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HomeMy WebLinkAbout10534-z fORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy z13725 August 7 85 No................. . Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 19 . . . THIS CERTIFIES that the building . . . . c;~?-.i.t;~'?~.'. . . . . . . . . . . .. .. .. .. . . .. . . . . . . . . . . . . 275 Parsons Blvd. East Marion LocatIOn of Property ......,........................................................ House No. Street Hamlet ,37 2 3 County Tax Map No. 1000 Section .,......... .Block .............. .Lot . . . . . . . . . . . . . . . . . Subdivision. . . . . . . .~. . . . . . . . . . . . . . . . . . . . . .Filed Map Na. ...:c... .Lot No. ....~........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .<!<:t!':U.,,:J?Y. .2... . .. , 19 .~9pursuant to which Building Permit No. ... .1.~~~~.Z........... dated ........ ;r.a,r:1,1<:t~.Y. . ~ . . . . . . . . . 19 .~ q , 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 . . . . . . . . . . . .G~~PP.:r:t;. {l$'l.C\j, t~P.~ . t9. .~~:!-!':t.:i,~g. ?~~~~~.r:'1:. . . . . . . . . . . . . . . . ., . .. . .. .,. ... . . The certificate is issued to ..... .~QJ:3j;:R~ . ~.'. .~ . $?,;L.~~. ?'.". .~.z:-..P?~ . . . . . .. . . . . . . . . . . . . . . . (owner:Xaf;.M/K~ of the aforesaid building. Suffolk County Department of Health Approval ............... '/fI( A . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . '/fI/1\ . . . . . . . . . . .. . . . . . . . . .. . .........W~..~................. Building Inspector Rev. 1/81 i L J."" J FORM NO. 2 TOWN OF SOUTHOLD 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~ 10534 Z Date ....JAiJ()Ar.c:~.r...... 4.,... ',,',.., 19,00 > KtH ---~- Permission is hereby granted to: K.Ei..; - . c.. ,...qc:..yl (( 7;.---" h ~- ~ U 0"- /.UlC/6J/.L..~::-...... ..,.aiA.. .. ',,,<U.:lt:: '.. ~ 73.:J."....;:::;a.k.....~L",.. .... ......" , ' f:;.~'5if...,)./,o..t/UAJ./",i.J.. '7..,:, . c _.. > .-,.. "'- - h-~t0. - to ...., ..Q..L<~./../.r::vG.J...,....l.N,<<:'...rH:J./(..t...~.....t<J.p.~;u. ./,0... ....../,..0: ..,..,......,......" S< ~- , -- -; ~ ~~ :p~e~se:';:~?~::P7~~f.:~~;:;::;?j;~;;:::~::::::Zi:k;;;;~;;>:~7 ......................'...........:.:..................:::.::..::.;.:.:::.'...'..'..'.'.....,.......................z...;::.::;?................,.............. c,.r2~,a/~V6..ISa.f...~s.7::.::.~.,.. ,..,~..,...,.......,...........,..,..f/.b..:f.t:. ,.,73....i7~ .- z. \'7' pursuant to application dated ....../<!tf..IU#;cy..'....'.....'........, 1 'tJ'tl.:" ond approved by the Building Inspector. /./.:'-c:::e.. Fee $... .:;)..,=..... i ' , "..., ~",1/ "j;" ,! "", FORM NO.6 TOWN OF SOUTHOLD Building Depan;mem Town Hall . . SouthoJd, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Thl~ <lopllcation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec. tor '.'JIm the following; for new buildings or new use: 1. Finol our/ey of property with accurate location of all buildings, property lines, streets, and unusual r:1~urJ! c:" tODograohic features 2. F,nJI JPprovai of Health Dept. of water supply and sewerage disposal-(S.9 form or equal). 3. Acproval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa. tion" a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit PI3nnlng Board approval of completed site plan requirements where applicable. B. Fcr eXisting buildings (prior to April 1957). Non.conforming uses, ar buildings and "pre-existing" IJnd u:es: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural ar toposrJDh 1c features. 2. S"lOrn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. DJte of Jny housing code or safety inspection of buildings or premises, or other pertinent informa- tion requ ired to prepare a certificate. , C. Fees: 1. Certificate af occupancy $5.00 2, CertlilcJte of Occupancy on pre.exlsting dwelling or land use $5.00 3. Cop,! of certlficJte of occupancy S1.00 Date. . . .. , .. New Building............. Old orpre.eXisting~Uil~f). _t<_,_ __. 'Vacant Land -............ LocJtlon of Prcperty . ..?I_,~:!5:"t/"f/?~!'~t~.. . .t,.1;JJ.. .. . ~!~7>.I: .P:1Ag.(q.'~",. N:~.... House No, Screer H mler Owner or Owners of Property R{'.~'>f.A-.r c,~.:'(~_$,It.LL.'1. 4.'. H.1t.'1) P. r:. . " . . . . " . . . . . . Countv Tax i\lep No. 1000 Section. . O'~~. . .. .. Black.. Q ~ . . .. . .. (I C. ~ Lot. _ ", .'~.. ........ SUOolvlslan,.. . . .. . ... '" " _ . . ... ... . . . .. " .Flied Map No. . . . . . . , . . .Lot No. :7. ~. -:. 7.. i .. . P'?rmlt No. .......... Date of Permit ,........ .i~ppJicai1t . . . . . . . . . . . . .. . .. . " . . . . . . . . . . . . . . HCJ!th Depl. Approval. . . . .. . .. . " . . . . . . . . . . . .Labor Dept. Approval .. .......... .... ..... .\.. Undervltiters Approval. . .. . " ...... . . . '" " . . .Planning Board Approval. .... '" .... . . " ..n . ., Request for Temporary Certificate. . . . . . . . . . .. . .. . . . . . .Final Certificate. . ~. . . ... . . . . . . . . _ Fee Submitted S , .6~ . !.~ J.l.~ 7. . .. . . . Construc:ion on abo~e described building and~'meets al~li,cabl~odes and regulations. ~RI=..:c\37~0 Applicant., .,...y . ,s>;g~.. ~1~'"J''''' .............. .010.;).70 - A... 10 10,78 Qo ~DX \ \ ~ fV". \tf0q " .~.' ~_ ..?-:ti:!~:'~~':", . , ~. I ~ -. '. , ' , I , !lJ.A. L ,,,,1 <~>g. " i . \.1 , FI~,D INSPECTION DATE COMMENTS co 1. .... ~ 0 ':!/I1; rIJ -;y; / IJ < ~h ~A4I t!j ~ JOUNDATIQI'T _ -11st) 4 y ~ 25 ~ . N FOUNDATION (2nd) , . , - ~~ 2. 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I - l I , 'I L I "'t" I 4-=-.....:..- .=::...: I - - . .: --.::.': -' ....... - -/1 --.. - - - - - ~. . - ' - -..j --- I \ - - _.~. - I -- -- ~1 . :-; I N L~_ I - ! -I , ~I , i I' I I , , I I ~ -.".. - - I .- - - - - <:::(: .::l - -~,- ! -.. ~, I - - I i , , I I I ! " ~ ()(:) ~ I j ~ N ~I f ( -'-L ........., - \\ " ~ ....... " , I,- '\ ~I ,,\~ ~ C:rt. ~ ~'~ -) '-, '\;. f' C ..,) , ') \ V ~I ~ ~_~ ~ ~ ~ ~ 1- ~~ <( \X . ....." \J ~ ~ ,~ ~ ~ .:: ----------- () ......" ./ ~ ,-- lC) {i ~~, 7-, 'Vv - I -::J.;zYJ>, ! - \ , . . ~ - ,'.. ~ , ~,~ , , FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 - TEL.: 765-1802 Exammed .JAJIJ. .2!-..,.. " 19~ ApplicationNoJQS:-.?~...... . Approved .J;U .:?:-. , , . . ., 19 J? Permit No.lO'$'.'$'.V:-:Z Dlsapproved a/c . . . . . . . . . . . . . . . . . . . . . ;/' . . . . . . . . . . , ..................... ,.. --...., APPLICATION FOR BUILDING PERMIT Date. . {,,,,:q. , f;. . . . , . . . ., 19 .8,Q INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Bu.ilding 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- catlOn. 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 premlses 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 herem 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 Us. ~ ' ,~~-z...-v,-",- , ................ d............................ , (Signature of applicant, or name, if a corporation) . :):'...Q. .43.0.4 . ~9;l... ,Ea.s:t .Mar,iQ:tl.. N.Y., . . , . . . , (Mailing address of applicant) 1 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , . .. .. .. .. .. .. . . . . ~e.:q'?r~J, ,qop..t.:r:~~:t.o.:r: . .. . , . , .. . . .. . . . . .. . . . . . . .. . .. . . . . . . .. .. . , . . . . .. . . . . .. . Nameofownerofpremises ,... R~1,. Ft" .Q... .:!j:~1;tJ?:t."....,..............,........"..,.............., (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. ~?J. Q (/;; 0:1. . . . . . . ....'~--~- Plumber's License No. ..,...,..........,..,.., El t" , L' N '~{VOIIU'J. - O2V1V..cn:.G ~~;-;- ec nClan s lcense o. ... .-. . . . . . . , . . . , . . . . . , 0 A./I ;,<J - . Other Trade's License No. ..........,..,... ., , I. LocatlOn of land on which proposed work will be done. .~7 P. .:RIJ.:r!3().I!G . ~;I.:v:q.. .. .({IJ.:r(i,i;t1,6,J;' ~ 13. . . . . . . . . . . . . . "........,....." B.ay.]Js,ta.t~s.,. ,Eas,t .Mar.ian,. N..Y.........,...,...........,.."",..,.... House Number Street Hamlet CountyTaxMapNo.lOOOSectlOn .,. Q;:;.7....... Block....O ?~......... Lot.'i:f?. .'7.1. .~,~~.,., Subdivision .~/t't:?l.tli~. .'M.{. ,~((...,.... Filed Map No. ..,........... Lot .7$~.7<j..... (Name 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy. . . .Q.Lf;3: i:-AH (~7' . ?E;?t R=./f:.!~. . .. . . . .. . .. , . ,. . . ., .. . . . . . <g . b. Intended use and occu~ancy ...... .~~ . .~ ~:?o.x:~ . . . . . . . . , . . . . . . . . . . . . . . . , . . . . . . , . . . . . . . . . . . . . . . ~ .', I " ,> ...-j, Ji.,d ,1: C,., i?/1;G" 3. Nature of work (check which applieable): New Building. . . . . . . . . (A~d". . . . ~. . . .. Alteration .......... Repair .............. Remo~al . . . . . , . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . , "" -crcJ (Deseriptian) 4. Estimated Cost . . $. .,), ( P. (J. t.f) P. . . . .. . . .. .. .. .. .. .. . Pee . . ..'/ ';:? . ~.. .. . . . . . . . . . .. . .. .. . .. .. (to be paid on filing this application) S. If dwelling, number of dwelling Vnits . . . . . . . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . If garage, number of cars ..... I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 with alterations or additions: Front ................. Rear.................. Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constr~ction: Pront . . ./2. ~. . . . . . " Rea~ . . . /.~~. . . . . . . . Depth. . . .41. ~ . . . . . . . Height' . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front. .. . ... . . . .1. . .. . . . . ... Rear...................... ~t>>r.'~'~" . .. ... 10. Date of Purchase ...........:.................. Name of Former Owner . I. . ... . !. .... . . . . . . . . . . . II. Zone or use district in which premises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction viol~te any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... ,. . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises. . .;. . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. .,. . . . . . . . . . . . . Name of Architect .~..~..... Address i3' ~ . . . . . . . . . . . Phone No. ....... . . . . . . . . Name of Contractor t. .. .' . ............. Address -.'11,... .. ~p.I....... Phone No..JI.77.-.'l-Y;J.~.... I c: 1>1A-7e/(J~ N,y. PLOT DIAGRAM Locate clearly and distinetly all: buildings, whether existing or proposed, and, indicate 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 S&c p/..-<JAJ.> 1: S--c /{;~ . ! NE/CC?e.J/ ~ ""' , , , . STATEOFNE~ is.s COUNTY OF . .. . .. ';./ . . . . .f'-!(,fP.. . . 1./1 . .<;:~f.1.-9:"1. . . . . . . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. I , ., He is the . . . . . . . . . . . . . . . . . . . .........,... " .... ."...... ,............ .... ....... (C011tnictor', agent, eorporate officer, ete.) of said owner or owners, and is duly authorized to perform or have performed the said wark and ta make and file this application; that'illl statements cont~ined 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 I . .. . . . . ..::::t he{. . . .... ..day of ..~t:\MAVn1:. .. . ., 198~ Notar~.. ..... t ...Stc.- ./i:county . C . , , ElIZAB , ANN NEVILLr .~..~............................... NOTARY PUB IC. State of Now Yb~1 (Signature of applicant) No. 52.8125850. Suffolk Co~ Term JiJ<p1ref Merch 30, 19 i