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Home My WebLink About11760-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z.I.I~.~ ......... Date ... ~.~l~.~mb.O~'..2.8 .............. , lgP.,~. THIS CERTIFIES that the building ................................................ Location of Property . 1 $ J .0. ............. ~O ~'.~:.11.0~RtqgO~l..I~r';Ly.e. ........ L~.~I~. e. ~t ...... House No. Street Hamlet County Tax Map No. 1000 Section .. 1 ~7 ....... Block . .O 6 ........... Lot ... g 0.8. .......... Subdivision...l~*~.e.o. 3,. ]E'.~,P. lf. ~.u.b, ......... Filed Map No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..~.~rl e. ~ ............ ,19 .E:~ pursuant to which Building Permit No.. 1..1.7.6.0...g ............ dated ....~.u.z~q. 3.0. ................ 19.8.R, 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 ......... ..... e,. pr.:t.v.~.t,.e..c~r~e.--.f.~,ro.:[.l..~..qt~,.e.Z.l:l.~... ....................................... The certificate is issued to . ..Job~a..&. ~J-.~l~o?..Be;~.t~.qr~o ............................... (owner, I~ of the aforesaid building. Suffolk County Department of Health Approval . .1.2. .- .~.-. ! .0 ,..9./..~.3/8.~. ,..1t.o.b..g....~.:. y.:t.J: 1. 9., UNDERWRITERS CERTIFICATE NO .......... ~qO~,'J-,~,$ ................................ Rev. 1/81 Building Inspector BUILDING D~PART~I TOWN HALL SOUTHOLD, N~ Y, BUILDING~ PERMIT (THIS PERMIT MUST BE KEPT ON ~HE PP, E/~ S.~S UNTIL EULL ~..[..1.~..;.,~ ...... 'N°. i1760 Z Date ...... ,...~,..~ ......... , .... Permissio~ is hereby granted to: ................... ~"'"';'"'"'"""~;" ':'""r .... : .............. , ~,~,~, ~o~,,, ~, ............... .~ ........................... ~ ....... ..?..?.. ,;..- ..... ~ ...... .................... .............. ~ .................................................... ~......~ ~?.~..s.~..~?~ ?..~ ........ ~.~..~t.t ..................................... .................................................. ., ........... S.,....~.,~...:~: ....... ?.~ ...... ,,.r~.,...~ ....................... ~ ,;~ ~ ,o. ~0oo ~,o~ ~. ...... .r~..7.~ ~ L..~.,LO.......~o~,o.~ ............ , .......... ~ : . '~ '~;~i ~ ~: .~ ' d a roved b the B~j ding Ibspector. : Rev 6/30/80 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, a~d subn:ritted 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 o'r 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 alt 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. / ' 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 j Date.. ~/ / ~/..~,?c// ~0 Z.-, .. New Building ............. Old or Pre-existing Building(X) ......... ~/Vacant Land ............. Location of Property ,2f~/, : .q.~4L~.t~.'~,.f~, .~(~ : ............. . /~-~O ~(~e l~_. W~ /' ~ ' Hou~ ilo. Street ........................ Owner or Owners of Property ......... ~ ~' ~,~'~O/V~ County Tax Map No. 1000 Section ........ Block .... O ~ Lot Subdiv s or ~ u ,~ ~. .Filed Map No. ~/~ .Lot No. ............. .. ' ............... ,.. Unde~riters Approval ~/.~/~ ~ g B ................. Plannin card Approval .................. Request for Temporary Certificate ................. , .... Final Certificate . Fee Submitted $.. ~ ~ O O Construction on above described building and permi~meets all aPp~cabl~odes and regulations. Applicant . ~~' :"" ' 'r' - " ......... Regulatory Affairs Bldgo -4.0~ SI~"Z - ~ 219 Stony Brook, ~_,I~ York 11794 (516) 751-7900 P, OBF~RT Fo FLAC~q Commissioner As a result of your inquiry concerning the above referenced parcel, this Depazh~nt has conducted an on-site inspection. We have found t~he ~a-rcel ~ Therefore~ pursuant to Part 661~ Official Comp.. ilation of Codes, ..Rules and Regulations of the State of N~,v York~ Section 661o4(b)~ no permit under .Article '25 (Tidal Wetlands) of the Envirommental Conservation Law is required° Very truly yours, DA1,:rr~ Jo I;LRKZ-i'J Regional Permit Adrminist~'~tor INSPECTION COMMENTS FOU['IDATtO~; (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION FER N. STATE ENERGY ODE FINAL ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 ~,~ , ~.~ TEL.: 765-1803 E×amined ....... . Approved ......?:., ,9 No.../. !. !. P Disapproved a/c . .c:'. ............................... ....................... (Building InSpector) ' ' ' APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No... Date . .~.//..~. ........... 19o¢.~..~ 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 and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli~ cation. 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 for removal or demolition, as herein described. Th~ applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to a~lmit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) .............. .... ........ (Mailing address of applicant4 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ ........................ ............................................. ]~ame of o~er of premises :'~..~.~7f..~/... '.77..~.~..~.'.~..~ ~.c/.~..2~ ..... . .~. d:~.'..)~.~ ./((.Q-~ ........................... (as on the tax roll or latest deed) If applicant is g.qorporation, signatur,e of du, ly authorized officer. Builder's License No .... / .-.~. ................ ~g~/o~/~ Plumber's License No ............... ~ ..... ~ ~ Electrician's License No ............ "'~'"'~''' Other Trade's License No ...................... 1. Locatmn of land on winch proposed work will be done....~ .-. ..... .................... i ............... House Number Street Hamlet / County Tax Map No. 1000 Section .... ./...2. ........ Block .................. Lot... ?. .............. Subdivision ....... d.~.(/./.(.¢.~.~...../.~.~..~f.~.' ....... FiledManNo....~./..'~: ...... Lot / R, t° 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........................................... ~' '2 ....................... b. Intended use and occupancy /.../~/~9/(/ ~/¢/e /-Z ............. ,/.. ......... ! .,. 7~. },.i. ~ :, t> '~: .......................... ~licable)' New Building ~ Addition Alteration .. ·. 3. ~Nature of work (check which ap ..... epair .............. Removal .............. Demolition .............. Other Work ............... ..~. ~. ~2% (Description) 4. Estimated Cost ....... /...~.a..~./..a..~ ............ Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units...~.../~.~.~f~.. ~.~/ 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 .............. t ........ 8. Dimensions of ent~ire new construction: Front .... ~ .Z.' ....... Rear . . ~.'~../ ....... Depth . . .~..~ .......... Height .... /.,~. ......... Numbe~r of Stories ....... / ................................................ Size of lot: Front ....... .~. ~.!~_ ........ Rear ... .~..o. .......... Depth .~... Z'..~. ............... Date of Purchase .......... /.~. ,.~9 ............. Nam'eof Former Owner ............................. Zone or use district in which pr~mises are situated ...... ~..- ............................................ Does proposed construction violate any zoning law, ordinance or regulation: .... fir...&? ........................ Will lot be regraded ...... fi??. .................. Will excess fill be removed from premises: Yes No Name of Owner of premises .?.t.[~.~fi.'7-P..Z~..~ .... Address ................... Phone No ................ Name of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor .~, ./~.~. l~. ~.:....~...~../~.f~.... Address.. ~02.~...~.. '. ....... Phone No. z,. ;~.~..-~ .~.~. ?..Z~.. 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all. buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block mmber or description according to deed, and show street names and indicate whether interior or corner lot. / STATE OF NEWt~RK, ,z _ _ COUNTY OF~. ~'~ .......... ~ ....... being duly sworn, deposes ~d says that he is the applicant above named. Heis the..' .................... ~... (Contractor, agenf, 'corporate officer, etc.) of said owner or ownem, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file this application; that all statements cont~ned ~ this application are true ~o the best of his ~owledge and belief; and that the work will be perfomed in the m~n~r set forth ~ the application filed therewith. S~o~ to before me this ........... ...... Not Public, .............. . .. County (Signa~m of applic~t) ' ~. ~,~ /.,,woOU " Approved m ~eeordm~ee ~ith I~ rd ot SUFFOLK COUN~ DEPAR1MEN] OF HEALTH SErViCES ~O~ ~N ~ ~O~OL~ sc~E: /. : 40' APPROVED NEW YORE STATE E~CAT,~ LAW THE y~/~ ~.iV~?%V~' - NOT BE CO~SIOERED TO ~ A VALID fRUE C~Y ..~.,, ~ :~,., ,.0 ...o, .o., .,,0 .o ....... ~ ~NDEH AVENUE &or ~o~s ~ '~ o~Ro~/~/o~oF&orR ~ ~ ~$.~ ALDEN W.Y~NG~ PHOFE~ION~L ENGINEEH ~O~L R4~ 4~ 0~ R~O~tY O~ ~4 ~4 ~ ~IL~O/~r~o~oEOFF~O~KO~O~/~4S~/& HOWA~O W. YOUNG~ LAND SUHVEYOH W ~ L~T~ ~ WELJW}~ ~PTIC T4NKJ~J a C[~OLS(~} ~N The sewage disposal an~ wet. er supplF ~ ~, ~ have e~ ~WN ~ SOUTHO~D ta~ilities tot this locah o b J ~ ~e sat~sfae~o~. I ~" ' ' ' J' ~RVEY - / SURVE~RS ,IHKED SE~L OREHBOSSEO ~AL SHALL HEALTH DEPARTMENT-DATA FOR APPRO~ TO C~STRUC T j H~E~ ARE ~ ~ELLI~ WITHIN )O0 FEET OF T~$ PROPERTT NTHEWATERSUP~Y~SE~GE DI~AL SYST~i~R~iOE~ J ~LIC~T, / PUflPO~[ AND ARE NO~ J F/L~/~r~CO~/CCO~r~c~OF~F~OgC~,/~S~/~IJ HOWARD ~ YOUNG LAND <URVKYO ~ N ~ L~ ~ W~L(W),~IC TAflK(STJa CE~OLS(CP) ~fl flEaj~ JJ NOTIFY BUILDING DEPARTMENT AT 765~1802 9 AM TO 4 PM FOR TFIE FOLLOWING INSPECTIONS: ]. ~:OUNDATION - TWO REQUIRED FOR POURED CONCRETE ,4, t?x A,ST° ~