HomeMy WebLinkAbout12407-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occ'up ncy
No..Z.~.1.9.3..0 .......... Date ....... S.c.p.t?.m.b. ?.~..2.0. ............ 19 83
THIS CERTIFIES that tbe building ..... n,c..w. ,d.w.e..1.1.~.n.g .............................
. ~365 Bridle Lane Cutchogue
Location of ?roperty ...............................................................
House No. Street Hamlet
County Tax Map No. 1000 Section 102 .Block 08 ..... Lot 021
Subdivision Highland Estates .Filed Map No..6.5.3..7...Lot No. 26
conforms substantially to the Application for Building Permit heretofore filed in this office dated
· .. iq.aY.. J .6 ........... , 19 .8.3. pursuant to which Building Permit No... ! ¢).0.7...g...' ........
dated ...... 4 u..1 y..7, ............... 19 .8.3., 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 .........
a pri, vate one-family dwelling·
The certificate is issued to 75 HIGHLAND ROAD CORP.
of the aforesaid building,
Suffolk County Department of Health Approval....~3-~qO.-.7. ft,..9./20/83~. ....... ..............-....R°bt' A. g±llaI. P.E.
UNDERWRITERS CERTIFICATE NO ......... 1~ . g .q 5.1.6..8 ................... '
Rev. 1/81
Building Inspector
FOB~ NO.
TOWN O~
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 12407 Z
Permission is hereby granted to:
...... :~....:/.,..:../......~..-.:...: ......... ,..~:..~. ~
,o . . . . . . . ::. . . . . . . . . . . . o . .. .......................
..... : ................ .~ ~: . . . ~. /. ..,~. . . . /,~.~. . . . . . . ., . . . .~. . ~.~. . . .'~:: ......................
ot premises ,ocoted
,~. ................. ~ ............. L~7::... ...........
Coun(y Tax Map No. 1000 Section., ./.~.,~ ......... Block ....~,.'~.. ........... Lot No. ~.~../.. ..........
pur,,o.t ,o opp,,cot,on do,ed ../~.~.~ ....... ~.,~. ...................... . ,~..:.. ond opprov.~ by
Building Inspector.
Building Inspector
Rev, 6130/80
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, 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. Su bm it Plan ning Board app reval of comp leted site p lan requirements where app l icable.
B. For existing buildings (prior to April 1957), 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.
C. Fees:
1. Certificate of occupancy $5.00 5/$
2. Certificate of occupancy on pre-existing dwelling ~ land use ~;/ 5.00
3. Copy of certificate of occupancy $1.00
Date .....~...'~..!.~.~.!~..%~.....
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
Location of Property .................................
House No. Street Ham/et
Owner or Owners of Property . . .~ .~.~\~'.~.~_~~ .........................
County Tax Map No. 1000 Section ..... ~.~ .... Block ~ Lot
Subdivision .... ~¥~.~ . ~~..Filed Map No.. ........ Lot No
Permit No.~. ~ate of Permit ~'~7, ~pplican[. ~ ~~ .~~ .....
Health Dept. Approval. )~..~P .... ~ ~ ...... Labor Dept. Approval ........................
Unde~riters Approval . .~.l .................. Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate . ..~ ...................
Fee Submitted $ ~)~
Construction on above described building and pe~~~~~tions. Applicant ..... / ~ ~. _ r_..V .~ ~../~; ~ ...............
1000681 THE NEW YORK BOARD OF FIRE UNDERWRITERS
1~S BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK, NEW YORK 1003~
..ts September 1, 1983 ~pp,c.aonNo. o.f~. 224815-83 N 615!$8
THIS CERTIFIES THAT
only the electrical equipment az described below and introduced by the applicant named on the abo~e application number in the premises of
Mohri~ & Sons~ N/$ of Bridle La~ 1RS' E/Of Bridle Ct., Outchogue, N.Yo
inthefollowinglocation; [~ Bazement [~ lstFI. ~J ~d r:. . Secao, lO2Bio¢~ 8. rot 24
was examined on ~U~US~ 26, ~ 98 3 and found to be in compliance with the requirements of this Board,
FIXTURE FIXTURES
OUTLETS SWITCHES FtUC~SC~T
27 41 28 27
RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
' SERVICE DISCONNECT S E R V I - C
OTHER APPARATUS:
NO, OF NEUTRALS
1
AW, G,
OF NEUTRA[
1
I-G.F.i.
paran°unt Elect. Co.
2091 Shelley Pl.
East Meadow, N.Y., 11554
LIC. #533
This certificate must not be altered in any manner; return to the office of the Board if incocrect.
~)G DEPARTMENT. THIS I ;ERTIF
GENERAL
Per_
may be identified by their credentials.
(MANNER.
r
FIELD INSPECTION
COMMENTS
FOUNDATION (1st)
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N. Y.
STATE ENERGY
q?DE
FINAL
ADDITIONAL
765-t802
BUILDING DEPT.
INSPECTION
FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[]FRAMING FINAL
REMARKS:
DATE ~'//;/x..///,'/,}'"~ IN~SPECTOR
76S-1802
BUILDING DEPT. "
INSPECTIO
FOUNDATION IST [: ROUGH
FOUNDATION ZND [ ]INSULATION
F~4MI~G/~'/{// r ~ FINAL
, ,. /: :4 -
//
/
DATE'
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined... ~/: .......... 19::
Approved. :./..Z ........... 1 4. pe it Z./
Disapproved a/c ....... ~T.~ .'..' ........... f~././
......
APPLICATION FOR E, UILDING PEP, MiT
Date ./~...?.
INSTRUCTIONS
Application No .................
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 ~'or 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, buildingz,~le, l~usit~g code, and regulations, and to
admit authorized in spec to rs on premises and in building for necessary
(~p lica~ll5 or nar~ ff a corporation)
· . .... ~..~..o...~.'do~.~..~.e, .............
( a.ili,n,g,itd d rgs s pi' ap p l~c~ ~
State whether applicant is ~lessee, agent, architect, engineer, general contractor, electrician, plumber o
Name of owner of premises ~'~ .~/.~/..P~.~ ..~J~ &~/~
(as on the ta~groll or latest deed)
If applicant is~'~n_?~ureyul~thorized officer.
Builder's License No ..........................
Plumber's License No .... .~.~..~.~...~'¢./.c.~..~?..J,...
Electrician's License No ....................... ',
Other Trade's License No ......................
1. Location of land on which proposed work will be done ..................................................
... e.. ............
l};~;e'~q~i~g:r ............ '.. F 'Street N/ Hamlet //
County Tax Map No. 1000 Section ~'./e~ .......... Block ~..~.~. ..... :~ 9.~./. ...........
Subdivision.. ,¢.¢~~.~~ ......... Filed Map No. ~.~.7 ...... Lot ~ q
~ (Na~ne)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
-
a. Existing use and occupancy ...............................
b. Intended use and occupancy .........................................
o
9.
10.
11.
12.
13.
14.
Nature of work (check which applicable): New Building ........ Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
Estimated Cost .................................................................
(to be paid on filing this application)
If dwelling, number o f dwelling, Onits .../. ........... Number of dwelling units on each floor ................
If garage, number of cars ........................................................................e-
If business, commercial or mixed occupancy, specify nature and ex,tent of each type of use ....................
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 ..................... Numb;,/of Stories. Ce'p' i~' ~.. :~. i ........
Dimensions of e~ltire new construction: Front . .~..~ ......... Rear . ~. ........... t
He~ ht '2 q~ - '
'g ............... l~umber of Stories .... ~ .........................
Size of lot: Front ./.~, ..~.~ ........... Rear...~. ~i,.~..,~. ......... Depth ' *¢~;' 7171......
Date of Purchase Name of Former Owner
Zone Or use district in which premises are situated ....................................................
Does proposed construction vie!ate any zoning law, ordinance or regulation: .............................
Will lot be regraded ...~ .-~.~.,~ .;;; :. ;....,. ~,. 't' "Will exc, e~%s ~fjll,b~ removed from premises: Yes .
Name of Owner of prel.C~s_es ,~&. ~/.~/.~ ~.. t.4~--. Address . .'¢__?f,J~O,/, ¢.~/..f?,.~. ~.,.~.. Phone No...(,~,.2. ( :.O..~..~f..
Name of Architect . ./.,,~,l~.~..t?t$gl ....... Address .~..¢-:~.. ~ .r~...~..~... Phone No..r,?!..~.~, ~ ?.~...
Locate clearly and distinctly all
property lines. Give street and block
interior or corner lot.
PLOT DIAGRAM
buildings, whether existing or proposed, and, indicate all set=back dimensions from
number or description according to deed, and show street names and indicate whether
STATE OF N~E~)~O~,K/..; / ' "S
.. ...... :.. .... ..... .~.. f,~. ..... .... ~ ..... 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 dully authorized to perform or have performed the said work and to make and file this
application that all statements contained in tl~i~s application are true to the best of his knowledge and belief; and that the
work will be pei'formed in the manner set fort~"~in the application filed therewith.
Sworn to before me this
........... .... dayo,f ...... ....
Notary~P,u blic~ ..... .~,. ....... ' .....~ '~ ~unty
~OI^RY,PUBMC, St[to of New Yorl~ /
' . { / ~' ~' / (Signature .of applicant)
' [ HO. ~2-8125850, Suffolk Cou~l~
I [ Term, Expires March 30, 19..~
u. D. Rg*. ~ ~ LOT,NO. 2~ , HIGHLAND ESTATES
~ CUFCHOGUE~
~aell~t~e~ rc~- t~t~ ~at.~o~ ~ ~een SUFFOLK COUNT~, NEW ~RK ~0. 83-720
' ~w ~ORK STATE [~CATtOa ~W ~MERIC~N TI TLS INSURANCE CO.
NCOPIES ~ ~IS ~VEY, NOT ~AR~G THE LAND
~h~ Of ~etl(~ll ~e~ SURVE~R'~ INKED SEAL'~R EMBOSSED SEAL SHALL
~rv~e~ NOT BE~COHSlDEREDTO ~AVALIO TRUE COPY~~~
~E ~ FOR WHO~ THE SU~E~ ~S PREPAREO
HEALTH DEPARTMENT-DATA F~ APPRO~ TO C~STRUCT A~D ~S- ~HaLF ~ TSE ~TL[ C~Y, GOV~N-
N~E~ A~,~ ~ELLI~I WITHIN IOO FEET OF-T~S PROPERTY TO A~ITIONAL I~TITUTI~S OR SUBSEOUENT
OTHER THAN THOSE SHOWN HEREON, OWNERS
' YOUNG YOUNG
-- RIVE~, NEW YORK
NO~E , ALDEN W. YOUNG, PROFESSIONAL ENGINEER
SUBDIWSION MAP FI~ED IN THE O~ICE OFTHF C~E~K OF
ANO CAN~ SURVEYO~ N.Y.S. UCENSE NO, 1~845
SUF~ COUN~ ON 4~. ~6 , 19F7 4S FI&F NO. 6537
;, HOWARD W. YOUNG, LANO SURV[YOR
~E~ FIE~ ~TI~S ~OR DATA OITNE~ F~ OTHERS N.~S. L CENSE N0.45893
~FFOLK COUNTY DEPARTMENT 0F HEALTH SERVICES MOH~ING ENTERPRISES, INC.
Fo~ ~F~ow~ 0F C0~S~OOTZ0~ 0~Y LOT .NO. 24, "~IGHL~ND ~ST~T~S ~Y
~T CU~CHOGU~ o~rE, 4P~. 22, 1983
~-~ / ~ ~WN ~ SOUTHOLD SCALE: I " = 50'
~ OS~NDER AVE~E
NOT~, ALO~N W.~UNG, PROFESSIONAL ENGINEER
SUED/VISION ~AP FI~FD IN THE OFF/CE OF THE CiF~K OF AND'~AND SURyEYOR N.Y.S UCENSE NO. 12845
SUF~ COU~ O~ ~. 26, 19FY ~S FILE ~0. E53F A
MOW ~
~ L~T~L(W),~IC TA~K(S~)mCE~OL~(~) ~ ~E~ N.Y.S,~LICENSE N0.4589~
il
·
ft
NOTifY BUILDING DE~,i~ARTMENT~I'
765-1802 9 AM TO 4 PM FOR~
FOLLOWING INSPECTIONS:
,I. FOUNDATION - ~O REQUIR~
FOR POURED CONCRETE
2. ROUGH - F~MING & PLUMBING
INSU~TION
4. FINAL - CO~TRUCTION MU~
BE COMP~E FOR C. O.
ALL CONSTRUCTION SHALL ME~
THE REqUIREME~G OF THE
~ATE CONSTRUCTION & ENERGY
CODES. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION
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