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HomeMy WebLinkAbout12386-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy ZI3300 APRIL 1 19~5. No .................. Date ................................... THIS CERTIFIES that the building ...iff.~.~... ?p.E.L..L .~[.q .............................. Location of Property 27840 M^IN ROAD ORIENT House Ale. Street Hamlet County Tax Map No. 1000 Section ...0.1.8. ...... Block .... 0.6. ......... Lot .... 2. q. ........... Subdivision ............................... Fried Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated ...?.g?..2.3. ........... , 198..3. pursuant to which Building Permit No .... q. .2 .3 .8. 5. Z. ........... dated .. ?. q .~ .E..1.6. ................. 198. .3., 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 ......... g NEW ONE FAMILY DWELLING. The certificate is issued to JOSEPH & EDWINA HATAIER ..................... ~d~,n'e'r,'l~ds~e'dr't~Aa'n'O ...................... of the aforesaid building. Suffolk County Department of Health Approval 1 3- S 0-4 1 N660~63 UNDERWRITERS CERTIFICATE NO ................................................. Rev. 1/81 Building Inspector I~OF, M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12386 Z Permission is hereby granted to:_~.~ ....... .~'.~.?.:.~.p.~......~X./~/~.~ .......... ........... /..~./..~. ....... ~.~:......~.. ..... ©~,.~.~..~....~ .............. ~ ...... , ......... ................. o,,,,,,,,~o,,, o, ..... ..:....:../....¢....0.. ........ ::::~ ........ :::~,.....~::~.~..:'": ........ : ..... County Tax Map No. lO00 Section ..(~.L'.Z .......... Block ...~..F.~.. .......... Lot No. ,,~.'~.'"~.......~..../.. pursuont to applicotion dated ...... z~..~......~>'.. .................. ', 19 .~.~..: ond opproved by the Building Inspector. Building Inspector Rev. 6130180 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Sbuthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY BLDG, TOWN OF SOUTHOLD 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 "pre-existing" land uses: I. Accurate survey of p~Coperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date. ,/.'?~.?~'~- ...../' '~" ' t ........ New Building ...~/ ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property z~. :~.~.. ,~.(~? ....... ,~,?,~/,~,~ .... !~,.0,~,~, ......... House No. Street ~ , Ham/et Owner or Owners of Property .~. ?.. ;?'.3 .~ ~. h .~...C_&.fi: ~ .i .~...~.. ~(~ ~--I iG' ~ .~.-~ county Tax Uap ~o. 1000 Section ...~../. ~ ....... Block...0..~. ....... Cot...~./~) .... .~../ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.. 12 .~.. ~. FDate of Permit .. ?.U.l?('. !~, .Applicant... ~-~ ~.'~) ~ ~ff:~ ~ ~ Health Dept. Approval ................... Labor Dept. Approval ........................ U,de~riters Approval. ~ ~ .~. ~.~ ~. ~ ..... Planning Board Approval ...................... ~equest for Temporarg Cortificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. App,ieant ..... ........ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY S~t~)T~ ~l~ i9~ JOHN STREET, NEW YORK, NEW yORKJOO:3B rate applic.tio. ~Vo. · .,~ ~.~,~,~ ~.~ ~ N 660663 only the electrical equipment ~ described below and introduced by t~ applicant named on the able application number in the premises of Jos~h ~t~.er, 27~0 Main Road~ in the following location; ~ Basement ~as exami,ted on ~p~ 7 ~ ~.9~ and found to be in compliance w~th the requirements of this Board. FIXTURE FIXTURES RANBES COOKING DECKS OVENS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET AWG. OF CC COND, 2/O NO OF HI-LEG OF HI-LEG NO. OF NEUTRALS Jos cgh E~t aier 1610 Platt Road Orient~ N.Y. 11957 GENERAL MANAGE, R :/ ll This certificate must not be altered in any manner; return to the office of the Board if [nco?rect. Inspectors may be identified by their COPY, FOR BUILDING DEPARTMENT, THIS COPt OF cERTi EICA;,E:M U~T N~OT BE/~LTER~~. DEPAR~TI~ENT OF TRANSPORTAT ' ~ ' PERM 42e (~183) STATE OF NEW YORK - ION Tote Re~iv~ $ 2~50 ~ ' ;. ~" ' LiabiliW nsur~nce Cash ce pt ; , ~ Deposit Rec. fof$ Di.bility"enefitOoverage ~ ,~ ~ '': D,.t~d 7-7-83 ' - Address ; 16]0 "3att ~ad ' ' "( f~l . '_~:~ ' orUndertakingonFile City O~e~ State NY zip 1~1~! ' ~e~en~ti~n ' % Polic? No. Mailing Address for Return of Bond or Deposit ~ Returh oflDeposit Made Payable To: ' , (Complete, Only if Different From Perm~ttee) (Complete only if different from above.) ~ ; ~ ~ Name ' ' ~,, Nam~ 'Address ~'' Address' . ~ ' Ci{y · i State - Zip City ' ! State Zip Under tH~'~rov~sio~ of th~ Highway Law or Vehicle & Traffi~ L~w Permi~sio~i~'~ereby grant~ ~o thep~rmittee to ~ ~g~ ~C~ in the county of ~ $~felk as set forth and represented n the attadhed app icat ~n; atthe pa~icular location or area, or ~ver t~b'ro~tes as stated therein, if required; and pursuant to the conditions and r~u at,ohs, Whether general or specml, and methods of performing wor~ ~f any all of which are ~t forth m the apphcatlon and ~o~m part of th~eym~t~ , ' ~; Dated at ~____, N.Y. Com~~~ ' Date~igned ~ulY 13. 19R3 : ' IMPORTANT ' , : ~ ~ J THi'S PERMIT, WITH APPLICATION A~D. DRAWING ~bR?OPIESTH~REOF) A~TACHED, : SHALL BE PLACED NTHEHANDSOF~HE~ONTR~CT~R BEFOR~ANYWORK sSTARTEDI NOTICE :-~lt is ab~01utely necessary that the perm~ttee n~tify ' , ~, ~. ~, ~S ~ ' 24 bP.' nbtffteatfen ~Ui~ Tel. No. , ~ i~ L~efore~ork is sta~ed and uppn its completion.~ The ssu ng 'Jth0rlt~ fe~rves the right to suspend or revoke this permit at it~,di~retibn ~ ithout a hea?~g or ~the n~esslty bf showing cause, either ~fore or d~r ng the o~erations authorized. ' (SEE OTHER SIDE) - AUG. ~' COMMENTS FIELD INSPECTION FOUNDATION (1st) (2nd) FOUNDATION 2 o ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: / NE~ YORK 3TATE DEPAP~T~NT OF ENVIPDhq~TAL Regalatory Affairs Unit Bldg. 40, SU.~--ROom 219 Stony Brook, !~f 11794 (516) 751-7900 A review hae been made of your proposal to: New York State Department of Environmental Conservation has found the ... parcel__project to he: ~Greater than 300' from inve~toried tidal wetlands. _Landward of a substantial man-made structure greater than 100' in length constructed prior to September 20, 19~7. ,,, Landward of 10' contour eleva~ion above mean sea level on a gradual, nat- ural slope. Lan~;ard of topographical crest of bluff, cliff or dune in excess of 10 feet in elevation above mean sea level. Therefore, no permit under Article 25 (Tidal Wetlands of the Environmental Conservation Law) is required at this time since the current proposal is beyond State mandated J~risdiction pursuant to this act. ~owever, any additional work or modifications to the project may r~quire a permit. It is your responsibility to notify this office, in writing~ if such additional work of modifications are contemplated. Very truly yours, Daniel J. Larkin Regional Supervisor of Regulatory Affairs DJL:KNT:cz FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Disapproved a/c APPLICATION FOR BUILDING PERMIT Application No...//d.~..~. ........ 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 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 issued 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. 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 building for necessary inspect~ ~ ~-~ ~,~ .............. '.F.. ............ './g... ..... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 0 Name of owner of premises ...... .41O. .8..~. ?..~.. ~ .~ ~/.~... ~. ~ ....................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. Plumber's License No ......................... Electrician's License No. Other Trade's License No. I. Location of land on which proposed work will be done .................................................. ........................................ ........... House Number '~x,~ Street ~ Hamlet 'Nt oT ! County Tax Map No. 1000 Section .... .O.. [ff. ........ Block .... .~ ............. Lot Subdivision .~..~.~...~..~...~...~-'-.~...P~./..~.~.../~.~7~./.~.~ Filed Map No ............... Lot ....... /. ....... . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~..~..(~....~......~..~...~t.....~..~...~..~. ............................ b. Intended use and occupancy ...... .O..~'..7~....~.../~...(/7.~...../t.~.O. ~ ..&~. .............................. 3. Nature of work (check which applicable): New Building J'"' Addition Alteration Repair .............. RemOval .............. Demolition .............. Other Work ............... 4. Estimated Cost.. ................ . ........ Fee.. ....... . ..................... . ... . ~ (to be paid on fding this application) 5. If dwelling, number of dwelling Units ..... ~. ......... Number of dwelling units on each floor ................ If garage, number of cars ..... i ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, 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 ... ~ .r ........ Rear ...zT'..~..r ........ Depth .. eT8 · ' ' ' / '~v.- 4~.~,~,.~-,~'-' ,~t.oa~ ,~,. ¢~. '.~ ......... Height ...~.o~. ......... Number or Stones ........ ..~...4~ ............. .(:.. ............ et.. ~ ........ 9. Size of lot: Front ..... .~..~.?,.~ ......... Rear ...... ~.).~. .... Depth ...~.?:.¢? ........... 10. DateofPurchase ....~J.~.~...t'.F. ii.~.~. ............... Name ofFornler Owner ..v'~.~Z...g~.,~..o.3.(.r'.~.~./f./. ........ 11. Zone or se dlstnct in which premises are situated.. ~ .... /¢.~--2g~..,~-. ................................ 12. Does proposed construction viola~te any zoning law, ordinance or regular'ion: .... .A(..~. ...................... 13. Will lot be regraded ...... t~,.q .................. Will excess fill be removed from premises: Yes 14. Name of Owner of premises .~,,.: ~./¢..~./.~'.'~. ..... Address ./.~./.~.~...~.: .~..../~..~... Phone No. 3..,2:. 3. ~.~..o'~..~ . . Name of Architect ........ q .)!r..~...e~. .......... Address ................... Phone No ................ Name of Contractor ....... ~. ~ .,~...~T(2.. .......... Address ................... Phone No ................ 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 number or description according to deed, and show street names and indicate whether interior or corner~_.~ STATE OF NEW YORK, · ..b(.O...~....~.../~.. /.~ ................. being duly sworn, deposes and says (Name of individual signing contract) above named. He is the ...................... ~ ................................................................... (Contractor, agent, corporate officer, etc.) ~[ owner or owners, ~d Js d~ ~ authorized to perfom or have perfo~ed the said work ~d to m~e ~d file this application;that ~1 statements coni :ined ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set fo~h ~ the application filed therewith. Sworn to before me thi~ ~ ~ Nota~ Public, ~ .,.~~6unty X ~ Z Nota~ public, S~ate of New York ....... ~' ' ~/ ....................... No. 52-0344963, Suffolk ~un~ ~ // ' (Si~ature of applicmt) ' ~mmisslon ~pims March 30, ~9~~ ~ PERM 33d (3/81) Application is hereby made for a highway work permit 1010 Platt. Requested duration from STATE OF NEW YORK- DEPARTMENT dF TRANSPORTATION PREPARE HIGH~AY WORK PERMIT APPLICATION FOR NON'J'~JTILITY WORK 3COPIES fENTER NAME AND MAILING ADDRESS IN THIS SPACE 19 _! thru 19 ~0~: $2 jJOO Cer~1ffed Cheek , to apply to the operation(s) checked below: Check Type Permit ~5howlns. Fee in Total Amount Guarantee Fee Amt. or PERM- of Fee and/ Deposit Amount of Operation 17 pr Under- or Insurance and/or Bond [] Comn~erclal $100 [~ Temporary access road or street $ 20 j~ Or~de, seed, improve I~nd contour, [~ ~emoval or planting $ 20 ~]DemolJtion ~]Moving -- -- -- NC -- -~. ]~mpro~vem~--~nt t~"~ me~-et D~epa--~tme~t st-~nda-~ds ........ N C - --~[~e~JJ)-- ~J~r -- -- '~ -- -- -- TOTAL PAID ORIENT, ~ tim puPpOle of_fnstalllng one ~' ~fde !n~e4~i~ type_entrance (4 .denSe ., base asphait, 2" tOD cout'se)~ concrete-curb w~th-'Eai~8~C~D- ~-amDs. shoulder restoration ~ 1/~" b~se ~sphalt 1 1/~" toD. 1n~nal dra~na~, e~. ~ Additiona~ work description is attached; ~ Plans pages and/or ~ ~Map is filed showing work to be performed at: LOCATION ( ~] ~ ~ State Highway No., 83~ between station and station in the T .... f ~O~O1~ County of S~01~ known as Acceptance of the request~l~ permit subject~th~,o, er~,~/~e~ to th~s, reguJations and obligations stated on this application and on the permit. I fin ~ ~ ~ZGI~ S~n ¥, ~ PERM 33d(3/81) RESP~ONSIBILITIES OF PERMITTEE REVERSE 1. PROTECTIVE LIABILITY INSURANCE COVERAGE FSermittee must have protective liability insurance coverage in accordanc~ with Department requirements. (See marion on Protecflve Liability Insurance Required for Highway Work Permits and/or Special Hauling Permits, Form PERM- 27). Expiration of, or lack of, liability insurance automatically terminates the permit. Insurance coverage may be provided by furnishing the Department with one of the following: a. iA Certificate of Protectlv~ Liability insurance for Permits on State Highways (Form PERM ]7, NYSDoT). b. A $2.50 remittance (check'drawn on a New York State Bank or Certified) for coverage under the Departmental Blanket Policy. c. An Undertaking may be furnished by Public Service Corporations and Government Units only and must include the wording required by the Department. 2. COMPENSATION INSURANCE AND DISABILITY COVERAGE The applicant is required to h'ave compensation insurance and disability coverage as noted inthe provisions of the Workmen's Compensation Lawand Acts amendatorythereof for the entire period of the permit, or the permitis invalid. .3. NOTIFICATIONS i N6tify Commissioner throughi Regional Office, one week prior to commencing work, except emergency work by public service utilities which shoulcl be reported the next work day. Work must start within 30 days from date of permit. Notify area gas distributors 7~ hours prior to any blasting. Notify Utility Companies with facilities in work area (permission must be obtained before doing work affecting utilities' facilities) before starting work. Notify land owners of abutting lands, before disturbing trees. Nbtify Department of Transportation at conclusion of work and return original copy of permit to Regional Office. Annual Maintenance Permit Notifications: Notify by telephone the District or Resident Office, one week in advance, each time regular maintenance work is to be performed. In emergehcies, notification by telephone should be made the next work day. SITE CARE AND RESTORATION Ad Undertaking, cs bond or certified check in an amount designated by the Department of Transportation may be required by the Regional Office, before !a permit is issued, to guarantee restoration of the site to its original condition. If the Department is obliged to restgre the site of its original condition, the costs to the Department will be deducted from the amount of the permittee~sjguarantee deposit at the conclusion of the work. The permittee is responsible for traffic protection and maintenance~ including adequate use of signs and barriers during work and evening hours. Anyone working within the R.O.W. will wear an orange vest and hard hat, No unnecessary obstruction iS to be left on the pavement or the right of way or in such a position as to block warning signs during or between workihours. Nb work shall be done to obstruct drainage or divert creeks~ water courses or sluices onto the right of way. All falsework must be removqd and all excavations must be filled in and restored to the satisfaction of the Regional Traffic Engineer. 5. COSTS INCURRED BY ISSUANCE OF THIS PERMIT All costs beyond the limits alt the protective liability insurance, surety deposits, etc., are the responsibility of the permlttee. The State shall be held free of any costs incurred by the issuance of this permit~ direct or indirect. 6. SUBMITTING WORK PLANS The applicant will submit work plans and/or a map as required by the Department. This shall include such details as measurements of driveways With relation to nearest corner, positions of guys supporting poles and a schedule of the number of poles and feet of excavation necessary for completion of the work on the State right of way. A description of the proposed method of construction will be included. Plan work with future adjustments in mind, as any relocation, replacement or removal of the installation authorized by this permit and made necessary by future highway maintenanc% reconstruction or new construction, will be the respon- sibility of the permittee. The permittee must coordinate his work with any state construction being conducted. 7. T,R,A, FFIC MAINTENANCE, Traffic shall be maintained by the permittee on the highway, in a safe manner, during working and non-working hours until con- st'ruction is completed. Suitable safeguards, to reduce conditions dangerous to life, limb and property to a minimum, must be pro- vided by the permittee incJudihg flagman when requested by the Department). 8. COST OF INSPECTION AND SUPERVISION J{~ in the accounts kept by the Pepartmenf~ costs of supervision are found to be exceedingly high, the Department re- serves the right to bill the I~rmittee for actual expenses incurred by the supervision and inspection of the permittee~s p~oiect, iJ 9. SCOPE ! a. ~,reas Covered Permits issued are for hi~hways~ bridges and culverts over which the New York State Departm~ent of Transportation has jurisdiction. (Local governments issue permits for their own jurisdictTon]) '~ b. Le~lal : The privilege granted by [the permit does not authorize any infringement of federal~ state or local laws or regulations, is limited to the extent of the authority of this Department in the premises and is transferable and assignable only , with the written consent o. theComm~ssmnerlofTran.spor.t,,atmn.. c. ,Comm~ssmner s Reserver OhS ~ The Comm~smner of~ Zrapsportahon reserves ~he right to modify fees and to revoke or annul the permit at any time~ at his discretion withoutla hearing or the necessity of showing cause. d. locations : Wo-~'~ locations must meet approval of the Department. (Additional pages to this application vary according to the purpose, and type of work to be permitted) ' 13'2 ' ,. o_9_ No lot sh~ll be subdivided or it~ lot lines changed in any manner at any future date unless authorized by the Southeld Tew~ Pi~g Board. There shall not be any vehio~lar ingress aud egres~ en Main (State) Read for ~et 1. Nc driveway shall enter the right-of-way within fifty feet cf the southerly end of the shert radius curve connecting the southerly side of the state road with the easterly side of the right-of-way. All stormwater runoff resulting from the development ~d improvement of this ~0division or any o~ its lots shall be retained on mite he adequate drainage struct~e~ sc that it will not flew cut iuto the right-cf-way of ~in (State) ~l~ p~ospective purchasers of lots within this eubdivi~ion shall be advised tn~t this subdivisiou is lecated within one mile ef Charles Rese Airport ~nd, therefere, may be subjected to noise emanating from the facility and frem ? II copper tubing is used , for water distributing. system; piping shall be of types K or L only ALL CONErRUCTION SHALL THE REQUIREMENTS OF THB , STATE CONSTRUCTION & E~ER~ CODES', , NOT RESPONSIBLE ' DI~SlGN OR CaNSTRUCTION ERRORS. NOTIFY BUiLDiNG ~EPAR~ENT AT 765-1802 9'AM TO 4 PM FOR THE FOLLOWING 1NSP~CTIONS: 1. FOUNPATION - ~0 REQUIRED FOR POURED CONCRETE 2. ROUGH - F~MJNG & PLUMBING 4. FINAL - CONSTRUCTION MUST BE ,C~br~PI,~E FOR C, O. h J ""? 11 [)._L 0 6F-~T ~ON 'A ~ITCH~:,I