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HomeMy WebLinkAbout9555-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z10bb5 Date Septe~b~r 9 THIS CERTIFIES that the building ................................................ Location of Propert¥ 845 Rose~ood Drive, Mattituck, ~!ew York County Tax Map No. 1000 Section . :,.1.3. ....... Block 2 .Lot 7 Subdivision· .~.o?.e. ¥.o.o.d.. ~ .a.~.a.~ e, ............ Filed Map No.52t~0. ..... . .Lot N~ 3 ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated · ...Np.v.q'¢ .b.e.~ . ~...8 ..... , 19 77 pursuant to which Building Permit No. 9 ~:~, Z dated .. ~1 oy.e. r01~fLr..1.8. ............. 19 '.~.7. , was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tl-ds certificate is issued is ......... ...e?..~y.a?.,.. 9.n.~.-. ~.' .a.~.~.z.~:. ??,.e.z..z.~.n..~. ............................................. The certificate is issued to ....p.~.n.~.', .X.~..q ~ .e.~.r.e.: ,1 r, [o wneryd~i~l~ l~tX~a~ff, X x of the aforesaid building. Suffolk County Department of Health Approval 7.-S0-166 7/15/81 R. ~t, Villa P.E. UNDERWRITERS CERTIFICATE NO. 11383243 .~. / Rev. 1/81 (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FbLL COMPLETION OF THE WORK AUTHORIZED) N? 9555 Z Permission is hereby granted to: ........... k~.~..2~:~ ............ ~.~.$.~r....I.~.~.~ ............. at premises located at ....La.?,...l,~ ...... .,~O.~.~'Q.O.~I...~.~.~. ..................................................................... ........................................ ~ ......... ~:~ood...D~. ........ ~a.~tit~ ............................. , ...................... pursuant to application dated .......................... ~-~'..-]-~ ............... , 19...~.~'., and approved by the Building Inspector. · Fee $....6.L.:;.~.~0 ......... FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Y Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tot 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 disposa)-(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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of peoperty showing all property lines, streets, buildings and unusua~ 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 or land use 3. Copy of certificate of occupancy $1.00 $5.00 .... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........ .~?. ,//..c?. ] .......... /~.~,5.. ~, .c~...©.O..~(.... ,"~../~.% .~, ~.~.~.~ House No. Street Ham/et ow~ o~ ow~ o~ P~o~,~ ~.~, o.;.~...~,.. C.(~,. c~.. ~%~ ................ County Tax Map No, 1000Section .//,~ .......... Block ,.~ .......... Lot .... 7, .......... Su~d~on ~~.~ ~,~r~ ~d~o ~Y~ ~o~,o /~ Permit No. ~¢ .... Date ofPermit ~/./{~/Z~Applioant .~~..~[~ ...... ~%' Health Dept. Approval .. ~ ................. Labor Dept. Approval .................... ~:tt~' / Underwriters Approval . ~.{'. ¢. ~..~ ~Z~..Planning Board Approval ............... ~%~'~ ~ Request Temporary Certificate ..................... Final Certificate ................ .¢~. · · ~ Fee S, bmitted $...~. ~ ................... ~) Construction on above described building and per_~ meets applica/~~ regulations. Applicant .......... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS I i BUREAU OF ELECTRICITY I'-- 85 JOHN STREET, NEW YORK. NEW YORK 10038 ,~,,. April 21, 1978 ~,.,,~.,o. No.o,..,,~ 950329 N 383 .43 THIS CERTIFIES THAT Denflll Do Claire Jro~ Rosevood Or., Mlttl+uck, N.Y. was examin~d on Aprl I 20, 1978 an~found.tobeincornpliencewithther~quiren~tsofth~oard. I I00 CB x ! Panelboard. t 1-17clr. 12~ amps I Smoke detector r I mwm ~t 13 EXHAUST 2 Dennis D', Claire Jr, Box 520 JllllPOrfo L.I. 11947 Lic. 2342E eBmALAWdAml : Th,s certificate ~ not be .ltered in an manner;: return to the office of thi~ ~Board if incorrect, Inspectors may be identified their ca~dentials. Examined ..... ./.. Approved ............ ~.~. ........ ./...~.... ....... , 19..~....~. Permit No. 9~'~-'~- ?'- Disapproved ................... ~. ................................................................................. ~, ......... ........... ................ , a. This application must be completely filled in by typewriter o¢ in ink and s~o~itte~ in triplicate to the Building~ Inspector, with 3 sete of plans, accurate plot plan to scale. Fee-acoo~Jj~lg to b. Plot Plan showing location of lot and of buildings on premises relationship to adjoining premises or public streets o~ ~ areas, and giving-a detailed description of layout ofpraperty must be drawn on the diagram which is par~ of this application. c. Th~ work covered by this ~app. ii~ation may not be commenced befo~'jssuonce of Building Permit. d. Upon approval of this application, the Building Inspector wiil 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 a Certificate of Occupancy.. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Bud ng Perm t pursuant to theN Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other appl cab e Laws, Ordnances or,~'~ Regulations, for the construction of buildings, additions or alterations, or 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 for necessary inspections. (Signature of applicant, or name, if a corporation) ....... (Address of applicant) / I T G y State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... .~c~'-~~.....~.~%'o.**~... .......................................... Nome of owner of prem scs .*~ ..~.1"~ I~ I ._~ .,(~;~ ..{~***.~..'.- ,,J ~ If applicant isle, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...............~....~.....~.........~T....! ............... Plumber's License No ....... ..~....~..~....."~... ..................... Electrician's License No....~....~).'~..~.~ ..... ~(~ Other Trade's License No ................ ~ .......................... ~. Location of ,and on wh,ch proposed wor~ w"~ ~l~ne. ~ap No.:~C~...~..~..-~. ~0~.~o. :.J:..~... .............. Street and Number ...................... ..L~.../...~. ...... ..~.O..~....t~....-~.(~L~.~..... ......... ~...~..~.~..-~...i,..-~...~..~.:..~.....L.~...~ MunicipallY/ 2. State existing use and occupancy of premises and intended use and OCCupancy Of prOPosed construction: a. Exisiting use and occupancy ................................................................................................................................. b. Intended use and occupancy 3. Nature of work (check which applicable): New Building.. ................. Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................... Other Work ................................................ . .... (Description) ,. Estimated Cost ....................... Fee ....................................................................... (to be paid on filing this application) 1--' 5. If dwelling, number.of dwelling units ......~)."'....' ............ Number of dwe~ng units on each floor ................... If garage, number of cars ......... [..(~f~g~/~--. ................................................................................................................. 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 additions: Front .................................... Rear ............................ Depth ................................ Height ............................Number of Stories ................................ 8. Dimensions of entire new construction: Front ....,.~..i'~.~ .................... Rear ..... .4.~2.~. ...........Depth.4::'~.~.,.-...(ct Height .................... Number of~Sto, ries ......~.....~.~-~.~,,_~_.__d'3~ ........ I.~.~_._..~.'.~..~..J'~.~.:.,....~,~,,..~..<~.....~....~ 9. Size of lot: Front ................ L~..~.......i~ ................. Rear ........ L.L~......~--~ ............ Depth ....I...~.~..'.'~.,~ ........ ]0." Date of Purchase ........... ; ............................................ Name of Former Owner ...~.:......~{~...~ .~.,./..,..~?J~.J~ ........ ! ]. Zone or use district in which premises are situated ..................................................................................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ......... .~...t~ ...................................... 13. Will lot be regraded ..~......~1~ ....... WEll excess fill be removed from premises: ( ) Yes ~4. Name of Owner of prem~ses~.~..~..~....~-.~...'E.. .............. Address ..~b!~.~.>..O..~ Phone No. 7~3~...~..~.7.~ Name of Architect .............................................................. Address ............. ~ .............. Phone Iq~ ....................... Name of Contractor~,.~.L~.L,L~-~..~R~'~....(~ .~.. ......... Address~.JL,~Ra~.~......'~l~ Phone No?...~d~c...~...I.~..~... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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. CTATE OF NEWYOP~ - -- ~c~ ~OUNTY OF ..~;...t~....'~.._...~.,..~..)'--'.'" ............ L,~.~D.~,'-~,.~ .ii:iL'L~..q.~.:~ .................... being d,~ ,,om,, d~ose, ~,d ~ ~ h~ ~ ~h. ~ (Nd~ of in~idUa signing:Contrac~' ,~ 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 ~ke ~nd file this application; that ell statements contained in this application Ore true to the best of his knowledge and belief; thaz the work will be performed Jn the ~anner set fo~h in ,fhe application filed therewith. Sworn.to be~gre me t~is N~ 52-7597250; S~folk C0uaty~~~ UnauthoHzed~ alteration or addition to this survey Js a violaffon of section 7209 o£ fhe New York State Education Law CopJos oF th~s survey map not bearing the land surveyor's inked seal or emt, o~ed ser[ d~ull not be conrid~red o ~e ~ v.:ld copy· )cOD °°° Nitrate§ -,Water not to be used baby formula or consumpti ~nfants ufider 6 mos. of age. SURVEY FOR DENNIS Cl._ A IRE, ,JR. i/O ~)S~wooo FIL~D~JAH.24 , 1969 AT MATTITUCK TOWN OF SOUTHOLD eUARANT~ED SUFFOLK COUNTY, N. Y. SCALE: I'% ~0' NOv. 15, 1977 P L ~! F r~ PL4C~ - ~ ,j ~,1 , AppROVED AS NOTED p/fi, twr p¢, , &l E][3Fi:E]W BEATTY & BEATTY A A. ARC~HITECTS 32 COURT ST,, BROOKLYN, N.Y. 111201 & SHOREHAM, L,I,. N.y,