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HomeMy WebLinkAbout10744-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy ~10071 Date J~ll ,tr 9 1980 THIS CERTIFIES that the building ................................................ 1110 Orchard Street Orient, New York Location of Property ............................................................ House No. Street Hamlet County Tax Map No. 1000 Section ...0~.~ ...... Block /+ .Lot 10 Subdivision .............................. Filed Map No ......... Lot No .............. conforms substantially to the Apphcation for Building Permit heretofore filed in this office dated June 23 198..©. pursuant to which Building Permit No. '107/tJ4Z dated ........................... Juno ,-°'5 19Q~.~.~'", 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 ......... Deck .~,dd5%io~ to }~wisting Dwelling Judith Wigro The certihcate is issued to ............................ w ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .................................................. Building Inspecto~ Rev 4/79 FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10744 Z Permission is hereby granted to: ......... L~..~z~./~.:......~/~. ~p..-.:~ ~ .... ........ ?J~-~.~....Z./.. ............................................ ......... ~r~:c~z~.~....~...~ ........ ~?.o~ ~ o . . /. .~. . . . . . (, ~.s~ .~2?~--_Z. . . . . . %~ c Zc-. .,~.~. . ~ ~ z' ~. .c ~ ~. ....... / ~. . . . . .~. . ~. ~z~,c ~ .... ..~.z./,~.~......~c ....... ::,.,:.~... . ...~..,.~. ......................................... /.... ..... o~ ~re~i,e~ I~ted a~ -~".. ...... /x/.~. ............ CO.,.~c,N'.~z~.z....~Z:.... ............................. ............................................................................................................. .~..,~.z~.x,.,~ ....... .~... ...................... 19.(~..~, and approved by the Building Inspector. Fee $,.. ,~...'~......-m:... .... r '"" ' ~ / '13~1'lding Inspector FORM NO. 6 TOWN OF $OUTH0/D Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcat~on 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 features. 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. 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 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 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 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 dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ... ,Z'././.O,....~,,~.~. ¢.~c~. C/...~;7~/, .~'.CC. ·~, .......... ~".~),,/x,'~?. ~. 7Z.... House No, Street Hem/et Owner or Owners of Property ...... ~.u~O~ ~'.~/~..../V(~ .i~. · ~ ............................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~. O,~..~tz. ~. Date ofPermit ~'/~?~,....Applicant .C~c;,~../.~'~'...~.4~..~./~, .~.~.°..~. 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. Rev. 10-10-78 ~, ~. ~_/~ FIE%D I~SPECTION COMMENTS FOUNDATION (lsd) FOUN~AWION (2nd) ROUGH FRAME PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 '"'--- TEL.: 765-1803 Examine ~ .~..-q. .... 19~. Approved~d~..7,5 .... , 1~..~. Permit No. f.~.7.~.~..~ / (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. [.Q 7.~..~. · ....... Date ...O'-~t.~.a. 220 ?.., 19C~D ? 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 t9 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 applicahon, 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 applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ..... .X~o~.. ?/...,~,~,,,:c..,, .~?./..//~..,.r.~ ..... (Mailing address o1~ applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ d~ ./d.~..~............. .............. ............................................... Name of owner of premises .... ~.t~ c/fJ.~. ~9.. / .~/,'6~.1,: o ................................................... (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 ....... ~ ~c~.~>~. ............ Plumber's License No. -- ~ Electrician's License No. ~ Other Trade's Lwense No ...................... Location of land on which proposed work will be done .................................................. · ./. ,: .0. .......... ..................... c,. ................... House Number Street Hamlet County Tax Map No. 1000 Section .... O ~ .~'- ....... Block ...... .~. .......... Lot... / ~. ............ Subdivision....~ ?.'. '~:..I:..~:~ ....................... Filed Map No ............... Lot ............... State ex~st~ng~ase. , ~a~$~¢p~ncg. . ,~prem~ses and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~.G ;C[o.~.C ~ ............................................... b. Intended use and occupancy ...... ~& r.& m.C .ff .... ~. (~(~ .~. ~(~ ..... 3. Nature of work (check which apphcable): New Building ........ ;. Addition .......... Alteration ... ........ R ~ptur ............ Removal ...... ',.,::.. :" 'D. e~,~,ltt($rl .............. Other Work .O, te~o~..de¢~. · , ~ i/~-.~ !~, ~ ~ i ;,.q ~,? ~ ~'Yt I~ ~ ~ ~ (::/, (Description)' 4. Est~ated Cost ...... ~. ~ ~. ...... :.:.:~ .:.."IX~ ¢:i 4, ~q"~ ~, .... g~ .... ~ .......................... ,':,?~ ','-' -'- (to be paid on filing this application) 5. If dwelling number of dwelling Units ..... Number of dwelling unit{ on each floor ........ .... ,'~' ,W ,'L~ , ~"~ .......... . , ; .... ' ' Ifgarage, number of cars . .: ............................................................... 6. If business commercial or mixedl occupancy specify nature and exte~ 0f oa~ typ~gf use ............. 7. D~ensions of existing stmcture~, if any: Front .... ,~.~..: .... Rear . .27,,~ ....... Depth ...~ ......... . Height ' ~ ~ Number of Stones ......... ~., .... , .... ...: ',' · '~ ................ Dimensions of same structure wi~h alterations or additions: Front ................. Rear .................. Depth ' Height Number of Stories 8. Dimensions of entire new construction: Front ..... Z~ ....... Rear ............... Depth .. ~ ......... Height .. ZO .......... Number of, Stories ............................................................. 9. Size oflot: Front ........... ...,.. ...... '~ar,~i ' :!~,,~ ~ ,.,,,...... De .. .................... 10. Date of Purchase : - ,~ ~ ~ , , .......Ng~q 9f ~om¢r Qwger ............................. i I. acne or use district in wmcn premises are s~¢uatea ............ ~.~ .......... ~ .......................... 12. ODoes proposed constructio~;~iolOte any zoning law, ordinance or re~lation: . ,~ ......................... 13. Will lot beregraded .... .....,....,..............~ Will excess fill beremoved from premises: Yes No 14. Name of Owner of premises .~ ~[..~.~o,,. ~ad~gst, ,, ~,.e~4~./~ ~ff... Phone No. ~a.3. f rchltecl ............ Address .......... P o~p No ............ N~eofContractor C'bo~/e~ ~ o ,,,xAfaress,~e, ca~,e~,~,.Z, rayne 9, ,~,~o,/,a~l, , Locate clearly ~d distin~¢~a~>bu~d~gs~.`~h~th~:`~xating`~pr~p~sed~d:i~ieat~[~iet-~back.)dim~nsi~.~s from ~r~p¢l~'lifios:Gi~a ~r,6t ~d ~bloe~ ~ufltbe~ or :dosen~on,hee0rdmg,to!flegd;~d ~shOw~ ~tr~e~m,es[and.lfdmatetWhother STATE OF NEW y~RK. .... COUNTj~L,QF ....~ ... ·~'~ ~,>~~~..?.~~~ ....... being duly sworn, deposes and says that he is the applicant " : (Name of individual sigping c ntra ) abow; named. ' He is the .......................................................................................... (Contractor, ,on~ onvn~ate officer. of said owner or owners, and is duly authorized to perform or have perfomed the said work and to m~e and file this application; that all stat~¢ients contained ~ this appllcaBon are true to the best of his work will be perfo~ed in the m~ner set forth m the apphcabon filed therewith. Sworn to before me ~i~ ' : ' ~ Notaw Public, ~. · · x ...... County (Signature of applicant)