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HomeMy WebLinkAbout9105-zFOEM NO. & TO~N OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office South&d, N. Y. Certificnte Of Occupnncy No..Z780.8. ..... Date ........... . A~g.. ~. ........ , 19 ?:~.. THIS CERTIFIES that the building located at P~il'way..Dr~,ve ............ Street Map No. Fa~[~n~a~ .F~Block No ........... Lot No..~.... ~lltehogue.. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. Y~:~...~.~, 19.77. pursuant to which Building Pemit No..~0~2~. dated ........... l~a~...22 .... , 1977.., 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~':i,va~;e. ~ne. £amll~ .d~e~[ltx~g ........................................ The certificate is issued to .Bruno. 1~.~116~ ....... 0wr~e~. ......................... (owner, lessee or tenant) of the aforesaid buflding. Suffolk County Department of Health Approval .~.'.u~y... ~2 .~.~....~Y..R.,..V~.7~.~ .... UNDERWRITERS CERTIFICATE No2el~lp. lly.KtlB2eki..~t]/.~. b HOUSE NUMBER ..... ~0 .... Street . ]~llae~F....D~ve ..... Cttgehogue ........ .... ........ Building Inspector FORM 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) No. 9105 Z Permission is hereby granted to: haw. g.:...h~.t...t..z....C.o..~?..~5.?.~.o..L..~.,n..e.......~/.c....~o Brunauer Mattituek N.Y. Lot ? Fairway Ferms et premises located at Fairway Drive Cutchogue N.Y. pursuant to application dated ............................. .~.!~ ....... ~..~. ....... , 19...~?.., and approved by the Building Inspector. FORM NO. 6 TOWN OF SOUTHOLD Building Depaffment Town Clerks Office Southold, N. Y. 11971 AFFLIGATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate 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 ta April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey o~ property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occuponcy 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: 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 Dote .............. D' ............................... New Building .......~ ....... Old or Pre-existing Build_.ing ............................ Vacant Land ............................ Owner Or Owners Of Property ....~ ....... ~~~ .................................... .... - Subd,v,s,on ...~..~.?..~...~..~ ................ Lot No......~. ..... Block No ............. House No.Z ......... Permit No.....,~..~,0..,,5'. ,~, Dote Of Permitr....~...~...?._.~2~Applican, ..... ~..'z..~ .................................. Health Dept. Approval ~..,,'~,,:,~.:..,,'7..2 .............. Labor Dept. Approval .................. ,,~,,..:.,,~,,. ................. Underwriters Approval ........ Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate .......................................... Fee Submitted $ ..'..~......~..~... .................... Construction on above described building and~e~~.~es and regulations. Appl, c a nl'~.~.~..~..~ .?........~[~ ~..~... ................................ ~ .............. S,w,:rn ~b:fa°::fm, e('~i: ~ . ..(' ~: ~Z (,tamp or s~~./~7~ (~- ........ · x... ............. Notary P.b,ic ..... TOWN OF SOUTHOLD ~//~z//~,? BUILDING DEPAP, TM~NT TOWN CLERK'S OFFICE~/77_~/_~-'~ ............................ INSTRUCTIONS o. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate Inspector, with 3 set~ of plans, accurate plo~ plan to ~ole. Fee according to schedule. b. Plot plan showing location of Jot and of buildings on premises, relationship areas, and giving o detailed description of layout o~prope~y musf be d~awn on the diagram which is po~ o~ this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, ~he BUilding Inspecto~ w~ll issue o Building Pen~i~ shall be kept on the p~emises available fo~ inspection throughout the wo~k. e. No building s~olJ be occupied or used in whole or in port for any purpose whatever until o Certificate o~ Occupancy shall hove been granted by ~he Building Inspector. APPLICATION IS HEREBY MADE to tbe Building Deportment for the issuance of o Building Pe~mlt pursuant to the Building Zone O~dinonce of ~e Town o~ Sout~old, Suffolk County, New York, and other applicable Lows, Ordinances Regulations, for ~e construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees fo comply with o1~ applicable laws, ordinances, building code, housing code, and regulations, admit authorized inspectors on premises and in buildings ~o~ n~essow inspections. .Bd~a~6 G. ~b~t~ go~e~o~ Z~o (Signature of applicant, o~ nome, i~ o corporation) Matt ituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. BUi id e r Name of owner of premises ....~.~1~...~.t~.~.~.~. .............................................................. if applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's License No ..................................................... P umber's Ucense No .... Electrician's License No ..... .o...~..~.~?..~ ............................ Other Trode's License No ............................................... Location of land on which proposed work will be done. Map No.: ..?.]fl~..i.~_w.a.~...ii~.:a.?..$..s. ...... Lot No....~. .................... Street and Number ..... ?~.°*...~.?.3.q..~.~/...~.,~..~..~[.~ .......... .C...~..t.~h..o..g~.e, .............................................. .................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exisiting use and occupancy vacant b. Intended use and occupancy .............. .0,.~...,~,.,8:~,~...~?:(,e.~..3:.,]:..~ .................................................................... 3. Nature of work (check which applicable): New Building, .....:f~ ......... Addition .................. Alteration ................ Repair .................. Removal .................. Demolitior ..................... Other Work ................................................... (Description) ?0~000 + .......................................................................................... 4. Estimated Cost .......................................................... Fee 113. ~'0 (to be paid on filing this application) 5. If dwelling, number of dwellibg units ...... O:a. fl ............... Number of dwelling units on each floor ............................ If garage, number of cars t,~rO 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 addifions; Front ..................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... .8~....~. .................. Rear ...... ..~.~.,.~.... . Depth .~.9.:,7./....2...L1:.... Height .................... Number of Stories ..... O. Tke ........................................................................................................... 9. Size af lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in whi,ch premises are situated ........ ~,.~.~. ................................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ..D,Q ................................................. 13. Will lot be regraded ....y~s ................. Will excess fill be removed from premises: (X) Yes ( ) No 14. Name of Owner of premises ..~,Z~.L.o....~.~D..~.~.¢.~. .............. Address .....~}..a; .t,...~. ~ ~..~. ,~ }~. ..... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ..... ~.:...A~;kJ~,~...~0.f~ .......................... 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. 1 STATE OF NEW YORK, ~ S.S COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the opplicam (Name of individual signing contract) 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 oil 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 Noto Publ c,. ................................................... Co,,n ........ ............................. t:~igndture o~' apcC;licant) Lo! ? ArBo -- ,¢0,~ ?0 s~ ff. ,' TEE LANE Lot ~00o' Lot B TITL£' NO. 77-8- 01796 THE LOCATIO~ O~ WELLS AMD CESSPOOLS S,OW~ HEREO~ A~E ~0~ ~r~C~ O~S~W~OmS ~ O~ ~Om ~ 0~ ~mO~ 0~S THE WATER SUPPL~ AND SEWAGE DISPOSAL SYSTEMS FOR TH~S RES~OENCE W~L CON~O~ ~0 ~E S~OS O~ ~ SU~O~ COU~ ~[. APPLICANT: ADDRESS TEL SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE APPROVED , , HS REF, NO. F ~A)~ 25~ 1977 MA ~3/, 1977 !SUEVEY FOR: YOUNG & YOUNG 400 O~TRANDER AVENUE, RIVERHEAD, NEW YORK W. YOUNG HOWARD W. YOUNG BRUNO H. BRAUNER LOT NO. 7 FAIRWAY FARI~S DOROTHY A. BRAUNER CUTCHOGUE SOUTHOLD GUARANTEED TO: CHICAGO: TITLE INSURANCE CO. SO~ITNOLD SAWINGS BANK .. SUFF,OLK CO., N.Y. 77-10~ S. 88°59 TEE LANE Lot ~ THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR FROM DATA OBTAINED FROM OTHERS SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY APPROVED Lo/ ? ~ IAi Areo = ~O, 6705~ff. % ~ Lo! B N. 88,59 '20 "~. ~20.00 ' F I NOTE: , m -- MONUMENT SUJOIV'I$10N MAP' F/LEO IN THE OFFICE OF THE CLERK OF SUFFOLK COUNT)' ON UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY 18 A VIOLATION OF SECTION ?209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEy ~Ap NOT BEARIN~ THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOTRE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLy TO FHE pERSON FOR WHOM THE SURVEY tS P~EPARED~ AND ON HIS BEHALF TO THE TITLE COMPANY~ GOVERNMENTAL" AGENCY AND LENDING INSTiTUTiON LJ~TED YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG ,sURVEY FOR: .BRUNO H BRAUIVER 8 DOROTHY A. BRAUNER LOT NO. ? ,. F~IRI~I,4Y FARI~S ' : U 0 ~ =¢ ~0 t DATE:~. 4 ,1977 NO.