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Home My WebLink About12739-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z12807 Date Sep%.25 19 84 THIS CERTIFIES that the building . .P.r.~y .a.L.e..Q.n.e..F..~..m~.].2(.. p.w.~.l. ~..J_.n~. .............. Location of PropertyHouse ................... No. G.~.c~D.~. .V. ~. .o.W. Street. I~. ... ............. Q~.. ~.o~.~. . County Tax Map No. 1000 Section ...Q~..4 ...... Block ...0.2. .......... Lot . ?./.Q..09.1.: .1 ..... Subdivision.. (.~.~..ng.r.)...~.~.~.qo..m ..............Filed Map No ......... Lot No...(.3.) ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...Np.v.:...1 .......... ,19 .8.3. pursuant to which Building Permit No... ~ .2.7.3.9. g. ............ dated ....~9,: ...... 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 ......... ... ?.~.~,w.e.e..Q.n.e..v.a..n.~.~,~.. p.w.e.z. $.~p.~. ............................................ The certificate is issued to ...I~Q~[.~ .~/~.G.N.~i~ ......... ................................. (owner, of the aforesaid building. Suffolk County Department of Health Approval .. ,1~3 = $ O.-.], 7 6 ............................. UNDERWRITERS CERTIFICATE NO .......... ~.~£~gr ............................... Rev. 1/81 Building Inspector FOR~[ NO, 9 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12739 Z Permission is hereby granted to: ..l...q.~...~......~'. J.,~..~..£~. ..................................... ~.~.'...~,~, ........ ~., ............... 1. ............ ~o ......C~..~..,~.~.~.~....~:.~_.. ~.,:,~. ~ ; ..~ .................. ~ ~.,.., ~, ~ .~. :~.,.~ . at premises located at ...................... w.~.%..,~x~.¢.w~. .............................................................. pursuant to application dated .... ~.~(~L&,....../. ................... , 19.~...~.., and approved by the Building inspector. Building Inspector Rev. 6/30/80 INFORMATION FOR BUILDING DEPARTMENT WE ARE 1N THE TROCESS OF ISSUING A CERTIFICATE OF COMPLIANCE FOR THE ELECTRICAL INSTALLATION AS COVERED IN AN APPLICATION FILED WITH OUR DISTRICT OFFICE. ~ ~ A. This applical tot with the ' THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ilding I nspec- natural or ~. ~ ~, and unusual 2. Final appr ' LOCATION / -- -. al). 4. Commerci DATE t i / ( ~-~-~/(-~.I[~'S~Eb~0, ...... and installa- tions, a ce FO,a],D(R~V.]/?S) ................. ~ ......... . ....... o ,~,'the building. 5. Submit Planning Board approval'of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming u~s, or buildings and "pre-existing" land u~s: 1. Accurate ~mey of peope~y showing all property lines, ~reets, buildings and unu~al 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 safew inspection of buildings or premiss, or other pe~inent informa- tion required to prepare a ce~ificate. Co Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / land use 3. Copy of certificate of occupancy $1.00 ~ --Fre-Ex£sting C.O. $15.00 Vacant land C.O. $ 5.00 New Building ..... Old or Pre-existing Building .......... Vacant Land ........ Owner or Owners of Prope~ ................................. County Tax Map No. 1000 Section 0/.~ Block Health Dept. Approval ....... Labor Dept. Approval ................. Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ............................. FIELD INS?ECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY -- ~ODE FINAL ADDITIONAL COMMENTS: t20 BUILDING DEPT. INSPECTION FOUNDATION XST '[ ] ROUGH PLBG. FOUNDATION ZND~[ ] INSULATION FRAMING REMARKS [ ~/FINAL DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, ................ , Approved ...... ~.~ ',.~ 19..~..~.. Permit No....I ................................ Disapproved a/c ............................................................................................ Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT / Date .......................... ././.~../ ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sete 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 ofproperty must be drawn on the diagram which is par~ 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 Perm t pursuant to the Bui ding 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 buildings for necessary )~spections. ....... ........ 'g pplic~l, , ' ,rp~rZitio ..... .............. (Add~'~ss of applicant) ~ State whether aj~lic~ant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~...~. ................... 4'~'...,~'~I.. ................................................................................. if applies a~orate~ignotu~ duly outho~zed officer. O ) q - a ~ - ~ ~(' I / (Name an~itle of comorate o~ice;)' '' Builder's License No ................................................... Other Trode's License No ............................................... 1. Location of land on which proposed work will be done. Map No.: ~ .... Lot No ....... ..~ .............. Street and Number ........................ .~J~.,~?~..~......~./.~?....~-~..~..~..~..~.. .......... .c~....~.L.~..~..T'. ............................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ............................................................................................................................... b. Intended use and occupancy ~~ y~ ~~ ¢~ 3. Natdre of work (check whichlapplicable): New Building .......... Addition .................. Alteration ................. Repair .................. Removal: .................. Demolition .................... Other Work ................................................ . .... : _~ . . ~ (Description) 4. Estimated Cost.~...'2.~.,,.~.~"' ....... :: ............ F~e ....~.'7..2,..~. ..................................................................... · . (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .~';~... ........ NHmber of dwelling units on each floor ............................ If garage, number of cars ~ . .............................................................................................. 6. if business, co~merciai or mixed occupancy, specify 9ature and extent of~ea~ch type of use ........................... 7. D,mens,ons of~--t*~ structures, if any: Front ......... "~.~.~. ......... Rear ....... ~.~, .................. Depth ......~'....'~....! ..... Height .....,,~..~...I. ......... NumSer 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 ............................ Depth ........................ Height Number of Stories ...................................... P, ear ......... /.~.~.,...~.¢ ................ Depth ................................ 9. Size 'of lot: Front .............~'.Ji'~..'..¢~..). ............................ ~'" ' 10. Date of Purchase .........../.~.~.'....~. ................................ Name of Former Owner ...~...~.~..~..,~../~..~..~C../,~.¢~...~-~....~., 11. Zone or use district in which premises are situated ...... : .............................................................................................. 12. Does proposed construction violate any zoning [aw, ordinance or regulation'. ..~...~. ................................................. 13. W at be renraded ~$ Will excess fill be removed from premises: ( ) Yes ( = ' ...... 7" ............... *'/~/ '~/' "~ ~" ~ ' ~'" /'~ "*: " PhenolS. Owner of pr mises ..... ^d res ..... ........... Nome of Architect ...... /,?..~./Z.~'.~'.~....,~.~r~.'.£......~ ................ Address .~..9.~.~.¢'.,CU.~.~... Phon~ No2.~:~..t:..."X.. Name of Contractor ....~..?~'.....~...~.__.~..~..~,.'~,..~...o........~.. Address ;~.~..,~...'.~./(.?..~...~.'.~'o~n, 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 lot. STATE OF NEbA~I~/~ /~ [c¢ COUNTY OF~~%....~~'¢ ~.~.?._...-.~..'(,~/r~:/J/~L~'~f/. be ng duly sworn, deposes and says that he is the applicon, .................. ~~'~Zd~i"&;~;~"~'Zg~7~'~ above named. ~. He is the ................. ~ . .............................................................................................................................. (Contractor, agent, corporate office¢, et~.) of said' owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that ali stoteme6ts contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in :the manner set forth in the application ~ therewith. ~ Sworn to before me this ~z~ // - / . /' / / ..... o, ...... z .... .......................... ............................. ~-~~~~~ ~ E ZAB~H ~NN N~IEL~ souND isLAND ' L DNG ~ 8lo4~,§0 'E. )aJInbeJ s s~Ouo [Ol3edS ~ ~ 'S ~OJ~IU Jo/puo sepl3~sed ~0 sTunomo ~ ~ ~ ~ . SURLY FOR ................ ............ '-~'~ ~-~'~ AT ORIENT DATE: FEB. 28, rATE ._i~iJ~'.E?.?JO. - ~{~ SUFFOLK COUNTY, NEW ~RK HEALTH DEPARTMENT-DATA F~ APPRO~ TO C~STRUCT ~E ~R~ FOR WHOM THE SU~EY iS PREPARED ;/ . ~ ~ RIVER~ADi NEW YORK AREA-' 5,806 ACRES ALDEN W, YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N*Y*S*UCENSE NO. 12845 HOWARD W. YOUNG, LAND SURVEYOR ~ L~T~ ~L(W),~PTIC TAaK(ST)aCE~OLS(~)~N ~ N.Y.S. LICENSE N0.45893 ~E m~ FIE~ ~TI~S ~ On DATA OeT~O ¢~ OTHERS :j _1 :_i -(9 .t' AP?EO~/~D AS NOTED DATE: !']?j.fa.~ B.P. :~ ~;'- 76'5-1802 9 AM TO 4 PM FOR THE ~OLI. OWING ~NSPECTIONS I. ,FOUNqATION - TWO REQUIRED -FO~ pgURED CONCRETE [or water distributing system; piping shall be s K or L only b4JlLl::21k~ q :ecA~r~ DONALD /, ) P~T ~c · It , ' ".~'eC F -¸I I I T-t I I ,1' ,',1 i I 't II 2--' ~z