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Home My WebLink About11816-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 2: ] .1.1.93 .......... Date .... Se.p t, emhev...1 .?. .............. 19 ~2 THIS CERTIFIES that th?~e~i;~i~.., p. aol ........................................ Location of Property . .5.7. 0 ................ Donn. a. Dr~t.v.e ............... klat.~&l~uck... House No. Street Hamlet County Tax Map No. 1000 Section ...1.15 ...... Block ...1.5 .......... Lot .... a 2 ~t .......... Subdivision, De,~p. H~.le. Cr.eek. Kat~=~;e.=..Filed Map No..~Z56...Lot No..26 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. Ju]..y. 36 .......... ,19 $2. pursuant to which Building Permit No... l 1 ~.1.6.. g ........... dated .... ~ul.7.. 20 ................ 198~., 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 ......... ..... .a.q..5..n~.9 .up.d..8. ¥.t.m.m.~..n ~..P. 99.1..a.n..d..~.qn. 9.e.,' ............................... The certificate is issued to ..... Bgt~.e.J, 9. !~..l~a..r'.l.e..15;[.1.R~. ~9 .................... (owner, [es~e'~ ~'~ .... of the aforesaid building. Suffolk County Department of Health Approval ...... ~1/~. ................................ UNDERWRITERS CERTIFICATE NO .............. 1,5.5.?.8 $ 09 ........................... Rev. 1/81 Building Inspector BUILDING TOWN .HALL' SOUTHOLD, N~ Y.~ BUILDING (THIS pERMtT MUST BE KEPT 0N~HE IS COMPLETION OF THE WORK AUTH~RIzEDi ~t~ ...~..~ Permission is hereby gro.n, ted to: S UNTIL I~ bLL at Premises located co~,y To× ~P No. ~000 Se~o~ .../.Z..~.%,? pursgant ia application dat~d ? BO I~llng Iospector. Fe~ ~$ ................ 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: 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 dr Engineer responsible for the building, 5.Submit Planning Board approval of completed site plan requirements where applicable. B, For existing buildings (prior to Ap~i.I 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusum natural or topographic features. 2.Sworn statement of owner or previous owner as to use, occ,upancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premise& 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 $1.00 New Building ............. ~d cr-Pce-ex4~in9 ~ng(X) ......... = Vacant Land Locatlon of Property .... ~ t9 ~//t"'//~ ~.~/~ ///'(~ · ~~tT~/% Street let Owneror Owners of Property .~,...~ / ~..~,_~,~.~" '".~~ Countv Tax Map No. 1000 Section .... /./~ ..... Block ....... /.~... Lot Heal[h Approva[~ ~ ..... Labor Dept. Approval ...................... ,.. Dept. Unde~riters Approval .......... ;.. ~. ,Planning Board Approval .................. . Request for Temporary Certificate ..................... Final, Certificate ................. Construction on above described, building and permirmeets all app~cabt~es and regulations. ............. . ..... THE NEW YORK BOARD OF FliRE UNDERWRITERS BUREAU OF ELECTRIQ TY~ ~ A~lt~;~ 10~ 1~ 85 JOHN STREET NEW YORK, NE~W~.~'t~ORK ~00S8. ~.~ ~.~.~..o.~...s,,~ ~'~ - ~2 N 572309 THIS CERTIFIES THAT ozdy the electrlcal equipment as described belo~ end introduced by the qpplica~a~d on the able application number in the prendses of in the following Iocatlon; ~ Basement [] 1st FI. was examined on AUgust 5~ 1..982 FIXTURE OUTLETS SWITCHES 7 3 RXTURES 7 [~ 2nd FI. Section Block Lot and found to be in compliance with the requirenrents of this Board. DISH WASHERS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: Pauelboard/~; 1-Stir. l~am~. 1-G.F.i. E NO. OF CC. COND R O~ CC COND~ A W G, ~0 OF NEUTRALS A,W. G NO OF HI-LEG OF HI.LEG OF NEUTRAL ($wi~ Ikol) ~is ,certificate covers c~pliance at ~he d~e of inspeotton only. ~use of uuusual environing_ars it is ~dvisable to have frequ~n~ test mud/c~ repairs i~,de by a qu~lified person. Glenn R. Bradley Horton Ava,, l~VO 169 N~ttitt~k, N.Y. Zl9§2 This certificate must not be altered in any mann~r; return to the office of the Board if GENERAL Inspectors may be identifie C~PY,~R BuilDING DEPART"~mN~. ANY MANNItR. FIELD I NSP E C ~," ON 1, FOUNDATION (1st) FOUNDATION (~nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL COMMENTS ADDITIONAL, COMMENTS: I o! 25 AZ. 8 7°1~ ~20 '~kK lot 27. A'OTE: · = MONUI~EN~ ~ = STAKE SUBDI IlS/ON MAP FILED IN THE OFF/CE OF THE CLERK OF SUFFOLK COUNTY ON dAN, ZSt 19GS AS FILE NO. /82.00 ' 182. O0 ~ MAY 12,197G AUG. 25,197~ THE £OCATION OF WE[L~ ~h~D CE$$POOL,q SHOWN HEREIN ARE FROM FIELD OBSEI~Vi~[TIONS AND/OR F~O~' DATA OBTAINED F/~O~ OTHF, SS YOUNG & YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUNG SURVEYFOR:. ~ . /Y}i~ AZ B~N MENDOZZA ,~ , LOT 26 "DEEP H~LE CREEK ESTATES" AT MATTITUCK TOWN O~ SOUTHOLD' SCALE: SUFFOLK CO., N.Y. I"= 40' ; OCT $OUTBOLD SAVINGS BANK AMERICAN TITLE INSURANCE CO. 5 I N°'%-?d6 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined..~..~z'....~'~..Q.., Approved No. Disapproved a/c ....... ~. ~7~ ......... ~-- ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No.. ~./. ~./.~. ........ 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, Ne,~ 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 applicafft, or name, if a corporation) (Mailing address of applicant~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................... 73. r/ ./9. .. ............................................ Name of owner of premises... A i.. ~. ~f.~/5~.~...2-...O ................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate dfficer) Builder's License No ...... /~.~. ................ Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ..... .~/~. .... ~. D~/. ..AlA ...... /~. ~.[.~..~ ................ ......... ......... .¢. .............. .c./.< ........... House Number Street Hamlet County Tax Map No. 1000 Section ....... l.[.~. ....... Block ... !?. ............ Lot...~.?t. ............. Subdivision ~.C?~...~..~.o.L.~.. CtqC=.e~. ~-j'f-/Jr~. ~.. Filed Map No..~.' ~'~' ....... Lot.. ~.~. ........ (Name) 2. State existing use and occupancy of premises and intended use and occupa,ncy of proposed construction: a. Existing use and occupancy .... ./...~..~../~.../.~/.~...~.~...~..././~...~.( ............................... b. Intended use and occupancy .../~/..6//'~.o..c(.~/.~....~../~..)~..'~.44/?.~(. ~ p.Z,. .... .¥./:..~.~,~..C...~ .... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work . ~.a. (-:. · .ff..~i e~../,~7..~. (Description) 4. Estimated Cost ...... o..o..~. ~ ................ Fe ............................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars ' 6. If business, commercial or mixedl occupancy, specify nature and extent of each type of use ..................... 7. D.tmenslons of existing structureg, ,f 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 constructiou: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ ' pth 9. Size of lot: Front ...................... Rear ...................... De ...................... 10 Date of:Purchase ~ Name of Former Owner 11. Zone or use district in which Premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... jr/P....o .............. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . ~ ./fJ.~ 4-~. z~.~.7.0... Address .~.~..~.,f:. ~./~/~'.~... Phone No. /~..~.Z-77., ...... Name of Architect .......................... Address ................... Phone No Name of Contractor/J//q~./../~. ~ ~...,~o/d£.. ...... Address .... /~. ,Z)TTT~. ,. .....Phone No............. ~-F o~- ~-~' ~ ..'%. PLOT DIAGRAM Locate clearly and distinctly all ibuildings, 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. STATE OF NEW YOR[,,, o COUNTY OF...-~'.t4~.' .~. ]./~.... S.S ......... being duly sworn, deposes and says that he is the applicant ndi al si above named. He is t]be .................................................................................. (Contractor, agent, oorporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ail 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 .............. /.(~ ....... dayo~ ............. , 19~.~ N°taryPublic'~'Z-r' "~' '4t~t"'~ '(~' '" C°unty ~-,,~ ~ z/'--" ~/~ ' '/~'a~l~f i Flffr~l{¥ PUBLIC State o k~ignature an't) I , Jqo, 5~.4524771 0 ; qultlilled in Suffolt~ Oom~ty . r