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HomeMy WebLinkAbout12667-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DE?ARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...a 1. ¢ .4.6.2. ........ Date ....... .N.aS'..9. .................... 198.4.. THIS CERTIFIES that the building --new dwellinq Location of Property 5045 Main Bayview Road Southold House No. Street Hamlet County Tax Map No. 1000 Section ... 9.7.6. ..... Block .... .0.2 ......... Lot ' 021 Sobdivision Gg.o.s.' .e' .N.e.q.k... Filed Map No..1.6..6.3...Lot No. · .8.1. .5..8.2.,.. conforms substantially to the Application for Building Permit heretofore fded in this office dated October 3 ..................... ,19 8.3. pursuant to which Building Permit No. 12667 Z -dated .... .O. qt. 9.bp.r.. ~ ............. 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 ......... ~ ~rJ~v~.t;e 9D.~r~ln~],y dwelling. Tile certificate is issued t6 ..... p,~I~t?[t..& .If~AY..ANN..~QT9. ............................ (owner, 1,~9~ or-~t~rrrJ- of the aforesaid building. Suffolk County Department of tlealth Approval 13-SH-155, 4/.26/84t Robt. A. v±lla, N 634477 UNDERWRITERS CERTIFICATE NO .................................................. ,' ' ............. ~O]E~ NO. ~ TOWN OF SOUTHOLD 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~ 126~ z Permission is hereby granted t~ ~ /, / ...~?...~-~.~.....~~...../~..~. ........ ....................... , ..~...~~...~,..~,~_~, ~ ~ ~o ......... ~~.~...~.~.~.~.....~L~.....~.~ ............ '. ....................................................... ~~.~..~..~.~..~ .......... ........................................................................................................................ co.~ ~ ~ .o. ~ooo Se~,o....~.~. ...... ~,~ ....~.~ ........ ~o~ ~o..~ ......... Building Inspector. ,~/~ Fee ~...~....~ .......... Rev, 6/30/80 FOI~M NO. 6 TOWN OF $OUTHOLD Building Department Town Clerks Office 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 Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusua~ 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 installations, 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: ]. Accurate survey of property 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 in- formation 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.............,..< Addition ................ Old or Pre-existing Building ................ Vacant Land .............. Owner Or Owners Of Property ..~..~....~.~./:~......~...~..~.......~.~...~.._~...~....~ ................................................ Subdivision ................................................................ Lot No ............. Block No ............. House No ............. Permit No. /~2/~'~'- Date Of Permit/..O...*.'.~.F..~..D.....Applicant ~C.,u~..~_~ ~ '-'-~ ...................................................... ......... Health Dept. Approval ./...-~.........~......./...~....-~... .............. Labor Dept. Approval ................................................ Underwriters Approval ....~.....~..?....Y.'.C/.:.7..?. ................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ....:..?..! ............................... Fee Submitted $ .,.,~.....~ ..................... ................ day of ............................................ Notary Public .................................... County Construction on above described building and permit meets~all app_licgl21e codes and regulations. App icanf-..-~,~ ............................................................................... Sworn to before me this ~..O '~'~'~'~'~'~'~- j ~/.qL(./~ ~)..' (stamp or seal) ~o3~o18 THE NEW YORK BOARD OF FIRE UNDERWRITERS EL~ BUREAU OF ELECTRICITY ~ 8.5 JOHN STREET, NEW YORK, NEW YORK 10038 .ate February z~, ~ ~,~,~,o~o.o.~,~ z3~3o-~3 N 634~77 THIS CERTIFIES THAT only the electrical equipment as described below and int~duced by t~ applicant ~med on the ab~ application number in t~ premises of Soto~ N/S Main Bayvi~w Rd. 100' W/O Smith Dr. South, $outhold, in tbefollowlng location; '~ ~.~,.~,~ ~ ~ ~. ~ Z.d rt. , s~¢tio, mo¢~ ro~ 981 was e~.,.i.~d on February 16~ 1984 and found to be in compllance wlth the requirements of this Board. FIXTURE OUTLETS DRYERS RECEPTACLE~ SWITCHES 38 22 15 FURNACE MOTORS FIXTURES RANGES COOKING DECKS OVENS EXHAUST FAN~ FLUORESCENT MERCURY FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLE1 DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I NO~ OF CC~ COND A W, G, / NO. OF H~-LEG PER ,~ O~ CC. COND, 21o OTHER APPARATUS: 1~ Smoke Detector Electric Room Heaters:2-2.0 K.Wo , 3-1.5 K.W. , 5-1.0 K.W., OF HI-LEG NO OFNEUTRAL: 1 AW, G. OF NEUTRAL 210 Peter Charbonneau 35 Sheppard La. Smithtown, N.Y., 11788 LIC.~2697 This certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified ~lg ! -tiS COPY ( credentials. FIELD INSPE~TIOI~ COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C DE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~ ROUGH PLBG. FOUNDATION ZND [ ] INSULATION ~.] FRAMING [ ] FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. .FOUNDATIONZND [ ] INsuLATION [ ] FRAMING REMARKS: [ ] FINAL , ,INSPECTOR 765-1802 BUILDING DEPT. INSPECTION 'FOUNDATION tST [ ] ROUGH pLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION ZND [ ] FRAMING [ ROUGH PLBG. INSULATION FINAL REMARKS: DATE 765-1802 BUILDING 'DEPT.- INSPECTION [ ] :FOUNDATION 1ST [, ] ROUGH PLBG, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ............ , Approved .............. , Permlt ...... Disapproved a/c .............................................. ~ ............................................ -~' / ~/(Building Inspector) APPLICATION FOR BUILDING PERMIT Application No .............................. INSTRUCTIONS a. 7'his 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 o~ areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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, New York, and other applicable Lows, 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 lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in. buildings for necessary inspections. Riverside Homes, Inc. (Signature of applicant, or name, if a corporation) PO BOX 274, Riverhead, New York ll90Z (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Agent Name of owner of premises Ralph & Mary Ann Soto If applicant is a corporate, signature of duly authorized officer. S. Gordon (Name and title of corporate officer) Builder's License No ..................................................... 2040P Plumber's License No ................................................. Electrician's License No. 2697E Other Trode's License No ............................................... Location of land on which proposed work will be ~lone. Map No.: 1663 Lot No. 81 & 82 Street and Number E/S Main Bayview Rd 100' N/O Smith Dr So. Bayview ~ _~--O ~ ~' Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy Vacant Land b. Intended use and occupancy ........................................................... ~ .................................................................... 3. Nature of work (check which[applicable): New Building ...... ~ .......... Addition .................. Alteration ................. ,. ................. Demolition .................... Other Work I Repa!ir .................. Removal ~ ...................................................... 4. Estimated Cost z,/ . .................... Fee ...... ~ ........................................................ '. ..................... j'" (to be paid on filing this application) 5.' If dwelling, number of dwelling units ......... ~ ................. Number of dwelling units on each floor .~.]:.~..o.n....2..n..d....P..]:.ooz ~ 1 car if garage, number of cars ..... ~ .......................... ., ............................................................................... ;; ........................... 6. If business, commercial or ~nixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure,' with a~terations or additions: Front .................................... Rear ............................ Depth ................................ Height ................ , ............ NuFnber of Stories ................................ 8. Dimensions of entire new cor~struction: Front ....... ~.', ....................... Rear....~.'. .................. Depth ....2.~.'. ............... Height 22~ Numberi of Stories 2 9. Size of Io~: Front 100' i , Rear 100' Depth ....... ~,5.0 ................... 10.' Date' of Purchase ....... ~,q]:.~X.8.~ ................................... Name of Former Owner .....F~..~X..~:.....C~...p..Z.~ ......................... 11. Zone or use district in which premises are situated ..................................................................................................... ]2. Does' proposed construction viplate any zoning law, ordinance or regulation: ..... ~.o. ............................................... 13. Will lot be regraded ....y..e.p......! ............. Will excess f/Il be removed from premises: ( ) Yes ( ×} No f f e ' ~]'P~ & Mary A~ $oto $outhold ...................... 14. Name o Owner o pr mines ..... ~ .............................................. Address ................................ Phone No. 477-~3.10 Name of Architect ....~.J=.a..h.~.~.d....~.~.d..o..~,o..s..~].. ..................... Address ...~.9..~.~.,'F'.,°.~...B,6Y.~ ...... Phone No ..... Z27,..~.~.- 9.5, ........ Name of Contractor ...R..J:y..e.~.s..J;..d..e...~.o..~..e...s.~....Z~..a... ................ Address ..~.~.y..e.~.e..a..d. ............ Phone No..?..2.~.z~.~..9..5. ..... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed and indicate all set-back dimensions from property lines. Give street and bldck number or description according to deed, and show street names and indicate whether interior or corner lot. ' See Attached Survey STATE QF,NEW YORK ...... ,-~~...,..'~/./--/--,~.~.~.~ ........... being duly sworn, deposes and says that he is the applicant ~ ~ ~(Name of individual slg6ing contract) "' above] named. ~ ', He ~s the ................................................................................................................................................................................ [ Contractor, agent, corporate officer, etc.) of said owner or owners, and is du authorized to perform or have performed the said work and to make and file this application; that all in this application are true to t of his knowledge and bellef;,and tha~ the work will be manner set fo~h in the application ~ this :.., 19 ........ Nota~ (Signature of applicant) New Yor~ (~uglifled Suffolk County No. 52-4601684 CommJssior~ EXpires Ma?ch 30, © 0 ,0q 0 Z "!11 ,,4