Loading...
HomeMy WebLinkAbout11686-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buliding Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No... Z.~ 2Q36 ........ Date .......... No~zamber..2 ........... 19 8.5 THIS CERTIFIES that the bufldingACOES~ORY ...................................... Location of Property .. 26~-5. Elijah .Larva ............. F2a/~.tituck ................. House No. Street Ham/er County Tax Map No. 1000 Section ... 4.08 ..... Block .... .C1/4 ........Lot ....%,.~15 ..... '... ~- Subdivision .E'I i,j.~h..L~e. Es.tate~ ....... Filed Map No..6©~.5 · .Lot No .... ~2 ........ conforms substantially to the Application for Building Permit heretofore fried in this office dated ·.. &priZ .26 ........ ,19 .@2pursuant to which Building Permit No.. fl.~.656Z ............ dated ..... Ha .y'. ~.q ................ 19~2., 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 ......... ..... ~o~ .~ · ~o43~.· ~.±.n -a~d- .d~ ck..a ~ ~l.i.t,$ e n...~ o · m~rJ:n - d~]t ~ ~_vrg: ............... The certificate is issued to WILLIA~ & JEAN SCI~II~Z (owner, lessee or tenant) of the aforesaid building. N/A ' Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO .......... .~./.A. .................................... Rev. 1/81 Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) Permission is hereb~ granted to: ....................... :....' ........ ~<. .................... ~ ........... ~-, .... ~. ~, ~, ~.~:....,-- ~.~,,~, ~,,, ,,.::~;'""~'~'~;'~ .......... ~....}~... ....... '::"'~'"" .................. .................................. t"',,5: .............. ~ ................... " .................................. :~:'" County Tax Map No. 1000 Section ....... ../..~...?...... Block ........ ~ .........Lot No ...... .?,.,.../.~..] .... pursuant to application dated .................................. ...~.~.~..1.......?...~., 19.~:i...:;...~, and approved by the Building Inspector. If;' Fee $ ........................ ............. :. :.:f:i~(~.-....~/. _/_:_ Z ............. Building Inspector Rev. 6/30/80 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 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 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: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ... ]~:!~ ............... New Building c'/" Old or Pre-existing Building ............ Vacant Land "D~- ' gL/J/Irf,5 LAME /TI ~I.T..L~C-I .................... Location of Property . z-... ~5 ............................. .~. ...... .~. House No. Street Ham/et Owner or Owners of Property . .~./.~.~. I./~..r~l... ~..,J.~./:J..~...~.C. ff..f~..I ~.2~. ............................. County Tax Map No. 1000 Section ...... /0.~ ...... Block ....~. .......... Lot...-7.../.~'. ........ Subdivision .~._._.~../.~..~...f~./.4..~.~,, .~.5.. (~.~./.'/..F_.¢. ........ Filed Map No...~.0.~....- .... Lot No../.2. .......... Permit No..I.i k~...Z_.. Date of Permit ... ~.~.Zl.-~2. Applicant. .~.I.L.L;.I.,.~! .'~q..~...C~.r~..17.~ ............. Health Dept. Approval .Labor Dept. Approval .......... '~ ............. Underwriters Approval '- - .Planning Board Approval ........... '-~ .......... Request for Temporary Certificate ..................... Final Certificate ....... ~ ............ Fee Submitted $..~:0..0. ...................... Construction on above described building and permit meets ~]ll applicable codes an, d-r~gulations. Applicant.../~/~ ~/~, .,~.~ ................ Rev. lO-10-7a ~n~pected by thl3 dep~rtmcnt aztd totmd SHOW~I ~r~'~l:i{~ AR; F~OM rI£LD O/S."RVAT/ONi · JfDIQI~ f&ON ~ATA OST&IN~D £&ON NOTE: -..~v,~,o.~ YOUNG & YOUNG MAR T~t974 400 OSTRAND£R hV[NU[:, RIVE~HEAD, NEW YORK SURVEY FOR; INLAND HOMES INC. EANE ESTAT ' LOT ~,12, ELIJAH S TOWN OF' 50UTHOLD ~%~.'~'.~ su~oc~ co., .. v. ~.~~ ..... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........ ........................................ ............ :....: .............. · (Building Inspector) Application No ....... {...~.....~....~.... .... APPLICATION FOR BUILDING PERMIT ~ - ~te ...... .~/.. .................................... 19.~.~ INSTRUCTIONS a. This application muSt be completely filled in by typewriter or in ink and submitted in triplicate to the Buildin Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plat plan showing location of'lot and of building~ on premises, relati'onship to adjoining premises or public streets c areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicotior 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 perm 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 Ocoup~nc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant agrees to comply with oil applicable laws, ordinances, building code, housing code, and regulatior~, and t admit authorized inspectors on premises and in buildings for necessary inspections. A (Signature of a_pplic~, or name, if a corporation) .................... u' (^ddress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Oco..,o ~.R Name of owner of premises .../~.../../-.*' ! ~ .~..,:... ,.,~.,.~/..~....~,. ...~... ~4~ : . . If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... P,.mbe.'s 'icen. No ................................................. Electrician's License No ............................................. ( 0 ~)0 '-- [ 0 ~ - ~[ ~ ~' {-B/ Other Trade's License No ............................................... Street and Number ........................................................................................................................ .~ .......... ~unEi~li~ State existing use and occupancy of premises and in~ended use end ~cupon~ of p~osed construction: ~. E~s~.~ ~se and ~pon~ ....... ~.4~fi.4~ ...... ~4.~L+.Z......~.~ ............................................................. b. Intended use end occu~ncy ............ ~.,~......~ ........................................................................................ 3. Nature of work (check which applicable): New Building'. ................. Addition ~" Alteration Repair .................. Removal .................. Demolitio~ .................... Other Work .................................................. ~' ~J~ I ~'_ (Description) 4. Estimated Cost .....~..~..1~.... ........................................... Fee ...... L?.... ............................................................................ (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 occupancy, specify nature and extent of each type of use '- 7. Dimensions of existing structures, if any: Front ......~'....5~.'..~...~. ...... :.. Rear ......~...?.,..~.~ .............Depth .... ..~..~.:...~..i. Height ...... ~..G..~. .......... 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 ......'~...' ..................................... /..q ............ D~th ...................... Height .................... Number of Stories .................... ~ ...................................................................................... 9. Size of lot: Front ............... .'(2~. ................................. Rear ........ .~...~...~.,~...o.]..'. ............. Depth .....~....~...~...'....~.,.~.~ ..... 10. Dote of Purchase .............. ~r.~...7...~.. ......... i ................. Name of Former Owner ...............(~..,C5'~£-~ .......... Z~....~.~../.F~ ............ 1 1. Zone or use district in which premises are situated .................. .~.. .............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........... .~....o. ..................................... 13. Will lot be regraded ......... d.~..q. ........... Will excess fill be removed from premises: ( ) Yes ( ) No Name of Architect ....................... :z ..................................... Address ................................~ No ...................... Name of Contractor - ,Au~dress ................................ ~ No ...................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all setJoack dimensions fron property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Jot. i.I t 'z .', ' STATE OF blEV~)R~r,~,J~' ~ S S~ cou . able named. ~ ~ ~ ' ~ He is the .................................. ~ ................................................................................................................ (Contractor, agent, co,rate officer, etc.) of said owner or owners, and is duly authorized to ~rform or have performed the said wink a~ to ~ke and fiL this application; that all statements contained in this application are tree to the ~st of his ~bdge a~ belief; tha~ the work will be performed in the manner set fo~ in the application filed therewith. Sworn to before me this . .... ................. ...... , ......................... Co U, ...... .................................. ._,... ~ ...~.: . ~'~~ "