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HomeMy WebLinkAbout11634-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zl1555 Date March 22 .................................................. 19 83 THIS CERTIFIES that the building ................................................ Location of Property 1540 Moores Lane Cutchogue County Tax Map No. 1000 Section . .1 9.9 ........ Block . ...0.3. ......... Lot.. 9P.~. '. g.~3 ....... Subdivision.. C p.u.n ¢ r ¥..q 1..u.b..E.a..~ .a?.e.s. ..... Filed Map No. 6. .7.3.6....Lot No... 2. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... .h.p.r. $ .~..1.9. ...... 198..2. pursuant to which Building Permit No .... 1. ] .6.3.4. Z. ........... dated ...... .H~.y.. 6. ................ 198.2.., 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.r.~y.a. ~. 9..qn. 9 .-.~.a.m. ~..~ y..d.¥?.~.~.~..n.g.. ...................................... The certificate is issued to BRENDAN & EVELYN PALMER (owner, l~ee-o~ of the aforesaid building. Suffolk County Department of Health Approval . .1.2.-.S. 0..-.3.9.,. 2/1.4/83 . ?.ob.o. rt A. Villa UNDERWRITERS CERTIFICATE NO ......... ~..5.8. 5. 9 .7.3 ................................ P.E Rev. 1/81 Building In~pectqr TO~N O~ sDUTHOL~ BUILDING DEpARTM~N~ TOWN HALL SOUTH'OLD, N~. ¥. BUILDING P,ER~IT (THIS PERMIT MUST BE KEPT ON THE P~,EglS~S cOMPLETION OF THE WORK AUTHORIZED) 111634 UNT L ~ULL Rev. 6/30/80 County Tax Map No. 1000 Sect,on ..... pursuont tO opplication dated .... .~. .... BUilding Ifis~ector. Perrhission is hereby granted to: .et No. . .,~and ~pproved by the 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 w~th ~he following; for new buildings or new use: 1. Final sun/ay of property with accurate location of all buildings, property lines, streets, and unusual naturat or tooo~raohio fe,~tures. 2.Fine, approve of Health DepT. of water supply and seweragedis[:osal--fS.9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildinas, Muir pie Res dances and similar buildin~ and installa- tions, a certificate of Code como anco fi"om the Architect or Encin¢or resoonslht~,r 5.Suom~t Planning Board approval or completed s~te plan requirements where applicable. B. For existing buildings (prio; to .~pril 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property Hoes, streets, buildings and t~nusual 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 $5.00 3, Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building(X) ........ = /Vacant Land ............ Locatlon of Property ............... Oo ~.-¢' Hou~ No. Srr~er Ham/~£ Couoty Tax Map No 1000Section t O~:~ 'Z~ ............... Block ............... Lot ............. Permit No ........... Date of Parrot ^- '~ - Health Dept. Approval ........................ Labor Dept. Approval ...................... ,. Under~/riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate ................ ' ..... Final Certificate .... Fee Submitted S ..... .~. ................... .~.. Construction on above described building and ~armit'me ble~codes and reeulatJons. 1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS  BUREAU OF ELECTRICITY 85 JOHN STREET, NEVi/ YORK, NEW YORK 10038 Bat, December 2, 1982 ~.plic.tio. No. o,,/ile 176626-82 N5 8 5 0 7 3 THIS CERTIFIES THAT only the electrical equipment az described below and introduced by the applicant named on the above application number in the premises of Brenda~ J. Palmer, W/S Moores Lane, Cutchogua, i,~,,,e/o,owin~,oea.on~ ~ B.semen, ~ ~*~ ~'. {~ ~.d ~l. Section Blo,.~ ~o~ ~a, e~.mi.od on November 29, 1982 and found to be in compliance with the ~quirements of this Board. FIXTUEE OUTLETS SWITCHES FIXTURES RANGES :OOKING DECKS OVENS EXHAUST FAN FLUORESCENT MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: 1-G.F.C.I. 2-Smoke 'Detectors, R 'V C AWG PER ~/ OF CC, COND. 1 2/0 OF HI-LEG NO. OFNEUTRAI AWG, OF NEUTRAL 21o Rnland Electric Co. P.O. Box 143 }~tti~u~k, N.Y., 11952 Lie. ~242-~ FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL PLEASE TAKE NOTICE that your application dated .. ~...'~. ~. ........ ,19 for pe~it to construct . .~.. ~~7..~ .~~ ................... at HOUS~NO. ' Streot~ co,,ty ~,~ ~o. ~00~ s¢otxo~.../¢¢ ...... ~oo~ ... ¢~ ...... ~ot .~,,~.. ,~,,,,,,/~.~ ~,,~, ~a~ ~o ................. ~o, ~o .... :~ .......... is returned herewith and disapproved on the following grounds .~~~.. . ~_~& .,.. ~ .~~z. ~..~.... ............. Building ~nspector RV 1~BO FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE : FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ................................ APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to Scale. Fee according to schedule~ b. Plot Flan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap~. cation. c. The work covered by this application may not be commenced before issuance of Building Permit, d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pent shail 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 Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) ¢ .... ............... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Nmne ofowner of premises ....1~...~..~..'~..A..~. ....... (as on the tax roll or latest deed) If applicant is a corporation, signature of duty authorized officer. (Name and title of corporate officer) Builder's License NO ..... ! .~.~ ................. >c lu,nbe 's icens No... ........... ~ Electrician'sLicenseNo...~...~..~. ............. Other Trade's License No ...................... I. Location of land on which proposed work will be done ................................................ House Number · Street Hamlet County Tax Map No. 1000 Section ..... I.O.U. .......... Block ...~-~ ............. Lot...~..~ ?..~. ........ Subdivision .......... ~-~'~ [-~'-'~h~' ~ Filed Map No ...... Lot ~ .... ~ c~,4-t~-,1 ..................... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b Iht nd d nd I ,~ ' ·' ' 'x . e e usea occupancy ............ 3. Nature of work (check which applicable): New Building ~ Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... 2 qO ~ ~' ~./d~..~ (Description). Estimated Cost , Fee (to be paid on filing this application) 5. If dwelling, nmnber.of dwelling units I Nmnber of dwelling units on each floor.. ! If garage, number of cars i. If business, commercial or mixed occupancy, specify fioture and extent of each type of use ..... --. ............... D pth ~- ;. Dimensions of existing strnctures, if any: Front.. w Rear ...7. .......... e ............... Height ' Number of Stories Dimensions of same structure with alterations or additions: Front - Rear Depth ............. ~ ....... tteight ........ .'~ ............. Nmnber of Stories..." ................... HeightDnnens~ons...%.~..-'? .%°t entire ..... new construct,on:Number of StoriesFr°nt .... ~.5.m. ~:.'2 .... Rear...5.X...~.; ...... Depth ..q.'4 .... - ....... ,. s ze of lot: Front ..... ........... i i i iiC. '.$1.1o.' i iiii iiii 71' ). Date of Purchase ............................. Name of Former Owner ............................. 1,.Zone or use .district in which premises are situated ................................... : .................. :. Does proposed construction v olate any zoning law, ordinance or regulation: .~.~ .................... 3. Will lot be regraded ..... .~ ........ ~ .......... Will ej4ess fill be removed from premises: Yes .L Name of Owner of prexnises"~.~..~?...~4'..~..[~ .~..~.?~... Address'r..~.~."l .~¢..,~..~.*e~..'7~?.~.... Phone No.~..~.'].~.°..%.~.~. ..... Name of Architect ...... t-a ................... Address ...... ' .... · ......... Phone No ................ Name of Contractor ~.....~.o. 4~ ~ ............ Address~..~..~! ~.~. ~.~.~.~..~.,-?.... Phone No."l.~,~.-..'~?..'l,~ .... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from ;operty lines· Give street and block number or description according to deed, and show street names and indicate whether terior or corner tot. rATE OF NEI~rx~ORK. /7 ~ '(Na~e of individual signing coMract) )ove named. ·.. being duly sworn, deposes and says that he is the applicant els the ...................... ~......~... ............. ~ ...................................... ./ L. (5°ntract~r'agent'c°rp°rate°fficer'etc') t' said owner or owners, and is duly aul'l~erform or have performed the said work and to make and file this ;plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the ork will be performed in the manner set forth fl~ the application filed t/:erewith. worn to before me this LOt $ T £0! / COUIVTt Y ClUB Ot IVE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES APPROVAL OF CONSTRUCTION ONLY APPROVED HEALTH DEPARTMENT-D&TA FOR APPROVAL TO CONSTRUCT WI~,kCONFOSM ~0 Tflg ~TANIMIiOS OF THE SUFFOLK COU~dTY DI~P~TMENT A..,,., II -- MONUMENT 13 = STAKE SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SL~FFOLK COUNTY ON OCT, I?t 1978 AS FILE NO. q J SURVEY FOR BRENDAN ,J. PALMER & EVELYN PALMER LOT 2, "COUNTRY CLUB ESTATES" AT. CUTCNOGUE TOWN (~' SOUTHOLD .~UFFOLK COUNTY, NEW YORK .UW, UT.O.~ZE. *LTE~TIO. OR,~OOmO. ~O Su.VEY n ,~ V~OL~T,O. ~.' SECT~O. TEOS OP NEW YONK STATE EOUC&TION LAW TO AOOITI0,IiAL IN~lflTUTiQId$ OR OW#E~$ DATE: DEC. IS, 1981 SCALE: I" :40' NO. 81 - 748 ' NOI~TANCES SHOWN HEREON FROM PROPERTY UNIES TOEXI$i'I~G STNUCTUR&~S ~ME F~ A PURPOSE ~NO ARE NOTTO BE USEO ~ ESTABLISH F~E~TY LINES OR F~E ~EC'TIoN ~ FENCES ! I YgU G's ~"~"AVE~E ~VER~AD, NEW YORK Lot $ ~UFFOLK COUNTY HEALTH DEPARTMENT 270.00' COUNTRY ClUB DRIVE _J HEALTH DEPARTMENT-DATA FOR APPROVAL TO C~;TR, IC T IM = MONUMENT r~=STAKE SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON Dc'r, 17, 1978 AS FILE NO. 6?36 SURVEY FOR BRENDAN &PALMER & EVELYN PALMER LOT 2,"COUNTRY CLUB ESTATES" AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK ,JAM, 4, DEC, ~, DATE: DEC. I§, IS81 SCALE: 1"=40' NO. 81-748 NUNAUTHOR1ZED ALTERATION OR ADOITiON TO THIS SURVEY I~l A VIOLATION OF SECTION 7Z09 OF THE NEW YORK STATE EDUCATION LAW ~ACOPIES OF THIS SURVEY NOT BEARING THE LAND YOUNG & YOUNG .O00S .A.OE. AVE.U RIVERHEAD~ NEW YORK ALDEN W. YOUNG, PROFESSIONAL ENGINEER ANO LAND SURVEYOR N.Y.S. LICENSE NO. 12845 , HOWARO W. YOUNG~ LAND SURVEYOR N.Y~S. LICENSE N0.45895 COUNTRY C UB D IVE SU~Y F~ SUFFOLK COUNTY DEPARTM~10P H~ALTH SERVICES ~EN~N d. ~L~R &E~ELYN PALMER LOT 2, "COUNTRY CLUB ESTATES" FOR APPROVAL OF CONSTRUCTION ONLY AT CUTCHOGUE DATE: DEC. 15, 1981 J~N ~ SOUTHOLD SCALE, I":~0' DATE ....................... 'NS ~F. NO._ ~ SUFFO~ COUNTY, NEW ~K NO. ,_ ,,.81-748 HE~ DEPARTMENT-~ATA F~ APPR~ ~ C~STRUCT ~ ~ ~OM WH~ Tx[ tU~EY is TOEXISTING ITRUCmRgt ~E FOR I SPECIFIC OF H~LTH ~1~. ~E~TY LINES OR FOR ~E ~ECTION ~ FENCES , G RIVER~AD, NEW ~RK ~: MONUMENT Q · STAKE , SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W.~UNG~ PROFESSIONAL ENGINEER SUFFOLK C~NTY ~ ~T. IT~ 1978 AS FILE NO. 6736 AND ~ND SURVEYOR N.Y-S* UCENSE NO. 12845 HOWARD W, YOUNG~ LAND SURVEYOR ' fl ~ L~T~ ~ W~L(W), ~PTIC TANK(S~ CE~OLS(~) I~N ;R[~ N.~ S. LICENSE NO. 45893 j I I f ii. 6F I:ICCU AN,CY .f U 1I APP, ROY~ED.~/~,: AS NOTED NO~UILD~NG 'D'EPARf~NT AT 765-1802 9 AM TO 4 PM FOR TEE FOLLOWING INSPECTIONS: 1. FOUNDATION ~ TWO REQUIRED FOR POURFD CONCRETE CODES. NOT RESPONSIBLE FOR DESIGN OR CON~RU~ION ~REORS. ~. _"%_ ..... ~.-~.