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HomeMy WebLinkAbout12795-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ......... .N.e.w..D..w.e.l.1. 5: .n[I ......................... Location of Property . 9.7.5. ............... .S.k.~..n.k..L.a..n.e ................C.u.~.ql~..og.u?. ..... House No. Street Hamlet County Tax Map No. 1000 Section ...0.9,7. ...... Block ....0.4. ......... Lot ....0.0.6. .......... Subdivision ............ X. .................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore flied in this office dated November 28 198..3. pnrsuant to which Building Permit No. 12795Z dated .... D.e..c?.m.b..e.r.... 9 ...... . .....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 ......... .......... 773.-.7773.-.. ~.?.w..~r.'.z.v.a.~.?..o.n.e., ?.a.m.~.z. 7' .?..e.~.~.n. 9...-.777Y.-.-.TT ......... The certificate is issued to BILLARD, WINIFRED ..................... io;;,,;o;, ~,idO~ ...................... of the aforesaid building. Suffolk County Department of Health Approval 13- SO- 174 UNDERWRITERS CERTIFICATE NO. N648142 Rev. 1/8t Building Inspector Z~Oz~M* NO. ~: TOWN OF $OUTHOLD I~UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 12~95 Z Permission is hereby granted to: ......... ~-~.~...~~,,Z~....Z~... ................ ~,z~,~:.,...~..~.....~.~.?~,~ , ,o ........ ~ ~ z~.~ zz~ .~.~:......~ ~ ~:..... ~ ~ ~. ~.... ~ ~ ~..... ~ ... ............... ~ z~ ~ ....... /~. ~./Z~ ......................................................................... ................................................................................................... ,~~~.::.~Z~... Coun~ Tax Map No. 1000 Section ...~..~.~ ...... Bilk ....~..f~ ....... Lot No...~.~ ....... Building Inspector. Fee $...Z~.. ............ Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, 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, 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 approva~ of completed site p~an 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 ! //$5.00 2. Certificate of occupancy on pre-existing dwelling ~r land use $ 3. Copy of certificate of occupancy $1.00 Date .September 6, 1983 New Buirding ............. Old or Pre-existing Building(X) ........ ~ ZVacant Land .X ....... Location of Property . .~.k.u~r)k~.L.a.i]e.~ .... C. Ul~c.h.o.§u.e., .N.Y. .................. ~ ....... ..~. .......... House No, Street Haml.°t Owner or Owners of Property . .J~a. ph.a.(~], .BAtto. g], l~ .-.- ..................................... County Tax Map No. 1000 Section .... 97 ......... Block ., .4 ........... Lot..6 ............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept, Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ..................... i..Planning_.~C~pproval .................. Requ, est for Tenlporary Certificate .................... ~/~/rna~C/rtificate ................. Fee Submitted $ .5.-.0.0. ..................... ]~./~/_.~ Construction on above described building ~~~e~u la~tions. Applicant .~~.~Q ........ ~ ........ P. O. Box 38 ..v. ,o*,0*Ta Main Road Mattitu , L. I., N.Y. 11952 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted~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 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 / 3. Copy of certificate of occupancy $1.00 landuse--Pre-Existing C.O. $15.00 Vacant land C.O, $ 5.00 New Building ,, ,,~,, ....... Old or Pre-existing Building ....... , ..... Vacant Land ............. Location of Property,..~.~. · ................ .~...~. ........ .~. · .'~. .... Owner or Owners of Property . .~ l.~.[.~h~.& /Jr' ~ ~ /~ ...... ...... .. ...... ................................. 7 ,a, o ..... .... Permit No,/ .......... Date of Permit ~ ,(,, ,Applicant ,~~ ............. ~ .... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate. ............. ...... .FinalCertificate...~...... ............ Fee Submitted $. ~......J~.. .... Construction on above described building and permit meets all applicable codes and regulations. ~¢._ ~,~-- ~rl ~to~5' Applicant .................... Wa. Rev. 10-10-78 10CO771 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW ~ORK 1OO38 THIS CERTIFIES THAT only the electrical equiprnent as described below and introduced by the applicator trained on the above application number in the premises of in thefollowl.g location; ~ Basemen~ ~ 1st Fl. ~ 2nd FI. , Section Block Lot was examined on ~ ~.~ ~ ~ and found to be in compliance with the requlrernents of ~his Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES NCANDE$CENT FLUORESCENTYA~OR 28 27 18 ~8 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDER! TIME C£OCKS UNIT HEATERS MULTI-OUTLE DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS~ Motors: 1--Fo I-G, F. Co I. 1-4~ol~ Det~tor S E R AWG OF CC, CONO V I c NO, OF HI-LEG OF HI4EG NO, OF;EUTRAL$ I OF NEUTRAL 5 RulaadElectricC~o Po O. Box 143 ~5%ttituck~ ~', 11952 Lic, 242 GSNERAL MANAGI~R 11 !?~., I This certificate must Not be in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their COPY DR BUILDII~ COMMENTS !ELD~ INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: INSPECTOR TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR TOWN HALL SOUTHOLD, NE~V YORI( CERTIFICATE OF OCCUPANCY NONCONFORMING PREMISES THIS IS TO CERTIFY that the No. Zl1933 September 21, 1983 /~/ Land /--/ Building(s) /-/ Use(s) located at 975 Skunk Lane, a/k/a Bay Avenue Cutchpgue Street Hamlet shown on County tax map as District 1000, Section 097 , Block 04 Lot 006 , does not conform to the present Building Zone Code of the Town of Southotd for the following reasons: the lot is s~ngle and separate, but has non-conforming area. On the basis of information presented to the Building Inspector's Office, it has been determined that lhe above nonconforming /_~/Land /--/Building(s)- /--/Use(s) existed on the effective date the present Building Zone Code of the To%vn of Southold, and may be continued pursuant to and subject to the appli- cable provisions of said Code. IT IS FURTHER CERTIFIED that, based upon information presented to /he Building Inspector's Office, the occupancy and use for which this Certifi- cate is issued is as follows: Vacant land, and may be used for such uses as are presently authorized by the Zoning Code in this 'A' Rest- de~tial-Agricultural District, subject to, however, all of the requirements of the Zoning Code. The Certificate is issued to of the aforesaid building. RAFHAEL F. BATTAGLIA & WIFE (owner, ~es~m~e- or ~e n~rr~ Suffolk County Department of Health Approval not applicable UNDERWRITERS CERTIFICATE NO. not applicable Building Inspector "It should be noted that since this property is located in an agricultural area. the possibility exists that the water supply may contain trace amounts ef pestickles and/or n~trates. Special analysb-'-/'-~-7,.il/.~.required' SVSTE?,~ CONFOR SLJ~F©L.~ SUFFOL~ SERV~c DATE _. APPROk,~ : SUF?C OWNERS DEED. L TEST k FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765~1803 Examined ~... .... 2 .... ,19 .~.c~-'' Approved ................. 19... Permit No ............ / Disapproved a/c .......... . .--~:7 .~ ............... APPLICATION FOR BUILDING PERMIT Application No.../..Gl.. :~..~..~.. .... INSTRUCTIONS a. This 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 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 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 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,necessaw inspections./, r/"~'~ ~/]4/-/~ xff--~~ t~ /q a (Signature of applicant, or nam% if a corporation) ...... (Mailin~ address of appl~ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................................ Name of owner of premises ~. [ ~. ~7. ]~../~_~._ .~...:/. :/./~.~. ,J~.~ ...................................... (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 ...... ~.7 ................ 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 .. D¢.~. ........ Block ....... ~. ......... Lot... ~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy.. ).~,~:.~. D.~....~.....~..(,/. i/.i: .................................... b. Intended use and occupancy ............................................... 3. Nature of work (check wt~ich applicable): New Building ....... Addition .......... Alteration .......... Repair'. ............ Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost .... ~'~1' O.O ..................... Fee.....~-:~C../....'7"_...~Y..~..~. ................ (to be paid on filing this application) 5. If dwelling, number of dwelling Cnits ...... /. ........ Number o f dwelling units on each floor ................ If garage, number of cars ..... ; ................................................................... 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 ............... · ' i Height ............... Number of Stories ....................................................... Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth: .................... i. · Height ...................... Number of Stories .............. ~ ....... 8. Dimensions of entire new construction: Front .... ,~.. (. ~ ' ..... Rear .. ~-.o~. ........ Depth ...~.~) ......... ~ h I! He'g t . .].~. .......... Num:ber of Stories ........ ]. Size of lot: Front .... [.D~..I..: ........... Rear ..... i[i~>i~ i ! i i i i i i i i i i 'i);~il}' i i i i)~. iO.' i(i i i i i i i i i i i Date of Purchase ....... .~O~O'h.~{..~.. o~.~ .... Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ..... ~. O ...................... Will lot be regraded . .~ ~,~... ................... Will excess fill be removed from premises: Yes Q Name Of Owner of pren[ises ~[/,IiV~ te/~.~c~./~, ~l'lll}dAddress .... Phone No..~. ~.fi/~..~-.J'~.~. Name of Architect ........................... Address .................. Phone No. Name of Contractor. ~.~.,. L~e~ ~.~, ...... Address .~.~. ~ ~ ...... Phone No. ~.' .~: ~.' ~.' '.~ ~./:: PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from or description p~o[ding to deed, and show street names and indicate whether 10. 11. 12. 13. 14. property lines. Give street and block number interior or cbrner lot. 1oo I0~ t (Name of individual signing contract) above named. : being duly sworn, deposes and says that he is the applicant County ( 'g pp' ) Sworn to before me this ........ ~ ..... day o~. N~,~~ubl.ic, ..... nntrac, ent, corporate officer, 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. ~:~_.,~0~;:.:~ AD NOTED ATE: NOT/F~ B~NG D~PA~R-~/~E~i~T AT 765~1802 9 A,M TO 4 P/vt FOR THE FOLLOWING INSPFCTIONS: ~. FOUNDATION _ TWO REQUIRED FOR POURED CONCRETE :2. ROUGH ~ FRAMING & PLUMBING 3. INSULATioN _ ~,,-..,--.~ 4. FIF~'AL _ C?'x?-qL, CTION MUST -~ BE C. ,-E~F FOR C.O. ALL CON~?z'C?~ON q~LL ~=? ~_~EOL' R:"',cNTS OF THE N.Y. blA~ONS~RUCTION & ENERGY CODES. ~N~T RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. "It should be noted that since ~B property is located in an agricultural area, the possibility exists that the water supply may contain trace amounts ef pesticides and/or nitrates. Special an.a. !ysis'7-'e--A. l l //~ required' RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YOR~ SUFFOLK CO. HEALTH DEPT. APPROVAL H. $. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR/~IS rESIDENCE WILL CO.FOrM TO /T/ OF THE SUFFOLK C/9~ D_~PT~//~3F HEA~TH SERVICES. /A~PLI~Nf ~~' SUFFOLK COUNTY DE~; HEALTH SERVICES -' FOR APPROVAL OF CONSTRUCTION ONLY H.S.~F. NO.. ~ % SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. OWNERS ADDRESS: DEED: L.?~ !~ TEST HOLE SEAL ,,zz 0 ~he sewase disposal ~ud water facilities for th,is lo~ation have been inspected by this department ~d satisfa~ ~ RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK S,C. DEPT. OF °~.~I'4ENT OF INTENT THE WATER SUPPLY AND SEWAGE DISI~)SAL SYSTEMS FOR THIS RESIDENCE Will CONFORM TO tHE STANDARDS Of THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTh SERVICES - FOr APPROVAL OF CONSTRUCTION ONLY DAte h. S. REF. NO. 13 ~ $ O ~ APPROVED SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL OWNERS ADDRESS: DEED:L:T~t~ TEST HOLE [ /-..Ztr¥~ STAMP SEAL -V © '1