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HomeMy WebLinkAbout10690-z FORM NO.4 TOWN OF SOUTHOLD BUilDING DEPARTMENT Town Clerk's Office South old, N.Y. Certificate Of Occupancy No. ... ,2.10015....,. Date. , . J.uly. 2. . . . . . . .. . . . . . . . . . . . ..,19.80 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . , . . , . . . . . . . . . , . . . . . . . . . , . . . . . Location of Property ... .1.120. New. Suffolk .Avenue.. ,..." .Matt.:!. tuck,. .N. Y",. , . . House No Street amlet County Tax Map No. 1000 Section ...1 :1.4. . . . . .Block ... 1<!, . . , . . . . . .Lot , . . . 11. .Bi. :17. . . . . SubdIvision. . , . . . . . , . . . . . . . . . . . . . . . . . . . , . .Filed Map No. .',.." .Lot No, ............. conforms substantially to the ApplicatIOn for BUIlding Permit heretofore filed in this office dated .... May. .1.9. . . , . .. . . , 19 BOpursuant to which Building Permit No. ... :106902. .. . ., . .. .. dated ..,.,. .May. .27. , . . . . . . . . . . . . 19 8.0 . 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 .. . . . . . . . .......... .. . . . . . . . . Access.ory. S.tQ:r~gfil . $p..~q.. .. . . . . . . . , . , .. . . . . .. . .. , .. . . . . . The certificate is issued to .......... Noman. .and. Al:!.~\6. AQ.Q.Y. . . . . . . . . . . . . . . . . . . . . . . (owner,~~ of the aforesaid building, Suffolk County Department of Health Approval ...........,. :M!R. . . . . . . . .. -......... .... UNDERWRITERS CERTIFICATE NO .....,...... . . . . . . . . N/n. . . . . . . . . . . . . . . . , . . . . . . . . ...A:.~~......... Building Inspector flev 4/79 II FORM NO. 2 TOWN OF SOUTH OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 10690 Z Dote .........IY.c::.fY.....c1..7........... .., 19PU Permission is hereby granted to: .........M4H.dt..l...A1/-p.y...... ..)2...... ........l.I..d.Q......!.4~.~r~A ,..,](Z;;, H/"1TTitvc,t...- Ai, Lj. .......................... ............. .......... ........... to ....C.cdl!.l.':?Z.ts:?~~T....d.;:..(.s.:;?.:;;,Q.&'1.. ...?.(P.:c.~?.~.~......~6(4"'p...,~=....,......,.., " ~.;.~~~~;~.~~.;~~~~~~..~;.::>(.;?;;::::::::::;;;;;;..:~:;~~;~::~:::::::.:::'::::::::.:::::.::..: ----- ......,.,... ....... ......... ......... .................................... ,..... .".. ,.",.............. .............. H6?II,./(,,(,<;'/;.::-:.I..i..Y- ,......................................................................... ......", ....................................................................... pursuant to application dated ........f.::Ir:g~.../ 7." .."........ ......, 19.f.Q, and approved by the Building Inspector. /0 c.G;. Fee $ .........=......... /~ ... ..... .....',.. .... . . ., ................................. .. Building Inspector ,_.!_ iJ. fORM NO.6 TOWN OF SOUTHOlD Building Department Tawn Hall Southald, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This appilcation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tar with the following; for new buildings ar new use: ,. Final survey af property with accurate location of all buildings, property lines, streets, and unusual natural or tapagraphic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S.9 form or equal). 3. Approval of electrical Installatian from Baard af Fire Underwriters. 4. Cammercial buildings. Industrial buildings, Multiple Residences and similar buildings and installa- tians, 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. B. For existing buildings (priar to April 1957), Non.conforming uses, or buildings and "pre-existing" land uses: ; ,. Accurate survey of peoperty shawing all property lines, streets, buildings and unusual natural or topagraphic features. 2. Swam statement of owner or previaus awner as to use, occupancy and candition of buildings. 3. Date of any housing cade or safety inspection of buildings or premises, or other pertinent infarma- tion required to prepare a certificate. C. Fees: ,. Certificate af accupancy $5.00 2. Certificate of occupancy an pre-existing dwelling or land use $5.00 3. Capy af certificate of accupancy $1.00 Date . . . . . . . . y)..!J,y. ?,. . ! '1!3.Q . . . New Building. . . . . . . . . . . . . Old or Pre-existing Building ............ Vacant Land ............. Lacation of Praperty ....1129..J.'! ~'fI. .q1J,f;fp),:!j: . {ly.€!IJ.1,1.!,. .. . . . . . . . . . . . . . )1.[!3-:~i;~ :t~.c:I!:! . !'J..,:{ ~ . House No. Street Hamlet Owner or Owners of Property ..... !'!P.r:!(li?-P. ,P,<J.qy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Caunty Tax Map No. 1000 Section. .. .114. .. ..... Block.. .1?.......... Lot... ..1.1../!<..1.'7.. .. Subdivision. . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . .Lot No. ............ . Permit No. 106.9.02... Date of Permit .5/?7.!$9.Applicant ....... .J:!5J.r:II!?l. Aq9-Y............. Health Dept. Approval . . . . . NJI1. . . . . . . . . . . . . . . Labor Dept. Approval ........................ Underwriters Appraval . . . . . N!FL . . . . . . . . . . . . . .Planning Board Approval ........ . . . . . . . . . . . . . . Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . . .. . . .4. . . . . . . . . . . . . . Fee Submitted $ . .5, 0.Q . . . . . . . . . . . . . . . . . . . . . . Canstruction on above described building ~mlt meets all apPlica~nd regulations. ." ",." Ap,Ii"" ?'" -= H ~o ~;~ ;~:.:- 7/02-/ ,yO ~~#17~/Y I ..1 J1,,_ ,j, _ FIELD yNSP~CTION DATE COMMENTS ....'~ 'd .1.. . ~ ~ HI ~ --~---------_.-------~- -~--~----'~- -- -"---_._--~---- Ic3 ~ -,--~,~ _FOUNDATICJ.!IT (1st) 2: -- _.~ 0 . N ~- - FOUNDATION (2nd) ~) -.. - - . CD"-t. 2. I . -- ROUGH FRAME & 2:~ PN PLUMBING . Q 3, w~ q~ - CD INSULATION PER N.Y. ~~ ~ STATE ENERGY ~ CODE ~ " ~, 4, .~~ . S ' - W /~ /.,~ ~/() I-'~ ~~\ / FINAL , - -, . ~~ ::s ADDITIONAL COMMENTS: ~~ ~ . --~_.~- ------- '" , 151. fU,~ ~~ ~ f-"~ g~ ; - 'x CD .' ~\ , CD ~ . , '\f- , , "", '''' 1. _ . , , ''''w 0 FORM NO.1 . ~~ '5C} TOWN OF SOUTHOLD BUilDING DEPARTMENT 10 r TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 1-1 "7 fo Application No. . /9.6. .7.0. . . . . . Examined.. 'Ay..r/. ..." 19. . Approved &.4.1'. ,47.", 19~ Permit No.IO(?Q..z Disapproved a/c. , . , . , . . . , - . . . . . . . . . . . . . . . . . . . . . . . . APPLICATION FOR BUILDING PERMIT "V> 7:' fJ 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 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 Budding 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 bUl~d,ing::Ot:n.:c~ss~ . . ~ . : ~~. . , . . : . . . . . . },,/"- ".",,= of """~' "=0, "",,,,mho") t';Vf/' 0 ;2~ ~? j' , 7 ... . .~.. .. .. .. .. . : .. .. 7 . (Mailing address of applicant) , State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,....,o'f<.!N,e.f!/:.. ...............',....... ,.................. -,......................,......,. Nan1eofownerofpremises .f)){)""m...~. .t.. /)'/',.(,''1'-:-., ,I.JJJ-}(.....".,.............,..,.,. "........... (as on the tax roll or latest deed) . If applicant IS a corporation, signature of duly authorized Off1Cn~,tUP ~~~t~ O~ , .. ' , , , , "'"~; ;;"iti; of ;;;,;,;;"~ ;jT,;;,)" .. .. {,:,:; \ '~~l~ \~ fUl . , . ~ \! ~" t1. '~~ """r'~r~Jf~~1E Budder s LICense No. .. . , , : , . , , , . . . . , , , . . , ' , ' . ""\ C" ~ \,:' ~b \ '" "', <' 1}1 L i:11 I ~ 1\1' , L \\.. I ' ',' , , . ,. . , ' ,~ Plumbers License No. .....". ,..........,... I~~ii, .~~) _ !i"~"1J~ ~ ,~'thnp v Electrician's License No. ...",...........,.,.' ut ~&t,<A ~\\& Other Trade's License No. ,.".,.....,........' I. Location of land on which proposed work will be done. ..... .....,...........,...................... ... .//..2.ti .. , .. .. ..., ,~. ':-X(rnw,. {)~.":...",...... .fJ1.A-:#.I:+"':~'~'"'''''''''''' " House Num ber Street Hamlet County Tax Map No. 1000 SectIOn ... /(:'/.. . . . . . . . . .. Block . . J ~. , . . , . , . . .. Lot...I I. :i. /7. . . . . . . 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. , , . ~~. .~~. ,. . .,. . ,. .. . . ., . . . . .. . . .. . ,.. .... b. Intended use and occupancy .lif,(././:t y-'" ~y..............,.......................... , j " " , I I ;4~J -- ~ 3. Nature of work (cheek whieh applicable): New Building ... ...... Addition. . . . . . . . .. Alteration .......... Repair .............. Rem<)val . . . . . . . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . , ~ 0= (Description) 4. Estimated Cost. . . . ~<f:V.. .,,:-,!,. . . . . . . . . . . . . . . . . . . . . . . . . Fee . . I. Q. .~ . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelJing, number of dwelJing pnits . . . . . . . . . . . . . .. Number of dwelJjng units on each floor. . . . . . . . . . . . . . . . If garage, number of cars .....,................................................................... 6. If business, commereial or mixed oecupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth............... Height ............... Num,ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth. . F'. . . . . . . . . . . . . .. . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8 D' . f f rh' F 9 I:? II 9. I ? 'I D h /,;J. 1 . ImenSlOns 0 en Ire new const ,chon: ront... .. ........ Rear .. ............ ept ............... Height . r. ~ . . . . . . . . . . . Number of Stories. . . . . />>.0 tJ. ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '? l' I ' 1 'I 'tJ. 9. Size oflot: Front. . . . . . . . . . .). . . . . . . .:;.. Rear. ../.Q .7." .9. . . . . . . . . . .. Dept!J:,1.G.1. ~~. 'i'iq7. .a"it;' 10. Date ofPurchas~~ t.'h. f..$/7p..,~........ Nap1e of Former Ownerln.l'l""I~"'. .1.c;bI}.I..tc"."!-'. .K/III 7"" I I. Zone or use district in which premises are situated. .tfe>: l.d ((1//1f.(, It.!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. D?es proposed construction :!;;I~te any zoning law, ordina~ce or re~lation: ...11 P. . . . . . . '.' . : . . . . . . . . . . . . . . . 13. Will lot be regraded ...... . 'j' . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises. Ye~ _ ~ 14. Name of Own~r of premises ~tmo'tA! f;19/~~ . .4ddy'. Address /.1..),.f.J'!ff.f.J.'~ lp.m. . . Phone No.';>'7. .r. ~.~ ~': . . . . . Name of Architect. . . . . . . . . .j. . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . , . . . . . Name of Contractor .. . . .. .. .;. . . .. ., . . ... ... .. Address.. . .. . ... ... .. . . .. . Phone No. ... .. . . .. . ... .. PLOT DIAGRAM Locate clearly and distinctly all i buildings, whether existing or proposed, and, indicate all set-baek dimensions from property lines. Give street and block i:lUmber or description according to deed, and show street names and indicate whether interior or corner lot. '~ I ~, ~~ , 1" y:./~'-7 /rq"- "- G, ;fo5E !;2 ~! '1.21 4 ~;JJ>> /2. ' ..[.- -i "CD~ ~G~y~~~ Ii'j (!;o/1/;fI[d- f).t~ ~ fJ? ~ t O/-t:J ... ~ tOP /(/c1' ~ !/ S'/..4,{) V, , ~ !APPROVED AS NOTED ~:L '1'/-16 'be., DATE: B.P. '=IF r:-,!Ig" ~ ~~~IFY BiJfCi51-~~ :DEPARTMENT AT t. X/$I .5'l..J{.{ 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I.:c-~J ,80/ T5?J ,1. FOUNDATION - TWO REQUIRED i FOR POURED CONCRETE ~2:ff5/1/ 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST ~1~~~~S......~d~?'1 BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL MEET fi. "[HE REQ=ENTS Of TI-IE N, y, orn,~)1.~se ~ll!JNis t!\1eBl1ERG1flt (Name of individual ning contract) CODES. NOT RESPONSIBLE FOR above named. DESIGN OR CONSTRUCTION ERIROIRS. He is the. . . . . . . . . . . . . . . . . . . . . .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owrier 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 wi1l be performed in the manne~ set forth in the application filed therewith. Sworn to before m~is , . . . . . . . .dO ~. . . . . . . . .day of. . . ~. . . . . . . . . ., 19@ .~~j{'~' Not""_,,,,",. ...;k........... .... ~ ~ ' \ I,INDA F. KOWALSKr < , NOTARY PUBLIC St' . . .~. ., ..... . . . . . . . . . . . . . . . . . . . ate of New Yorll (' f J' ) , No. 52.4524771 Ignature 0 app Icant Q~al1fled In Suffolk County , , Comml$sion ExpIres March 3D! 19~