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HomeMy WebLinkAbout12965-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. ~.'(3.4-3~. ........ Date ............. l~ia~..q~ ............ ,19~5. THIS CERTIFIES that the building .. ,a.c!.~-.~.~q~. .................................... Location of Property . .~. ?5.©. ............... ?.e.q o..ll.i.o,. ~..a ~r..B. ~. ¥.d.. ......... .~.a.~.~.. e..]. ..... House No.. Street Hamlet County Tax Map No. 1000 Section .. ,~ .~ ...... Block .... Q~ ......... Lot ...0.~..~ ........... Subdivision .... ~. .......................... Filed Map No .... ~ .... Lot No.., ~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~..I'9.~' .~..0 ...... 19 ~ pursuant to which Building Permit No...q..29,6,5, ,~ ........... dated ...... Ha ~eB, .}0 ............ 198¢., 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 ......... .... .~,~, ,~ ,d.d.J-,~5. 9~..~Q..eXJ,~l;;J-~g. 9~e.-r.:~V~J~y..d.~_;L,q~, ....................... The certificate is issued to ..... ~Tg4~. ~....~¢. lv/~. ~.O. IJ. ~)0J~0~X~ ..................... (owner, le~e-o~tep, a~ of the aforesaid building, Suffolk County Department of Health Approval .... no~ ~?ec2uizcecl UNDERWRITERS CERTIFICATE NO ............. ~.../.~ .................................. Rev. 1/81 Building Inspector FOB,~ NO. B TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMJT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12965 Z Permission is hereby granted ~: ~ ..... ~ ........ ~,~.~ ................... .... ................ ..C..~..~.........~....~ ............ .~ .................... .~. .................................. . ................... ~ ......................... at prem,ses located at ..... .[.......~.~...........~....~. ........................ ~....~ .................... ..~..~. ......................... pursuant to application dated ......... .~....~...C~.~..t~,....~ ............ , 19.~..~.., and approved by the Building Inspector. Rev. 6/30/80 ~xamined . '.~..a'5~'. Q3. ~ .~..., {pproved ...~. ~l.3.~..., 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ,~OUTHOLD, N.Y. 11971 TEL.: 765-1803 19~.(]. Permit No. J ~kD.... fi'.5"..~ Received ........... ,19... )isapproved a/c ..................................... (Building Inspector) ~¢t..F_..~;.~/~ APPLICATION FOR BUILDING PERMIT a. This applicatiTn mua~mpletely filled in 2~t;;~r~t~Ir~Sin ink and submitted to the Building Inspector, with 3 ets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of build~gs on premises, relationship to adjoining premises or public streets ~r areas, and givh~g a detailed description of layout of property must be drawn on the diagram which is pa~ of this appli-. ation. c. The work covered by t~s application may not be commenced before issuance of Bufld~g Permit. d. Upon approval of this application, the Building Inspector will issued a Building Pe~it to the applicant. Such permit hall be kept on the premises available for inspection ~rou~out the work. e. No building shall be occupied or used in whole or in p~t for any purpose whatever until a Certificate of Occup~cy hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Build~g Dep~ment for the issuance of a B~lding Pemit pumuant to the luilding Zone Ordnance of the Town of 8outhold, Suffolk County, New York, and other applicable Laws, Ordnances or {egulations, for the construction of build~gs, additions or alterations, or for removal or demolition, as herein described. the applicant agrees to comply with all app~cable laws, ordinances, building code, housing code, and regulations, and to td~nit authorized inspectom on premises and in build~g for necessa~ in~pFctions. .... .......... ~¢Sig~t~e ~ ~pplicant, or name, ifa corporation) . .ffc: ..ge. !..&h. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Na,ne of owner of premises .... .Z./.J. ~..~/~...~ ....]?.,...0.~.~..~..O.._3'...~..[i ................................. (as on the tax roll or latest deed) if applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Buildcr's License No...~../..~. ...... .~: .~?..~. .... mlmnber's License No. /.~'./.A. ...... .'~..~.4. 5 .... Other Trades License No..~ ..... :~ .~. .... House Number Street Hamlet 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 ~..,~. Z~..~. ~//..~. .... ~..~.4~ ./..~. ?'..(.~..~-...~. ......................... b. Intended use and occupancy .~...~.~../. ~ .0..g/. ~..d .~../...~.C.~ .~..~r'..A/..~.-.(~D , .~.~., .p?]..L..~.-fl..~..5./..D.~r'..3/..~.~. 3. Nature of work (check which applicable): New Building .......... Addition ...... &~... Alteration .. i ..... Other Work . ~ .... Repair .............. Removal ............ Demolition ..................... 4. Estimated Cost ....... :. r~..o ............... Fee .. . p..o. .................... · ./~, Z.~. ~'. (to be paid on filing this application) 5. If dwelling, number o,f, dwelling units/~ .... Number of dwelling unit~ on each floor ................ It'garage, nffmber of cars ......... :17. ,~. :: ........................ i ................ '~y '~"; ..... 6. if business, commercial or mixed occupancy, specify nature and extent of each tYpe of use ..... ,~..Z~..,,r. ff4 ...... 7. Dhnensions of existing strUctures, if any: Front ............... Rear ....... i ....... Depth .} .............. Height ............ Number of Stories ............................ : ............ 4'....~.:~..~"~ ·.. ~)~?~l~sions of same structure .w. ith ;[te~[~t~ons or ~ddition. s: Front... iq.u.n~;; ;~i~i;~i:sRear 8. Dimensions of entire new construction: Front ............... Rear ........ i ....... Depth/ .............. 'Height , Number of Stories .............. t... ............. ~ /' / 9. Size of lot: Front ..... /. ~,..O ........... Rear ........ '.2.. ~. ......... iDepth ~. bi... 2" '~:~' '~' ...... 0. Date of Purchase ~..~. ~'./. ~./ ................. Name of Former Owner £4~.~m~. i. Zone or use district in which premises are situated ............ ~. :W'.../~ ~..~..I. ~.~ .~...Ti ./,4 ./7. ............. 2. Does proposed construction violate any zoning law, ordinance or regulation: .... ! ............. ./Y.. · ?. .... ~., .... 3. Will lot be regraded .......... ~ .~. ............. Will excess fill be remove!t from premises: Yes ~ No 4. Name of Owner of premises .z~.A. (~/?.X.-.~ wP. q g.o.$ ~./~ddress~.°~'.~q.x. .d:.~.~.~g( .tr. ~F.,Phone No.:~. .P .~.-..P. q~ .7.,. Name of Architect ..; ........................ Address ............... i .... Phone No ................ Nmne of Contractor .... ......... Address ~ . Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, i~dicate all set-back dimensions from street names and indicate whether roperty lines. Give street and block number or description according to deed, and show ~terior or corner lot. NOTIFY BIIILfblNG DEPARTMENT 765-18¢? 9 AM -r'o 4 PM FOR FOU ©WING !hm?FCTIONS: 1. FOIJFlmA'! IQN ~ TWO REOUIRED FOR P'-~t J'.¥fD CONCRFTE 2. ROLJGH - FRAMINc' ?, PflIMRING 3. INqLI[ A'! 4, FINAl .l"r'~vq,P'' I '%1 k'~'IST ALL Cr~,~x!~"'Cq'ON ?tp!l t, aC'FT ..STA-r~ Cr.~¢-ro..[iCTiON ,o. ~- ..... cOr~FF, hl'.r REqp,~h? p,~ TATE OF NEW YORK . u s.s OUNTY OF. ~. .......... ~... ...... ,~, ?..M..g'..~. ~..Q., ./?.~.../~.0, ,J, ,/~, ,/, ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) bore named. ~ ' - , . .,, o ' .. ~e ~s me ......................................... ........ i ......................... (Contractor, agent, corporate officer, etc.) ~ owner ~, ~d is ~uly authorized to perform or have perfomed thel said work ~d to m~e ~d file this pplication; that all statements, contained ~ this application are true to the best of his knowledge and belief; and that the ,ork will be performed in the manner set forth in the application filed therewith. worn to betbre me this NOTAR~ PY~t116, Slate of Ne~ ~o~k / ~ .......... .~. . No. 4'tQISTS, Sulblk c;m~tZ ~ ~ // tm~gnature of apphcmit) 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 to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate Iocatlon of all buildings, property lines, streets, and unusual natural or topographic features. 2. FinaJ approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of p~operty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings, 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $ 1.00 4.Vacant Land C.O. $5.00 ~_/~.'~' / p~)- Date ......................... ,,~.~,~,~ e-- New Building .. ~ ........ Old or Pre-existing B~ilding~ ....... ~,.. Vacant Land .~ ........... · ' · Location of Property . /Z ....... ~~. ~. ,~1 ......... ~~ .... ? Subdivision ....... ~ ...................... Filed Map No..~ ..... Lot No...~ ........ Permit No.~.~ ~=&ate of Permit ~/*.O~Applicant./- -- '~~~__~ ........ Health Dept. Approval ..... ~ ,%~, .~ ..... Labor Dep~Approval .. ~ .............. / ~nde~riters Approval . .~ .~ ............. ~l~nn~n~ 8o~rd ~Oprowl .... ~ ................. ~e~uest for Tem¢oraw Certificate ..................... Final Certificate ~ Fee Submittod $. ~' Construction on above described building and p_,9/mit meets~ ap,~bte codas an~ regulations. Applican ................. F f~ELD~INSPEC T I©N - FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY C0 E ~, .... ~ CO~4MENTS FINAL