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HomeMy WebLinkAbout10618-z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Sauthold, N.Y. Certificate Of Occupancy Z100"r.; Jul)! 11 80 No. ...,..,'~ ...... . Date . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . ., 19 . . . THIS CERTIFIES that the building , . , , . . . ' . . , , . . . . . . . . . . . . , , . , . . . . . . . . , , . . , . . , . . . . 51225 Ma'in Hoad Sou.thold, N.Y. LocatIOn of Property ....,....".,.. . . . . .. .. . . .. 'street . .. . . .. .. . . . .. . . . . . . .. . Hamiet House No, 70 1 2 County Tax Map No. 1000 SectIOn ........... .Block ...... . . . . . . , . .Lot . . . . . . . . . . . . . . . . . Subdivision. . . . . . . . , , . . . , . . . . . , , . ' . , , . ,. Filed Map No. . . , . . . . .Lot No, .,........... conforms substantially to the ApplicatIOn for Building Permit heretofore filed in this office dated . .. .. ~p'~j,~.. :1. , , ,. , . . , 19. 89pursuant to which Building Permit No. .."..: 9.6~ 8?<. .. . .. . . d d Aproil 3 19 [J(} . d d f II f h . ate ...... ....,..."......,..,.. , " . , was Issue ,an con orms to a 0 t e reqUIrements of the applicable provisIOns of the law. The occupancy for which this certificate is issued is . . . . , . , . . Breezway with Attached Garage .............. ,. .. . ................. -.................... ...................... Th t f t ,. d t James Loughlin e cer 1 lca e IS Issue 0".,...................... mJrJrJf7hifrl'r:F ' . . . , . . , , . . . . . . . . . . . (owner, . of the aforesaid building. N/R Suffolk County Department of Health Approval ......................,...,............... N/R UNDERWRITERS CERTIFICATE NO. . . , . . , . . . . . . . . . . . . . . . . . . . . . , . , . . . . . , . . . , . . . . . . . . . Cv ~.. ?I ~ -' ... .7<./~. ..'~.'..,.... :~~....)....... Building Inspector Rev 4/79 ! " 1. '_li _.> ~..;.... ~j. J.l L:~ L_._. ~'" . II- , FORIII NO. 2 TO~N OFSOUTHOLD BUILDING DEPARTMENT TO~N CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL \ COMPLETION OF THE WORK AUTHORIZED) ~ . 7 ~ N~ 10618 Z Date ..:p/C.f..L........~........,..............., 19d1J. Permission is hereby granted to: .....2Ga-o:...L.....-#..:i77.. ......, . ~ -~ h .......d~ . . '(;Jib..."::':':..M:..... ..: ...."..,.. ...................................................... ..................... . to .....CcJ.I4~,t:C(.;.r;:;r::...(j.&?~P.......A.<::.~.&;:::?$:~~.....~"~..f2L'.j .............~..<..........:JA&?;;:S.... .CI.."";i.6I.'iC..t..,&I................... .................................... . at premises located at :::#...~d,;,:;:........y.6}./..I.J......~..f?e.............................. ..... ....... .............. .............. ...................... .......... ......., ..... . ........ ...................... ...... ...::::Jaf!.["t:(c?'?".Q.~. '...................................................4..........:.:.........................................'(}....................................,.. pursuant ta application dated ..~fiJ<<::t..t............t..,..................., 19J:O., and approved by the Building Inspector. Fee $./O...~..... ...................~...~~....... Building 'Inspector j ; ~'d, < J<J, , .~ . Aib.< , .. ... . ..' :1 TJ I 'P . i ::j. ,. '~_..i":IS I ,.., V1P'D r"re::r...."',L '0:\' t_r....l1j - ------ F-~ - ;~::__:::::.~~~:.:--::::---=:-:-=======i~~ ---- - - ..;..,..-.-.--.-.. L~ " ! 1 I ::d ~ '7 _'" ~~__J-_ H ; ~ , d -,,_.._~.~ -~ / .A -7:.- /y . '7i:7.---.-.-~------ FOUJ\1DATION (1 st) z 0 - -~--~--- l . N 6$ FOUJ\1DATION (2nd) ~ -P:;,..n-A II L~' I 2. z~ ROUGH FRAME & PI\.! PLUMBING , ~ , ~ wI::; 3. ~n. - (]) INSULATION PER N.Y. ~~ STATE ENERGY CODE ::r;1;I " t;/~ t7'~ ~ ".f/ ?J /0 ~ ... !D' 4. ~ - , ~ (]) IT , FINAL rJ. /j~ #. /'r!-/O I 7 .... ':-\ ~0 ADDITIONAL COMMENTS: ~ I> , ~ ~ '" ~:::;~~:!~L/ ,~~~~Jfj;j~c( ~ - " C- , ~~ ~......... 'i "l.' ~"" g~ ~ - ::r; (]) I !D f-', . ; \ . .- i i "", J ~.:o-i. .> .~ .,,:," . b3. t t ! 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" ,! , , l' 10 f~ 111 11Ji FORM NO.1 ~~~.jf TOWN OF SOUTHOLD l' BUILDING DEPARTMENT 0(/' " (J' (gv TOWN HALL '~\D 1\11 SOUTHOLD, N.Y. 11971 ~ TEL.: 765-180:1 .' IL.5 ~ ,. o6/~ Exammed/.. . C/f.. . . . . . . . ., 19., . , :2 ApplicatIOn No.1. . . , . . . . . . . . . . . Approved ff(((~:..f.., I~. Pennit No 106; ~ f ~ ~/.. ~~ ~ rn.,,,ro,,d 0/, ...... ... . . . . . . . . .&. . . . . . . . ....,........,.,...,..,. ..........,.... .".. .., ~;t?~~ ... ..'.~i~.I~~~~r APPLICATION FOR BUILDING PERMIT Date ?:f6..../.. .. ., . . .. .., 19'P!. 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 Buildmg Inspector will issue a Building Pennit to the applicant. Such pennit shall be kept on the premises available for mspection throughout the work. e. No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Buildmg 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 :ys~e5tions.,. ~. _ '/ ... ..t'~{dX:llfiiT............... (Signature .e:applicant, name,. if. a corporation) ~ .- -:l.l ;r :f ,...........~ J.Y- .~, fI.....~. .,....,..... (Mailing address of applicant State whether applicant is, owner, lessee, agent, archItect, engineer, general contractor, electrician, plumber or builder. , . . ... . /3.-.tAd(l;~0... ...,....".,............,............,..............,............... ~ " , Name of owner of premIses ,'/'" d-1-:Z:i. 'iL1. .4-J ~~!ii:-::x' ~;li;~ i~t~~t' d~~d)' , . , . . . . . . . . . . . , . . . . . . . . . If applicant is a corporation, signature of duly authonzed officer. .................. ,...,'... ,-............... (N,., ,"d tid, 0'4'''' offim) ~ Builder's License No. , "~...". .... Plumber's License No. ...........,.."...,.... Electrician's LIcense No. ..."..........,.. .. . Other Trade's License No. ."....",.,......... I. Location of land onyhich proposed work will be done. ......................,..,...........,.......,... >~'.!. ,~. ?:, )~.. ,..',., .I?fa!-!/{, /4/1/.-/1............ .-<d~f4:./.I.,."........,...... House Number Street Hamlet . 70 ( ~ County Tax Map No. 1000 Section "."............. Block..., . . . . . . . . . , . . .. 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. . . . . . .. . ., , ,( . .(",:,:,":'/':41. . , .~~'~':':!. ',' .~. '1fY:~.e:.;~-:-)-;-;. . '" .. .. b. Intended use and occupancy .......,.. ./.~q..~.. .. . . . fr~~'~"l.. .lIje!. . '1~':::~~. . . .. .... .... i " 1 ~,," :--"i",J "it , ,.1,' 3. Nature of work (check which applicable): New Building. .V. . . Addition.. . . . . . . .. Alteration .......... , Repair. . .. . J '7~' . ~emoval . . .. .,. .. . " .. Demolition .~;.;;;... Other Work.. 'd)~~~;i~ti~~)" , 4. Estimated Cost. . .. .. .t! /? < .~ ~ . .. .. . . .. .. .. .. .. .. .. . Fee ./.. . . ~.. . . .. .. . .. . . .. . . .. .. .. . .. .. I (to be paid on filing this application) 5. If dwelling, number of dwelling upits . . . . . . . . . . . . . .. Number of dwelling units on eaeh floor. . . . . . . . . . . . . . . . If garage, number of ears .... ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed ,occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensfons of existing structures( if any: Front. . . . . . . . . . . . . . . Rear .............. Depth............... Height ............... Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Dt,pth . . . . . . . . . . . . . . . . . . . . ., . Height. . . . . . . . . . . . ./ . . . . . . . . Number oj Stories. . . . . . . . . . . . . ., . . . . . . . 8. Dimensions of entire new construction: Front. . . .~ P. . . . . .. Rear . kl{J. . . . . . . . . . Depth . z....y. . . . . . . . . Height ............... Numller of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size oflot: Front .... . . . . . . . .! . . . . . . . . .. Rear...................... Depth ...................... 10. Date of Purchase ............!................. Name of Former Owner ............................. 11. Zone oJ! use district in which preI}1ises are situated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction viol~te any zoning law, ordinance or regulation: .../.I/."?J......................... 13. Will lot be regraded ......... j. .. . .. ... .. .. ... . . Will excess fill be removed from premises: Yes Noy 14. Name of Owner of premises . . . .: . . . . . . . . . . . . . . . . Address .... . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name of Architect .. ',R' . . . . . . . . i::.' ~ . . . . . Address .... . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name of Contractor . . ~. ," .. ~ Address ,)ouT1:!. f'h-b.. . .. Phone Na. 7.6sf.-.,!!3, 1tJ.. , , PLOT DIAGRAM Locate clearly and distinctly all buildings! whether existing or proposed, and, indicate all set-baek dimensions from prop""" linoo. G'" ."", wd Wook "~b'''\"oorlpIinO "',,_ '0 ""'d, wd "ow ."", ,~~ wd mdi,,'" wh"b" interior or corner lot. ' ~ ' o ~- / , Tar...v, " . '. I d"'^"'\ I I \ ~ ' I 1~ ' I I ; .~. " ! I { ~; ;t{.bW j 'i \ r,,, "'Aj <.0;;..3 ' " I t--....~' j ~ ' I \ -,~ ' I ! I ' , j :;1 ,~.. ,_,' ~ 1 i i l r ~' II LJ'J r'> I, r' ~ j , I : ~/I r ,~, ,,; j I .!:. I .., , ."f.'IO},>;~_ ;,..,.,~~ i { I , ,. I, I ! I .. I I .: I I --..', ...,.L... ./ l..j-r ~~''''" ~> -, -'''' ~,_.,-",,~.~"-,-~. '. :...... t" ,,/ , STATEOFNEW~ SS ' . COUNTYO~ ......: " . . . . . . ..It .. : M'i/': .~..~ w:: ~7". b."" d,ly ~om, do",,~. wd ..y""" b." "" .,,"=, (Name of individua Mgn' g co ract) above named. C't). :... He is the. . . . . . . "~' .Cf..,('J;"l.;ry. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contfned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manne, set forth in the application filed therewith. Sworn to before me this /~ ; ~ . ~.~ J<~.1):/' ...... .. .., 19 P-P N a Public, ...........................\...... County /u ~_~. .,,~~ LINDA F. KOWALSKI ",;.. .. , NOTARY PUdllC, Stotl of Ny' . . . . . . . . . . .~. '~o!",L.~, . ., . . . . . ew ark . f r t) No. 52.45247/1 Ignature 0 app lean Qualified In Suffolk County CommlsslOll Expires Mtrch 30, 19~