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Home My WebLink About10086-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ..... Z.9.7.733 ....... Date ..... Qg~.o.~..er..2.9 ................ 19.79 THIS CERTIFIES that the building ................................................ Location of Property I01.5 Dear~ D~ive Street Cutcho~e~ House No. Ham/et County Tax Map No. 1000 Section 1 fl 6 .... Block 5 .Lot ? · · Subdivision....DP..'~q~..v.~.e?. ................. Filed Map No...5..5.0.9...Lot No ...... .8 ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..D.~.qt?.nt?l~...5' ........ 197.~. pursuant to which Building Permit No....~.O.Q~ ............ dated .. ~).~lq?~gb.e.u..29 ............. 19.7..~3, 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 ......... ............. P~.ivag.e..One...~ami!y.. Dw.e. ll 2.Ag .w/A.ttackad. Gay. age ............. The certificate is issued to ......... l-.l.a.z2~!r. ~.o..? .ay.3..o.z'. ................................ (owner, of the aforesaid building. Suffolk County Department of Health Approval ... 1. .O/fl.5../79... ~.-~.O.-. 1. 39...R. ,. A... y;t.l.l.a... UNDERWRITERS CERTIFICATE NO ....... .N.6.5.1. 53.0. .................................. Building Inspector Rev 4/79 FOK~V~ NO. ~ 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) N.o 10086 Z Permission is hereby granted to: .... .~.... ~<-~.7....~.ZXo..~ ............. ...~.~....~/.~;?..~.~...: ........ ..~~~ ...... z~..:.~ ........ ~...~ / ' ~ ..C~.~,.~.x....%~....~.~.~.....~.~.~...~.~...~~ ....... .......... ~.~~...~.~ ................................................................................ ~, ,,,~,,e, ,~,~ ~, .~ ....... ~..~...~.,..~Z~..~ ................................ Building Inspector. Pea ,.../../.~.....~.~. 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- 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 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 Date ..... .~. ~ .~.~..~..,~..~...~. ...... New Building .... ~. ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ..... ?~-?.~....'~../~../.M.e. ......... ~.t~..~...~..~. ?.~..c).~'. ............ House No. Street Ham/et Owner or Owners of Property ..... ~ .~..,~../~.......~......~.~..~.~.~..~.~. ................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision... .. .. . ........... Fi ed Uap No .... ........ Permit No./.~?..~..~..~x~'.. Date of.,permit .~'.~.~..~.~...Applicant. ~'~.~¢~:'.~'~. '..~..¢,~. ~...~.~(:2.~.... Health Dept. Approval. '~'~ '~'..x '0~'~' ~' ~"' '~/?'~'''' ."~-Labor Dept. Approval ..... ~..~ .............. UnderWriters Approval ..~..~.,~./..~.-~..(~. ....... Planning Board Approval . ~..~.--~. ..... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .-~.-.....-:... Construction on above described building and permit meets al~L~ppl[c~ble codes and regulations. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK. NEW YORK 10038 o. te october 3, 1,79 4~.,io.~o.o.~. 030758 N 451 THIS CE~IFIES THAT !len~ F, Ta~lo~, n/s Dean Dr., Locua~ Ave, ~ Llnaen Ave,, Cu[cno~ue,i~ ~.~.~do. Oetobe~ 1, 1979 a~ fou~ to be in compliance with the r~uirements of this Board. FIXTURE I 6 IFIXTUREs OUTLETS ECEPTACLRS SWITCHES INCANDESCENT FLUORESCENT ~v~r~ ~6 28 2 DRYERS FURNACE MOTORS FUTURE APPUANCE FEEDERS A/~T. K.W. OIL H.P. GAS H.P. A~T. NO. A.W.O. RANGES ECIAL REC'PT i 7,7 1 9.5 ~. TIME CLOCKS ~IUNITH~TE~UNIT H~TE~ M~TI~T~T T NS ~ SYST~S ~T. ~5. '~ ~ H.P. ~.~ ~ EXHAUST FANS DIMMERS 1 600 ~RVICE DISCONNECT I NO. OF I S R V i METER ~,ERCC~. A.W.O. NO. OF Hi-LEG 2 ].50 CB x 1 3501~1CM :~lee. ,,bo~ Heater/s:6-2.0, 1-1.5, 3-1.25, 1-1.0, A0-.75, Panelboard/~: 1-15e! r.-15Oamp ~-. ~ok k. W.O. NO. OF NEUTRAL~ A.W.G. OF HI-LEG O~ NEUTRAL 350~4CH Dettner Electric Co. P, lverhead, i;.Y. 11901 Llc. 6q3-E emaaAJ. MARAGL'R ~This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TEL. TOWN OF ~OUTNOLD OFFICE DF BUILDING INSPECTOR TOWN ~LERK'S OFFICE SOUTHOLD, N. Y. TOWN OF SOUTHOLD BUILDING DI~PA RTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E omined ........ ' ......... Disapproved o/c .......................... '"'~[L_. ........... .'~ ........................ ' .......... ....................... 22.~22~ -{~1~ Inspector) ' Application No..~.~...(~..~.,.~% ............. APPLICATION FOR BUILDING PERMIT ......... .......... , INSTRUCTIONS a. This application must be completely filled in by typewriter at 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 aT 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 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demo!ition, as herein described. The applicant agrees to comply with ah applicable laws, ordinances, building code, housing code, and regulations, and to on for necessaW inspections. admit authorized inspectors premises and i~ buildings ~ _ .................... ~:.~....~~~.~. .............. ~ (Signature of applicant, or nome, if a do~rl~oration) ..... f'" ...... ~'""A~iT;;;of ~i;;o;;t)"~;~;~ "~" State whether applicant is owner, lessee, a~, architect, engineer, general contractor, electrician, plumber or builder. ', ome of owner of premises .......... ............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ...... ~ ........................ ~ ........ Plumber's License No .... -.'~...,..~..../...~...T..,./2... ................... Other Trade s License No ............................................... 1. Location of land on which proposed work will be done. Map No.:~.(~..~..'...~../...~.~.J~.... Lot No ...... ...~... ............. Street and Number ........... ,~?......~..~./~,...r~....~./,..~...~-. ........... ~...~.~..~..,,~.~.,~..~.C¥:..~.. ........................................... ,~/~ </",~ Municipality 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 ............................................................................................ "7" .................. 3. Nature of work (check which applicable): New Building ,X Addition Alteration Repair .................. Removal .................. Demolition .................... Other Work ................................................ . ..... '~"// ~ 7 ~ (Description) ~ ~...~...~.. Fee ~) ' ' 4. I:stimoted Cost ......~.~,...,~ ............................................. /..,... ....... ,~.~ .................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ./.. ................ Number 9f dwelling units on each floor ............................ tf garage, number of cars ...... ~..,....~'..~.,.~ ...... .'..~..~./../~..~.~-?~..~....~.,......,~.~,~.,f..~,. .............................................. 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 ¢flterations or additions: Front .................................... Rear ..~ ......................... Depth ................................ Height ............................ NtLmber of Stories ,,~ ~_(~ z~' ~, ' " 8. Dimensions of entire new construction: Front ,."..~..~.....!..~...?. ............Rear ....~/.',-~....~.... ........... Depth ,.~.,,..~..'.'.,~., .......... Height ....Z~ ....... Number of Star,es ........... Z~ ...... £~....~.. ...................................................................... 9. Size of lot: Front ............... ~.....~.,...~.,. ........................... Rear ............ ~ ........................ Depth .............................. 10. Date of Purchase ........................................................ Name of Former Owner .... '.~.,...~../~.,~.. ................................ ! 1. Zone or use district in which premises <~re situated ..................................................................................................... 12. Does proposed construction violate any zoning Jaw, ordinance or regulation: ..... ~,.~. ........................................... 13. Will lot be regroded ..~.~...~..' .............. Will excess fill be removed from premises: ( ) Yes ~ No / 14. Nome of Owner of premises .................................................... Address ................................ Pho~e No ....................... Name oF Architect .............................................................. Address ................................ Phone No ....................... Name of ContractOr ............................................................ Address ................................ Phone No. ,~.~:7...T.,.~,~./...~,. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, aad indicate oil 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 NEW Y.0RK. ~q ¢ CO(JNTY~ OF ...~?~..~'..~.~'. ........ ......... ~...~,..~/..,~........~.-~...~'.~,.~,.~-d.,~,,,~. .............. being duly sworn, deposes and says that he is the applica~ (Name of individual signing contract) abOVeHe is thenamed'~Z ............. ~~z'" <Co~or, ~g~,, ~o;~;;;f;';?~i;;;',";;;.'~ ............................................................. of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke cnd fi~ this application; that ali statements contained in this application are true to the best of his knowledge and belief; thru the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this -- /7 ............. ..... ................ , . _ / ~ ~ ~ . ~ ~ignature or a~p~cant) No, 52-4655077 , ~mllJied in Suffolk (~', ls~lon Expires March 3~ SUFFOLK CO. HEALTH DEPT. APPROVAL ~ATEMENT OF iNTENT coNFORM TO THE OF THE SUFFOLK COUNTY DEpT, OF HEALTH 'CO~TRU~IoNSERVICES -- FOR APPROVAL OF~ SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. ~ r"~ THE WATER SU~LY AND SEWAGE DISPOSAL ~-~ ~ SY~EMS FOR THIS R~IDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. ($) APPLICANT CONSTRUCTION ONLY DATE: APPROVED: ~- '~FFOLK cO. TAX MAP DESIGNATION: ' : ~;/~ ~ ~ sU" o,s NEW YORK i 'F~LL APPROVED AS NOTED 'T .i '0 FOOM~A.% ~01~ T~L~,H t b FIP--STFLO0~ SCALE '/~," -- ',/it4'IL FLOOR ~&" O,C, ~ ~"0" 5ECOMb FLOOP.. PLA. f'-t %Zog. ~-o ~ ,~,'TA',( Lo~.. I-"r ~-+ A'~P4.1ACT FI~ONT ELEVA't' I Ot~ to ~q ,P,'TA"{ LO ~.. .79 -r J 'U WE.~T ~6.. F_..L6VA'T IOtA I t I I A% ~ g,C..L.'T' '-': ',.-k ~, ~ ¢.,-,, (. E.. EA.'5-'¢ '5~.~::¢.. 'F_LF=.VA,'T~Ot,A ~t, P,"rA"f LO ~ II ~ SE~3'IoN TRP.,U GAP..A~E. T LA. LL~ .t SOFFIT Z" P,C, FL, OO~ SECTION 'T~EO LIWiN, G/bINtNCT SECTION THP..U 5TA~P-.IIELL 7% Ir P~'A"rE"5 ,~ ~ .,Z" SECt's, ON TR~.U EI'qCLO~C.b '~O~C~ ~ tYTC,~E~.I '~...ALF. C UT C ~.~ O(-.,r O F... id,, ~J~. ~, "//5-5- o'1