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Home My WebLink About11771-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 2~qqT02A. ........ Date ........... ~.¢n...e..5 ............... 19~35. THIS CERTIFIES that the building . g.c¢¢~.aa~o;y' ...... .............................. Location of Property ./+7~3.0..O~L ~..C¢~- s..~ar~B ........ k~r'ebt' .... ~a~'¢ ~_.~.u,¢]:r ............. House No. Hamlet County Tax Map No. 1000 Section ....q 22 ..... Block .... 0.~. ........ Lot ....... Qq'.q ....... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... J~me. ~. 0 ...... , 19 .~32 pursuant to which Building pennit No...'I .'1.~.~. ~J g ............. dated ......... J.~Z3r. .3. ........... 19 B2, 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 ......... ..... £o~ .... £.{~27, o7~_ g?ou~n5] .s?. ~.m.m.~.n..g..p.o.o..~ ................................ The certificate is issued to .R053~. · &. ~.H¥I~X~q. CrtCgflJ3]3 ................................. (owner, les~a or tenant) of the aforesaid building. Suffolk County Department of Health Approval 31/~ ~ 56s357 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 N°. Pe~nissior~ is hereby gradted to: BUILDING TOW~ SOuIH~O (THIS PERMIT MUSTBE KEPT COMPLETION OF THE WoRK AOTH~RiZED~ ~ate ,.,~,, to Coug~ Tdx Map No, l'~O0:Section: .. : t.:~: BI 0nd :approvod by the FORM NO, 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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: 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 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 'pra-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 safeW 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 Date ....... New Building ............. Old or Pre-existing Building(X). ~ - ~/Vacant Land Location of Property .............................. ~,,, .. .. . ... . . ... ... . House No. Street Hamlet County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot 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~.~, .~T~,. ir'meets a,II a~cable..codes and regulations. A icant ~' ~ " O'~4r~' pp ·; (.. -,~ ........ .., ,. ,/'.~., ;-.~f ....................... Rev. lO-10.7a FORM NO. 6 TOWN OF SOUTHOLD Building Departmen[ Town Hall Southold, N.Y. ~11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and subr~itted in duplicate to the Buildihg 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 topograohic features. 2. Final approval of Health Dept. of water supply and sewerage disposat--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple ReSidences and similar building~ 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 t957), 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. / ' Feas: 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 ............. Old or Pre-existing Building(:~) .......... =/Vacant Land ' Location of Property Z, ................ · · ...... Hou~ No, Srreet Hamlet Owner or Owners of Property PO.~ ~ ~.:N~'4. d~ZO-~ ' C tyT M pN 1000S ti · oun ax a o ec on ....... Block ............... Lot Subdivision ................................. Filed Map'No, ..; ....... Lot No .............. Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Unde~riters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate Final Certificat~ Fee Submitted S Construction on above described building and per~mee~s all apP~bt~odes and regulations. Rev. 10,10.78 FIELD' [~SPECTION FOUNDATION (1st) COMMENTS FOUNDATION ( 2nd ) ROUGH FRAME & FLUMBING INSULATION FER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: Bt) ;LD NO DEPT COPY OF APPL OAT ON FORM Fm LE THIS COPY WITH BUILDING OEPT;iWHEN~R6 STREET A~D ~O~ OR ROAD AND P~L~ NO. f~/ /~ t/ CflO~ 8Tfl E E~,IS . ~EMtSE~ L~ATED? NAME SULLIED ' ., LISTBELOWALLEQUIPMENTWHIC.H~ U~N~ L~LED ' ~- ;NUmBeR O~ OUTLETS N~ of F,xtur~ & ' TEfl ~ . La~p R~ptac~ MOTORS lion CediS. ~: Wail ~ept*ls $w,tcll Pendent Bracket No. Ty~ ~. NO, ~a~ .~i EACH , AV~ D D.~A~; 8Y GIVING. FULL AND ACCURATE rNFORMAT 0N ALL SPACES'~t STNEETA ' ~{ ! 1000663 THE NEW YORK BOARD OF FIRE' UNDERWRITERS BUREAU OF ELECTRICilT~ Jo.. STREET, .E V 1OO3~ a~t~ j~y 8, 1982 ~p.n~.t,o. ~o. o.~u~ 174663-82 N5 G 8 3 5 7 THIS CERTIFIES THAT only the electrlca~ ~i~t~nt a{ ~s~b~d ~e(~W an~ int~d~ed bX ~ ~pl~¢o~ed on tlw above apptication number in the premises of FIXTURE OUTLETS RECEPTACLES SWITCHES [] 1st Fl. [] 2nd FI. 0~C$~ Section Block Lot and found to be in cornl~lia$ce with the r~quirements of this Board. RANGES OVENS FIXTURES FLUORESCENT EXHAUST FANS DRYERS SYSTEMS E E C NO, OF CC. COND PER ~Y OF CC. COND, . NO. OF HI-LEG OTHER APPARATUS: OF HI-LEG NO, OF NEUTRALS A, WG Hob. on Ave., RFD169F : //:' ~CCituck,, N.Y. 11952 ~y~Jj~]e m~2.~t be altered in any manner, return to the office of ~e Board if ~incO;reft. Inmectors may be identifio~ b~ their crodent as COPY FO~ BUILDING DEPARTMENT. THIS COPY OF NEW YORK STAT£ D£PARTMENT OF ENVIRONMENTAL CONSERVATION pERMIT PERMIT NO 10-82-0 8 ARTICLE 24, (Freshwater Wetlands) [] ARTICLE 36, (Construction in Flood Hazard Areas) ROBERT A. GRAEB Ole Jule La., Mattituck, N. Y. 11952 ~,tlO~. OF I~OIECT (Section of stream, tidal wetland, dam, building) North end of Canal off James Creek on east side of Ole Jule T.a. '~ ~IPTIO~ OF PROJECT Erect 15' × 2~' above ground swimming pool according to plan submitted and on file with south edge of pool no farther south than south edge of house. CO~4MUNITY NAME (Cily, Town, Village) TOWN ; Mattituck Southold [ Suffolk ' 1. The permltlee shall file in the office of Ihe appropriate Regmnal Permit Admlnfstrator, a notice of intention to commence work at least 48 promptly ~n writing of the completion of the work, order the work suspended if the public interest so requires. 3. As a condition of the issuance o( this permit, the appbcant has ac- copied expressly, by the execution of the application, the lull legal respon- sibility for all damages, direct or ~ndirect, of whatever nature, and by whom- ever suffered, arising out of the pro]ed described herein and has agreed costs of every name and description resulting from the said project. shall be removed evenly, without leaving large refuse piles, ridges across the bed of the waterway or flood plain or deep holes that may have a tendency to cause inJury to navigable channels or to the banks of the waterway. 5. Any material to be deposited or dumped under this, permit, erther in the waterway or on shore above high-water mark, shall be deposited or dumped at the locality shown on the drawing hereto attached, and, if so prescubed thereon, within or behind a good and substantial bulkhead or bulkheads, such as will prevent escape of the material into the waterway. 6. There shall be no unreasonable interference with navigation by work herein authorized. 7. That if future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the open,on of the Department of Environmental Conservation it shall cause, unreasonable obstruction to the free navigation of said waters or flood flows .or endanger 95-2~-4 (9/75) FIA CO~4MUNITY NO. j DAM NO. J P~.~T~)2~%TION DATE GENERAL CONDITIONS 8. That the State of New York shall in no case be hable for any damage or injury to the structure or work herein-authorized which may be caused by or result from fut)~re operations undertaken by the State for the conservatm~ or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. 9. That if the display of lights and signals on any work hereby authorized is not otherwise provided for by law, such lights and signals as may be pre- scribed by the United States Coast Guard shall be installed and maintained by and at the expense of the owner. 10. All work carned out under this permit shall be performed in accor- dance wit~ established engineering practice and in a workmanlike manner. 11. If granted under Articles 24 or 25, the Department reserves the right to reconsider this approval at any time and after due notice and heanng to continue, rescind or modify this permit in such a manner as may be found to be lust and equitable. If upon the expiration or revocation of this permit, the (SEE REVERSE SIDE) SPECIAL CONDITIONS Special-Conditions attached: DJL:cg c.c. LAW'ENFORC~2~ENT r U'S'A'C'o~ Engineers File Attachments Receipt DANIEL J. ~.~ldg.40,SUNY,$tony Brook, N.Y. ~/ ~ J~ _. llT?~ FORM NO. 1 TO~N OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved~.~.. ~ ..... , Ill, Permit No. ~.(. Z~.~. 2 Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted ~ to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoinin~ premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced before issuance of Building Permit. '. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Depad~nent for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southoid, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordinances, building code, hous/ng code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if a corporation) (Ming address applicant), ~$'J~" '~' ~ D~~ ......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. ,~.?.~..oTtR.T~.., .~..?.t~..¥.6..ts .... .~g~,',~ tg..~...~. ............................... (as on the tax roll or 1,atest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Plumber's License No ......................... Electrician's License No. Other Trade's License No. 1. Location of land on which proposed work will be~lone .................................................. .... ¥...?.E.Q ........... .o. ........ r:.,.. ...... . ....... House Number Street Hamlet County Tax Map NO. 1000 Section .... /.~..~. ........ Block ...... .0..~.. , . .... Lot .... .~...~.( ......... X ' pN SubdivisiOn ............ Fried Ma o ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~.-~. ~ ~.~... (~'.-~..,~!.~. y~...~ ~. ~-~4,.x,~: ........................... . b. Intended use and occupancy . .~.C,Y.4. 3. Nature of work (check which a~plicable): New Building ...... ' ....Addition ...-'~.. .... Alteration .' ......... Repair Rembval .............. .............. Demolition .............. Other Work./4-~7-q:~. ....... (Description) 4 Estimated Cost ' : (to be paid on filing this application) 5. If dwelling, number 0f dwellinglunits ....... /. ....... Number of dwelling units on each floor... ~ ........... If garage, number of cars ...~"7, .................................................................. 6. If business, commercial or mixe~ occupancy, specify nature and.extent of each type of use .................... 7. Dimensions of existing structur0s, 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 ... ~..%.."~../..5':.: Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front .......... } ........... Rear ...................... Depth ...................... Date of Purchase .......... i .................. Name of Former Owner ............................. Zone 6r use district in which pr~mises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ................................ Will lot be regraded ............................ Will ~xcess fill be removed from premises: _~Y~s No Name of Owner of premises .. i ................. Address ................... Phone No. o~.~.~y.~'.~.,~.O.... Name of Architect .......................... Address ................... Phone No..~.. ~ 7 .~. ~..-?.~..'.'25 Name of Contractor . ~q~-f~.. ~.~.'~ ..... Address .................. Phone No ...... ~:~.o~... PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block~number or description according to deed, and show street names and indicate whether interior or corner lot. 10. 11. 12. 13. 14, STATE OF NEW YORK, 'S.S county .... ..... .~F.o.~.O. (.c~.../~ ... ~?~.~.l .................... berg duly sworn, deposes and says that he is the applic~t : (Name of individual sig~ing contract) above named. : He is the ............ ~ .................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file ~is application; that all statements conthined ~ this application am true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set fo~h in the application filed therewith. Sworn to before me this .................. day of. ........... Nota~ Public~o~~~ ........ C~ t.~N.~ F. KOWA~OKI ~ Commi~si0n ~xpires .ar? ~0, ,gB,.~ ~