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HomeMy WebLinkAbout8611-zFOi~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z7295 ..... Date ............... 0et ...... .~.%., lg..~.6 THIS CERTIFIES that the building located at ............ S. ol~$h. B.~'. Ex~;. Street Map No.. ~a~7~.e~ .Pall~ck No ........... Lot No, .12/.1%. &l 9/~-2... Mat ti.tuck.. ~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ M..ay...2?.., 19.7..6. pursuant to which Building Permit No..8~] .1Z.. dated ........ May.. 2~. ...... , 19.76., 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 .. P~ivate .one..family. dwelling...(one..floo~, oiliLy, fi,,'~ished) ..... The certificate is issued to . .~lllam..P.~'ko.~ ..... 0w~l, ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..0.e.t... ] ~...1. 97.~. .... .b.y....R.o..V.i..1.1.a. UNDERWRITERS CERTIFICATE No..by. ,~... Xub~eki...10/8/.7.~ ................. HOUSE NUMBER .... 900 ....... Street .. S~tth. Lane. ext...(.gan~e .Pa.th).. Mattltuek ...... .... ........ Building Inspector / FOI~I 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) 8611 Z Date ............................... .~. .......... ~.. .......... , Permission is hereby granted to: ............. k.o.~...?..?..~ .......... .~. i ~..k~..~..t:.~. .................. to .~,~;.~J.,L~i...~,¢~.~z...~ ~ ...dr~J. ~:...~.~¢~.~ L$.~ .................................................................................. at premises located at ~:~;~?:~..~:~:~..~.~J.~J.~.~x~.~.~.~.~ ............ ..... ~.Z~ft...~:~.u~h..~.~.~.~...~.~:~...~.,. L ~.~.)...~.~...~&~..~...~...[~,~h...(~e~ Mattituck N.Y. B~d~n~ ~aspecfor. NOTE: Permit covers basement ~'first floor only~ requires a ~.it?~on ~ alteration ;ermit 2o Complete 2nd ~ ~..~[~[~.[).~ .......... · Building Inspector ~7~ . . I~ORM NO. 6 TOWN OF $OUTHOLD , Building Department Town Clerks Office 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 Inspector with the following; for new buildings or new use: ]. 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 o certificate. C. Fees: 1. 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 to/ v'~ Date New B~ilding ................ Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Location Of Property ..................................................... I ..................................................................... Owner Or Owners Of Property ..... :......~..,~..Cr...~....~..,.~'.., .~, ........ ..~...,~.....~w....~.....~,-..~ ............................................. Subdivision .... ...~....~...~..~...I..~;.-~.........~,...~......l~t....~.... ........... Lot No ............. Block No ............. House No ............. --I can ............................................................. ,.. Date Of Perm t ................... t Health Dept. Approval .... .,~,.,-.~"...~.....~.....;....',. ............ Labor Dept. Approval ................... J.~. ......................... Underwriters Approval .... ~.. (...~...~'' ~/r'~ ................ Planning Board Approval ................................. Request For TempororYoC~ificote ........................................ Final Certificate 5 Fee Submitted $ .....~ .~ ................ Construction on above described building and permit meets all applicable Cedes and regulations. Sworn to before me this (stamp or se~, /;~0~;~ THE NEW YORK BOARD OF FiRE UNDERWRITERS Jl BUREAU OF ELECTRICITY THIS CERTIFIES THAT ~ IXTU~ES ~ - E~G~ IC~AING D~CAS/ ~ENS ~ISH WAS~ER~ [ EX~UST FANS Ele~.'~:~oOm'HeaHerS: 2-2.5, 2-1.5, Motors: 1-3/qhp, 1-G.~.C.I. 1-4.5k~. Hot water Heater 1-l.0, 1-.Shw. WalCer Finger ; Mattltuck, ti... 11952 Lic.#!845E o~ ~ Per ..... ~ - -- This certificate most not be altered e any manner, return to 'he off~ce of the Board if incorrect. Inspectors may be identified by thor' redentiols. FOJR,~ NO. 1 TOWN OF SOUTHOLD ~ "l' h BUILDING DEPARTMENT ~ omcs SOUTHOLD N, Y. Examined ,, ........................................................................ ........ ................... ..... .................. Date INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 adioining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the 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'~lnspector will issue o 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 o 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 ther~ 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, os 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 inspections. ..... ....... .................... (Signature of applicant, or nome, if a corporation) (Address of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricia umber or builder. Name of owner of premises ~ I ~- ~ I ¢~ ,*'~ ~O /~r ~L If applicant is a corporate, signature of duly authorized officer. ~J,,r,,, i ~'~n" q (%~,/~, ................................................................. , ..................ct/~, -&" - '~J,/?¢ (Name and title of corporate officer) "C~-~ '~,1 ~f-~'~' Builder's License No ..................................................... ~/~ j¢I Plumber's License No .... ..~..~.¢~..~..~..~.'~.~....~../..~...~! ........ Y~'~('"I~o~c30- \"~ ~ \~ Electrician's License No ..... ..~..~T.-.~...4C.......~-.'~...t}~.'.~.....iL ~ /C,~~/~ Other Trade's License No ............................................... ~"~f~~*J ~:~c'~t/C- '4L 1. Location of land on which proposed work will be done. Map No.: Street and Number ............... ~7~...~.-.~.~.1..i.:~,.~.~ .,.~: ...................... ../J...~..'~U.j..,V....~.~..~:.../....~4.,..~..;. ~/,ff/z,a~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ~u/¢~' C F~ b. Intended use and occupancy ................... !...'~..~,-~, .. !.?...~..~Z...'.~.,i'Z,'~... ....................................................................... 3. Nature of work (check which applicabie): New Building .; ................ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .................................................... 4. Estimated Cost ............. .~.~.,.~ .............. .............. Fee ~:~''~' ~ (Description) (to be paid on filing this application) i 'u b ' · ......................... 5. If dwelling, number of dwelling units ............................ m m er or 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 ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or o~l~li'tions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ ~.~...'~; ................ Rear ......... .......... Depth ........................ · 'Z- 2._ o i ~ Height .................... Number of St r es ....................................................................................... ~ .... c. -r' [ /::::r' e th ~.~/'0 9..,ze of lot: Front ............... ~..~.,/....',~..: ....................... Rear .......... /.~.. .......................... D p ............................. 10. Dote of Purchase ........ ..~........~...t..1.~. .......................... Nome of Former Owner .................................................... 1 1. Zone or use district in which premises are situated .......... ./.~...~.~.!..~...~.~.!..?.....C~'... ..................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: /~J ~ 13. Will lot be regraded' ........~:~ ............ Will excess fill be removed from premises: ( ) Yes ( 14. Name of Owner of premises ...~...:..i?./~..~...I..~....~.~.~ ................ Address ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ~.....~:...~.~.../.....~...~..~'..~.....C,,O...~... ............ Address'~'o~: 3 ~ I Phone No~'~b'~. 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 whether interior or corner lot. STATE OF NEA'V2fzjl)RK~,.¢ .~f t~: ' '%, COUNTY OF .~ ...... ~ .... .......... ~.~.1~.l¢.~....¢m. ........ ~.~...'~. ............................................. be ng duly 'sworn, deposes and says that he is the applicant (Name of individual signing contracf) above named. He is the ............................................. ...~...~..[..~...?.....~.../..~.. ......................................................................... .............................. (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 conta,ined in this application ere true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this · ....... ............................ ' ~OTARY PUBLIC, State of New York No, 52-812585(], Suffolk Cou~y.~ 1ream [xpires March 30, NO T£ : · -- MONUMENT LOT NOS. REFER TO MAP OF "BAY VIEW PARK" FILED IN THE OFPICE OF THE CLERK OF SUFFOLK COUNTY ON MAYIS, 1910 AS FILE NO. 578 WATER SUPPLY = PBIVATE WELLS NEAREST ~TER IWAIN -' 1. 5' MILES ,~ \ TITLE NO. 1292192 0 \ THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OGSERVATIONS AND OR FROM DATA OGTAINED FROM OTHERS THE WATER SUPPLY AND SEWAGE DISPOSALSYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPAR'PM/NT 0¢ HE&LTN SERVICES. APPLICANT_ ADDRESS TEL -- -- SUlk'FOLK COU~ITY HEAS'J'~ D~PART~EN~ riOT i41976 ~. ~. ~. ~75~5~:7:: DAT~_~ The so'~:~?~ d!sD°sa]- ~n~ tv~t, eP supply YOUNG & YOUNG 400 ©STRANDER AVENUE, RiVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W. YOUNG SURVEY FOR: 'R/CHARD PARKER AT /vMTTITUCt( TOWN OF SOUTHOI D SUFFOLK CO., N.Y. THE rlr~E G~RANTEE SCALE: /"= ~ ' I UAT~. APR./, 1976 J \ \ NOTE: · = MONUMENT LOT NOS. REFER TO MAP OF "BAY VIEW PARK" FILED IN THE OFFICE OF TNE CLERK OF SUFFOLK COUNTY ON MAY IS, 1910 AS FIiE NO. ~Y8 / / TITLE NO. 1292192 THE WATER SUPPLY AND SEWAGE DISPOSALSYSTEMS FOR THIS RESIDENCE WILL APR. JCANT- ADDRESS TEL_ -- SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF cONSTRUCTION ONLY DATE~ HS REF. NO.__ APPROVED__ ' REVISIONS YOUNG & YOUNG 400 OSTRANDER AVENUE, RtVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W. YOUNG SURVEY FOR: R/CHARD PARKER AT TOWN OF SOUTHOI D SUFFOLK CO., N.Y.