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Home My WebLink About12071-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 11743Z Date June 28 19.3.3. THIS CERTIFIES that the building ....... ne~..clwe 1.1. ir~g. ' .............. Location of Property 535 Birch Lane Cutchogue h3~s; 'N'd ....................... 's'tiebi ............ h3~iel County Tax Map No. 1000 Section .... Q83 ..... Block ...0.1 ........... Lot ..... 0..2~7 .... :... 7 Subdivision ..... I3 i r~.h. I~ i&ls ............. Filed Map No...6.9. Q ~3..Lot No.. ~..2 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... No.v. e m b~.n. 30 .... ,19 @ 2. pursuan~ to whicl/Building Permit No ...... .Z.1 ?. 0. 7 .~ ......... dated .... De.c. ember.. 1.4 ........... 1982., 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 ......... ...... ~w. o.~- fa.mily..~we l~.ing ............................................... The certificate is issued to BERTHA DAVIS (owner, le~ cr tc~,ant) of the aforesaid building. Suffolk County Department of Health Approval 12-5~04161 UNDERWRITERS CERTIFICATE NO... 51 6 0 5 1 3 9 Rev. 1/81 TO~/N~OF ~ou'r~l~i~ BUILDING DI~PARTMI~NT TOWN HALL $OUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE/~ISES UNTIL gULL COMPLETION OF THI: WORK AUTHORIZED) Permission is hereby granted to:/~ / '~ ~ ,/ . //-Y , Coun~ Tax Map No 1000 Sectioo., ...................... ~1~ .;?4 .............. ~-gt No. ~ ....................... pu~uont to appllCOtlOn oot~ ................................... , ....... 54~t.:;...., ly.....~.., o OPP Y .,Built, lng inspector. Building Rev. :6130/~80 , ~, , ~ ~ 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: I. Final survey of property with accurate location of aH buiMings, 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. 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 ~r land use $ !s'/ $5.00 3. Copy of certificate of occupancy $1.00 Date .~/~ 7~' ,~., New Buildin§ ........ Old or Pre-ex[sting Building(X) ........... ~ ~Vacant /and Location of Property ..... ~,3,~.. .................................... House No, Street Ham/et Owner or Owners of Property .. ~ County Tax Map No. 1000 Section .............. Bl~ck .. ~¢.~. Lot. .......................... Subdivision.,..~;.['H~... ,~.~.[.~..~. .............. Filed Map No ........... Lot No..I. ~ ........ .l~..O:~.l..~DateofPermit,' . ~ ~¢~;/ ~..~X~_'~.~.~.~.~),'t~!;.~. Permit No. /~. __~. plicant . . Health Dept. Approval ./~, .':'/.',~. ~. ~//..¢'"/f ...... Labor Dept. Approval ...................... ,.. · / d App Underwriters Approval .... Planning Boar roval .................. Request for Temporary Certificate ..................... Final Certificate .... . .~.-.. ....... Fee Submitted $...~.~.~. ....................... Construction on above described building and ~ee~s all app~cabl _,e,,~c~o~7~-f'e g u I a t ion s. Rev. 10-10-7a ~/~ ~_.~? tL:,(zL ' ~ x ' ..... ~(,~ 771 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITY ~ 85 JOHN NEW YORK 1003~ STREET, YORK, NEW o.,e .Tune 7, 198:3 ~ppllc. tio,, No. on/ile 2003:27-83 N THIS CERTIFIES THAT otdy the elec trical equipment as described below and introduced by the applicant named on the above application rtumber Jn the premises of Bertha D~vis, S/$ girc[~ lame, 500' W/O Duck Pond I~:t., 6Mtehoguo~ in th~ /ollowing location; [] Basement [] 1st Ft. [] 2nd FI. ~Section Block Lot was examined on J~ne 2, 1983 and fouttd to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES FLUORESCENT 25 27 DRYERS SYSTEMS NO. OF FEET EXHAUST FANS OTHER APPARATUS: 1-G.F.C,I. 2-R~ ~tec~rs 1-20.0 KoW. Heat 1~. E R I C NO OF CC. COND A.W.G, A W,G, NO, OFN6UTRALS A.W,G PER ,e' OF HI-LEG OF NEUTRAL I 2/0 1 2/0 Rulm~d E[eCt o Co. P. Oo Bo~ 143 Matcit.~ck, N.Y,, 11952 LIC. #242 GENEI~L MANAGER This cerlifi¢ote must not be oltered in eny menner return to the office of the Boord if ~ncorrect. Inspectqrs mey b~ identified E,y their credenfiels. ~¢~l~m COpY. FOR ~BUILDI~NG DEPARTMENT, THIS COPY OF CERTIFICATE MU~ N~T BE ALTEI~ED N ANY MANNER ~ ~l FIELD ~NSP~CTION COMMENTS FOUNDATION (1st) FOUNDATION (~nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~DE FINAL ADDITIONAL COMMENTS 7G5-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ~ FINAL REMARKS: DATE ~INSPEG~I'OR ~ Chief of Gene~-a! EnE~ineeri~ ~0: N/A ServiceS ,.,:: ~,~ ,/ ~"' ~ ..: , ~., ~ ~, ~l -' .~ ~, ~ /' .." .~/ ~s~ ~ s.*~ ~r. c~. MAP OF I_OT T~ ~ 5~TnOLO.,N .Y. I ...... 1, °' to,, ^pF.,ov*L. oF ~u~o., .,e-,.¥.. I THI~ WAT~lll SUPPLY AND ~WAOE ~ DATE: , , ...... l~l STAND~ OF SUFFOLK 00. DE~. OF H~LTH~ APPROVED: , ,, (S) ,, ~ , : ,,, AP~LICA~ OWNER: AREA: Z TITLE sUrF. co. N ~IF. ALTH ~EP'r. APPROVAL ? ? SU ~F. CO. DEPT. OF HEALTH IlIERVIGEG STATI~gNT .OF INTENT TE~T HOLE O' FOR APPROVAL OF C~U~IO,N ,ONLY TH~ WA~ SUPPLY AND SEWAGE , ~, s. ~. NO,, /P - , ~/~/ s~ o~ su~o~ co. ~, ~ APPROVED: I~O~,M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .~.~......./..~.. ............... , 19..~....~,~ Approvedxx/~.~......./...~... ........... , 19 ........ Permit No ............................... Disapproved o/c ............ "'~Z"""'~'"~'?' ................ "'" "~" ................... (Building Inspector) Application No. L~..~...~././. .............. 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 Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot end of buildings on premises, relationship to adjoining premises or public streets o areas, and giving a detailed description of layout ofpraperty must be drawn on the diagram which is part of this appJJcotion. 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 pa'rsuant 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 for 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 in buildings for necessary inspections. .... ................... (Signature of a~plicant, ,~name, if a ~orporatien) .... ................ (Address of applicant) / State whether applicant is ow~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or, builder .......................................... ............................................................................................................................. Name of owner of premises ~. '~X~ .~. ~..~....~4~.. ~.¢..D.~.. ................... If applican~ a~corporate, s~nat~e of duly aut/heri~ejd officer. (Name and title of corporate officer) Builder's License No ..................................................... P,umbers ',ce,se Na. Electricians License No .~...J'..~.~.J~....~..~/'~.::~--~ 0 her Trade s L~cense No ............................................... 1. Location of land on which proposed work will be done. Map No.: .~.../.~..~...~..L.~..~' ...............Lot No.../.i~ ........... Street and Number ..................... ~.~.4~.~..~..~ ........ ...................... ........ 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 ................... !~ .............................................................................. 3. Nature of work (check which applicable): New Building~. ................. Addition .................. Alteration ................. Repair .................. Removal .................. - Demolition .................... Other Work ................................................ W'/..)Zj- ~...~..('/....-':~...........' . ~ ' ,/ ~_~ (Description) 4. Estimated Cost .... ./..~...,~ .............. :'Fee ".'~'"' ~f~;'n6~';~'~i~i~"~;"¥'i'li'~'~"~'I~i'~"~'~ii;~i;~i,--- r - .................. 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 allerations or additions: Front .................................... Rear ............................ Depth ................................Height .......................... ..N~urgber of Stories ............... ~..~ ............ 8. Dimensions ~f en, lire new construction: Front .......... .~...~., ................ Rear .........~.., .~.. ........... Depth ..~....(~ .............. 9. sil~l~'go~t lot: ~o~ ..... .N.~.,m.b./~.r'.~...~..~i.~..r;~.~.. ....... !~.. Rear ...... ~./....~....~..:.....~.. ................ Depth ..... .'?..~...~...,,,....';~.....; .... 10. Date of Purchase ................. , ....................................... Nam of Former Owner .,...,.-mz-~ ............................................ 11. Zone or use district in which~premises are situated ................................................. ~,~, ............................................ 12. Does proposed construction v!olate any zoning law, ordinance or regulation: ,..~...~. ...................... ;i~ ............ Will lot be rearaded ..~.~'~ Will excess fill be renloved frompremses ( ) Yes ~( /;(No 14. Name of uwner or premises ..J~.~ .m'..~...'T..t.~....~4.W.~.:..~...~ .......... ~aaress ................. ~......~ ....................... Name of Architect ............................................................. Address ................................Phone No. ...................... Name of Contractor , ..~.~.~l~.~.~4~....~... . Address ~ ..................Phone .~o ..................... PLOT DIAGRAM Locate dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from propc~rty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner Iol. STATE OF: NEW Ygt~K, ~, / ~4'c c C OUN', .DE-~DF~~.-~_ ~",'~~'" ,, ........................... (Name of individual si~ning contract) above named. ~ ~. : He is the ....................... .~.~..r.;.,~ .................................................................................. ' .................................................. ; (Contractor, agent, corporate officer, etc.) of said owner or owners, and is daly 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 ~york w I be performed in the manner set forth in the application filed therewith. Sw0rn,, to bef, gJ~e me this · _.,. // / - Notary Fuouc, ~.r~.~,~,~.....,,,,~r~ .... ;:-.-.;,' ............................. ~ - ' 4,;~-----'/~~gnature of applicant) JUDITH T. TERRY ~ llolary Pubtic. Estate of New York Ilo. 52-0344963 Suffolk County..~ C~nission Exp res March 30. Ndfl~ ~ILDING DEPAR~ AT 765-1802 9 AM TO 4 P~ FOR THE FOLLOWING IN?~CTIONS: 1. FOUNDATION - ~O REQUIRED FOR POURED CONCRETE 2. ROUGH ~ FRAMING & PLUMBING 3. [NSU~TION 4. FINAL - CON~TPUCTION MUST BE COMPLETE FOR C. O, ALL CONSTRUCTION SHALL ME~ THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY ~DES. NOT RESPQNSIBLE FOR DESIGN OR CONSTRUCTION ERR~S. If copper tubing is used for water distributing sys:em; piping shall be of typeS K or I. only sys!em~ p~pi~l~ ~i~u ~ . ~ of types K or L only If copper tubing is used for water distributing sys:em; piping shall be of types K or L on~y