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HomeMy WebLinkAbout6449-ZFO~ NO. 4 TOWN OF SOUTHOLD BUT[.r~ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupency No. Z..%7.0~ ..... Date ..............D.e.c.....1.8. ..... , 19.73. THIS CERTIFIES that the building located at . 01.e .~T~,e. ~e. ........... Street Map No ....zx .......Block No.. xz ......Lot No. m... F~tt$~;~ck.. ]B,~, ........ conforms substantially to the Application for Building Permit heretofore fried in this office 19. 72 pursuant to which Building Permit No. 6~9Z dated ......... "30 ..... ' '73 ' dated ...l~a~... 23..872. &14~r. ,31~g .73., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Pri~te. one. fa.~ll7. ~e~..1.:~n. g .v~L.t.h.. 1.5.d.i..t~L..o~...&..f.e.~..e.e ............. The certificate is issued to . Cole~te. PLtvolf. a ....... C)w~e~. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....N:.R... ............................ UNDERWRITERS CERTIFICATE No...~I. ~121~2~.... Oat.. 3.~... ~ 97~3 ............. HOUSE NUMBER ..... 3.0.30 .... Street ... J:Lle. J.ule. Lane ....................... ' /~ /~-'~" r:B~,u~~r ............ FOKM NO. 2 TOWN OF SOUTHOLD 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 AUTHORIZED) N? 6 49 Z Permission is hereby granted to: c OLL: -~ E ~UL T,~ pursuant to application dated .................................. ..~....~.......~.?..~....~ 19.'7~.., and approved by the Building Inspector. Fee $....../..~..~... Building Inspector FOI~M NO, 6 TOWN OF ~OUTHOLD Building Depa~ment Town Clerks Office Southold, H. 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 Inspector 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 topographic features. 2. Final 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 installations, 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property 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 in- formation required to prepare a certificate. C. Fees: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 ~ ' New Building ................ Addition ........... Old or Pre-existing Building ................ ¥ocant Land .............. location Of Property ...,~ .............................................................................................................................. Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No.....~:..~.~....~.....t~Date Of Permit ."~/..J..~;/...2.~.....Applicant .~..;....~...!.~.o....!.~. ................................ H~alth Dept. Approval ............................................ ~r ~t. Approval ................................................ U~e~riters Approval ~.~.~..~..~ ........................ Planni~ B~rd Approval ........................................ R~uest For Tempomw Ce~ificate ........................................ Final Ce~ificate ..~. ................................... F~ ~bmiff~ ~ Construction on able descried building and p~it ~ets~l app!i~ c and~ulations. · ......... .......... ................. Sworn to before me this /'~ ~. ....... //~ ..... ;./..~.. day of .~.~..~:;~?/.~..~:~...../...~...~.~.....y~-~/~~p Notary Public ....../.u,~,vl~....;...~...... Cou ty ~ j"ubllc, ,me of New No. 31-4510807 ~llfled in New yMk CG,T.~,SiIOn Gxpire~ March or seal) ~5"70 f THE NEW YORK BOARD OF FiRE..UNDERWRITERS 85 JOHN STREET, NEW YORK, NEW*¥O~iK..IO03~:~ THIS CERTIFIES THAT ChRomes ~vo~a~ ~/n~de O~e Ju~e Lane~ ~000~ ~/o K~us~ inthefMIowing~at~n~ ~ B~ement ~ lstFL ~ $nd FL outalde ~t~ m~ W,B. Ruland, Mattltuck, L.I. ! I COP~.FOR BUILDjlNG'DEPA~TMENT~ THIS COPY' OF CERTIFICATE MUST NOT B,! .,~.~, ~TB~D~ IN ANY MAliNE ' - I FOlg,M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. ............... Examined .............. '...~, 19..:.... pp d ......................... .,. ............. , 19...~.,,. Pemit No ..................... .~.,...... ..... Dfsapproved a/c ....~......................_~ (Building Inspector) ^pplicotion No ................. Z .......... APPLICATION FOR BUILDING PERMIT /~,~J F Date 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 diagram which is part of this application. 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, Suffotk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, o~ 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 fqr necessary inspections. (Signature of appli~orporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... ............. Name of owner of premises .~....o...¥...~.. If applicant is a corporate, signature of duly authorized officer. ~Name and title of corporate officer) Builder's License No .......................................................... Plumber's License No ......................................................... Electrician's License No ..................................................... Other Trade's License No ................................................... 1. Location of land on which proposed work will be done. Map No .............................................. Lot No ......................... Street and Number .~..~. ~.~L~x~~-~~/~?~/~ ............................................... Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~...~. ~. .~...o..~...c~ b. Intended use and occupancy ~/~5~~c~"~/~7~~/~.~ .~....0.?...~.~ ..................... 3. Nature of work (check which applicable): New Building. ..... ........ ......... Ad'iffo on .....................~ Alteration ............... Repair ........................ . Removal ................ . . . ...... Demolition ........................ Other Work ................. (Description) 4. Estimated Cost .....~.....~. .................................. &"12 Fee ....... ~. L.,~... ........................................................................ O ~-~ (to be paid on filing 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 occuoanc¥, specify nature and extent of each type of use ..................................... 7. Dimensions of existing structures, if any: Front ........ ~ .......... Rear ......¥.~. ................. Depth ................................... · Hmght ............ ./..~, ........................................ Number of Stories ......~... .................................................................. Dimensions of same structure with alterations or additions: Front ...... ~ .................. Rear -<'~. ~ Depth ............ ~..~..5~....~ ....................... Height ......... ~'..~. ............................ Number of Stories ~ 12' 8. Dimensions of entire new construction: Front ......................... Rear .o../....~. ................. Depth ..,~...o~,. ........................ · - Hmght ......~. ......................................... Number of Stor es ............................................................... ,~, ~ ~ '"w ............ 9. S ze of ot Front ~ · . Rear .. /.~...q Denth /60 ~' - 10. Date of Purchase ......../...~..~...¥'. .................. Name of Former Owner ...~...~,.~....~..o...~....~../. .............................................. 11. Zone or use district in which premises are situated .................................. 12. Does proposed construction vio ate any zoning aw, ordnance or regulation: ....~..LO. ............................................... 13. Will Iotbere~aded ............. ~..~..~.. ............... Will excess flll be remo~e,,d from premise,,s: [~ Yes [ ] No 14. Name of Owner of prem see ~ .o. [.~..~...~..(..V...o...~.?...R.....~..O..~..0....o.~....~.~.c.,.~....~.~..~.~ ......... ~.~.~.. ¥.....~..?..,..~=. ............. (Address) (Phone No.) Name of Architect ............................................................. (Address) (Phone No.) Name of Contractor ......................... (Address) (Phone No.) PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate wheth- er interior or corner lot. STATE OF NEW YORK, ~(,/ cou.wo ................ )ss .............. (~=me ofi~divid~j~~) .................... being duly sworn, deposes and says that he is the applimnt above named. He is the ..................... of said owner or owners, and is duly authorized to ~rform or have ~rformed t~e said work and to make and file this application; that all statements contained in this application are true to t~ best of his knowledge and belief; and that the work will ~ ~ormed in the ~nner set forth in the application filed therew;th. TERRI LEE E~ · ............................ ~.~...day of ....~..~ ~a~.~r~ 19 Notary Public, ..~~ .... ~O~ ............ [......~..~2 ?' - ' ...... ................................