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HomeMy WebLinkAbout10551-z fORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy Na, .. .2;9(35.1.. , .. .. .. Date. , ,J.~I}1,I.a):'Y. .Z5. . .. . . .. .. .. . . .. ., 19.80 THIS CERTIFIES that the building . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property. . . . , .4:E}Q. F.';rc~d. S.tJ7Ei1I':t. . . . . . . .. . . . . , . . . . . . . .NI3J11. .Suf.folk/1' .N. Y. House No, Street amlet County Tax Map No. 1000 Section. .. .1~7. .. . .Block ... .O~... . . . . . .Lot .. . .009. ...... .. . Subdivision. . , . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. ....... .Lot No. ............. canforms substantially to the Application for Building Permit heretofore ftled in this office dated . . . JA!,\1,tI;l:ry. .21. . . . . ' , 19 S.Q pursuant to which Building Permit No. .. .105512. . . . . . . . . . . dated ..... J.anuar:y. . 22~. . . . . . . . . . 1980. , 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 . . . . . . . . . .. . . . .. .Scr.e.en. s.d.dit.iQn. to. .One. .F.amil:y: .Dwelling . . . , . . . .. . .. . .. .. . . .. .. . . . The certificate is issued to ...,...,.. .Ros.aIie. .Inza~aoo. . .. . . . . .. .. .. .. ... . .. .. .... . (owner,~ of the aforesaid building. Suffolk Caunty Department of Health Approval ........ N/.R . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . N./.R. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . ......................... . uilding Inspector Rev 4/79 ~ ',"- "'."",_>,11 ,1. }:i>t :ivl b>'L L. JL' FORM NO. 2 TOWN OF SOUTHOlD BUILDIN~ 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? 10551 Z Date ..J;;N..~.&1?7.....z.L......., 1cxf?:1.. Permission is hereby granted to: _0_') ......./Ca. 'SAJ./..f..6:.....ZNZA/-6J. ,CO ' ..........1I..?Q....&E/2..X."..,' .", .., ___ .....l./t:d..I.....:5~.PFO'LF.. (..t..; .,(.. to .l.9........(!.O..t..J51/.?:,(.u::T.......;;:r.;::;;..e;=-;::- A.)..., :E.i0.C.WSCl,/ei;i, ,,:r.:cr,~,...... .....,~I..:;;.T../..4.:.....?,,;),n..O.....A;7;i CUoEC/. ..2(i.:..,..:.iu.r.c=.j41.J~I............, . at premises located ot .~.....~..?t;?.....,..l::.I.CE',Q......57.K15:=..I....................... ............".." ..,.,..,.......................,.....,..................................,.. ,. ...,'".....,Vew....~EF.o.t...s...:-:-.tY.,7,. , .............................................................................. .................................................................................. :z ' n pursuant to opplication dated .'d.(.I.GI,,(?'~.. .~..........,...., 19M.., and approved by the Building Inspector. Fee $.i.~....~..... Building Inspector ........ , I " ~ ! .d. L i , fORM NO.6 TOWN OF SOUTHOLD Building Department Town 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- tor with the fallowing; far new buildings or new use: 1. Final survey of property with accurate location af 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 or equal). 3. Approval of electrical installatian from Board af Fire Underwriters. 4. Cammercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer respansible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (priar to April 1957). Non-confarming uses, ar buildings and "pre-existing" land uses: 1. Accurate survey af peoperty showing all property lines, streets, buildings and unusual natural ar topograph ic featu res. 2. Sworn statement of owner or previous owner as ta use, occupancy and condition of buildings. 3. Date of any housing cade ar safety inspection of buildings ar premises, or other pertinent informa- tian required ta prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy an pre-existing dwelling or land use $5.00 3. Capy of certificate of occupancy $1.00 ~ /~ ~ \ Date .J.I)J,J<)f!./7.t?y .Z;.~ . . . . . . t .0ew Building. . . ~. . . . . . Old ~re-existing Building ............ Vacant Land .~........... Locatian af Property .:1. f.d. . . . (7 ~p.. . . . .;J: Il/.?:!'((. . . . . . . . . . . . . . t.r ~ :-:<?:Fr~f:..f:::..,/ p '7 House No. Street Hamlet -, 1/ Owner or Owners of Property ../.~ (l: S<<"? .1. .$'. . . .If.!. 2A ~N.CO. . . . . . . .. . . . . . . . . . . . . Caunty Tax Map No. 1000 Section .. !(7. . . . . . . .. Block...~ 't:'. . . . . . .. Lat.. 99.~ . . . . . . . Sbd'" . -- u IVlslon........................;;;. .~. .Flied Map No. ......... .Lot No. ............. Permit Na.I.G..5.T?<=Date of Permit I. . ?-.~ .~ .Applicant .. .t(!S4A (E.... /.1:--1 Z<J./..,1'!C:;.Q. . Health Dept. Approval . . . . !J If2-. . . . . . . . . . . . Labor Dept. Approval .. Vi {.~. . . . . . . . . . . . Underwriters Approval. . . .!.-!.; re.... . . . . . . . . . . . .Planning Board Approval " .)U/~. . . . . . . . . . . Request for Temparary Certificate. : . . .. . . . . .. . . . . . . . . .Final Certificate ~ . . . . . . . . . . . .. . . . . . . Fee Submitted $ . . S~ . . . . . . . . . . . . . . . . . . . . CMOru,,'"" "" ,b", d=,'bod '" dd'" ..d if! m""" .~' ."':It; 'M """ ,,,"'"" '"."..n Apo';""' HUcU H H H ~;;'(i i~Jr~ . !M l:1 '() CD I 4 . 1 1 . ~ .m,,- ,.".,,-,,1,... , {i'H" , ,'V; FORM NO.1 t TOWN OF SOUTHOLD ':/ ~, BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 - TEL.: 765.1802 Examined J;Q/J.. .27.. .,,19<0 'CJ '~-~/ ........ "7 -/, <f' . , "'-C-/ -2 Application No.!.. . . ~. ......... ApprovedV/.J.;..). . . ,~-. ~-:-. . ,,19 . q Pennit No. / .Y..,1; .u. . - Disapproved a/c ..... .~~ . . . ................... . ........... ...................... ..Ja.... . :~k~M/.~ .'1::A . .. ...... (Buildi g Inspector) APPLICATION FOR BUILDING PERMIT :z;j ILl 2- I &J 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 Pennit. d, Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such pennit 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 Pennit 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. L ) .{' , Jl'C4~.~.c(.........{~ ' , yl._"""?..,;f., ( ;;.t c--<,.\ . . . (Sig~~t~r~'~i ~~~l;;a~t:~; ~~ide', ii ~ ~~~~~;ati~~)' . . . , ~ ":l' ( JII' ~ .. fllr. P,. r~c! ,,",4<1... ./tll": ...-:<i.I,', .i.;f,.ft... (Mailing address of applicant) r State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ,.. -......... ,....................................... ........... ,... ,......,. Name of owner of premises ..)( p, 5.11 J.I. .f. . . . . . . :J: N.7:-'. f1. {, f1 ~. P. . . . . . . . . . . . . . . . . . . . ' . . . . . . . .. . (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. .... .-:;::;.E.:.t.,-,.<.. . . , , . . . . . . Pl"mb,Mjooo" No. .. ..!............ Electrician's License No. .."..,.....,....,.. . Other Trade's License No. ", . . , . . . . . . . . . . , . . . . I. LocatIOn of land on which proposed work will be done. ............ ............................... ..... . ?:t?':~ . . . . . . . , . . . . . . , . . . , . , ,h<?I.J. . ,~~~ . . . . . . , , . . . . . . . . . . . . @':~. Jvr.F.9 t,.!-. . . . , . . . House Number Street Hamlet County Tax Map No. 1000 Section ...1 /.? . . . . . . . . .. Block . .Cr'/. . . . . . . . . , . .. Lot. C?.Q J. . . . . . . . . . . . . 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, . .1!)'h7{:;. t:?1:;Jj.'(d.~. .A.vii:.i//.iVr::y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy .-:5/. :/1/.I.7tf. . X/.(~~I.L). i!f',u;:.1a4V~. . HfK;.P.d).1. d. . . : . . . . . : . i , , < dl, "t . II "',, ' ! , , S'c- -&,rxli 3. Nature of work (cheek whieh applieable): New Building. . . . . . . . . . Addition . .~.N.c:;.t..q, Alteration .......... Repair .............. Removal. . . . . . . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . .:z; J- (Description) 4. Estimated Cost. . . . . ~ f':? . .:. . . . . . . . . . . . . . . . . . . . . . . . . Fee. . . . . . . . . J.f';. . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this applieation) 5. If dwelling, number of dwelling ~nits . . . . . . . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . If garage, number of cars ..... ,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixe4 occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structure~, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth............... Height ............... Num:ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . , Depth . . . . . . . . . . . . . . . . . . . . i. . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constf].lction: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth .. . . . . . . . . . . . . . ~eight ............... Num;ber of Stories. . . . . . . . 'il . . . . . . . . . . . . . . . . . . . . . . . . . ;J . . . . . . . . . . . . . . . . . 9. SIze of lot: Front.... .1.{'.9.,........... Rear...I...9.............. Depth ./..;;;;..... ././.;:....... 10. Date of Purchase ...........:.................. Name of Former Owner ............................. II. Zone or use district in which pr~mises are situated. . . . .Ii. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ........ .:. . iJ. . .. . .. ... .. .. . . Will excess fill be removed from premises: Yes f- No , . , E ' t,.- f' l,I' 14. Name of Owner of premIses . . .;5. . .M. . . . . . . . . . . Address.. . . . . . . . . . . . . . . . . . Phone No. ? 3. . . . . . . . .7. . Name of Architect .......... ,. . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . Phone No. ..... . . . . . . . . . . Name 6fContractor .. . . .. . . .;. . . .. .. . .. .. . .. . . Address.. .. ., . . " . ... .. . " Phone No. . ... ... '" . . . .. PLOT DIAGRAM Locate clearly and distinctly all i buildings, whether existing or praposed, and, indicate all set-back dimensions from property lines. Give street and block twmber or description according to deed, and show street names and indicate whether interior or corner lot. I ::i C/C" rZ a.J ;E..vC'- Sl/EIC. . <.. 'Ef</~7/ "'<7 ?..oTI e , " i, , " I ) '-I ~ \ I' i .~ EX. ,Ii )/\oVf LL. 01)/ \ - r S'l> --------.------- ff2Gi) 5'r. STATE OF NEWYQRK" is.S COUNTY OF. . . ) i,.\.l (. :. .. . . . e?' I -, .f< C ~ (, I 1'- I 11,' c.: "!( () b' dId d th t h . th r t .. . n ,..'....... ..~'..'.. . .. .. .'.. '.. .. .. . .. . .. . .. .. . emg u y sworn, eposes an says a e IS e app Ican (Name of individual signing contract) above named. He is the. . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dulY authorized to perfarm or have performed the said wark 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 , , , /.,/-. . . ./. . . ,..{. . '.":. . . . . . . . . . . .day o~. . .f!. J. ... . . . . . . . . . . ., 191. (.! 'l ,., f '-'/,) (i" /:1' ;,' {(L.i ( /" : If' , ; / Nt Pbl' j.'fl C t o ary U IC, ............................ '. '.,.... oun y . : \ "),: " ,(, I Ii' ~ I /".'f .1' ('.. '. '-, .> rl ' ~ LINDA r. !<OWALsr<r , . . . . . . 'o'. . . . .. .'. . . . . .1. . . ..... . . ..."~,,,...I_). . . . . . . . . . . NOTMY PUBLIC, St,te of New i01I1 ) (Signature of applicant) No. 52-4524771 Qualifwd In Suffolk County ! blffilfnlssJOn t.xplles M,ml! 3D, IpSO