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Home My WebLink About12595-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z ~ 2,3.66 .......... Date Hatch 15 t..1,98.4. ............ ,19 THIS CERTIFIES that the building On.e..£~m.],l,y. fl.w.e. ], .1.~.n.g ......................... ty R~.P. t~r,i.d.ge..Lane. Cutchogue Location of Proper '~}~usa ~vo. ' ..................................... Street Ham/et County Tax Map No. 1000 Section .0.85 ........ Block ...... .2 ........ Lot ..... .2.2. .....:..~_~. Subdivision...~t,r..A..c ¥.e.s. ............... Filed Map No. 5872 .Lot No. 17. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. 5.e.[~ t, ,...~ ........ ,19 ,8.3. pursuant to which Building Permit No. '[ ~ 5.9.~ ~ .............. dated .~, p.t.... ] 3 .................. 1~.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 ......... .....Qn~ f.~Y ........ ~wel.l~.ng ..................................................... The certificate is issued to ... Th.c~mas..~ho~,o.~,~ ...................................... (owner, levee or tenant) of the aforesaid building. Suffolk Cotmty Department of Health Approval ... ~ 3.-~ ~.-.1.4,~ ............................ UNDERWRITERS CERTIFICATE NO ........... ~.6.3. tt ~.0.2. .............................. Building Inspector Rev. 1/81 FORM NO. ~ 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) 12595 Z Permission is hereby granted,t~ ._~_~ . [/ · ....~T.~.~ ...... ~.:..~.~....u..~..~.~ ro c~ o- ~' Z~'~ ....... ~. ' ....... Fy' .......... ..~ ................ ~.....;,,,; ......... ~ ............ ~.,~.--~ ............................. ~, premise, ,~o,.d o, ...~.~.~.~...:....~.~.~..~,..-..~~..~ ........ Building Inspector. Building Inspector Rev. 6/30/80 DATE COMMENTS FIELD INS?ECTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & ?LUMBING 3. INSULATION FERN. Y. STATE ENERGY ~ODE FINAL FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall " ~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apptication must be titled in typewriter OR ink, and submitted in duplicate to the Building ~nspec- 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. Commerc al buildings, Industr al buildings, Mu t p e Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Eng near 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: 1. Accurate survey of peopertv 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: f '-- t. Certificate of occupancy C $5.00~ / 2. Certificate of occupancy on pre-~ing dwelling / 3. Copy of certificate of occupancy $1.00 t landuse--?re-Existing C.O. $15.00 Vacant land C.O. $ 5.00 /~Date .......................... / New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property '~-,~..,~,.(~, ,.~,:^~',,~,. ~'~'"~". House No. Street Owner Or Owners of Property ............ . .~Ofy~, .~ ~.(~ ................... County Tax Map No. 1000 Section (~ ~ ~ Block Subdivision....~,, .~%.', .V?~O~,. '~, , .,~,, .C-~-, .~, .S-, ........ Filed Map No. ,~,..~.'?. ,~..Lot No ...... I.,~. ..... Permit No. ~ ~-¢~ ~--~-~ Date of Permit ?( ~,~ 1 ¢.~., .Applicant ,~~. ~ ~.~ · · · Health Dept. Approval ............. abor Dept. roval ........................ ~') ~r'~ V O0 .P~, Pla c~ Appr Underwriters Approval.. ......... .. ....... . .. nningBoar ova ...... ~ ............. Request for Temporary Certificate Final Certificate Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 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 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 disposel-(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings. Industrial buildings. Multiple Residences and sir~ilar 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. B. 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 / 2. Certificate of occupancy on pre-ex~sting dwelling 3. Copy of certificate of occupancy $1.00 land use --Pre-Existing C.O. $15.00 Vacant'land C.O. $ 5.00 / New Building ............. Old or Pre-existing Building ............ Vacant Land ............. House No. , Street Owner or Owners of Property ............ .'~-~-~..~ ~.~-;~ ................... County Tax Map No. 1000 Section . (~ ~ ~ Block .(~.~ . Lot ..... ~ ~ ~ Subdivision...-.~...~....¢¢~L~' . .~...C~..-~ S-. ..... Filed Map No..-5...~.r¥.%.Lot No ..... ..... Permit No. ! .~-.?.~.?.'~. Date of Permit ?[~.~ 1.~..Applicant....~Y~. ~ .~. · .~ · · · I ~-- " ' ' ' App ~. ~ ~-~.. ,., .~-.~..Labor Dept. roval .............. Health Dept. Approval . .'.', '.. · ' .................. /~ ' '~' ';.Planning Board Approval Underwriters Approval . ~. .- ........ · .'; ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. described building and permit meets all appliCable~ codes and regulations. Construction on above X..~~. ~~~ Applicant ................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICtTY~ ~- 85 JOHN STREET, NEW YORK, NEW,Y~RK 1OO38~ ,.,e~."el~'~ :L6, ~4 App,,c~.,,o.~'o.o..,',e ':~'~S.8~ ~ N 634002 THIS CERTIFIES THAT only the electrical equipment as described belo~v and introduced by the applicant ~am id on the abo~e application number in the premises of was examined on ~Xqla~j' 13~ 1984 ~ 2nd Fl. Section Block and found to be in complian se w th the requirements of this Board. FIXTURR FIXTURES RANGES OVENS EXHAUST FANS Lot SYSTEMS E E R V NO OF CC~ COND, A, W G. PER ,~ OF CC, COND 1 1/0' OTHER APPARATUS: I C OF HI-LEO NO OF~EUTRALS A, WO OF NEUTRAL 1/o Electric Corp. Cliff ~o~91t ~out~-]d, N.Y 11971 This certificate m~st not be altered in any manner; return to the office of the Board if ~* 281~ GENERAL MANAGER ~ Per- 11 / / Inspeeto~ may be identified by thek~¢redentia/s. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ...:'~.'~.. ).~-., 19~ Permit No. l.~k..~'.~ .~..~ Disapproved a/c ..................................... ................................ ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... ,19... INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 tot 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 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 buildin~gj~de hous~ag~ode, and regu~ation~s, and to admit authorized inspectors on premises and in building for necessary inspe~~~t~. ~ . . ._._:w (Sign~fire of applic~'nt/r na~me, if.a corporation) .... ,../.. (Mailing address of applicant) C, tate whether applicant is~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner or premises . .-77~O ,v~.,z¢.5....--~.~.~.../~.~..4.0. .~. ........................................ (as on the tax roil or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No....~. .................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done... ~,C.,:c~ ~./zqO. G... d~..~.G./Jg. ~9. ~v.c/.~ ........... ~ 10.. ~r.. .~e.~... llouse Number Street Hamlet County Tax Map No. 1000 Section /~r.~g~.~.x~Block . ... ~.,.~.O. .... Lot..~ ~ ............ Subdivision. ~ ~..g~C ~ ............... Filed Map No... ~Z~ .... Lot... ~ ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . .. . .~fi~ ......................................................... b. Intended use and /~ ~ t:~O~ occupancy ................ ~ .................................... 3. Nature of work (check'which a ~plicable): New Building .../ ..... Addition .......... Alteration .......... Repair ............. ; Remgval ..... Demolition .. ............. Other Work ............... .4g . i ~ (Description) 4. Estimated Cost.. ~'~.'~. ~.~. ....................... Fee .[ .~..~. '...~'Ac.). ............................ .! (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .J ......... Number of dwelling units on each floor ................ If garage, number of cars .... ~ ................................................................... 6. If business, commercial or mixe~d occupancy, specif,~j~ure and extent of e.~l~jype of use ..................... 7. Dimensions of existing structurbs, if any: Front.. ~ ......... Rear . ~ .......... Depth ............... Height ............... Nurflber of Stories ........................................................ Dimensions of same structure With alterations or additions: Front Rear Depth ................... i' ' ' Height ..... ~ t .. t, ............ Number 1)~; Stories ...................... 8. Dimensions of entire new construction Front . .~....' Rear ...1.].¥.. Deoth . ~q~.t . Height ............... Number of Stones .... [.5 ..... / .......................................... 9. ~ze of lot. ront ../,~.~', ~d)... Rear ../~. 10. Date of Purchase ..... fl/(../.d..//g/ ............. Name of Former Owner t I. Zpne or use district in which pr~mises are situated .................................. '.....'.. .... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...................... ~ ....... 13. Will lot be regraded ... J/~.~.. ..... ~ ........... Will excess fill,be remo. ved from premises: ~ . No 14. Name of Owner of premises.. 7/l~m.,~,~./~..a~oj~4~.r~Address . g/,'7~/..~.r)./~4~. ~ ..... Phone No..7. ~.¥?-. ~..~..O.7.. Name of Architect ...5'.o.u.?IloJO(../okt~Jo.e.~. ..... Address ...,qaciJiV')oJC. f,. ...... Phone No. Xd~..."..*?¢7...ff.*,Z.. Name of Contractor ¢o. e4 ~..ao.~.do~ ....... Address . ~ ~ ...... Phone No. 7-?.~.'r ,5'/.c~. .... 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 N[W ....'f5 (Na~ne of indiJdual sig ~ .......... being duly sworn, deposes and says that he is the applicant above named. lie is tile ....................... i ................................................................... ~ (Contractor, agent, 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 ofhls knowledge and belief; and that the work will be performed in the rnann6r set forth in the application filed therewith. Sworn to before ~ne this ........................ day of .....15 ..u? Not ary Pu blic,~~..~...Q~.~.-~./.f(..q~C%unty ': i, ..... , ...: ... ........... ' { ~1o. 52.034496.3 $.u?qlk Count~ ~ V {/ (Signature of applicant) Tbs sewage disposal and w~.ter supplF facilities for this l'~c,':'ion have bee~ inspected by %his dg~rt~nt and~ou~_ Chief of General Engineeri~ SedUces SUFFOLK CO. HEALTH DEPT. APPROVAL H.S NO. {~-~o-i~%Z '_STATEMENT OF INTENT THE WATER SUPPLY AND sEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUfFoLK CO. DEPT. OF HEALTH SERVICES. (si APPLICANT SUFFOLK COUNTY DEPT. OF SERVICES -- FOR APPROVAL CONSTRUCTION ONlY DATE: h.S. REF. NO. 13 - 50 - i~Z APPROVED: OF SUFFOLK CO. TAx MAP DESIGNATION: DIST. SECT. . BL~CK .PCL. OWNERS ADDRESS: FIL?D SEAL GREENPORT NEW YORK NL55'IS'40"V< SU i2'v'E YD D The sewage disp facilities fat inspected by to be satis£actor~ SUFFOLK CO. HEALTH DEPT. AI~ROVAL 'STATEMENT OF INTENT ,/~~ )'*" '-' '*~ · ,~,~ THE WATER SUPPLY AND sEWAGE DISPOSAL I k/ '., ./ j ~ SYSTE~ FOR THIS RESIDE~E WILL CONFORM TO THE STANDAR~ OF THE SUFF~K CO. DEPT. OF HEALTH ~RVlCES. N,'¢ APPLICANT SUFFOLK COUNTY DEPT. ~ HEALTH SERVICES - FO~ APPROVAL OF 1984 ,. D. RI~. ¢~/~ CONST"UCTION ONLY DATE:~ ~posal and ~ater supply H.S. REF. NO.: r this !~cr. ~on have been ..... ~ A~ROVED: [his de~rt~ent and ffo~d. ' ~FFOLK CO. T~X MAP DESIGNATION: .... OWNE~ ADDRE~: MONUMENT '.EA'41,585 5.~ FILED ~AL TITLE tNSUNANC~ COMPANY O[~K VAN TUYL~." L ' ICEN~D LAND SURVEYORS REEN~RT NEW YORK Chief AE '\ ',,I O T £ ~ ', :.LOT No's, ~[~ ~ TO'MAP OF' iSHA~. OFFIC[~ A,.S MAP HO. 2. StJ FF: CQ, TAX MAP; ICXD0- 085 I 'APPROYED AS NOTED FOL. LOWPXrG iNSPECTIONS. FouNr~ATIOKr - TWO REQUIRED FOR POURED CONCRETE POUC~H FRAMING & PLUMBING f 7,¸ -I: T' ±.L 't t