HomeMy WebLinkAbout9673-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No ...... 2110 .~.8.7.. ..... Date~. ..... Me~..1~ ................... 19..8.1
THIS CERTIFIES that the building ................................................
Location of Property ,...~ 5.0 O..q 19..J. tl % 9. J~.~O .e., .......... .l~.a.g. ~. ~..~.u.qk. ,..N.e?...Yp?.k. .....
i~ouse tvo. Street Hamlet
County Tax Map No. 1000 Section . .1.2fi. ....... Block 4 .... Lot 1 2
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
·..gpr.~,l..1 ~ ......... ,19 7.8. pursuant to which Building Permit No ..... .9.6.7.3...g ..........
dated ..... Ag~.~ 1..1.R ............. 19 7.8., was issued, and conforms to all of the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
.P.~iv~te. Or~e-. Family. D. well~ing..(F, lr~.t..F.~>~.~ .OI~.L.Y.). ........................
The certificate is issued to ...... Waz'.~en..~.oon .......................................
(owner.,,.l~.,~.,~,.O[. ~O,e.~l~ ....
of the aforesaid building.
Suffolk County Department of Health Approval ..... 8-~B0..~2 ~.. A/. 29Z80. Rnhe t'.l;..g,..VJ,~ la
UNDERWRITERS CERTIFICATE NO ....... I~ .6.45.~$ ...................................
Rev. 1/81
Building respecter
FOI~i~I NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, Iq. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 9673 Z
Permission is hereby granted to:
at premises located
pursuant to application dated ... A~IL I.~.,
............................................... 19 ......... and approved by the
Building Inspector.
.ee .....
Building Inspector
FORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.. :7'?.~'~)(~'. ......... Date ...~'.e.~?.u..a.ry] .2.- .5 ................. 19 ~q
THIS CERTIFIES that the building ................................................
.... ' ............. ~ ............................. ?...~ ........ ~...
Location of Property 2.500 Ole Jule Lane M~-bt:~-l;uck~ 1~ o"~.
House No, Street Hamlet
County Tax Map No. 1000 Section ..... ? ~.2 .... Block /4 .Lot 12
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore ~ed in this office dated
.... .~p?.5:.]:..I.2. ....... , 19.7~. pursuant to which Building Permit No .... 9. 6. .7.~.Z. ............
dated ...... .~p.~.~. ~..1.2. ............ 197...~. , 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 .........
........................... ?.~y.~.~. ?..o.~?. F..~.~..,.y...~. ?.~.~.~.n..~ .....................
The certificate is issued to ' Warren Croon
..................... /o.,;&;, .~.~; ......................
of the aforesaid building.
Suffolk County Department of Health Approval .... .8.-.S..0.-.2.1.... ~./.2..9/.8.0. .................
UNDERWRITERS C~RTIFICATE NO ............ .N..~ .~ .5 .8. 8. 8. ............................
Rev 4/79
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 rifled 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 electrica~ 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.
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.. ~., ~.~.~
House No, Street
Owner or Owners of Property .....~...-v~¢¢~.../.~..%....~...zt~..~ ............................
County Tax Map No. 1000 Section ../.' ~, .,~.~ ...... Block ..... .Z~./. ....... Lot .... /..,~-~ .......
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. ~'..~.~. ~ ~ Date of Permit ~'//~./~-/?.~..Applicant...~..~....~..~-~...~z~--~ .......
Health Dept. Approval . ~..~. ~.'..~. :-. ~../. ........ Labor Dept. Approval ........................
Underwriters Approval .~...~./;/~. ~. ~..~. ....... Planning Board Approval ......................
Request for Temporary Certificate .... ~ .............. Final Certificate .......................
Fee Submitted $.. ~.,.~//.~./ ....................
Construction on above described building a~d~p/~,mit meets all applicable codes and regulations.
Rev. 10-10-78
FORM NO. 6
TOWN OF $OUTHOLD
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:
I. 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.
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 v/ Old or Pre-existing Building Vacant Land
Location of Property ~. .. . - ............................
Hou,, No. Srreet ...............
Owner or Owners of Property
County Tax Map No. 1000 Section /~:~ Block tT/ Lot...
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No. ~.~.' ~.~.' .~... Date of Permit ~.'. ~.~-~ .~.O. ,Applicant. ~,~,.?~? .... ~??.0.~. ..............
Health Dept. Approval 4:~- SO - ,5/ .Labor Dept. Approval
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate ..... . .~...'. ........
Fee Submitted $..~.~ .': ?.(! ...................
Construction on above described building and permit m~t~?ll applicab~,~codes and regulations.
Applicant .......... : ~-'~... ~ .'~.~ ................
TOWN OF' SOUTHOLD
rlFFIO~' OF' I~UILDING INSPEnTnR
SOUTHOLD, N, Y.
TEL,
THE NEW YORK BOARD OF FIRE UNDERWRITERS
Aug. u~ 17~
THIS CERTIFIES THAT
BUREAU OF ELECTRICITY
1979
/tpplicatlon No. on file
N 445888
1st Fl. ~ 2nd Fl. Section Block
and found to be in compliance with the requirements of this Board.
1 ~.3 L 1.2
TIMECLOCKS I Mu tUNITHEATERS MULTI-OUTLETi
OF CC, COND.
Lot
EXHAUST FANS
AkAT. H, P.
D~ERS
OF NEUTRAL
Wal:ev Flnge~
?.0. Box 991
Mattltuek, N.Y.
11952 blc.18~5-E
Per
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by
t~eir~b'i~[ential,'
~,~.ll'l fUK BUIL;;;;~ E)EPAKT;~;~'T. THW COPT ~)P ~.mKmlrlfvAi[' MUb! Pi~)~ BI: ALImKL~O IN ANT MANNEK.
765-1802
BUILDING DEPT,
INSPECTION
FOUNDATION 1ST [ ] ROUGH PL'BG.
FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING . ~/~] FINAL
REMARKS: /,u , .~/~/~//~/~, ~ ~
DATE ~ .... INSPECTOR
765-1802
BUILD,lNG D'EPT,
INSPECTION
FOUNDATION 1ST
FOUNDATION
FRAMING
[ ] ROUGH PLBG.
ZND [ ] INSULATION
D~/FINAL
DATE
INSPECTOR
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ................. ~......./....'~., 19..7.,..~.. Application No... ,.~....~.....Z.~. ..........
Approved ................. ..c~.~...../..¢~,., 19...~.....~. Permlt No....~.....~...?,,~..~,, . .....
D sapproved a/c . .'...~...... ................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
ate ....... ....... ............. ,
INSTRUCTIONS
a. This application must be completely filled in by typewriter ot~ in ink and submitted in triplicate to the Building
Inspector, with 3 set~ of plans, accurate plat 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 far 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 ir~ buildings far necessagz inspections.
(Signature of applicant, or name, if a corporation)
............................... ..........................
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
........... .....................................................................................................................................................................
Name 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 .................................................
Electrician's License No .......... '. ..................................
Other Trade's License No ...............................................
Location of land on which proposed work will be done Map No . Lot No ) ?'-
Street and Number ..... .O.~-.~...~...~.. ........... ..~....~.~..~.. .......................... iiiiiiiiiiiiiiiiiiiii'.'.'.iiiiii~.~.~.'~i~ ~iiiiii
Municipality
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 ............ ,.~..]./~...~..~-..,~m.....~ .............. !.!.~, .............................................................
property tines. Give street and block number or description according to deed,
whether interior or corner lot. CSI~e ~'~-ff~(]~'i~D -~0 ¢..x/b-"q ~
3. Nature of work (check which applicable): New Building'· ................. Addition .................. Alteration ................
Repair .................. Removal .................. Demolitior, .................... Other Work ................................................ .
&~ (Description)
4. Estimated Cost~....~g...O...O...O.. ........................................Fee :
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..--~..!..~...~.~..E: ............ Number of dwelling units or~ each floe?/J6
If garage, number of cars O.t4.E ..............................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...~...O...N.~.. ...............
7. Dimensions of existing structures, if any: Front ...... N..0.~.6, ........... Rear ................ ---~ ............... Depth
Height ~'- Number of Stories ....... ..-72.2 ..................................................................................................
Dimensions of same structure with alterations or additions: Front ........... -..R.T.; .................. Rear .......... ~--7.: ................
Depth ................... % ............ Height ............................ Number of Stories .................... .~ ..........
8. Dimensions of entire new construction: Front .... ,~'..~..; ................ Rear ........~,.~...~ ........... Depth ....~...~..; ..............
Height ....~..' .......... Number of Stories Ot~r~
o '
9. Size of lot: Front .... J....O. ............................................ Rear. ......................................... Depth ...............................
]0. Date of Purchase .....~..:..~..:..7.,c~, ................................... Nome of Former Owner .....~...W.,.~....~..,~,.....?...~.._~..~ .........
1 1. Zone or use district in which premises are situated .....................................................................................................
]2, Does proposed construction violate any zoning law, ordinance or regulation: ....... .~...O.. ...........................................
13. Will lot be regroded .....~...~...~.. ............... Will excess fill be removed from premises: ( ) Yes (Y-,) No
.................................................... Address ...¢.~,V.~.g..'~.,...,.~:.~.; Phone No. ~,~..~.T....2:~...~..~
14. Norne of Owner of premises ~/~,~l~ <~/~,,001,~ ,~'7-ff~.lP,,P~l~,
Name of Architect ............................................................. Address ................................ Phone No .......................
Nome of Contractor ........ ..~.....,~....~....~. .................................... Address ................................ Phone No .......................
PLOT DIAGRAM
Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from
and show street names and indicate
STATE OF NEW YORI<, . t c c
COUNTY OF ...~-_¢...~.,...~..~..~.~....[o.o
...... .~.~....r.~l'..~...~...,.~......~.~..,..ct¢. .................................. be ng duly sworn, deposes and says that he is tbe applicam
(Name of individual signing contract)
above named.
He is the ............................................................................
(Contractor, agent, corporate officer, otc,)
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 the best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to be~ore me this .~ ~ ~ t
============================================== .............................
.?
' -'eu!
FOR ~ePROVA, I. OF~ CONS'I'R~U~TiON ONI*Y :
H. S. RE:F, NO,:
APPROVE:O:
WATE~ SUPPLY AND SEWAGr
D|~,F~.~AL' SYSTEMS: FOR THIa R~I-
WILL C~FORM TO THE
STAND. D5 OF SUFFOLK CO.
OF H~L~H, ~ERVIOES.
~ .~j..~.~ facilities for this 10oation h~ve been
~nspscted by this dep~rtment ~d found'"
/
/
/ ~ ~l~'_. ~ . ~. ,
~ ,' '.. ~ e.~ "
~DUCAT~ON LAW.
~RICK VAN TUYL. P. C.
LIC ~ND ~URV~ORS-~RI~RT. N. Y.
~ 'lUll?. CO. DEPT. OF HF. AL'rN RVIClI:~ .,_. -- :-':-~-- --
O'
a-.~_~.'~ ~" FOR AJ~OVAL OF CON~'t~UCTION ONLY
4-~.
~/~,' DA'I'~: ,DISPOSAL IY~I'EI,4~I~I~:)~ TI4MJ
:J~l:J~' OENGle WILL CO~IIIO~M ~' THE
H s. R"~ NO.: ,~ -- ,.~d~ '-' ,,~ / S'TANO,~O~ O~ SU~i'O~,K CO.
/.,.'/z '
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I 17' API~.I CAN'T