HomeMy WebLinkAbout11801-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Buildin8 Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
Ne. Z11428
January 14
Date ................................. ! '
THIS CERTIFIES that the building ................................................
Southold
...........................
Location of Property North Parish Drive
............................. Hamlet
Street
County Tax Map No. 1000 Section 0 ? 1 ..... Block 01 .... Lot 016.002
Subdivision ·..X. ........................... Filed Map bio..X. ...... Lot bio. · .X. ..........
conforms substantially to the Application for Building Permit heretofore fried in this office dated
July 2 .......... ,19.8fipursuanttowh~chBuildingPermit'No~ 11801 Z
dated .... .J.u. 1.¥..1.4 ........... 19 .8.2., was issued, and conforms to all of the requirem*nts
of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... a private one-family dwelling. . ...................................
GREGORY M. & CAROLE S. POWER
The certificate is issued to ..................... idv~,n~,it'e,f~.~i,~[' .....................
of the aforesaid building.
Villa
Suffolk County Department of Health Approval .12-S0-62~ 1/11/83~ Robt. A.
UNDERWRITERS CERTIFICATE NO:. P e n d i n g ..........................
Building InSpector
Rw, 1/81
ToW~ .~f i
soUTH~LD, N~¥. i!.
BUI~DI ~ER~I~ :~
(THIS PERMIT M~JST BE KEPT, ON ~TId,E PI~MI~ES UNTIL}FULL
COMPLETION OF THE WORK AUTHORIZED)~, ~ ~
~9 118{)1 Z
Permission is hereby granted~ to:
to ~., .............. ~....3t.. ....... ~...~,.....~...., ..............
af premises I~ated at
COqn~ Tox Map No. 1000
o~r uant *to a hcat~on dat~ .................... ...~. ...... , .-.
B~i~dlng:,~ Inspector
~..t ...... ,.l L~t No: .....,4.~.:..E,.,. .....
, , 1 nd;opproved by the
Applicant
FORM NO. 8
TOWN OF SOUTHOLD ;'
Building De~artmen~
Town Hall
Southold, N.Y. 11@71
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and subr~itt~d in duplicate to the BuiIdlng Inspec-
tor with the following; for new bui!dings or new use:
1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or tooograohic features.
2, Final approval of Health Dept. of water supply and sewerage disposaJ--(S-9 form or equal).
3,Approval of electrical instal~ation from Board of Fire Underwriters.
4. Commercial bu~ldlngs, 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 Beard 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 sur,~ey of peoperty showing all property lines, s~reets, 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. Cartif[cate of occupancy $5.00
2. Certificate of occupancy on pre*existing dwelling or land use $5.00
3. Copy of certificate of occupancy $1.00
/ Old or - Date .. ~.'C~'/f3 , ..
New Bud ng .......... i ' ' Pre-ex~stlng~ui/ding(Z) ......... =/Vacant Land .........
House No. Svree r Ham/et
Owner or Owners of Property ...... ~ ~ ........ .~t
/¢'
County Tax Map No .1000 Section ...~,~ ......... Block .~ ............ Lot ...... f ........
Subdivision ................................. Filed Map'No. · ·: .... Lot No . '
. ' )l/Yl / I , / , _ L .....
Permit No ............ rm~ ....... t.~ ..~pp cant ~¢~,~ ¢~l~w~[
Health Dept, Approval ................ Labor Dep. Approval .....................
Unde~riters Approval .............. , .......... Planning Board Approval ..................
Request for Temporary Certificate F~nal Certificate'
Fee Submitted S .............................
,..,, .., -.;...~. , ¢::
~E~D INSPECTION COMMENTS
FOUNDATION {1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
C,~E
FINAL
ADDITIONAL COMMENTS:
THE NEWYORK80ARD OF FI~E
UNDERWRITERS
~URIEAU OF IELE~GTRiCI~¥
85 JOHN STREET, NEW YORK NIEWi YORK 100';38
~egory M. Power, N/$ N. Parish Dr. Ex~,, Southo~d, N,Y.
in the followlng Iocatlo,~; [~ Base,tent ~ 1st Fl.
wasexamirtedoa Jt~l~ 10, 1983
FIXTURE
OUTLETS
42
~ECEPTACLES SWITCHES
~2 27
FIXTURES
42
~ 2nd FI. ;: Section Block Lot
and found to be in co,~pli~tnce with the requirements of this Board.
DRYERS
E R' V
2/o
OTHER APPARATUS:
1-~.F.~.
2-~amke Del:em:ors
1-4.5 F.W. *H. W. H.(~t Water ~a~r)
1-20 ~W. ~at ~.
R~tlend Ele~t~ie Co. //' ~
P.O. Box 143
11
ny man~~t, Inspectors may, ~e dentJfied ~h
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y~ 1,i971
TEL.: 765-11~0
Examined ..... .~ ¥,t~.~
Disapproved a/c ................ w-..¥ ....... ..........
............... .............
~'~'- ..... ' "(Bt;ii:i~g Inspector)
INSTRUCTIONS
Application No. f C&~ /
a. This application must be completely filled in by typewriter or in ink and submitted-i~*.-d~.!h~!~ to the Building
Inspector, with 3 sets o~ 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 ora 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.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing c]~ and regulations, and to
admit authorized inspectors on premises and in buildings for necess~spections. /
(~ignat~e of~pplicant, or name, if a corporation)
.~.~...~.~..,~. ~. ~:... ~o..,:.,7./.d~.. ~.~:..
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu.ilder.
" ......................... -v .... ~.qo~O~
N, e o, o,,vner ofpremises ....................
~ ' (as on the tax roll or l~test deed)
If applicant is a corporation, algnature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No.. ~.].~..~,~,...~..~..~. ~d~. ~/'-p.
Plmnber's License No .........................
Electrician's License No .......................
Other Trade's License No ......................
Location of land on which proposed work will be done ..................................................
I Y..~. ./Oo.:.~..~or,~.:Dr.,.x~.. ..~.'.~.t~.~.l..d ..................
House Number Street Hamlet
County Tax Map No. 1000 Section ..... ~ .~ ....... Block ..... ~ ............ Lot~.
Subdivision ..................................... Filed Map No ............... Lot ...............
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~ ~'~ ~
appli'cable
3. Nature of work (check which ): New Building .. ~'~ Addition., Afieration
Repair .............. Removal .... .......... Demolition ~ ........ Other W6rk ...............
4. Estimated Cost ........... ~7~,~t ~ ............... . .~~f, .~.~ . .~. ~.2. .......
, i C'~-' (to be/aid on filing this applic~a~ti,~a~l,,~
5. If dwelhng, number of dwelling u~its .... ~.tO.~' ...... Number ohw~lh!g_uniLs~n each J~O_o~: ,-~ .~.t".~. ......
If garage, number of cars.. .... :~.tl]O ........................................... i ...."~' '~'
6. If business commercial or mixed 6ccupancy, specify nature and extent of each type of use ... i · ;.. ~ ~.-- · Cfi(..
7. Dimensions of existing structures, Jif any: Front ............... Rear .............. DePth ...... Z ~ · .'~..'..
Hetght ............... Number of Stories ...................................... ; ................
D~aensmns of same structure wJtl, alteratmns or add~tmns: Front ................. Rear [ ................
Depth ..................... ! Height .................... Number of Stories .... r. .................
8. Dimensions of entira new construction: Front ..... .~.'.~ ...... Rear ..... ~ ....... De~th . ,,~. ~. .......
Height ..... ,~..7 ...... Number of Stories ....... ~ ............................. ,',..,1 ............
Size of lot: Front ................... Rear ...... ! ........... ,
Date of Purchase ...... '~.": ./~.'?. ~.2 ............ Name of Former Owner .~let~....fi4.6'7 .l~Ct/.~. .....
Zone 6r use district in which premises are situated .....................................................
Does proposed construction viol~a[e any zoning law, ordinance or regulation: .............................
Will lot be regraded ........ _.~..~ ................. Will excess ,fai~ be removed from premises: Yes
Name of Owner of premises .~'~:./~..~'~0~',~( .... Address e~..'~.~?.gdJ, d. ~'"7"" Phone No. ~r
Name of Architect ......... ,, .i.,.,., .......... Address ....... t ·., .t..~ .....Phone No ...............
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 lin~s. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
STATE OF, NEW YORK,- 'S.S
cou Y .......
· ..''[.D: ./'~.,.~..~..~. · ./~ .-. ff.O. '14J...~., ............... being duly sworn, deposes and says that he is the applicant
/ [Name of individual signing contract)
above named. :
He is the ..................... ....................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is du, ly authorized to perform or have performed the said work and to make and file thig
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in the application filed therewith,
Sworn to before me this
.. ~rYe2 I
........ ~...-- .......... day qt,,
LINDA F. K
. .........
SUFFOLK CO. HEALTH DEPT. APPROVAL
H.S. NO. 12—50—l02
( EPARTMENT OF HEALTH .
MAP OF'PROPERTY Ia.o :
(••7�r`��_''-{�'+^''J�� —yyy•���SRU RV EY E D FOR y.�A ,Iy `�.r ,K, '8 3 J 0 11 FIN I r Q Q - j'`
STATEMENT.OF'INTENT -..
y �/l J n t") THE WATER'SUPPLY AND SEWAGEiDISPOSAL
Y V F, .SYSTEMS FOR THIS RESIDENCE WILL
Quo CONFORM TO THE STANDARDS OF THE
LBA\t" I_ fin/„ SUFFOLK CO. DEPT. OF HEALTH,SERVIdES..
TO-\&(PJ OF 50l1T���!.47ata.Y: . APPLICANT
SUFFOLK COUNTY DEPT. OF' '.HEALTH
SlJFFO'hR O�� �M DEPART SUFFOLK
— F Q R APPROVAL O F !fa'
aATS R. D. O I00'� CONSTRUCTION ONLY
F. # �_f�.:6 cV DATE: I N
The sewage disposal and pater supply H. S. REF. NO.: 12-50-G2
facilities for this location have been Ar{ APPROVED:
inspected by this department and found e
to be satisfactory _n �,1�+A _
.!1 " SUFFOLK CO. TAX MAP DESIGNATION:
Chief of General Engingerin� ~' L TOP \� SCALE-.40=( DIST. SECT. BLOCK PCL.
services , LU z r6 Pool- '0,MONUMENT
w _.c100a, - 071
`yoj°�y rK 3� At2: ahY2�C #SQ.Fi; OWNERS ADDRESS:
SNIC�'S i<f�1V .
v Ld
i/2 _ s-ry j Fools S Cox11'F�i OE>0« J4 `(, .t t19-71
tiQ IpU�L ,/ 0 -
�►' �'' ;NOTE: DEED: L. P. t: _
�• ELE1/Al"IOt�lS REFER TO Q.OI AT_ TEST HOLE STAMP.
GAQ-`GE ;
QRD1NA;ZY HIGH WATER IN
TH_ - VNAUTHORIZLV,�LkKAlivty Ut At*
PECQNIC BAY, G9ZADE 90 THIS SURVEY IS A VIOLATION OF
IECTION 7209 OF THE NEW,YORK STATI
Q / N Z°j/ ! Q _N TDLICATION LAW.
.TOP504L- POPIES OF THIS SURVEY MAP NOT KARIN,
THE LAND SURVEYOR'S INK:D SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
Q -V IO BE A VALID TRUE COPY.
�.m _LCFAIYI .
GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOP.WHOM THE SURV--
s
0 IS PREPARED,AND.ON His BEHALF TO THE
\a' - 7Q At�I EI,IDEf� .lAN. It Imo} 3 � �5 TITLE CO¢1PANY,GOVERNMENTAL,AGENCY I_
fvOh�� N�lo "L _ - 0 LENDING !t45T;TUTION LISTED,HERECk ANr
G Z4 n c� 30,S7. Tv THE ASSIGNEES OF THE LENDING INSTI
•�/ o / 16•� *�UTlON:tUARANTEES ARE NOT TRANSF_Eel
\b IY.GZG' � W. _ i0 itDDITIONAL INSTITUTIO#,K 09-WBE., F
L(r ZDS{dtiERa
a .I hR>>t5"PAN- SEAL
Wu. aAHTl�:E0 .TO -rHl=
_ CLAY.4I
_Gr�vt
FZODE;: -CK AN TU.Y, P.0 ,
'_j ? LICENSEDIAND SURVE -•ORS
Z.a t GREENPORT NEW YORK
SUFFOLK CO: HEALTH•DEPT.APPROVAL
+ratiJ �P° H.S. NO.
MAP OF RROPE-Rry
Si. RV� .YEP FOR O��C' ^YeQ MA
4 �/��j _ S „s:
� .��Y.Y-i. �-� +c� STATEMENT OF INTENT.
�T THE WATER,SUPPLY AND' SEWAGEIIDISP.OSAL
Oa FOR TH
_SYSTEMS IS RESIDENCE WILL
. BAY-Vj•�' `t, -_ - � _ :C NRORM TO :HE TAN A DS •
TOWN OF THE
` SUOFOLK DEPT. OF HE. T SERVItrES,
AP IC T
?l
SUFFOLK COUNTY DEPT.- OF HEALTH
Q `! Q`_ . S�E'F V I C E S — F Q:R A PP.R,O' .A L ' OF
'CONSTRUCTION-ONLY''
r f DATE: S Z
A.`*j H. S REF. NO. 6
�;•s ors+ APPROVED:
rcLc+ofl _
)BANK — —�
TO P
SGALE=.I�S�=.� �S_UFFOLK CO. TAX MAP'DEStGNATION:: `
,n -R MONUMENT : DIST: SECT. LOCK PCL:
oa0 _��:{] "�A6ZS`_OF
�1t°1fA OWNERS ADDRESS:, .
V?'
tp pool s
_ O�O
y O 0 .:
wed/ ,• - _ • Q' - �� � _ N�rE�_. ;• -- . - • •`. . -- - - . - -
DEED: L. p;
ELEVATIf0RS:-.REFE. 7' r
po R o.:Q:o a
�H. OR'DI_NA Y.•:.NtG}�I..wA?E ,TEST HOLE $TAMP;10
}ati p��9 pi -
` 'Y•y -J ,_ :I? V11� P.IAYi•'.. - �IMt►1/10RRR4Al p� .YFRAkIm 11�D c,
( S,•" GR'AIDE, io'TM SURVEY IS A V1olAWm q*'
SECTION 7109 OF THE NEW YOR!(STATE
i� EDUCATION LAW,
COFIES OF THIS.SURVEY MAP NOT BEAM11.
J ME LAND SURVEYOR`S INKED SiAL OR
Z EhUOSSED SEAL SHALL NOT 11E CONSIDERED
[�I TO BE A VALID.TRUE COPY.
.- AFI. GUARANTEES INDIGI7ED HEREON SHALL RLA•1 ONLY TO THE PERSON FOR WF:OM.TY.E SjJE>'i
�n- IC PREPARED,AND ON HiS BElfALF TO WE :-
n _ S > TITLE COMPANY,GOVERNMENW AGEPCY A:.
A I h Q .��/.5.7. : LENDING INSTITUTION LISTED MELClitl, kHD
►6.0` _ - - . , . _ : f0 THE ASSIGNEES OF THE LENDItiG
' `UTION. GUiIRANTEES ARE NOT. RK371
/`( 7 ADDITIONAL 1lST TAAA06fQ4ABLf
."ERS 1 10/�OR fQUENI
Ave 'V AI�iT "' �iA��-:PAN ;SEAL
��S �• . „ . C tr .7J7.i:E-:':�i. ttQ i,ic� .co.. `
Ive
l ur41 ..'Tat =�18 -CLAY 0
PX
- C
o LICENSED LAND S_URVE ORS
-
- GREENPORT NEW PORK.
- ~
^ `
'
. �
- .
-_'
/
' -� --- '--'---- ---- ------- OCCUPARYOR
'11
V��K� 13, ��U�8m8D� TUL
'
V; APPIZ0,11VED AS W-Trm 17
OYIFY 13UIEFTING . ' `.
�65'/8O2 9 AM TO 4 P�\ F�� T\��
F0LLOvY/NG /N5p�C1�I[)NS'
^ /}. FOUNDATION ' TWO IAt�
FOR POURED CONCRM
2. ROUGH ' FRAMING a, P[UAMMN9
13. IhSULr\T/[)M
' -4. FINAL. j\JU�-f
BE Cn/NP| FTE FOR C �)
. . ALL CONSTRUCTION SHALL Mfft
THE RE{)!.|(R7ME0^7S or ]=AP NY/.
. . STATE COWSTRU[TION & EN' ��V
CODES. @(l'[ RPSP()hJS)Er M
DESIGN OR CONSTRUCTION Ei\RO-S.
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,mnn; piping shall be
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