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HomeMy WebLinkAbout10752-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13792 Date August 15 19 85 THIS CERTIFIES that the building addition. Location of Property 12910 Main Rd. East Marion House No. Street Hamlet County Tax Map No. 1000 Section 3~ .Block ~.~ ....Lot 'It Subdivision X X X ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ... ~ .u_~..e. gO. ......... ,19~.0.. pursuant to which Building Permit No. ~ 0~.~. 2Z dated .. JLu~e 25 19 .8.0., 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 ......... ... ~e.o.k..~.~.q.~.~.t.o.~...~.o., ~. 9.c.e.%..o.~., s..~?.u.c.¥.u.v.e.: ................................ The certificate is issued to .. .~OPa~_~ M. MIT,T,ER .................. iol;,.'d.~ ..................... of the aforesaid building. Suffolk County Department of Health Approval ..................... I~../.~ .................. UNDERWRITERS CERTIFICATE NO ............................. 1~../.g. .................. Building Inspector Rev. 1/81 FOBM NO. i~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10752 Permission is hereby granted to:,.-.~ / ....... 1~~.. ,~...~-... Z~e~~/ ...... ~d...~=.....~,r,,v.,r.~,~,...Z' ..~.. ,o...~.~.~z'.~:=.....-z.l~ ....... ~.~.~..~.~.~.:.~.......~.a...~.cc.~.....sT'a'~.~-¢,,~ ...... ~ ............. ,,r,/~..,~,.~......,,~'.......~.,. at premises located at ..,L'.~,,~.,/,~ ............ ,,~'~ ....... ,~[~,~..~... ......................................... . 0 ................. , and approved by the Building Inspector. Building Inspector FORM NO. 6 TO',TN OF SOUTHOLD Buiiding Department Town Hall Southo~d, ~'" i APPLICATION FOR ~cR ~ ~r CAT; OF OCCUPANCY instructions Th~; =22f[c3tio~ must be fiHed in typewriter OR ~nk, and submitted in duplicate to the Building tot ,.ui~ ~e following; for new build~ngs or new use: 1. E~;l :ur;e,/ of property w~th accurate location of aH buildings, property lines, streets, and unu~al 2. Fin2~ ;~=crc'za~ of Heaitn Dept. of water suootv and sewerage dispose --{S-9 form or equal). 3. Asr:c.,.al of electrical insta!ladon from 8o~d 'of Fire Undecwriters. 4. Commerces1 buildings, Industria bu dines, Mu tip~= R¢*[den~¢~'., - don~. a c~r[t~lcate of Co~= comn~i~n¢o f~ ., '.'~ ~ --- and s~m~lar buhdmas and ' m ~n_ ,&~c,,~t~c~ or ~ngm~er responsible for the building. 5. ~ubm~; Planning Board approval of comp~e(sd si~s plan raqu[remsnts ',,/here 'applicable. Fcr existing buildings (prior to April 1957), Non-conforming us~s, or burial,scs and ~= '-' ,, land uses: ~ ' "pr~-.xlsdnq ~. Accuro[e sup/e,/ of peoperty showing all ¢rcoerty lines, %feets, buildings and unusual natural or tosojr3ph~c features. ' 2. Sv.'crn sr3tement of owner or prey{Due owner as to use, occupancy and condition of buiidings. 3. C2te of 2n',, housing code or safety ~nspect~cn of bu~idings or premises, or other pertinent informa- tJcn rcqu[r*~ to prepare a ce~ficate. / Fees: ' - 1. Ce~Jf;c3~e of occupancy $5.00 2. C~r::fic=te of occupancy on pre-existing dwelling or land usa S5.C0 3. Cc2,,, of certificate of occupancy SI.C0 Date .. ~'.v £ui?:~~ .Z~ ' ' ' .... -' ............. Old or Pre-existin~ ~ ,';-~' ~,"~ - ~,u h,~ln~,..) ...... "V acam: Lend ............ Hou~ ¢Vo. ' ................ ~'~¢ . o,..,~ o~ c...,,,~s o~ P~ope~t,/ ......... F~RX ~ Ccun~,/Tax :'.14o No..lOOOSec:~on ~/- /¢~ ............... B~ock . .. Lot ' %';' '~ ................. W.. ¢~,,d ,~.~¢ ~o...: ....... Eot No... ........... He3~[h De2t. Approval .................. ~P2,~c~nt ~ ........................ Labor Dept. Approval U..~, ./r:,~rs Approval ............... . ......... Plann~ng Board Approval .................. , . .~ F = ~ ~ . , ~ ¢~ ' ' .................... Final Certificate' ......... ~lOIl~ ~. . . ~,,.'~.~' ~'¢/// -' '- ' ............................. FIEL~ iNSPECTION 1. COMMENTS FOUNDATION (Jst) FOUNDATION (2nd) ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~.~64 .~... ?..~...., 19~. · ..... 7.,:Z, Disapproved a/c ..... .:.: '...,. · ._. ........ i~. .......... / APPLICATION FOR BUILDING PERMIT Application No../f~l 7~.,~ ...... 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 removal or demolition, as her~in 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· (Signature of applicant, or name, if a corporation) / or /-2 ~ A' /.5 ~_, State whether applicant is owner, lessee, agent, architect, engineer, genera] contractor, electrician, plumber or builder. · .~. ~r. ....... i ............................................................................ of owner of premises ............................................ (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. ~..~7 ................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done ..... .~.-X~.. ~..~./.~.: ~'~....~..~.....~.~..~../.~.. (..~-~2.. .... .../.~.Stf.q ................................................................................... House Number Street Hamlet County Tax Map No. 1000 Section ....~..~.~//. ......... Block ....... /..~ ......... Lot..~../.~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ~,. ~lke'~. ,..,,~v~.~,l~ir'e,~__~.. . ~., b. Intended use and occupancy ....... ~ .-~..~ .~.(. ~,~,;..~:~:~t. [ 0'~ ................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alterati~L~ _' '_'I_' ..... Repair .............. Removal .............. Demolition ............ Other Work. A-~'. .... ~- ~ .~./.~..--- (Description) 4. Estimated Cost ~5~--..o~..~' -- ~ -fdT.- ~- ................................... Fee . (to be paid on rifling this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nat.ur~,e and extent of each_type of use ................... 7. Dimensions of exisJ~ng strpctures, if any Front - - · '~. t~ear ~ - ' ~ ' ' ~: ,, ~ --~t.-,_ ~ _~ . ' .... , ............... o ....... IJ~ptxt .~-L~-r~-.. ........ Dunens,ons of same structure with alterations or additionsfF/on'~ -'i~ ~ ......... '~ ..................... .................. l~ear ................ Depth ...................... Height .......... : ;.~.~ ........ Number of.Stories .......... ~. ........ 8..D.~n..ens~n~s_of enti~r/e: new c, gnstruction: Front ...... /. ~ ..... Rear · f. ~". · · Depth height ~. ,~~/. Number of Stories ..... ' ................. 9. Size of'lot: Front ............... ·... Rear .................. ....................... 10. Date of Purchase ~ ,,~6/ /~',7.~ ' ' ~( .... k'__' ........... -., · ..................... ~ . · ...../ - · · o t~.~. t. ~ ......... ~ame of Former Owner .~%'~'_~_t_~,a//. 1 1. Lone or use restrict in which premises are situated .......... ' ' e ...................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...,.~ ........................ 13. Will lot be regraded ..... . .,Cr~0~., ..... ~ ............ Will excess fill be removed from. oremises: Yes No 14. Name of Owner of premises ./.¥.~..~. [,,/~ ..... Address,.~.$.~.,~'l]-:. ~_~ No..~.,;2,.~..-~a~0~.J.. Name of Architect .................... ~ ..... Address ................... Phone No ................ Name of Contractor ~,O2~ .~ . ~.J'~ Address ................... Phone No ...... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF Nt~W COUNTY OF .'~t~l~l~,~. · above named. tot, e er, 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 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 rifled therewith. Sworn to before me this Notary Public .............. ~ta~a~.~4{ Count -. NOTARY PUBl_ltC,State of New Yorh ~ ~ature of applicant) No. 52-8125850, Suffolk Term Exl~lres March 30.