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HomeMy WebLinkAbout10701-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin~ Impector Town Hall Southold, N.Y. No .... .~.1.0.4. 3 .a ....... Date .......... ~. p.e.~.]:...3., .............. 19...81 THIS CERTIFIES that the building ................................................ LocetionofProperty~937)~: llar~,ow River Road, 0~tent~ I~.Y, County Tax Map No. 1000 Section ..... Q~? .... Block ....~ ........... Lot ...P.a.~.~...o.f..~ .... Subdivision ............................... Filed Map No ......... Lot No ........... conforms substantially to the Application for Building permit heretofore filed in this offioe dated ~.0?01 z ..... ~PRq. 3 .......... 19 ...8~drsmnt to which Buildin~ Permit No ..................... dated .......... J. 9 .n.a..~ ........... 19...8,0~as issued, and conforms to all of the requirements of the applicable pmvisiom of the law. The occupancy for which this certificate is issued is ~£1LVa.t~.~ The certificate is issued to ...... l~e~Ilq~. ~.~17. t~qm~ ~..~~k..~_._~._ of the sro _re~id building. Suffolk County Departme~t of Health Approval . 10,-30-.35 I/~/81 Rober~ A, .V.t. lle ,P, UND£RwRrr~.RS CEaTI~IC, TE NO ....... ~.. ~ .~ .a.l.5. 9 .................................. / Rec. 1/~1 FORM NO. 2 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDIh~G PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL ' COMPLETION OF THE WORK AUTHORIZED) N? lO?O~ Z Permission is hereby granted to: ~o....~.z~,.~z~.~..:... ~.~,s.....~:/.~.,.cyx....,z~a ./z~.~;. ~7'"" ~' '/'"~"~'~/~ .. z-Z-.~o.....~,..~. ~..,c,~x.2~.~ ~--~ .... ~..: .............................. ~ ................. ~ ...... Building Inspector. approved by the FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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- 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 featu res. 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. Commercia~ 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 site plan requirements where applicable. B. For existing buildings (prior to April 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 featu res. 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- tion required to prepare a certificate, Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use 3. Copy of certificate of occupancv $1.00 $5.00 Date ........................ New Building . ~?~. ~'~' Old or Pre-existing Building Vacant Land Location of Property .... .~,.., ?,- .~. :..o.~... ~ .~, .~.~..~..~....&., .~, .¢_~._ .... ,~. ~ ............ .~.~./..~./~'.. T. House No, Street Hamlet Owner or Owners of Property ...... ~. ~.~,..~. ~. ?../'¢....~'~ .[' .~..~..~./¢.'~.~/....,:~. ~ ................. County Tax Map No. 1000 Section ~ ~-'7 B~ock ~ Lot .... ~. Subdivision ................................ Filed Map No ........... Lot No .............. Permit No.t~.~. 7.0./.... Date of Permi~,.A.°~Z~D.. ,Applicant... )~7~/.J./?/~..~.~, .... .~?.~.~..c_. ~ .~../~. Health Dept. Approval ...... ~.~./~/. ...... Labor Dept. Approval ........................ Underwriters Approval ..... .~.~.~. .............. Planning Board Approval ... ,~..~.~. .............. Request for Temporary Certificate ..................... Final Certificate ... ~ ............... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations, Applicant..~. ~'~,,'..~..~..~-~.~.~ ....... ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS / BUREAU OF ELECTRIC~ITY. ~- ]'~,~C~D 2~ ~P~.], 86 JOHN STREET, NEW YORK, ~~O38 THIS C~RTIFIE$ THAT only the elec rical e u' e~t,a .de ~ 'b be ~nt d e he a~ lic t d o~ t ab ye licatio~ er' ' in thefollowing loca~on, . ~.Bas .... t ~J 1st FI. ~ 2nd FI. ~;~l~O ~/~ ¢ 1 ~J~.[ Sectiort Block. Lot was exatnlned on and /ound to be in compliance with the requirements of this Board. FIXIU~ I FIXTURB RANGES OVENS EXHAUST FA~S FLUORESCENT AWG AWG OF HI-LEG OF NEUTRALS Sotttlx~!d, N.Y. J1971 This certificate must not be altered Jn any manner, rlLDING office oard IN ANY MANNER. Ei'lt ANN NEVI NOTARY PUBLI~, State of New No. §2-81258~0, S~JffoIl~ CouJqb'_ Term Expire~ Mar~h 30, FIP~LD I.I~SPECTION COMME~i~ ~_ FOUkrOATION ( J s ~ ) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY C0 E a FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL /~..~F/L /~ SOUTHOLD. N.Y. 11971 TEL.: 765-1803 Approved~/~.'~' .~.~...~. ...... ~, 19 .~.~. Permit No../~.7~. t~ / Disappro/yed a/c .................................... J ........ APPLICATION FOR BUILDING PERM IT INSTRUCTIONS Application No./.{~.7{~../. ....... Date .... .~.//..8- ....... ,19 ~..o 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 ptan 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 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 appticable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a co{poration) ...... .F.~. T. ~.~. ~'...~..~.¢ ~...~...~....O...~./.~ ./~. T. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises ..... /~. B~. ~. ~.~.~.4~. ~.-~.....~..~-t~. ~ .c:.~..,~. ..... v'..~..~. ~.~..~. .................. (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....C-= .~ ~./~...K./../W..~. .... Electrician's License No .... .Other Trade's License No ...... . ............... 1. Location of land on which proposed work will be done ......... ~-. ]O. 9). T.l:ff .... .<~. ~...../~..~.~ .~_.O..;~ ...... ........ ~.l. ~.~.~. .... ~.~= ................................ ~ ~ ./~. E ...................... House Number Street Hmnlet County Tax Map No. 1000 Section ..... ~ ~.~ ...... Block ..... ~ ........... Lot... ~. ............. Subdiwsion .......... ~7~' ~ .................. 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 ........ ~/.~ ~.~ ..... ~ ..... ~.~ % .~ .... ~l [~ .......... 3., Nature,ofwork(checkwhicb applicable): New Building J Addition Alteration Repair .............. RemoVal .............. Demolition .............. Other Work ............... ,~f -v ~-- ~4 //~ ~5-,~" (Description) 4. Estimated Cost ........... [. ~.t..O..O..O. ................. Fee. ~. ...... .-x.. '.: ........................ (to be paid on filing this application) 5. It' dwelling, number of dwelling hnits ...... I ......... 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 ..................... 7. Dimensions of existing structure!, if any: Front ............... Rear .............. Depth ............... Height ............... Number. of Stories ........................................................ Dimensions of same structure wlth alterations or additions: Front ................. Rear .................. Depth ...................... Height ...................... Number of Stories ............ ~ ......... 8. Dimensions of entire new construction: Front .... ~.'.,~.~2!*.. Rear ............... Depth . .2..~. .......... Height ... '~. '. '~. '~ ' ·. Number of Storms .... ~, ........... ' ....................................... 9. Size of lot: Front ...... ~,5.C>..~ .......... Rear ........ ~...~...c> ......... Depth ...~..~. .... , ............ 10. Date of Purchase ..... $/.:~.~/.~.o. .............. Name of Former Owner ~6.~P~.~r~'.. 1 1. Zone or use district in which pztemises are situated ..... t~... ~ ~'S/,¢?~¢. T~',~,, ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... ~4..O. ................. 13. Will lot be regraded ....... .F~.5. ................ ..~_ill excess fill be removed from premises: Yes 14. Name of Owner of premises ./~.a.~-.c-~.~..Y.r.~p. cff.~ddress ~-t~/T' PhoneNo..~'~-2..A.%?.~-.. Name of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor ......... ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block?umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK t ~ ! ~ ~ COUNTY OF . .~¢~. · · · . .... i °'° ........ ...... (Name of individual sigping contract) above named. I 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 m the mantlet set forth in the application filed therewith, Sworn to before me this N~~ .~.. ~~,,' .......... County NOTARY p , , . UDLIC, St,~te of New York .~.?~.. · , ~ ..... No. ~2'452~7~1 ' ' (SignaturCbf applicant) QuaIfhed in Suftotk'Count), Comm~mon Expire~ / ! RODERICKVAN TUy_J.o P.C.^ LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H. S, NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPT. OF HEALTH SERVICES FOR APPROVAL Of CONST R UCT ION/O N)-rV_~ DATE: H. S. R EF. NO.,*~-~ SUFFOLK CO. TAX MAP DESIGNATION: DIS~. OWNERS ADD--S: O~'~'?, ~J.~. ;:957 DEED: L. ~:&86 TEST HOLE Tot"-- P. ~9 STAMP SEAL SU~OLK COUntY RgA~?H D~AR~N! the sewage disposal and ~',~t~r supply facilities for this l~ca~ ',~,:, ]:ave been inspected by this dapart~nt and found Chief of General Engineering% Semites SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT, OF HEALTH SERVICES. (SI APPLICANT SUFFOLK COUNTY DEPT, OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. S. REF. NO.: APPROVED: 'SUFFOLK' CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. OWNERS ADDI~ESS: TE~ ~LE ~A~ ~AL / ' ,, , ,,, ,../ Mar. I1, i~I RO~DERIJCK VAN ]'OYL.P.C LICENSED LAND SURVEYORS GREENPORT NEW YORK \. SUFFOLK CO HEALTH DEPT APPROVAL H.S. NO. '- -.~ " .......................... STATEMENT Of INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL ~ CONFORM TO THE STANDARDS OF THE ~ i SUFFOLK CO. DEPT. OF HEALTH SERVICES. % ~) ~ APPLICANT ~.: ~ SUFF OLI~ LrJUN I ¥ UI:.I' I , ur ntnLi n SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: SUFFOLK CO. TAX MAP DESIGNATION: DIST. ~CT. BL~K PCL. ~WNERS ADDR[~: TE~ HOLE ~AMP SEAL .. ~.~..~~ i . ;' .." > , .... / .. .. , ,..,-r>,_~ 7, M":"~ ' ~ ~' "' ' .... ~ LICENSED LAND SU~VEY~S ~ GREEN~RT ~W YORK L .J 1, ~N~ATION - TWO ~ ~UR~D CONCreTE ROUGH - F~MIN~ & 3. INSUlT(ON A. FINAL - CONSTRUCTION MUST BE COMPL~E FOR C.O. ALL CONSTRUCT]ON SHALL MEET THE REQUIREMENTS OF THE N, Y. ~ATE ~ONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE VOR D~IG~ OR CO~$TRUCTIO~ ERRORS.