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Home My WebLink About12680-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. ~.1.~5~5 .......... Date ......... .J.u.~.y...3 ................ ,19~.4.. THIS CERTIFIES that the building,, ,0,ri.e,. ~,a~. ~¥..~w.q .~.~.J..n. ~$ ....................... LocationofProperty qd~.O:.~n.~..et,. V..i. 9.w' E.a..~3 ~.?: ....... Mattituck Mouse lye. Street ........ Hamlet County Tax Map No, I000 Section 100 .Block 03.. .Lot 10,11 Subdivision .I.n. 1. e..~..g.a.s..~..E.s.g..a.g.e.s. ......... Filed Map No. 6.2.~ 9. .... Lot No. conforms substantially to the Application for Building Permit heretofore Fried in this office dated ..... qq $ ,..1.,1. ......... 19 ~.3. pursuant to which Building Permit No. 1.2680 Z dated ... 9.c.L.,..1 .~ ................. 19 ~.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 ......... ......... &. ............................................... The certificate is issued to Hu.~.i Chew (owner,/~(e~ of the aforesaid building. Suffolk County Department of Health Approval ..q. 3-S0-178.. UNDERWRITERS CERTIFICATE NO ........... ~ ~ 6.4.9.~/~ 7 .............................. FORM NO. 2 ?OWN O~ $OUTHOL~ 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~' 12650 z . .-, County Tax Map No. 1000 Section ..... ~..O...~.. ......... Block ....... .O..~1 ....... Lot No...J..~..:..I.I ....... pursuant to application dated ..... .(~..~.....J.J .................. , 19..~.~., and,approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY 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, {ndustria~ buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer Cesponsible 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: 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 2. Certificate of occupancy on pre-existing dwelling land use $/5'/ $5.00 3, Copy of certificate of occupancy $1,00 Date ,~,~. ~, .~.. 2/.~, ~, ..... New Building .... ~ ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ,L~.. ,~. House No. Street Ham/et Owner or Owners of Property ,..~..~..c~.~.~... ~.-.4'~. ~, .~4~'. .................................... County Tax Map No. 1000 Section .../'.Q.~. ....... Block . .0, .,,~. ......... Lot. ~.~. ~./../. ........ Subdivision..L/~,~-.~"~.~., ,~.~, .5,~..~. ~,--~', ?,--~,~, .~., .Filed Map No.. ,~,~..~, ,~,, .Lot No. ,//. .......... Permit No./. ~/~,~,O. ,:~., Date of Permit/,~,-X/,/,~/~,-~.Applicant ,~, .~, ,A~, ,~-~,, .~?-, ,~, ,~, ,~,, ,/'?/, ,o,/7, .~;, ~. ,/,A(, ,C.,, Health Dept Approve ........ · ........................ Underwriters Approval .... Planning Board Approval ~'~ .......... Request for Temporary Certificate ..................... Final Certificate , ,~,,, ................. Fee Submitted $.....~'...o...O ................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ~ ~!N~,, .--.~...~--~V'. ~..~.' ~ ./~,'*. ,~/.~../¢.~'..$ //~+f~. Po R~. 10'10'78 ~ ~ ~¢r ~O ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 113~021 BUREAU OF ELECTRICITY, ~'~. 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.~ ,~7, ~ ~.~..o,,~o,o.~.~ ~9/~ N 649947 THIS CE~IFIES THAT ~ Ch~, 460 lnlot ~t Estates~ ~A~tl~ N.Y. irtthefollowinslocatioE; ~)~.s~D~ ~ lstFl. ~ 2nd Fl. Section Bloc~ Lot 11 FIXTURES RANGES OVENS EXHAUST FANS FIXTURE OUTLETS SWITCHES FLUORESCENT OTHER APPARATUS: 2~O. F, C..[, J-~ke Detectors S E R V I C AWO, A.W,G OF HI-LEG OF NEUTRAL NO O1~E OND OF ~C COND. 4/0 4/0 Trwee C, Electric Inc. Route f/1 45 M Sound Avenue Riv~c~ad, N.Y, 11901 ~TAc. This certificate must not be altered in any manner; return to the office of the Board if incorrect Inspector, s may be dentlfied by COPY FOR BglLDING DEPARTMENT. TH S COPY OF CERT EiCATE M U;BT NOT BE I[LTERED iN ANY MANNER. 76S..1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [,] INSULATION FINAL r' DATE: ~INSPECTOR i I . / ~ FIELD INS?ECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY qODE FINAL DATE COMMENTS / I / ~ /,~ Y~ .'1'~,.. ADDITIONAL COMMENTS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .~.~..~.~..., 19~.~k' Approved . .O.~.[ .~. ., 19~.~Permit No.}. R .g.$..O..'~.. Disapproved a/c ..................................... ................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT : ' INSTRUCTIONS ~ a. This application must be completely filled in by typewriter or in ink and subrriitted 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, relations~hip 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 regulation_s, and to admit authorized inspectors on premises and in building for necessary inspections. ..... ~ .o. t4.~...C ?. ~ .~..~.. t4.~ e.-.~...[6t.C..... (Signature of applicant, or name, if a corporation) ..~.o.. ¢.o. 7...q-.~, .q...,)~ ~ ~. ?.~. &q'.. ~: .Y,../?/~7. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· ~ ~t. ~.o. ~w-a ~, e.-~.a..&.., .................. Name of owner of premises . .~, ?..Iw..~ . . .~-..~4 .~ .u.Z. ~. .................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ..~.0~.&..W.. ¢,o~g- eels, .......... (Name and title of corporate officer) Builder's License No .......................... Plumber's License No.. 7.~.'..~?.?. ............. Electrician's License No...~..~. ?. Y..~. ........... Other Trade's License No ...................... . 1. Location of land on which proposed work will be done.~.fff'./~.'/.q .~..----/,/~/.L'.~.~-..V./~.~'. . ..~.D.. { .7'~.' )/-/~,og,'3" '(a'~' ~',3'~'~'Rtff'~/~5°'~' ' ' ' .... ttouse Number Street Hamlet County Tax Map No. 1000 Section . .~.~..O. ........... Block ....O .3 Lot ~.,/~.~. Subdivision .//.~fl.~...z~../..} ~./.'~...~...~?./~./.~.~. ......... Filed Map No. ~,'~ q/~, Lot (Name) ,, de rio 2. State existino nse and occupancy of prerJ]ises and inten d use and occupancy of proposed construc' n: "-i-- a Existin usean' ccu anc .V...~ ~._;~/xD) g . ao p y .................................... ~ ................. ~ ......... .~.'. · 0~/~ F~, ~ ' b. Intended use and occupancy .................................................................... 3. Nature 0fwork (check which ' ' . .... apphcahle): New Building . ~... Addition .......... Alteration .......... Repair .............. Remoyal .............. Demolition .............. Other Work ............... i ~ (Descr/ption) 4 Estimated Cost /~¢ Oo:~.orJ ].~.~,:?..~, ............. , ........................ Fee ............................. (to be paid on filing this application) 5. If dwe no, number of dwelhn mrs ........... Number of dwelling units on each floor If garage, number of cars .. "~'i .............................................................. 6. If business, commercial or mixed! occupancy, specify nat..n~..a..tu,,~a)a,d extent o f each type of use .................... 7. 'mensions of existin structures if an ' F ~ ~ . Depth .............. D~ g ., y. ront ............... R ................ 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.. ~.~.~..,~.~'. .... Rear f../. ~..~.'~ ...... Depth 3.Of. ....... 10. Date of Purchase . ~..c...~.... I .~ ~.~ .............. Name of Former Owner ........................... 11.. Zone or use district in which premises are situated .................................................... 12. Does proposed construction v~olete any zoning law, ordinance or regulation: ...~. ........................... 13. Will lot be 'regraded ..... /t/O.i ................... Will excess fill be removed from premises: Yes PLOT DIAGRAM Locate clearly and distinctly all i buildings, whether existing or proposed, and, indicate all set-back dimensions from propeffcy lines. Give street and block gumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF ?,~F~¥~ Y.O'RK.~ / COUNTY ..... gOin above named. He is the ..................... :'' ~a~o~c~);~; a't} 'o'f~i~};,'e't~ .') ...... - ..................... of said owner or owners, and is duly' -'"'~ ' ' -~'-autho~'retr-Fo--~pert~rm or have performed the said work and to make and file this applk:ation; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will he performed in the manner set forth in the application filed therewith. Sworn to before me tliis being duly sworn, deposes and says that he is the applicant ~ ~ S.~~ bOl area, the possibility exists that the ~ I . water supply may contain trace I amounts of pesticides and/or nitrates. Special analysis required. : Contoct this Dep¢~rtment prior to sampling". . HULL CH~W HEALTH DEPARTMENT-DATA F~ APPRO~ TO C~STRUCT me ~R~ FOR WHOM THE SU~EY IS PREPARED ~ ~ [ [~T~:~t~ ~? ~ ~ [~ ~or~, I :~r RIVER~AD, NEW YORK su~mv/~/o~ ~ ~/~o /~ rH~ o~/~ oF rHg cc g~ oF ~uFFo:~ ALDEN W. YOUNG~ PROFESSIONAL ENGINEER couNr~ o~ ~Ar/,/9~ ~ ~/~ ~o. ~9. AND LAND SURVEYOR N T.S. UCENSE NO, ~845 a · HOWARD W. YOUNG~ LAND SURVEYOR ~ L~T~ ~ ~L(W),~IC TANK(ST)a CE~S(~) ~N ~E~ N.~S. LICENS~ N0.45893 BRANDIS & SONS, INC, 1618 ,,,,,, HARBoRWEW i0 Lot Lot 4.8,g 57 s'f' Tho sewa~, disposal and water ~u~plF inspected by t~;Is department ~'~, .Chief of ~eneral H[AL~ DEPARTMENT-DATA F~ APPRO~L TO C~STRUC'T N NEAREST WAII~ IAIN--MI. "* N SOURCE OF WATEr, PRIVATE ;..7.[P/U/~LIC N ~UFF CO. TAX MAP DIST/OOO SECTION /00 BLOCK 03 LOT NTHENE ARE HO DWELLIHO$ WITHIN i00 FEET OF THIS FROPF. RTY OTHER THAN THOSE SHOWN HEREON. SURVEY FOR HULL CHEW Lor Ivo. II, "lwL£r£Asr EsrAr£s " AT ~IATTIrUCK TOVIN ~ SOUTHOLD ~UFFOLK COUNTY, NEW ~RK dUNE 4, 1~84 FEB. £/, /~84 · ~.~' 2-~, dU,&'~' G,/~8~ SCALE: /" : ~0' NO. 83 - GUARANTEED TO: sourtIOLD CHICAGO YOUNG a YOUNG AL'DEN W. YOUNG, PROFESSIONAL ENGINEER ANb LAND SURVEYOR N>LS. UCENSE NO. 12845 HoWARO W. YOUNG, LAND SURVEYOR N.Y~S. LICENSL N0.4589:~ 'CO. R AVENUE RIVERHEAD, NEW YORK