .... Rear.... . ." ./.&/:$.'.. ...... Depth ..273...25. J.... ...... . 10. Date of Purchase ........ A~:r1.1 .:1, 9~.e. . . . . . . . . Name of Former Owner ~ElJ>>'Y. .FI/i!.YJII.Q:t . . . . . . . . . . . . . . I I. Zone 0r use district in which prkmises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ I i 13. Will lot be regraded ........:................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises Gepr.<<e. Bud. . . . . . . Address. .Matti.tuok. . . . . . . Phone No. 2984tJ.Sl. . . . . . . Name of Architect .........;................. Address .... . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . ! . . . . . . . . . . . . . . . . . Address .. . . . . . . . . . . . . . . . . . Phone Na. . . . . . . . . . . . . . . . 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. , . '8' t:-J< 0$ I N _ I....llp1vn~ D'n o{'\~ I ~ 190 i ':;.5 / fr-<:>m f(c(lcL Ii' I 'I' ~ '--' ,,4 ~ <>-_: tovt5'~ 'i.! 2.Cax.. 9a."""4<'.... .~ );. 10 I : ~ e: , ~ ~~' L J ~:. - ~ ,", V) " .:. 0 A ;, ,:, rrGpM<2I~ J '- ..:. '8'1(tGS g rf..ot) )0(1..';;(_ , ox 7' 2, '~:lS'/I.:'J STATE OF NEW , S S <- ?:>- COUNTY OF . . . . ..( . A"J . A . . . . . . . . .. . . . . . ~. . . . .. being duly sworn, deposes and says that he is the applicant ame ofind' idual sigring contract) above named. , He is the ....................~.......................... ........................... i (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 ! . . . . . . . .. . . .)0. LiJ. . . .day of. . . ',' . . . . '~i . ., 19 @ Nota~public, ... .~..... " County d I '.......~n'1.....,."'.,..,...~.'fwmulfr : ..'''~, , IZABETH ANN NEVillE" . I NOTARVPUBUC,SI,te01 Nell'VoIU' . . .........:.... i No, 52.8125850. Suffolk COI\DJ!'., (Signature af applicant) Torm E,pIr" Mar,h 30.1~