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HomeMy WebLinkAbout10609-z FORM NO.4 TOWN OF SOUTHOlD BUILDING DEPARTMENT Office of the Building Inspector T own Hall Southold, N.Y. Certificate Of Occupancy z 10366 January 29, 81 No......... ......... Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 19. . . THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property . .~~. ~~'?'. ~~~~~~~ .~~!I:~~......... .~t;t~~?~~?e.,. .~.'~'......... House No. Street Hamlet County Tax Map No.1 000 Section . .1.~? . . . . . .Block ...~...... . . . . .Lot . . .J~. . . . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. .....,. .Lot No. ............. confarms substantially to the Application for Building Permit heretafore filed in this office dated ~~~~~. y ~. . . . . . . . . . . , 19 ~? pursuant to which Building Permit No. ... ~ ~.~~? ~. .. . . . . . . . d t d r1s,J:'ch 31, 1980, d d f t 11 f th . t a e ............................ . . . , was Issue , an con orffiS 0 a 0 e reqUlremen s of the applicable provisions of the law. The occupancy for which this certificate is issued is . . . . . . . . . . . . . . . . . . . . . . . . . . . /!c9~.~!J?rY. .~'!;~f:~g~. )3.~n!i.l.qg. . . . . . . . . . . . . . . . . ., . . . . . . . , . . . Th t'f " d t James Homan e cer I Icate IS Issue 0....................,.... ?C~ . . . . . . . . . . . . . . . . . . . . . (owne , of the aforesaid building. N/R Suffolk Caunty Department of Health Approval ................................ , . . . . . . . . . N/R UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . C~ 714/l/th\..-' ...... ...... ..... ..... ........ ......,.. Building Inspector Rev. 1181 , I , t ' ;,;,1; ,,"",15<1 j;j, Ad .L. ;,. FORM NO. 2 TOWN OF SOUTH OLD BUILDING DEPARTHENT 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? 10609 Z Date ./k!4.KC./:-l..,......:J.t....,............" 19i.-b., Permission is hereby granted to: ..........::i;lAd~.~.~fc,.UM.t~..,.., ......... ' 'e. 7 ~ r?. C! --- ~'~ cy ...... ',.I.(;1.,(.......J. .......... &'/'(#C17V':;;;".""" . .................................................................,. .,...-, to ..(~9:.fY.5.?.-<(.I..J...,a::c.7."..S.70./'c"O'7&..'.. .~-L.'7....II..J......Id;:.rn~..,y.tCP . .............................................................................,. ." . .... ................................................................. . at premises located at .$..Q......6I.?;<,!,.;...52.T..T.w.k6;....LA:J.....C.L;;:~.d,.(.(i7...1,.;. '1' .........................................................................,. .... ... ........................................................................ ,......................................................................" ... .................................................................... ........... pursuant to application dated ...I::(.A/.C.c..I:;l., ..5.1...........,.., 1~.., and approved by the Building Inspector. - Fee $/0................. / ~r. ................. ) '<'-+' .i ilJJ ,it. l . fORM NO.6 TOWN OF SOUTHOlD Bu iIding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicatian 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 tapographic features. 2. Final approval of Health Dept. af water supply and sewerage disposal-(S.9 form or equal). 3. Approval of electrical installation from Board af Fire Underwrfters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa. tions, a certificate of Code compliance from the Architect or Engineer responsible far the building. 5. Submit Planning Board approval af campleted site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-canforming uses, ar buildings and "pre.existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural ar topagraph ic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any hausing code or safety inspection of bu ildings or premises, or other pertinent infarma- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of accupancy an pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 / / .. /' ... . Date ....~~0/.......... New BUilding. . . . .. . . . . . . . Old ar Pre-existing BUilding ............ Vacant Land ............. Location of Property .. .':~ .~. ~. . . . . . . . . II-! ;e. ':L! . ~.~ ~ ~=. ~ ~: ~ . . !-: .~.~. ~. . . . . . . . . .e. t.; :r.t? A 'f:!j. u e- House No. Street Ham78t ----- I / Owner or Owners af Property ....;>..~. YY! .P..!.'. . . . p.o. .11-1. I'l ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . County Tax Map No. 1000 Section . .1.C!f . . . . . .. Black.... ~ . . . . . . . .. Lot..~............ Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. ......... .Lat Na. ............. Permit No. ./t!6p.7.. DateofPermit~.-.3/:.~~ .Applicant.. ..,J :. )j(!.m-.If}.~............... Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Labor Dept. Approval ........................ Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .Planning Board Appraval ..,..... . . . . . . . . . . . . . . Request for Temporary Certificate, . . . . . . . . . . . . . . . . . . . .Final Certificate ~. . . . . . . . . . . . . . . . . . . Fee Submitted $ . . . . . . . . . . . . . . . . . . . . . . . . .. .. Construction on abave described building an per it meets ~/:::s and regulations. ~~ w~; .. 't .Y#w. . . . . . . . . . . . . . . . . . . . . . . . . . . ! Q '~b ~~/~\ ..... tit J i ,~_ L0if .J.tJi; -Jk_ L _ r\ ' ;!IEL? ~~~~~~~~llION _.:-.~__-=~=~:2~(_'~====--=:::=_ i~ t ['(\1,1 '~b~\_~~'_____._~~~~~__l--:--=-.~_":::I ,OJ I ~ ~ 1 ~ ~ - ~~ j ~, FOUNDATION (1st)" --~. _.._....~.._-~.... ' ~ - ~ 1 -------!---- ? l' - I~~ FOUNDATION (2nd) ~ I 2. - ~ ROUGH FRAME & 1~ PLUMBING , ~ i 3, , ~~ - ~ :t~ INSULATION PER N.Y. IT\'; ~ STATE ENERGY f;' COpE - .. ~ 4. II 3.-<7f /q; / - (8 //7 ~ ~, - '/ / I . IT ( 4 ~- ~ (t3/ /) FINAL , -d . - _A A' da_ 7;' 'I' ~ ~, ~~ . ~~ ADDITIONAL COMMENTS: \ -- 'b t ! ...- - , , ;(" ~Q -- ...,"'" PI" ~'" - g~ f - , ::I: (j) .' iJ) f-' IT ::Y . t:I . ~ I IT ._.- . 1 d ,_ -<., "'''', , <4, {{;,'t of; "u_ ,-. . t ~"J '* " ,^ "f", 1 '}' <, ", ,", " " , fORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTl\IIl:NT TOWN HALL ' " SOUTHOLD, N.Y. 11971 TEL: 765.1802 Examined .~I<<.#: .~/, 19~ Application No.l.O("o. 9.'. . . . . . . . Approved !i.-<?I.tc:/:(..t'.1. " 19JJ. Permit No. /Q( 9. .9.-i:.. Disapproved a/c. . . . . . . . . . ................ . ! - ..................................... . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date. "$./Jl........., 19 ~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c, The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICA TJON IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bUildi~ e, housing code, and regulations, and to admit authorized inspectors on premises and in buildmgs for nec~s.s~~ ~~~~~~. ~~ ~~. . . . . . . . . . . . (S~atu of applicant, or name, if a corporation) , ,. ..... ~.$.t. :/.f!#T~. .1f'7~-:'f~.J: \ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ... .&f~Y.. ... if.... .,........ ~.~. .~~;................................... Name of owner ofpremIses/. . . Ch...-rt--.. . .. &. ., . . , . , . .. . . . . . .. , . .. . .. .. .. .. .. . . . . . .. , . . . .. . . ... . .. (as on the tax roll or latest deed) If applicant is a corporatio , signature of duly authorized officer. ..... ......................................... (Name and title of corporate officer) Builder's License No. ...;:::;;et.F......,...... Plumber's License No. ...,..........,......... ElectricIan's License No. .-?".i!f.4F........,.... Other Trade's License No. ....,......."....... I. LocatIon of land on which proposed work will be done. ............,.,...........................,...... . ,~(9... " .',....... ,~. /)1((?:,-d~4.~~..... .&4~'P~...."""" House Number Street ,Hamlet County Tax Map No. 1000 Section . .. .. I (:J. '-. .. , .. Block . .. . .. .. 6. .. .. .... Lot. ~.. .. .. .. .. .. .. .. 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 . .\~E;~. .~..I':J ~ N. .. (cJ.C;J.t:J. f. ~.~.0-:t. (~~. . .e ~3.~ :.. . .. . ,. .\. . . .. .. b. Intend~d use and occupancy........ .,,\' .11. .":10.~.: .7+/,. '~. M~. :-.1J.I:i7. .z:........ ,., j ".:J, ,.~\ .w,J,J ::i.:, . ! , ,; 'i\' ", 3. Nature of work (check whieh applicable): New Building. . .v.. . Addition . .~ .' .Jtetatian .......... r' t '{, Repair .............. Removal . . . . . . . . . . . . .. Demolition .............. : Other W:ork. . . . . . . . . . . . . . . , o1:f ,,',. (Description) 4. Estimated Cost ... .l1~'~p. .,......................... Fee.. .Ie;;:;. .~. ,'..,... .:-................. (to be paid on filing,this application) 5. If dwelling, number of dwelling 1.!nits . . . . . . . . . . . . . .. Number of dwelling units on each 'flQQr . ... . . . . . . . . . . . . . , . If garage, number af cars .... ',' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ',' . ... . . . . . . . . . . . . . . 6. If business, commercial or mixed accupancy, 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 construction: Front. . . . . . . . . . . . . ., Rear . . . . . . . . . . . . . . . Depth ..... . . . . . . . . . . ,I ' Height ............... Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front.. .Ip/..~. ............. Rear. /.{).l.n)J.~........... .~th <!'.f:~-:-. .V.f;tl........... 10. Date of Purchase ..... /. f(j, .f. . . . . . . . . . . . . . . . . . Name of Former Owner. -H. A' MH.-1: . 11. f.~ 1'.1>,. . . . II. Zone or use district in which premises are situated . '~" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. D?es proposed construction vi ~te any zoning law, ordina~ce or regu.lation: ..............:.,...........@ 13. WIll lot be regraded ..41~.. '......ta.......... Will ex~~e removed from premises: Yes No 14. Name of Owner of premise . ~. . .-rn~.Address. .. .~:l1...;r....PhoneNo. .'l.l.tf.-;v.')P.P.. Name of Architect '. . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name of Contractor ... .. . .. .i.. . .. . .. . .. . ... .. Address.. .. .. . . " . ..... . " Phone No. . ... .. . " . ... .. PLOT DIAGRAM Locate clearly and distinctly al( buildings, whether existing or proposed, and, indicate all set.baek dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. 5cc ~/.d/VS. ~ S Ct A':'VE; N!2,fL).v /Iff' STATEOF~~ iss COUNTY OF : . . . . . . . . . . " I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant , (Name of individual signing contract) above named. He is the. . . . . . . " . . . . . . . . . . . . . . . . . . . . . . . . . " . . . . . . . . . . . . . . . . , . . . . . . . .' . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . (Contractor, agent, corporate 'officer, ete.) of said owner or owners, and is duly authorized to perfarm or have performed the said work and to make and file this application; that all 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 mann~r set forth in the application filed therewith. Sworn to before me ~ ; . . . . . . . . . . . (~ . . . . . . . . .day of. . . . . . ~~A.. ., 19 .c:f.b ~4d.. ~--- Notary Publi . . . . , . . . .~" 1 """'?'~~ounty JUDITH T. T~RRV .~....... Notary Public, State ;01 New York . . . No. 52.0344963 Suffolk Countf,1 (Signature of applicant) Commission ExpJres March 30, 19 . ," I ,0 :\~' '; ~'e,' <, """ ~..' ,-t ,- f,' 'v "'s~"'<"~"'~:'} "~J,,~,:~!}^ ::'t;~;-;:'if;j;;tt,/ '{~rj;~~hIf:~i.'{:;.':;~:') t<' ",);.:,> ~-T~;i ",; '"". -j(r~' ", 0"""T:,\" <i~ . Iv! f~~- /tV 4 ~' ", " Y ';"i ,'''':<e: ,,;:"" '~.,', ,,";:; ,', ' ), " ......" 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