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HomeMy WebLinkAbout12743-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14~.06 Date December 19 ... ................................................ , 19 85 THIS CERTIFIES that the building .... QX3~:-~r~./[~ qt.w.e.l,1. $.n9. .......... Location of Property .],lOO ....... S..k.U~t]q, .L.a.n.e.. (Bay Ave. ) Cutcho ue House No. Street Hamlet County Tax Map No. ]000 Section ..... ?7 ..... Bloc]< ........ ,3 ......Lot . p/o ZZ Subdivision .... R, .M~iragl ia 347 1 ........................ Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated November 2 19 .8.3pursuant to which Building Permit No. 127z~3Z dated ...N. o¥~raber..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 ......... .P,z~J~v~.t.e. 9De-family dwelling. The certificate is issued to ......... .R.QN.A. LD & ~I~ STRAIN of the aforesaid building. Suffolk County Department of Health Approval , 13-SO-158 UNDERWRITERS CERTIFICATE NO ..... N671623 Rev. 1/81 Building Inspector ~eO~ NO. ~ TOWH OF $OUTHOI. D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted~d~to~ ~ . ~ .~...~..(.~.~.& ....... ~.~ ................. ...~?.~....~.t.~ ............................................. ...~~...~....~..:~_...).t~..~ ~ .... .................. ............................................................................................................................... at premises I~ated at ...... ~ ................ ~.-.,.,~....~.~ ............................................ .... :.. 9 .... .~.~.~ ...................... .~.~. ....=...:......~... .. County Tax Map No. 1000 Section ...... .~,.~,~, ......... Block ...... .~..-~ ........ Lot No ..... ~/,~...,,~,..[.[ .... pursuant to application dated .....~...~?.7.~..~.....~ ..................... , 19~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted ml~mm~a 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: 1. Accurate survey of pZoperty 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 New Building ............. Old or Pre-existing Building ~/ ........... Vacant Land ............. Location of Property./'./..~.~. .... 7.~../~. · ./~...~..../--~-~...~.. House No, ~'3 ~ ,/ S~e.t (-~ ~ , Ham/et Owner or Owners of Property ...~.?.~ .¢~..~..~....~..../~...~._. ?~. 4. ~ .... ~.. ,-~..,~..~._./..~) ............ County Tax Map No. 1000 Section . ..~..0.l...~.. ..... Block ...~)...~. ........ Lot. ?~/.o., .J.j ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.; ~.~..~.~.?--. Date of Permit ii/?. (.~..'5..Applicant,, ! ,~. ,~,~. (~.... ~..f,r'..~...~.. ....... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ....... Final Certificate ~ Fee Submitted $ . L~..~.......~...~..~..~. ......... Construction on above described building and i;~m. it meets~ll a~plicable co, des and regulations. ..-r ........... ................. Rev. 10-10-7S THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF= IU~CTRICITY 85 JOHN ~, NEW YO~ NEW YORK 1~38 ~r 17, 19~ ~.,~o.o.~ 2530~/~ THAT N 671623 D~r 10, 19~ ~ ....... '~ ........ '., ~,' I _ '" ~ot0rs: 1-1~hp. Pn-%elbo~rds 1-1~cir. 125~s. 1-G. F. I. 2-Smo~e De~ec~ors. I~a~k Lighting 16'(~' 0 Lite~. 2~7E Br~kw~Fer ~oad ~ttituck, N,Y. 11952 Lic. 1329 AMOUNT FIELD INS?EC'TION COMMENTS FOUNDATION (~st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL V :-" . ~-1802 E AM,TO 4 P~ FO~ THE 'FOR POU~ED CONCR~ 4 FINAL - C THE REQUIREMENTS OF ' ~ESPON5~ DESIGN~ STRU~IOR-~ ............. ' ................................... r .... , 76S-1802 BUILDING DEI~'. INSP*ECTION' r ,] FOUNDATION 1ST [ ] ROUG~H PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ~/FiNAL DATE ///4~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 E×amined. 19 S..S Approved ..~..~J'~..~.'~.., 19~t Permit No. l ~'~..~.3 .~. Received .......... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT r>ate 1',30,~, -:z-- ,19~B 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 givhig 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, b~ding code, housing co~, and regulations, and to admit authorized inspectors on premises and in building for necessary~ifts~ections. , ~) ~ .... ' -~ ...t~f.v'~. . .~-~.,~n. ~ ........ ~ ..~..].~. :~ ....... [(Sig~nature of applicant, or name, if a corporation) ...................... ...... : ..... ' (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~¢~J-r-dT/,1~ o, ~/~ ~l~ ........................................................... © Name of owner of premises....~..O..~..¢~..~...~...~...~. :,?../~..~..~..~j.~. .....~.~. ! .~y...~.- .t ~ . .~..~. ~?. ~...~....~.~.. (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..t/.. .... .~- c~c: Plumber's License No .... -.~..~-:.~?'. .............. Electrician's License No .... .~..~...~..~ .~?,..~ ...... Other Trade's License No ...................... 1. Location of land on which proposed work will be done. House Number Street Hamlet County Tax Map No. 1000 Section (~ ~::[ ~1 Block (~) . .-~>.... Lot..~./O. 0 Subdivision ~ t¢O C, CC ~c~.~ Filed Map No. ..~.~. '~.. Lot .. I ........ (Name) 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 ..... ~'. ........................ 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .......... ~rr' Remo~val. .............. Demolition ............... Other Work ............... 4. Estimated Cost , ~rJ~O -- ~:~'~,~D ~23 ~ (Description) ~ · ........... . .... ~) ................... Fee ..................................... (to be paid on filing this application) 5. Ifdweliing, number of dwelling finits .... {~...'.~. .... Number of dwelling units on each floor ................ If garage, number of cars ..... j..'~ ................................................................ 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 .... ~...'~.., ~.q'!t~ .~'. ~g. i.. Height ...................... Number of Stories ..................... 8. DimenSions of entire new construction: Front ................ Rear ............... Depth ............... Height ..... Number of Stories . .~ 4J.~' . .................................. S~zeoflot. Front' '~'~'~',a' '.' ........... Rear ... J.~-~. ............. ~Depth .. ~.f~.,,-,~./. ........... Date of Purchase ....... .~..F'. ~ ................ Name_of Former Owner . ._I~-.~.C..~. ~.../Iff/!.. ~ .8:...t~q... Zone or use district in which premises are situated .... ~.. ~-~..~:. ~..~..~... ,'~. ~ .<- ......................... Does proposed construction violCte any zoning law, ordinance or regulation: .. ~ .c;> ................... .,,<7..~__ Will lot~ be regraded ....... ..~ ............... ~ ....Will excess fill be removed from premises: Yes Name of Owner of premises . .[%. ~..~'.'?.~ ~..a~... Address ................... Phone No .............. Name Of Architect .......... i ................. Address ................... Phone No ............... Name 6f Contractor ' Address Phone No 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly alE buildmgs, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block mmber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEY~ YORK, COUNTY OF .Q~ .rd (Name of individual signing contract) above named. Heis the ' ":''""'""''"''"'i'"'"'~'''""''"', ( ~ntract~r~agent,.........~....................................corporateofficer,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 all 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 m.~ this . ........................ y ............. 19...f-h Notary Public,. ~4~<~..~-r'.,~_,. , - ' .i ow^Ls //',--/,(, rd" k.__ " i No. r~2,?'524771 ' ' ' ~' ....................................... ' Qualified in ;'Suffolk County 19~ z £ __/] (Signature of applicant) Commission Ex[~Ites bitch 30, ~7- ~lf copper lubing is used for water distributing ~iping shall be of types K or L onl~ 765 1802 9 AM TO 4 PM FOR THE 1 Fou~r~ATIQN - TWO REQUIRED a Rodc,-~ FRAMING & PLUMBING 'l *'~* *'*~,,~ ~.~,.~,,o. ~.,Y. L,~'~.~'', ~ :~: ~d GUT~HOGU~ I ~.,~"~"~' , ~ ,.~ TOWN OF ~OUTHOZD ~ SUFFOLK CO. N. Y, ~ QEItTIFIED TO: SAG HARBOR SAVINGS BANK COUNTY ABSTNACT COI~P, COMMONWEAl. TN LAND TITLE INS. Q~ RONA(D ~, STRAIN MA~IA M, STRAIN donack associates land surveyors and consulting engineers :51:3 west main street riverhead,new york 11901 (516) :369-1717 (212) 746-3020 May 17, 1983 dob N~85-259 1000-097-03-P/0 II Scale :1" = 50' donack associates land surveyors and consulting engineers :515 west main street riverhead,new york 11901 (516) 569-1717 (212) May 17, 198:5 dob N28:5-259 1000-097'05-P/oll ScQled" = 50~ C U TCHO GU£ TOWN OF SOUTHOI D II',ISPECTION REQUIRED COU~VTy ~.~ A~miA~ SUmVE~. £. 1451 A¢I~ES MA P OF Pt~OPEt~ T Y AT C U TCHO GUE ~'OWN OF SOU?HOlD SUFFOLK CO. N. Y. ABEA= 108,230Sq. Ff. donack associates land surveyors and consulting engineers :51:5 west main street riverhead,new york 11901 (516) :569-1717 (212) 746-3020 May 17, 1983 Job N-° 83-259 1000-097-05-% II Scale =1" -- 50'