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Home My WebLink About12613-zFORM NO, 4 TOWN OF SOUTHQLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z..q .aS,~. ] .......... Date . .8..u.n.e..S. ....................... ,19 .8.6. THIS CERTIFIES that the building One family dwelling. ~50 ~5 & Rio.hard. St. Mattituck Location of Property .C.q~..n.eF..T..h.e?.e.q 9. p.r.: ....................................... House No. Street Hamlet County Tax Map No. ]000 Section .1,1.5. ........ Block ...1.4. .......... Lot . .~ ............... Subdivision. p.e.e,g, lt.o.l.e...C?.e.e..k..E.s. ~ .a.t.e .... Filed Map No.' ........ Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated s e.p.~.. 18 19 .8.3. pursuant to which Building Permit No. 1 2.6. 1 3 .Z · dated ...S. 9p.t.....~ .8 ................ 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 ......... ... Qp.e.. ~'~.~,],y..d.~.~ $ :L~.ng, ..................................................... .. A.n. gelo Accardo ....................................... The certificate is issued to ............... (owner, lessee or reheat/ of the aforesaid building. Suffolk County Department of Health Approval .. fi.3.-..S.O.--fi. 4. ¢ ............................. ~';645443 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FOBM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT {THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12613 Z County Tax Mop No. I000 Section .... .~.~..~'~. ......... Block ...... .~...~ ......... Lot No ........ .~ ............... Building Inspector. and approved by the Rev. 6/30/80 FORM NO.§ TOWN OF SOUTHOLD Building Department- Town Hall ~jouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in tvpewriter. OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or now 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- tlons, 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. Bo 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. Fees: 1. Certificate of occupancy on pre-existing dwelling Certificate of occupancy $5.00 2. 3. Copy of certificate of occupancy $1.00 landuse--Pre-Existing C.O, $15,00 Vacant ].and C.O, $ 5,00 Date,, ~/.5-/~, f ................ New Building .......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ... House No. Street //em/et Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section .... ! ,l~. ....... Block ...... (,~. ....... Lot ....... ( ......... Subdivision ~.~.?~O Filed Map No ....... Lot No .......... Permit No ........... Date of Permit .......... Applicant ....~k. ~, ~.~j ','..~.c.~..~. ,~.~.~ .......... Health Dept Approval .~ ~,, - ?-~?..Z ~..~.-~.. Labor Dept Approval 0 ,~,~, ?-..z(.~.~. Planning Board' Approval UnderwrJteFs Approval ..................................... Request for Temporary Certificate ..................... Final Certificate ...... v~. ................ Fee Submitted $ Construction on above described building end permit meets all applicable codes aod regulations. Applicant.. ~-'~. .... ~ ..................... Rev. 10-10-78 FOUNDATION FOUNDATION 2. ROUGH FRAME 3. INSULATION STATE 4. Fit ADDITIONAL COMMENTS: 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 featu res. 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 / //$5.00 2. Certificate of occupancy on pre-existing dwelling ~r land use 3. Copy of certificate of occupancy $1.00 Date ..... New Building ............ Old or Pre-existing Building(Z). _:/..c~_"~)~ = 'Vacant L._and Location of Property...- -'-..:_ ':. ..... ':-.~ .... ~.. ;:~-i r .... ~ ...... - .......... House No. Street Hamlet Owner or Owners of Property f~/-~ ~/z¢~O~, County Tax Map No. 1000 Section .../'.~/..~.. ...... BIock.,:,~,.~. ..... ':,, Lot...(t ............ Subdivision .~4~. ~,,~. ~;~¢,. ~ ~,..Filed Map No....~..~..'~.~..Lot No ..... ~, ....... Permit No Date of Permit Applicant , Health Dept. Approval ........................ Labor Dept. Approval ......................... Underwriters Approval ........................ Planning Board Approval .................. , ~., Request for Temporary Certificate Final Certificate - Fee Submitted $ ............................. Construction on above described,building and per~.~A~s2~p~, I~o::$~nd regulations. Applicant ....... ~,-~.~ .:...~r.~-.._. ~/. ~ .-.~ ........................ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [/~J~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~j]~ FRAMING [ ] FINAL REMARKS: DATE THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY G~5 JOHN STREET, NEW YORK, NEW Y~RK 1,0038 THIS CE~IFIES THAT only the electrical equip~nent as described be~ a~d introduced by t~ applicant ~m~ on the above application nu tuber in the premises of ~elo ~c~'~ C/O ~eresa Drive & Rict~ St~t~ ~at~itu~, N.Y. in theJ'otlowing location; [] Basement ~ 1st Ft. wasexamin;don April 26~ 19~4 FIXTURE OUTLETS NiCEi'TACLES SWITCHES 17 14 FIXTURES FLUORESCENT [] 2nd FI. Section Block Lot and found to be in coznpfian~e with the re~ ruirements of this Board, RANGES DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS LINIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE D SCdNNECT ~ OTHER APPARATUS: Motors: 1-F. I~G.F.C.I. ].*--Slroke Detector. S E R I C E NO OFpERCC~,COND. A W, O~ OF CC CO~4D. NO. OF HI-LEG A, W G. NO OF NEUTRALS A, W G, OF HI-LEG OF NEUTRAL Fred G. Korte ~} Abinet Court ~elden, N.Y. 11784 This certificate must not be altered m an, manner; return to the office of the Board if i [EARTMEI Inspecto~ may be their credentials. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved.....~..~ .I..¢.., 19~..~. Permit No.~..~../.~ ..~'. Disapproved a/c ..................................... ........ . ................. (Buil~ling Inspector) APPLICATION FOR BUI LDING PERM IT INSTRUCTIONS Received .......... ,19... a. This application must be completely filled in bY typewriter or'in inl~ and submitted t0 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. adjoinihg~ 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 isstfed a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. ¢. 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 tire 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 ~aolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, b~g code, houythgJ:ode, an~regulations, and to admit authorized inspectors on premises and in building for necessary/A~s?e~i~ns.// / / . // · (Mailing address of applicant) 'J' State wh~ther applicant is owng~r, lessee, agent, architect, engineer, gene/~ai contractor, electrician, plumber or builder. Name of owner of premises .......................................................................... (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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ....................... N - I. Location of land on which proposed work will ~o~n~.e..~. · ~.~. ~.~.~.....4~./~..,..~ .~ .~ .... House Number Street Hamlet ~. J]~ Block ~ 9 ....... Lot... County Tax M~p No. 1000~ ~. ~ .~.~~ection ...~. .............. 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 ....... ~~ ~ ' .............. :..., ............................ b. Intended use and occupancy ~ ~, . 3. Nature of work (check winch ap?hcable): New Building .......... Ad&tmn .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............. (Description) 4. Estimated Cost ...... .~..~)/ .......... Fee .... .~--.'.'.'.'.'.'.'~). · .......................... i (to be paid on filing this application) 5. If dwelling, number of dwelling )nits ............... Number of dwelling units on each floor ................ If garage number of cars . 6. If business, commercial or mixe~l occupancy, specify nature and extent of each type of use. ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Heiglit ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth i Height Number of Stories 8. Dimensions of entire new constrUction: Front ... ~ .B. .... ~.,. Rear~. _. ~ .~. ...... Depth ... ~ ..2=. ...... I-[eight ............... Number of Stories .d?./~..~.~-/o~/.. ~..//'. ....... ................. '22 ......... ...... 9. Sizeoflot: Front ...... ~ .......... Rear ..... ~t~l.l.~ ..... y.... Dept ..................... 10. [)ate of Purchase ........... ! ......... Name of Former owner ........................... 11; Zone or use district in which pr6mises are situated ............................. / ...................... 12. Do[s proposed construction v/iolate any zoning law, ordinance or regulation: ....... ./.~...O ............ ~ ...... t3. Will lot be regraded ..... 7..t~.,~..,..,...,/]:.;.~.:, >.,.. Will excess ~ilJ be remoy£d from~l~.n}ises: ~ No 14. Name of Owner of premises ...,~. ~.'.,~./?....~'/A4'..'~ddress i~'.~..//e;~-q7./'/..~, t .-.i'~Z) t~i'~ No. Name of Architect ....... ; ............... Address ................... Phone No ................ Name of Contractor ~'~/../'> ~/c/ PrAy /4 Vic~4/ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocklnumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEV(~RK.,,/ ~' 'S ~ COnNX O . : (Na~ne of in, iv[dual sig~ing contract above named. ' . ,.' being duly sworn, deposes and says that he is the applicant (Signature of applicant) He is the ......... ....................................................................... ~ontractor;- ' ' 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 conthined in this application are true to the best of his knowledge and belief; and that the work will b~ performed in the manndr set forth in the application filed therewith. Sworn to before me this · 'it shautd be noted that since, this proPerty is located in on agricultural area, the possibility exists that the water supply may contain trace amounts of pesticides and/or nitrates. Special anaiysis-/~ tK~ required. ACCARD~i 'ITUCK :; sOu~HOLD ~ NEW YORK TO THIS OF THE ~}NO THE LAND ;O SEAL SNALL IUE COPY, E SURVEY'IS PREPARED, E COMPANY, GOVERN- NSTtTUTION LISTED (~F T~NS LENDING TRANSFERABLE SEQUENT SPECIFIC PENCES. DATE : 'AUG. SCALE: 1":40' NO. ; 85-640 YOUNG RIVERHEAD, NEW YORK PROFESSIONAL ENGINEER · LICENSE NO. 12845 LAND SURVEYOR H0.45885 ; TITLE NO. 8 408- 0175.'5 ~ ~J'~07,~ 00tj31~¥ HEA~TH DEPARtMEnt= ' ~ ~A~REN W. MOORE ~ SUSAN L. MOORE '~,~: JUN5 - , , : ~ ':~ LOT ~, "DEEP HOLE CREEK ESTATES" ~ , r ~ . , ,;% ~ ~e~ ~. , ~0NA~THORIZED A~T/RATION 0RADDITION TO THIS ,Al O H S BEHALF: TO THE TITLE COMPANY, GOVERN* WIL~ ; ~. ~ T~ ITAN~"OF tHE S~K~¢~ D~T T( E~STING STRUCTURES ARE FOR A SPECIFIC I ~ 1 ~/AI Ik,~ A &/Al Ikl~ 4000STRAN~ER,AYENUB