HomeMy WebLinkAbout9617-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
$outhold, N. Y.
Certificnte Of Occupnncy
No.. Z9174 ..... Date .......... August..16 ,. ~97~ 19.78.
THIS CERTIFIES that the building located at .~80. B.~b.e..D.r~.v.e. ......... Street
Map No.. 36~6 ...... Block No ........... Lot No .... 32 ............................
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ....... F. ebrnary. 3.0 ,, 1978.. pursuant to which Building Permit No.. 961.7.z.
dated ....... F. ebr~ary. 14,., 19 .7.8., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is ...I~RI.VATE. OA]E .-FAMILY. DWELLIN. G .....................................
The certificate is issued to . FRA~;CIS..&. D~ROTH/..ROMANC~ ..........................
( owner, ~m:~)
of the aforesaid building.
Suffolk County Department of Health Approval . A~gust..16 ,. 1978 .... 7 .-$.O.-.178.*...
UNDERWRITERS CERTIFICATE No ....... N.. ~3.9.6.5.5.2 .............................
HOUSE NUMBER.. 2. .~.o ......... Street...B.e. 9.b.e..D..~.i.v.e. ,..C.u.~q.hp.~ge. ,. ?.e.v.y.o.~;]~,
Building Inspector
*Private well with high nitrates - See Health Department note on
final survey.
TOW~
SO~
BUILDING :JeERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°. 9617 Z
Permission is hereby granted to:
nt premises located at ................................ ; ...........................................................................................
pursuant to application dated .............................. ........ 19..Z~., and approved by the
Building Inspector.
Fee $...../..~ .............
D~jilding' I
~specfor
FOEM NO. $
TOWH Orr SOUTHOLD
Building Depo~tment
Town Clerks Office
Southold, N. Y. 11971
APPLIGATION FOR CERTIFICATE OF OGGUPANCY
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:
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 disposol--(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, o 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 property showing oil property lines, streets, buildings and unusual natural
or topographic features.
2. Sworn statement of owner or previous owner os to use, occupancy 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 o 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
New Building .~l C- _,~ Old or Pre-existing Building Vacant Land ............................
Location Of Property _~ ~-~ ~ eo
Owner Or Owners Of Property ............ ,~,..,~.,.~: .......... ~. ....... ~.,9>,, .................... ,~..~.,,~,.,,,¢~,,..,L?. ........................
· .. c
Subdivision ................................................................ Lot No.~. ........Block No ............. House No .............
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate .......~...,.. ..........................
Fee Submitted $ ..~.~...~...~.. ...................
Construction on above described building and permit meets all applicable codes and regulations.
App,con, ..... .........................
Sworn to before me this
r,
,.~,,,...%,,, day ...........................
Nota~ Public ....~..~...~.~..~...~.. ............ County
Commissmn J[xpiO~ ~ar~h 30~ ~
(stamp or seal)
,
THE NEW YORK BOARD OF FIRE UNDERWRITERS
f~ BUREAU OF ELECTRICi~
l--~,,~ AusulC 2 , 1978 85 JOHN STREET, NEW YORK, N~YORK,,~,l.[~)10038
.,,.,,,,.,,o. o. N39n 552
THIS CEI~erlFIES THAT
· KO~) ~.3 DeeDe ~. zuu-i! r-uSene~ B~a. ~uccnosue)~,.-.
13
DRYERS Iq,IRNACE MOTORS I iqJTUll AIqKJANCl FIIOIRS
MT. K, W,'
LaEaAL IIBC'PT
EXHAUST FANS
MT. H.P.
~/o
1-SKW
103 Briarwood Lane
Plainv/ew, L.X.11803 Ifc. 149E
This certificate must not be altered in any manner;, return to the office of the Board if incorr~t. Inspectors rn~y be identified by ,l~eir c~le
..............copy FOR BUILDING D~ART_MENT. THIS COPY OF C~TIFI~TE M~T ~T BI~.______~ m H~___
COUNTY OF SUFFOLK
DEPARTMENT OF HEALTH SERVICES
MARY (;. McLAUGHLIN, M.D., M.P.H.
The attached approval was issued sub,~ect to the notation contained below
our approval stamp. Would you please type the 'following condition of
approval on the final C of 0 as this will ensure that any future owner
will be masse aware of the nitrate problem.
"Prive. te well with high aitrates - see Health Department note on final survey",
~obert A. Villa, ~. E.
Examined
....................... ~./-..../.~./ 19....~1~ Application No ........ ,
Inspector)
FOR BUILDING PERMJT
INSTEUCTIONS
a..This ~.,c~l~mat. i~n.m.ust be Completely fil!ed in by .typ~_writer o~..in ink and ~bmitted in triplicate to the euilding.~
inspector, with ,I~ m' plans, accurate plot plan to linde. Fee ~ng to schedule~ (
b. ptot plan showing location of lot and of buildings on premises,: relationship to adjoining prem ses or pub c streets or
areas, and giving a detailed description of I~yout ofpmperty must be drown on the diagram which is pa~t 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 applicam. 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 Del~artment for the issuance of a Buildina Permit nur~mmt ~n she
· ' ' -- -- ~ -- ~- '--~.-'~T' ........
Zon? ,nonce of the T.?n o.f. Southold, Suffolk County, New York, and other applicable Laws, Or ,nance or
Kegula~!ons, Tar me construction of ouildmgs, additions or alteratiarm, or for removal or demolition, a~ herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, ho~JsJng code, and ~ragulatiam, and to
admit authorized inspectors on premises and in buildings for necessary inspections.
(Signature of applicant, or name, if a corporation)
.................... ...................... ...................
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ..~.~...~....~..~.~ ........... ~.~ ....... ...~....,~..¢ ....
If applicant is o corporate, signature of duly authorized officer.
(Nome and title of corporate officer)
Builder's License No .....................................................
Plumber's License No ................................................. 'I~ c~'/~s'~
Electr~c,ans'' ' License No ...... ~-
Other Trade's License No ...............................................
1. Location of ~undm~rWhic~..~___~.w...o..~::, ..b~..done. ~MapNo.: ............ ..~..~...!.:! ..... Lot No. ....~.....~ .....
Street and ..................... ~ ....................................................... :::..::..:
Munl¢ipall~
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
Exisiting use and occupancy .................................................................................................................................
Intended use and occupancy .... ! ....?... ~.~
r
3. Nature of work (check which applicable): New Building.. .......... Addition .................. Alteration .~i ........ ?
Repair .................. Removal .................. Demolition .................... Other Work ................................................. ....
(Description)
4. Estimated Cost ...........~....[..t..~ ....................... ~ ....... 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 cars .............................................................................................................................................
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 ............. ~'.~'..LJlc .......... Rear ............................ Depth ...,.1~..,'~... ..............
Height ....... .~...~. ...... Number of Stories ..... !- ..................................................
9. Size of lot: Front ............. !..~....~.. ............................ Rear .......... !..~C~.. ....................... Depth ...... .~./~..~ ...............
10. Date of Purchase ....... !..qL...~..~. ......................... Name of Former Owner ........................................................
1 1. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................
Will lot be re,~raded ~'~ Will excess fill be removed from premses ( ) Y.e~, ( ) No
13. ~ ............................ ~. ~.,f_
'mc[~ .~. ~-, . ~~.~'~'~'~ - ~..~:.! ....
14. Name of Owner of pre ........... Address . . Phone No .......................
Name of Architect .~..~....~.~ ................. Address .~.. Phone No .......................
Name of Contractor ~k~ ~...~.......?. ............... Address~..~.. ~ Phone bio ...................... ~
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from
property lines. Give street and block number or description according to deed, and show street r~mes and indicate
whether interior or corner lot.
STATE OF NEW YORK, IS S
COUNTY OF ..~¥~..~...~..~-~.. ............ f. '
..~.f~.-~/;~t /-J ..~../~/~ - ' deposes and says that he is the applicon~
............................................... : ............................................... ~e~ng duly sworn,
(Name of individual signing contract)
above named.
He is the ............... ('~ontractor, agent, corpOrate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to rn~ke and file
this application; that all 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
..... ............. .
~. ~ ,,,'~...;/ ................ County .........................
NOTA. R¥ pU'BLIC, ~ta~"~of ~'le~
%.
MAP OF MOOSE COVE
AUG. 30) 1960 MAP 32.30
0
'0 0
MAP OF L,A~ L
EAST CUTC'HOGUE
FRANCIS & DOROTHY ROMANO:
B=MONUMENT
MAP OF MOOSE COVE
AUG. 30) 1960 MAP 3230
STA K E
· -MONUMENT
N
MAP OF MOOSE COVE
AUG. 30-" 19 60 MAP ~2.~0
%sew~.L.,e disposal an~ ~ter Supply
High Nitrates - Ware:
baby
)t to be used for preparation of
or used by infants 2nder
~*f OF L&ND L~C~D AT :-:';
EAST CUTCHOGUE
TOWN OF $,QI,13'HOL:0 ' COUNTY OIr BUFF'DLK-
'- o FRANCIS & DOROTHY ROMA_NO
- /'//~'/4,,~ ~/'/f/'/~,,4/ 7 - z'9~'- 7~' ROCKY POINT, N.Y. ~
:: ,- STAKE a-MONUMENT HOUSE STAKE-OUT 3-13-78 ~u~...~..... ~
,6
? - 24- 7~
MAP OF MOOSE COVE
AUG. 30.~ 1960 MAP 3230
MAP OF LAND LOCATED AT
EAST CUTCHOGUE
TI3WN OF'
$OUTHOLD COUNTY OF' c::UF'F'OLK
FRANCIS 8, DOROTHY ROMANO
GEORG~E H. LUTZ, 3 ,i'-~' I" 20¢
,I
,~ N d, f o ,o N P, fi T i ~, ~
IIL- -__ -_T ..... --_ ..............
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T~ GAL.