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Home My WebLink About9602-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building .. ,A..T. .......................................... Location of Property ~/~c;s~ ~oi ....................... ~r~t' ........... '! ........... ~r~l~' 2..B,ock County Tax Map No. lO00 Section .... ......... .... Lot .... .,9'.- .... :~.. ubdivision ............................... vneo Map No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~)~'¢ ~3 19 .~.~. pursuant to which Building Permit No....~. ¢.P.~....~-:-.~... dated ............ -.~.~.'.('....~..~.. ..... 19.7.~, 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 ......... ~e ce~ificate is issued to ..................... [o~n~),~ ...................... of the aforesaid building. Suffolk County Department of Health Approval ............. ............................. UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev 4/79 (THIS PERMIT MUST BE KEPT oN THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9602 Z Permission is hereby granted to: ................... : ......... :'"':'"'"2~'"~ .......... /~/~, ~,., ~ ~ &~, ............................ at premises Iocatea ar ....~...v. ........................... ~. :~-~ - ...................................................................... pursuant to application dated ........................... ~..(_~....~'.~..~....., 19..~...~.., and approved by the Building Inspector. Fee $....~. .................. 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- t/OhS, 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 peoperty showing all property lines, streets, buildings and unusua~ natural or topographic featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of anv 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 $5,00 3. Copy of certificate of occupancy $1.00 Date . .'~.Z~,~, .~, ,%,. /~, ,;~,'./, .~?~',' · . · New Building J Old or Pre-existing Building Vacant Land Location of Property . .O~'..~. ?. .... .~../~/~/,_./.~..vv..2~.....~...o../~..~. ..... ~. ?. T. ~ ~.? ~..~. ~.. .... House No. Street Ham/et Owner or Owners of Property ./~.~-~.~. ?./Y~.. ~.~..~..d'~.,j'..~/.q ,,~..~.~.' .~.v. ~h ?..,3(,. z/.,,~'...~-~-. ............. County Tax Map No. 1000 Section .... ./¢. ~. ...... Block ...,~ .......... Lot..~.~,. ~. ........ Subdivision . ,~.~/.~//,/./.1%~/..~. · · .'~'.~'. · · : .~..e~.'., ..... Map No...(~..G'..~. ~. .... Lot No....?.~. ........ Permit No. ,~(;.O.. ~t,..-~,.. Date of Permit/.~./.'~../.27..Applicant . .~, .z~. ?:..o.,ff', ,~.., .~.~,~'~.~-;..~,; .,y.- ,/'. ,~'.~- Health Dept. Approval " - ~" abor Dept Approva ................. Underwriters Approval/~[/. ~./..~./. ?. ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate j Fee Submitted $ ~, .~. · ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant...~.~¢.//.~....//.~.,¢~.o~.~....~¢..,~..~.%~.~.. ~ .... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~f SUREAU OF ELECTRICITY '--- 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CE~IFIES THAT ~ln Po~d Const~. Corp.~ in the fol~ing ~.tton; ~ ~e~nt ~ 1st Fl. ~ exami~ on J~ U ~ ~ 2 ~ ~ ~ ~ ? 9 a~fou~ ~ ~ in ~m~iance with the r~ui~nts of th~ ~. 12 33 14 12 1 Fr SYS~ SERV~ ~N~ K.~ S E R V I C E ~50 La)~e Ave. Nescons~t, N.Y. 11767 Llc. 307-E This ce~ificate mu~ not ~ altered in any manner;, return to the offi~ of ~ ~ard if incor~. !nsp~ors may ~ ide~if~ by their c~entials. COPY FOR BUILDING DEPARTMINT. THIS COPY OF CIERTWICATi MUST NOT Bi ALTIBID IN ANY MANNER, Approved ......................................... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo 19....~.. 19.'~..~ Permit No...?i..~,...~,...~,:..~,~,~.,:[: ..... Application No. ~-'~ 0 ~__ ........................ .... ............................. APFLICATION FOP. BUILDING PEP`MIT 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 adjoining premises or public streets oJ areas, end 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 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 Deportment for the issuance of a Building Permit pursuant to the 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, 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) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ........................................... ................................................................................................................................... Nome of owner of premises ../.~..;..~...Z.¢.~....~..-~.......~....~..~..~...~..'!.~,?z..~x~..,:.Z~.~ ...................................................................... applicant is a corporate, signature of duly authorized officer. .......... /(Name and title of corporate officer) Builder's License No ...... ~ ........................................ Plumber's License No .... e/.,x ....... ~. ..... t~. ;.¢ Electrician's License No. ~.i'/.~..i.~.c~.~.L..~./m~.~':~..~.f..:.. Other Tr~de'$ License No. ~ .......................................... Location of land on which proposed work will N.mber .............. Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy b. Intended use and occupancy ......... ~....~K~.~. .. [.. .¢~E..~ .......................................................... 3. Nature of work (check which applicable): New Building ...~ ........ Addition .................. Alteration Repair .................. Removal .................. Demolitior ................ :...~ Other Work ................................................ . .... ~, ~ ~-~ (Description) (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 ........... .'TTi ............. Rear ........ -iT ...................... Depth ...."q. ............... Height ............ ~ ........... Number of Stories ...... ..-~..: ...................................................................................................... Dimensions of same structure with alterations or additions: Front ............. '---:. ..................... Rear ....."--. ...................... Depth ........ ~ .................... Height ............................ Number of Stories ..... ~...-~T...' .................... 8, Dimensions of entire new construction: Front ........... ~...~.~.~. ......... Rear ....... ~.~...~'.. ..... Depth ....~..~.. .............. 1 I, Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded . ....... ..~..?. ............. Will excess fill be removed from premises: ( ) Yes ( Name of Architect .............................................................. 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 whether interior or corner lot. S'I'ATE OF NEW YORI<, ~ c c COUNTY OF ................................ f ""~ ................................................................................................. being duly sworn, deposes and says thot he is the applicam (Name of individual signing contract~) above named. He is the ................................................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, o~d is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ Notary Public, . ................................................... County (Signature of applicant) ~t 4~. G ~L ~ V~T J-L ~B talc, -1 I" THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND/OR FROM DATA OBTAINED FROM OTHERS NOTE: TH£REAt~E NO DWELLINGS WITHIN I00 ' THIS PBO PERT)' OTHER THAN THOSE SNO VKN HE~£ON. THE WATERSUPPEY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CO~FORM TO THE STANDARDS OF THE S FFOLK COUNTY DEPARTMENT OFHEALTR --- ~ -- -~----~ T~L. ~-~-- SUFFOLK C~N~ DEPARTMENT OF H~L~ ~V~ FOR APPROVAL OF CONSTRUCTION ONLY . .ROVEO ~XX / ~ ~r- ~ YOUNG & YOUNG ~~ ~' 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W, YOUNG HOWARD W. YOUNG SURVEY FOR: · ~,~ ~o~ ,~ ~ v,o~,o~ o~ ~,o, TWIN PONDS CONS TRUC T/ON, INC. ~w LO T NO. ~8, "HIGHLAND ESTATES ' ~.w~ ,~ ~. ~ o~ ~,~ ~ SOU TH O L D A6["Cy ANO LEN01"~ t"STITUT{O" ~IST[~ SUFFOLK ~0 DTIE NO 77-$-77011 THE WATERSUPPEY AND,SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL 400 OSTRANDER AVENUE, RtVERHEAD, NEW YORK CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES JUNE 5, 1979 APPLICANT' ----TEL ADDRESS NOTE: THEt?EAI~E NO DWELLINGS V//THIN [00 ' OF THIS PROPERTY OTHER THAN THOSE SHOWN NE-~EON. UNA~JTHORIZED ALTERATION OR ADDITION TO TO BE A VALID TRUE COP~. ALDEN W. YOUNG HOWARD W. YOUNG SURVEY FOR: TWIN PONDS CONSTt?UCTION, INC. 'LOT NO. 3B, "HIGHLAND ESTATES" AT GUARANTEED TO: 'OWN OF EOUITY ABSTtqACT, lNG SOU THOLD SCALE; /"r 50' DATE:.'VOV. I; 19FF IN°*z?-84/