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Home My WebLink About10065-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No....9808Z. ........ Date .... D.e~e~el~'. 2.~. ............... 19 29 THIS CERTIFIES that the building ................................................ Location of Property ..... .2,~5865..~JaJ,Zl..F[O&i~ ........................ O~'iel'~c ~ ' H/~Te~ House/vo, Street County Tax Map No. ] 000 Section . .0'~ ~ ....... Block ..... 2 ......... Lot .... 2t~... ~ ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. D.e~o elltD.e~.. 6 ....... 19.7.8 pursuant to which Building Permit No ..... .10065Z .......... dated ... D.e.o. elllD.e~..7. ............. 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 ......... ......... .One.. .a at ,y .................................... The certificate is issued to ........ ~,I:"I;ll,LI~. '~/owmr,'~ .... i ................. of the aforesaid building. Suffolk County Department of Health Approval ...~-.80.-.1./4~ .... '[2/.19./79.. R,A...~J.13.at.. UNDERWRITERS CERTIFICATE NO .......... 1~ .~599.0]~ .............................. Rev 4/79 Building Inspector FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Nr. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N.° 10065 Z Date ..'~' -~...-..7 ....... , Building Inspector. 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- 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: 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- tion 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. ~: ,~. 1.2 !./..~..? ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property . .~..~..i.~.. ~,,(~,~,,j ................. .~..~i .~.h, .~, House No, Street Ham/et Owner or Owners of Property ../~.~ .K'..th ,.~...~....r~..,~ .~,..o...~_~...~. ......................... County Tax Map No. 1000 Section ..O. ! ?.-..~.:~..~,', . Block ' Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. I.Q .o, ~, ~.., Date of Permit .}~../.7./..7?.Applicant ./~-, .P .~../1..~..~..?...~! ?.O..~.~..~' ........ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval. ~...~. S 0 .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate .... 7' (?~' .............. Fee Submitted $ <~.~'. ?..O. ..................... Construction on above described building and permit meets a~,pp~able codes and regulations. Applicant. ~ ...... F.~~ .......... ./: ....... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~JI~ BUREAU OF ELECTRICITY ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date becembe~' ] l, !979 Application No. onfile Olld 3~1 N4:9903 THIS CERTIFIES THAT only tl~ electgic_q~ e_~u.~.. ~t. _as_~d~, rib~d ~b~lo~, and.i~troduoed by_ th~ gl~otlean~l~ .~, on~h~ abo~ oiItillc~t~on q~rnber in the premises [] 2nd FI. Section Block and found to be in compliance with the requirements of this Board. Lot COOK[NG DECKS OVENS DISH WASHERS AMT. K.W. AMT. K.W. ~ MT, K.W. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET A~,. At4PS. TWINS. C NO. OF HI-LEG A.W.O. NO. OF NEUTRALS OF HI-LEG EXHAUST FANS DIMMERS OF CC. COND. OF NEUTRAL f, rtnur A. ?u~oede i~i This certificate not be altered in any manner; return to the office of the Board if incorrect, inspectors moy be identified by th~ credentiaJs. must COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST. NOT Bi ALTERED IH ANY TEL. TOWN OF SOUTHDLD OFFICE FIF BUILDING [NSPE:OTGR TOWN CLERK'S F1FFI:E COUNTY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES DAVID HARRIS. M.D., M.P.H. The attached approval was ismled subject to 'the notation contained below our approval staT~9. Would you please t~,pe the folio;ring conditiou of approval on the f~.nal C of 0 as this wit]. ensure that any ~uture owner ~ll be made aware of the nitrate problem. "Private well with kigh nitrates -- see Health Department note on fi~al survey. Memorandum from.. · · BUILDING INSPECTOR'S OFFICE TOWN OF $OUTHOLD TOWN HALL, Sov'rHoLr~, N. Y. 11971 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT ........ .......... Date / / INSTRUCTIONS a. This application muSt be completely filled in by typewriter or in ink and submitted in tripiicate 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 p,emises, 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Departmeqt for the issuance of a Building Permit pursuant to tho Building Zone Ordinance of the Town of Southold, Suffolk Couhty, New York, and other oppllcable Laws, Ordinances or Regulations, for the construction of buildings, additions or a~terations, or for removal or demolition, as herein described. The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of app )cant, or name, if a corporahon) ......... ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ..0..~...~ .~... Name oF owner ....... /3 ........ ............................................................................ If appHcan~ is a co~orate, signature of duly authorized officer. 50-/ b (~nme nnd title o~ Builder's License No ..................................................... Plumber's License No ..... 5~...[...~,. ........................ Electrician's License No..g..~..}...~...--...J~, ................. Other Trade's License No ............................................... Location of land an which proposed work will ? done....M?p..~No.: ........................................ Lot No. ~;..... ........ :;~ ..... Street and Number ......... ~.~J-..~-.fl.O...~-.z.~-. .~'~[4~'~ ............................................................. ~"tJi'~'~"('" .... Municipality State existing use and occupancy of premises and intended use and occupancy of prc~posed construction: a, Exisiting use and occupancy ...... V.~-k.~.~..~.~.~....,b.O .............................................................. : .......................... . . -.. ..4~....¢1J.,..~..5. b. Intended use and occupancy ...... 3. Nature of work (check which ar)plicoble): New Build. lng .,..-.J~.,] ......... Addi,tio.n .................. Alterotlon ................. Repair .................. Removal ..................Demolition .................... Other Work ...................................................... (Description) st moted Cost 3 .<2.., a 0 0 .......... ................................................... ................................ (to be paid on filing this application) .5. If dwelling, number of dwelHng units ........ I ................... Number of dwelling units on each floor ..... , ...................... If garage, number of cars ................................................................... '. ......................................................................... 6. If business, commercial or mixed occupancy, speofy 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 ............................ Death . Height Number of Stories ................................ / 8. Dimensions of entire new construction: Front .....~.~......?. ................... Rear ..~..~......~. ............. Depth ..~.....~. .............. Height ...~ ~. ........ Number of Storms ........ J ........................................... ,. ...................................... :~"~'>'~"~';z .......... 9. Size of lot: Front ...[~.(~..*.,~..~. ..................................... Rear ...L.~.'..~.:..~,....~'.. ................... Depth I~.~'LI.=/II,..!.~. ......... 10. Date of Purchase ..2.../~,~./.44..~.~1.~...T...1.~,~....~.,. - L_.~_ .......... Name of Former Owner ....~..~...~..C.....~.?..C~..~ ......................... 1 1, Zone or use district in which premises ore situated .................................................. ~ .................................................. J2. Does proposed construction violate any zoning law, ordinance or ragu arian: ..... ~,.~.. ............................................. J3. Will Jot be regraded ...xj.~ .................. Will excess file be removed from premises: ( ) Ye~s 14. Flame of Owner of premises ....... Address J~l~i;.0.../~g. ff.~..~,.~!~hon~ No. Name of Architect .............................................................. Address ................................ Phone, No Name of Contractor ............................................................ Address ................................ Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing ar proposed, and indicate all set-back dimensions from proper~ lines. Give street and black number or description according to deed, and show street names and indicate whether interior or corner lot. .......3 59 ~TA,E: 0~' NE ~ .............................~/~../...? ........................................................... being duly sworn, deposes and says that he is the opplicon~ (Name of individual signing contract) above named. He is the ......... 0m~...~ .......................................................................................................................................... (Contractor, agent, corporate officer, etc.) of sold owner or owners, and is duly authorized to aerform or hove performed the said work and to make and file this application; that oil s ~tements contained in th'is application are true to the best of his knowledge and beffeF; ant that the w~rk~' will be perfo~ ed in the manner se~ fo~h in the ~plication filed therewith. .......... ..~-~f ~ . ., ~..~' ~ ..: ...... ....................................... , O~%=,_,_...L :,, )UT!-;OL D, Ai2TNU~ AJ?UP..OEDE '!~/k~N I?,OAS. . OI?JENT~N.Y'IIg_$7 AP. EAj ~. P_.4,616 -..rGQ, IF'F.: . _ % ~.7~'46'm"~. ~.,. ~0~_~ 0'5}~HIGH NITRATES- - be used for DreDarat ~Water not to ~f baby formula or consumption by %nfants under 6 mo~. oF ag~. - O~ c-. ' - ' 5.,0 ~ ~0 '~ .. ~.~7 Z GENE~L 1~ . , ' . . c~km~n~o~ b~¢,r~ p~oceed~9 With' con~frpc- SPECIAL INCT~: ?0 APPROVED AS NOTED NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM I:o 4PM FOR REQUIR- ED INSPECTIONS: 1. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERING P[P,~S OF ANY KIN~, 4. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS S, ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N.Y. STATE CODE AND TOWN HOUSff4G CODE & ZONING , EXPLANATION OPsECTION oR'D ,L=?AIL MARKS ~o%1o ~LT" I. MAIN BEAM - (3) 2";~ 10" SPIKED ~'/16D NAIL. St BREAK AND STAGGER ALL JOlt!TS OVER COL_LIMi45 ~ ~'-o" o.c. COENICE R A, FT E ~ I~AF FLE. ,JOIST .... % ~00~= ~. 4,5" O.C. J5 ~Sb~ ;,'~/&"- l~-O" : APP~O~ LEF' 51DE ELEVATION /1¢, :1 1 F,,b ;HT 51DF_ ELEVATION FROHT EL E. VAT IOlq ¢X~PHALT ~ E. kI:. .W/~" WEATHILP', F-,EAF,