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HomeMy WebLinkAbout10562-z - .- fORM NO.4 TOWN OF SOUTHOLD BUilDING DEPARTMENT Office of the Building Inspector Town Hall South old, N.Y. Certificate Of Occupancy Z10390 February 18 81 No................. . Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 19 . . . THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330 Village Lane, Orient, N.Y. LocatIOn of Property ............................................................... House No. Street Hamlet Caunty Tax Map No. 1000 Section ..... .Q?5. . .Block ......Q 1. . . . . . .Lot . . .. . .QQ\3...QQ?. . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. ....... .Lot No. ............. conforms substantially to the Application for Building Permit heretofore ftIed in this office dated ..... .f?b.r:\lar.Y.. !~.., 19 .f?9pursuant to which Building Permit No. .., .19??2. .~...~ .??6.3 Z FEbruary 15 80. . dated .......,.................... 19 . . . , 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 ...... . . . ............. .A.c.q~,?:"J.o.r:y. .B.4PAi.qg. i'I.n.<:j, ~!1.d.H~pp:............................. The certificate is issued to ......J. ~(3P.e. . (\,. .Mql,1 ~P. .& . ]').1.1::1:}. ~'" .119!l.1.c! . . . . . . . . . . . . . . . . . (owner,-IeostIe-M'femrntr - of the aforesaid building. Suffolk County Department af Health Approval ........ ~ !.R. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . )'I/~. . . . . . . .. . . . . . . . . . . . . .. . . . . .. . ... . . . . .. . A; y ~:~/ \<<""1/ .: /~o;tot-o-' . ......... ". '" ...... ....... ...... .... Building Inspector Rev. 1/81 " . , l~J ~ Ii :, ,~., ' FORM NO. 2 TOWN OF SOUTH OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUiLDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTl-IORIZED) - ~ N? 10562 Z Date h:-i::..(!.d:.(/,AI(:.r..../.~.... ., 19J'"O Permission Is hereby granted to:...-. .......0:..;?~.t;;:..6J.~......t.::(<?.,Cl.4 0 ,..,.. , ....#...f,:}o......0:(f~.7-{;.. J.,/UyE, .......CJ.te.tJ(;:A!.T,<.., (:of,:.';!..:. ........ ".., to ....CQ..b!..;?T.a:y...~.C..../.9.P/?.l7J. ,o.l.J ..:TQ.. ..~.6.T.I.tY...J............,..... ' , .......C'l.C};..~.-:;;,.~R;,7:......1?.~r:.~g.t.N~.. "....... ........................,....,......,............. .., at premises located at Tt../;l.;r.Q......v/.f./v9.Gj~..L;fjN.~f.....Q(<;r..if:.~.'[;...N..7...... . .............................................................. ........... ................. ..,......................................... ..................... ,.... ..................................................................... .......... .............. ..................................... ............. pursuant to application dated {;;t!/.:(.Y-.(J(,?/-...I..:?. ,.... ,. , lJ.C?, and opproved by the Building Inspector. Fee $..IQ..~~..... ; Ii ,.J}. ',' . 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 ta the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate lacation of all buildings, property lines, streets, and unusual natu ral or tapograph ic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal}. 3. Appraval of electrical installation fram Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings. Multiple Residences and similar buildings and installa- tions, a certificate af Code campliance fram the Architect ar Engineer respanSible far the building. 5. Submit Planning Board appraval of campleted site plan requirements where applicable. B. For existing buildings (prior ta April 1957). Nan-canforming uses, ar buildings and "pre-existing" land uses: 1. Accurate survey of peoperty shawing all property lines, streets, buildings and unusual natural or topograph ic features. 2. Sworn statement of owner or previous owner as ta use, accupancy and candition af buildings. 3. Date af any housing code ar safety inspection of bu ildings ar premises, or other pertinent informa- tion requ ired ta prepare a certificate. C. Fees: 1. Certificate of occu pancy $5.00 2. Certificate af accupancy on pre-existing dwelling ar land use $5.00 3. Copy of certificate of occupancy $1.00 d--!3-,f'( Date...... . .... .. . ... ... . ..... New Building. ... '::... ... . Old or Pre-existing Building ............ Vacant Land.. .. .. ... . .,. Location of Property .if A? '?. . .. . ~F1I.~.~. .4.0 !'... .... . . Q.~ .l~.';~.. .. .r:v:y.. .I,.9.j~:.. House No. Street Hamlet Owner ar Owners of Property . .-:f~5,'~ .fI:.!. .R,:,.1.". 0:.t1-~'!/c:~.. .... . ...... . ... ... .. . . . County Tax Map No. 1000 Section.. .i'?PJ.-A....... Black. 9. {........... Lat. 9.9RII?.c!.7;-;-... Subdivision. . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . F lied Map No. .......... Lot No. ............. Permit No. (~~~!:~&. Date of Permit ? ~ !r.":~?Applicant .--!.'.PJ i~{!J.~!<A. . . . . . . . . . . . . . . . . . . . Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Labar Dept. Approval ........................ Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .Planning Board Appraval ...................... Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . . 1<. . . . . . . . . . . . . . . . . . . Fee Submitted $. .~9.'?... .~tt.9/.?..... i Constructian on above deseribed building and applicab e odes and regu latians. ~ I;' 40 Applicant. . . Rev. 10-10-78 I j ,]I ..;, ' ' '" -J ~ ,,,.j, --'C. , FIELD I.NSPECTION DATE COMMENTS. . 'u:--. 1. -- ~ ~ tlb~~~~4 d1~~ - -- ~~ _FOUNDATION _ -list) / . . ./------ a ~ . N FOUNDATION (2~d) ~ ~ 2. ROUGH FRAME & P: ~ PLUMBING . ~ ~ 3. ~~ - ~~ CD i\ INSULATION PER N.Y. c+ ~ STATE ENERGY ~ C Ol;JE iift 4. ~ - !J..//'7 Vq 1.- :ft. - t1 (fJ / // rL /, L . ~,' .." ,7 v FINAL ' ~ ~ L7.. r--u / (/ ~ . ~.~ - ...H f J ADDITIONAL COMMENTS: ~ _.__' 1t >, - ~ . , ~~ R~ 'i ~ ...-- ~~ ~ ~ .::; "" f- ::r: CD .' (\) I--' n ::>' . t::J -~ c+ . i ;' i;, ~ .' ",,~ ,._ ,,,1. ,.,..: ,1- ~ .(,;: :~~ '. ',\ , " " ,t;;:.- ".,' "" ~ .\"' . . ,< rij',; <':';f' '_.; ...', ',N., !"-,~ ",;- f-- ;'7. ~1" , /1 I: -'J" ~ /~ ~ ~ . ~.? ~ .. '.'", " ,; . .~ i. v' .., " \. '" ~'~ ,~ .",- , .." ~: . _.. ;~ ~,,~- ti I.... .. 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Ii to '1 Di 11) <{ I,^ ' co ) ;, ~ l..:,_,. /ence /' f: W. -', J l! ,:,. t:....._ 1'33. / I Z Z ; ,'-" ... 7., _.2 ~ _~ ___ ~.___ ...... -~....."'{ ~ It-" ^ '" .~___.....-.__ ~~_~~ _~____"^______ ~_~ $.;;:'6 '/8'5';"W. j ~ (~ MAiN t5T';<;'I3~T Q-Z. VJI.....L.AG.S" e;.., '~ \ .~~,.. ~~ -- .-....... -........,.--~_. - .~".....~ ----.......,..-,~ ~...".' - ~<~'---~'~-;---_._---.........- - ,~.-------~----_. ~,.-t -~---- -..- ----...,--~_.-~-~ \\l ....,.'.... t "'-'~'--""~"""""---"'-""""--~-----""""'---""""""-~-""._-~~-, c" '~.--....~~........---~- : :",,-- - ~ - . -~_. -""-" 1 __---"'-"""-'~..,,,l:. ,,,,,-.1, ",,. <Ie " ,,;.~^, ^. , fORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765.1802 Examined TJ::~. /:f.'.. . . ., 19 f'<? Application NolQ f:?!:. b. . . . . Approved/.:'.:l!'''': 5."". . . . . ., 19 f.~ Permit No. 1C?:3? 7;02.. 3 -= &~~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date r:"'&.4'.'",."'.': y. . /~. .., l~<:. 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 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 eval or demolition, as herem descnbed. The applicant agrees to comply with all applicable laws, ordinances, building ode, ousing code, and gulations, and to admit authorized inspectors on premises and in buildings for necessary' sp ion. ..... . . . /1/ .. . ..... . . . . . . . . . . . . . . . . . . . . . . (Si re of applicant, or name, If a corporation) ... .Y.'!'.~3.": .~?-~~.\:?<:\i,:-t:".'!.:Y: .'.'':I'?'.1..., ",. (Mailing address of applicant) State whether applicant is ~r, lessee, agent, architect, engineer, general contractor, electncian, plumber or builder. ......... ,-.............................. ,-..,. ,.......... ,.....,.... ,-........ ,................ Nameofownerofpremises ,~e?": .1;1... :V-:4?,u,'!:1) !':''I.'. .(')9'.c~'c;l......,..,................................ (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;(~ f. , . . , ...... . Plumber's License No. ,. ,I.Y.<::J ,Mt;:,.. . . . . . . . . . . , Electrician's License No, ,A!.9 4E:-. . . . . . . . . . . , , Other Trade's License No, ..................... I. Location of land on which proposed work w!ll be done. ........".." ..... '1' . . . . , . . . . . . . . , . . . . ., ..... :5-,; G . . . . ,t;,#:r . i~1':-,-Z . . . . . . . . . (p 0"-:-'f-:,:-'<, . . , . . . . . . . , . , . . . . , , . . , . , . . ' , ......... . ..... . House NumbN Street Hamlet C t T M N 1000 S' a .2- S-- Bl k 0 ( L C;O '? ODk-: ounyax ap o. ectlOn. ....,........... oc .. .,.....'.,..... ot.~..-......, ......, 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 .. . I t';c? . . ..<f....(.~ ..................................................., b.Intendeduseandoccupancy .. .IF':'" \. ,~~~\'\.. .~."q(?/?/7~Q.0.............,................... j ",,>.1,.,-1. I. ..~. . . , , 3. Nature 'of work (check which applicable): New Building. . . . . . . . . . Addition. . . . . . . . .. A1teratian .. ~ . . . . . Repair' . . . . . . . . . . . . . . Remqval . . . . . . . . . . . . .. Demolition .............. Other Wark . . . . . . . . . . . . . . . , '? ~ Z -' ~ (Description) 4. . ! CiO Id ~ EstImated Cost. . . . . . . . . . . . .:. : . . . . . . . . . . . . . . . . . . . . . . . Fee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this applicatian) 5. If dwelling, number of dwelling \.inits . . . . . . . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . If garage, number of cars .... .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If busiI:ICSS, commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. D' . f' f t t "f F t oS7 /. R .s," D th 16:>0" Imenslons 0 eXls mg S rue ures, I any: ron ............... ear.............. ep . . . . . . . . . . . . . . . Height, . .-;t?<i>:. . . . . . . . . Nu~ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front /.Qt/. ~~ . . . . . . . . . " Rear~..q.g, :'. . . . . . . . . . . . . Depth . . . 1.t4.o:: . . . . . . . . . . . . i. . Height . . (i? f~ :'. . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . 8. D' . f f t f F t $/" R,.5.'/" D h /60" ImenSlOns 0 en Ire new cons I}1c Ion: ron ............... ear. ............. ept ............... Height . IPi'. '.'. . . . . . . . . Nu~ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of. lot: Front.. .lJ'!"!~.'1l. .1. .. .. . .. . .. Rear...................... Depth ...................... 10. Date of Purchase ....6.:-. ?,r,.. .'. .. ... .. . .. . .. . .. . Name of Fonner Owner .~<,;I(~ 7. ... . ... " . .. . .. ... ... II. Zone or use district in which prJmises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction viol'ate any zoning law, ordinance or regulation: .ty'~............................. I 13. Will lot be regraded .........,................... Will exeess fill be removed from premises: Yes No 14. Name of Owner of premises .. .:. . . . . . . . . . . . . . . . . Address ... . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name of Architect .. . . , . . . . .'. . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone Na. .. . . . . . . . . . . . . . Name of Contractor . . . . . . . . .:. . . . . . . . . . . . . . . . . Address .. . . . . . . . . . . . . . . . . . Phone Na. . . . . . . . . . . . . . . . PLOT DIAGRAM Locate ~learly and distin ,build gs, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give and block numb r or description aeeording to deed, and show street names and indicate whether interior or cor 01. : ";'a... t3 r ., ,}. ~~ :' ,1 ,qr",:)<t' )- i u! , :a:: , i . ~ 'f/ddt hot? ~ '" .....J. () I - , ~ t.u .311\ r,: I '" .... ~ ij: , [ ~E ...JI I ~ ~ ~r~ 1 '&()01l.,/:lJ STATEOFN~ 's.s eO; COUNTY OF . .... . . . .. I . . . . . . . . .,. . . . . . . . . . . . . . . . . . . j. . . . . . . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant (Name of individual sigI\ing contract) above named. ' , He is the . . . . . . . . . . . . :": . . . . . . . : . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have perfonned the said work and to make and file this application; that all statements eont~ined in this application are true to the best of his knowledge and belief; and that the work will be perfonned in the manner set forth in the applieation filed therewith. Sworn to bUare me this I , ........ ./~.~..,'.... .ct;:j3~." 19.ef!J Notary pUbli~l...7: ~~. . .. County , JUDITH T. TERf1Y Notary Public, Stete of I New York . . . . . . . . , No. 52 0344963 SuffO:lk coun':!.! (Signature of applicant) , I Commission Expires March 3D, 19 . , ' I I