HomeMy WebLinkAbout10013-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.. Z.~66~1 .......... Date .... Set~;embo~..6 ................ 19. '79
THIS CERTIFIES that the building ................................................
Location of Propezty ....31.5. Co~mt~u~ · Club. Es.ta~e~t~ivo ..... Gu~ehogue. · '~/e~
County Tax Map No. 1000 Section ...109 ...... Block .. 09 .......... Lot... 2...2@ .........
Subdivision.. Coun'l:r~¢: .CIuJo .Esl:o~ges ..... Filed Map No... GT.36.L0t No ..... ? ........
conforms substantially to the Application for Building Permit heretofore ~ed in this office dated
· · .0¢.~ober..~50 ....... 1978. pursfiant to which Building Permit No. i .qO0q ~Z .............
dated ...NOVeraber..qA ............ 19~@., 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 .........
.......... Pr&.vate. One. ~mail¥..Dwe-l.l. izag ......................................
The certificate is issued to ... OouRtr~ .¢'~Ob .T.S~oOw~e~,~) ......................
of the aforesaid building.
Suffolk County Department of Health Approval .. @-~0- q .~-'1 .... AU~US ~;. ~ ~ · ~ ~79 .........
UNDERWRITERS CERTIFICATE NO .... ~/4.~/4 ......................................
.........
~uildmg inspector
Rev 4t7~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, FL Y.
BUILDING PERMIT
(THIS PERNIIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 10O13 Z
PermisSion Is hereby granted to:
~, p~,,,I,~ ~,, ........................ ~ ..................................... ~ ....... .~. ...................... ~ ..................
............................................................................ .~ ~..~.~!.~.~..~. .. ............................................ . . .
....k°..~ ...................... .c. oo,~*r c~,u~ ~s'ra-~ ~.
.7. , ................. ~.. ..................................................... , ................................................
Building Inspector.
/oeo-
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 featu res.
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-
lions, 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-
lion required to prepare a certificate.
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
/ /
Date ...... ..........
New Building ...~...c.~. ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ...................................................................
House No, Street Hamlet
Owner or Owners of Property . ,~,~¢..~.,...~... ?.~..~..~.:~ .......................................
County Tax Map No. 1000 Section ...... t.~.'(. ......Block ..... ~. ......... Lot ...... ~...,..E ......
Subdivision...(~.~¢-:~.~'-~..¢~, ............ Map No, Z~ ?.~. ,¢, ....... Lot No., .-~..~. .........
Permit No. ,//)o.,.~..~... Dateof Permit )~.'//?.~....Applicant ....~...~..'....~"'~'...~ ...........
Health Dept. Approval . .~..".~. ~..~../. 3./ ........ Labor Dept. Approval ........................
Underwriters Approval../k,!..L! .~ .~..(0..~. ~(. ........ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ ..... , ........................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant.. ,~¢J..'~. ', ........ . .~.,.. -'.~.. ~,.. ,~¢¢2~¢/,~/¢~I~ ~
Rev. 10-10-78
TOWN Of SOUTHOLD
TEl. ?~5-~66~
nFFIOE OF BUILDINB INSPEOTOR
TOWN CLERK'S OFFIOE
SOtJTHOLD, N. Y. 11973
TOWN OF SOUTHOLD
Building Inspector's Office
Town Clerk Building
Southold, N, Y. 765-2660
J~d[y 12 ~ 1978
Nat-;:;.ituck~ ';'~e,~' %'ork 11952
TNo fei!or, ins r~ese!uhions were passed at the re~suiar mae%ins of
the Pls~l,.li'r~,S 13oaP,'i held Jls~e 26~ 1978.
'to £;Pant final, appraval of the preli;}i~ar:,~' sard
approve i;l"~e site plan wit]o farine i'or ~hhe sub-
kno~-al es ~"Co~:iliry Cli~b Estates".
request a bond es'hiraate from La~rUence
K,R~917,£iiiD to approve ~e site plan and tree pta~ltir~.g for
'~'l,~ s;tbd, ivi,'}ior.' ka,l~,'sr'. as "Co~u~tr~y CluJo Es%ares'.
1 '/ou!,l ~ope '~o recei~e rir~a! approval of %he pre!iminaPy r~ap so
t',h{~-i- !-his oe.,i be subfnitt;ed %o %he Suffolk Cou:a%y Pla,nninS after
Yo~u~s tru!y,
~{nmiel Brush, SecFetary
Sou±hold To~,,g~ PlazAing Board
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .................. ¢:...: ......... ~......, 19 ...... ~ Application No .................................
.......................... 19~.6 .... Permit No .....................................
~i~rove~ ~/c ................................ '?"' ~w.~ ........................................
............. . .................... .................................
. ~ ~¢ om~ ..................... ~..~..2 ................ , 1¢.2:~ .....
~ I ~STR~CIIO~S
a. This application must be completely filled in by typewriter or 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 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 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 Department 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, buildin, g code, housing code, end regulations, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or nc/me, if o corporation)
(Address of applicant)
If applicant is a corporate, signature of duly authorized officer.
'~ r~'~(N"E-me a~d title of corporate-'-Effi;:';'~i .........
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.................. .................................................................................................................................
Name of owner of premises ..... ~ .......................................................................................
Builder's License No .....................................................
p umber's Ueense No.
Electricion's License No,'~.~c,~.~,~,~...~C-.[:.~.L4..~
Other Trade', License No ...............................................
Location of land en which proposed wor~ will b, done. Map No.: ~.....~.~...~.. Lot No...~.~ .............
Street and Number .................~;..~:...~?~ ......... '~ ....... C~~ ......................................
" ¢] Municipali~
in~en use
State existing use and occupancy of premises and ~ and occupancy of proposed construction:
a. Exisiting use and occupancy ................ ; .........................................................................................................
b. Intended use and occupancy .................. ~¢~ ' ~ .......... ~.~....e ........ ~ ...............................
3. Nature of work (check which applicable): New Building........'~... ........ Addition .................. Alteration ................
Repair .................. Removal .................. Demolition .................... Other Work .....................................................
'~.-~r~ - (Description)
4. Estimated Cost .......... ~....g~',..~.~.(,/ ................................. Fee
(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
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 ....~Z~. ......................... Rear...~..~.~ ................ Depth ~
Height ..J...~....(. ...... Number of Stories ...... : .~..X~..~ ..................................................................................................
9. Size of lot: Front .... L'..:~/.~...~.~.. ..................................... Rear ...J...~..~;..~£.....~..~.. .......... Depth ..~...~.'.~..~..~.~] ............
10. Date of Purchase ............ ~ .................................. Ix~e of Former Owner ..... ~; .............................
11. Zone or use district in whi~:h 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 0k) No
14. Name of Owner of premises ~/-~/~..~,,~/,u~..J,,~/~,~ ........ Address .~..~.(.~f.~.~4, ....... Phone
N o. ~.,~. ~'.~. ?. ~.'~..~..~...
Name of Architect .............................................................. Address S~s....~....,..~C,.. Phon~ No .......................
Name of Contractor"~J/~/-~J~. ...................... Address .......... Phone No.. ,.~.~.6~...;~...
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
COUNTY OF ...~ ............... )"~'
................. (J~.~..~ .......................................................... being duly sworn, deposes and says that he is the opplicam
(Name of individual signing contractO
-- (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 contained in this application are true to thebest 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
Notary Public, . ...... ~ ........................... County ..............
Notary Publl~, State of New Yo~
No. 52-4635190 Suffolk County
Commission Expires March 30,
Lot B
CO uN y
Lot ~
Lo t I0
~ Lot //
Lot ~
lot 4
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FOR A. ROVALO.LY
HEALTH DEPARTMENT- DATA FOR APPROVAL. TO CONSTRUCT
-K- NEAREST WATER MAIN ~._MI ~ )E SOURSE OF WATER' PRIVAYE~,~PLIBLIC ---
OTHER THAN THOSE SHOWi~l HEREON.
~THE WATER SUPPLYAND SEWAGE DISPOSAL SYSTE~,'I FORTHIS RESIDENCE
OF HEALTH SERVICES
APPLICANT.
A T CUTCHOGUE
TOWN OF souTHoID
SUFFOLK COUNTY, NEW YORK
SURVEY FOR
COUNTRY CLUB ESTATES
LOT NO. 7, "COUNTRY CLUB ESTATES"
-~ UNAUTMDRIZED ALTERATION OR ADDITION TO THIS
NO?E : ~ = MONUMENT"
IN THE OFFIC~OF ?NE ALDEN W. YOUNG,PROFE SSIONAL ENGINEER
SOSOIW~ION M~P FI~O AND LAND SURVEYOR N.~S, LICENSE NO 12845
A~ FILE ~. 6?36 HOWARD W. YOUNG, LAND SURVEYOR
~THE LOCAT~N~WELL(W),SEPTIC TANK(ST)eC~SPOOLS(CP)SHOWN HEREON N.~S, LICENSE NO 4589~
ARE FROM FIELD OB~RVATIONS AND OR DATA OBTAINED FROM OTHERS ~
SCALE.
NO
400 OSTRANDFR AVENUE
RIVERHEAD, NEW YORK
1
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DATE:
FEE=
NOTIFY
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1. BEFOR
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NOT
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5. ALL
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DEPARTMENT 'AT
to 4PM FOR REQUIR.
FOUNDA.
START FRAMING
INSPECTION
PlP.,ES OE ANy
JOB COMPLETED
FOR DESIGN ERRORS
MUST MEET
OF N.Y, STATE CODE
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