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HomeMy WebLinkAbout12102-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate OI Occupancy No. Zl2035 ......... Date ........ aqv. e~ahe.~' ............... 1983. THIS CERTIFIES that the building . AD]0~.IQ~ ..................................... Location of Property ... 6D.0. Smith. D~iYe ............. .~o~tSh.clld... i ............... House No. Street Hamlet County Tax Map No. 1000 Section ... 0~.~ ...Block ...0.~ .......... Lot ..... D.20 .... ;.. b- Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. Eiovem.he~. fl2 ..... 19 ~2 pursuant to which Building Permit No. ~12.'1D.2. Z .............. dated ....... ~ra~a~y..~.fl ......... 19 E~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 ......... ~or an additio~ ~o an existing dwelling The certificate is issued to CHARLES 1LET~IG - (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......................................... U D RWmrEr s CERrIFICATE NO Building Inspector Pe~nissiOn is hereby grontedltp~y / ~ ~ BUILDING ~EPARTM TOWN' BUILDING ~HIS PE~IT ~MUsTBE '" ~ , KEPT:DN ~HE at 'l~remises located at ................................ .... ....... Tax Map NO. p~ant ~o app Icat *n' dat~ ............ .....~.....,..~ B~'l~lrig I~$pector. and approved by the FORM NO. 6 TOWN OF $OUTHOLD Bu ilding Department Town Hall Southold, 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 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 / land 3. Copy of certificate of occupancy $1.00 / use ~-Fre-Existing C.O. $15:00 Vacant land C.O. $ 5.00 New Building ......... Old or Pre existing Building ..V/ .. Vacant Land ~ ........... Location of Property. ~i~i ....... ~,T~....~.~.I.//.'~.~..'?..'~i. ii ................ ~.~..~.~'~..~.. House No. -- Street/~-- Ham/et Owner or Owners of Property .... .~,~r~-~..~'. ~...~.~i,~..~ ~.~./.~7 .................... County Tax Map No. 1000 Section .. ~.?.4 ....... Block ... (~.'~. ....... Lot .... .~.~..~..('~. ..... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. J~:~./,~, ,~,. Date ofPermit ,'//.~,~..Applicant., ,~~.~,. ,~, ~. ~-.~./,~,?T ........ Health Dept, Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ..... t~/,, ................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ,,, ,~, ................. Fee Submitted $ ............................. Construction on above described building and p~et,~a~ apple c . Rev. 10-10-7e NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Regulatory Affalas U~ Bldg. 40, SUNY-~Room 219 Stony Brook, NY 11794 (516~ 751-7900 RE: A review h~s b~en made of yow~ proposal to: Vo~ St~e..~ep~e.~ of Enviao~e~tal Co~v~on ~ found the rojeet ~ be: Gre~ t~ 300' from inve~o~ed ~ w~. ·nan 100 ~n ~ngth contoured p~or to S~t~~ ..... Lam~d o~ 10' eo~ow~ ~ev~on above me~ sea lev~ on a g~, slope. , _ Landwa~ of topograpgieal ernst of bluff, e,~lf~ or dv~: i~ exee~s of I0 feet in elevatlon above mean sea level. ' 'therefore, ~o pea. mit under ~;e~e 25 (Tidal Wetl~nd~ of the ~'v~,o~e~ Co~v~on L~ ~ req~ed sinc. e ~e proposal d~ beyond S~e m~d~ed j~-- ~on p~ua~ to t~ a~. THE NEW YORK BOARD OF FIIRE UNDERWRITERS I~.~ BUREAU OF ELECTRIqlT~ V 8S JOHN STREET, NEW yORK, NE~/ ~ORK 10031~ ~.,~ ,~*~. ~, ~ ~,,~.,,o..~o...~,,~ ~o~z~-~ ~o~z N 598595 THIS CERTIFIES THAT only the electrical equipment ~ ~scrlbed be~ and i~troduced by t~ applicant ~ed on t~ able application number in the premises c~les G. ~ttig, 600 8~h Dr. ~u~, b~ld', ~.Y. i~ the follo~ing locatlo~; ~ Basement ~ 1st FL ~ ~nd FI. Section Bloc~ Lo~ w~ examined on ~ ~ , 198~ and found to be in complian~'e w th the r~quirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS OUTLETS SWITCHES ME,CU.V FLUORESCENT VAnOR 2 8 2 2 DRYERS FURNACE MOTORS UNIT HEATERS MULTI-OUTLET SYSTEMS NO, OF FEET DIMMERS SERVICE DISCONNECT S E R : NO, Oi~ECR~,CONO OTHER APPARATUS: ~lectric ~ooa D~acers:l~l.5 K,W. OF cc, COND I C E NO OF HI-LEO' OF HI-LEG NO OF NEUTRALS Charles G. Rettig 20 Cottage Ave. Bayshore, N.Y., 11706 COF must not ~n any manner; return to the office of the Inspectoi MANAGER by their credentials. ' MANNER, '~ ~,'' I COMMEN~s F'I EIJD ~I N o t~ECT. ~)N ~ FOUNDATION (2nd) RONGH FRAME & ?LUMBING INSULATION PER N. Yo STATE ENERGY FINAL ADDITIONAL COMMENTS: Memorandum from.... BUILD1NG INSPECTORS OFFICE TOWN OF SOUTHOLD Tow~ HAUL, SOVT~IOLO, N. Y. 11971 I 1A/L. 765-1802 SURVEYED FOR:- ':"A,'.,q,~4z~ ~'. ~-=,~,e.'A ,<~..,~ETZ'."O LOCATED AT ,~,04.//~-~,_4<:~.Z2 SUFFOLK CO,, N.Y. SURVEYED /I~,E'c/-/ /.~, 1979 BY WILLIAM R. SIMMONS, JR. 150 BAYVIE~V AVE. EAST ISLIP, L L, N. Y. PAGE GRID FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To ~, ..~' ........... V.. PLEASE TAKE NOTICE that your application dated. ~qeC~.~V..(.~., 19 .~ for pe.it to construct.. ~'.~.. ~.. ~~ ~ e~A ~/ at cou,t~ ~ax ~ ~o. ~000 S,,tio~ ...~ :.~ .... ~o,~ ...~% ...... rot . ~MO ..... ~ ......... Filed Map No .............. Lot No. is returned herewith and disapproved on the follow~g grounds ~/J~. ~ .~~ RV 1/80 ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 ,,pprovad :.,. ..... , l Pe,mitSo.. (Building Iflspector) APPLICATION I~OR BUILDING PERMIT INSTRUCTIONS Date .................. [1 /l~- 19...~'C~ 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 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 describad. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulatio~llg~i~d to (Signature of applicant, or nme, ifa c~fporation) ~'(Mailing address~of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... ............................................................................. Name of owner of premises...C~.47.~-- .... .~ .~.~ .~..~ ............................................ (as on fie 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.. ~. ~, ~} I...~'~ I.:..~.C~ ~.'~. o ¢ Plumber's License No ......................... Electtician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done..~.~.~.,,tl'~... ~.. 5 I~klDI · -~"..nil,.. ,~ 9''~ ...... ...................... .................. House Number Street Hamlet I~) 0~0 County Tax Map No. 1000 Section ..... ~..-~...(-Q ...... Block .... ~..~. ......... Lot.. ~ ............ Subdivision ...... G.O. q5.5,.o~ .... /~i'P~Q-~ ..... FiledMap No..(. ~0..~ 3"' Lot....~...~ ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~(3~... Y~ .......... ,...~ ................................. b. Intended use and OCCUpancy . .~.OJ/B-~... ~2~... 0_.~ .~ 3. Nature of work (check which applicable): New Building .......... Addition . ~ ....... Alteration .......... Repair .............. Rem6val .............. Demolition .............. Other Work ............... 4. Estimated Cost .... ~..~.~. i~).i ......................... Fee ....... / ~ ........................ ! (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, co mercml or m~xegl occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structur0s, if any Front ............... Rear Depth Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth. ................... i,. Height ........ ~L ............ Number of Stories. 8. Dimensions of entire new constrUction: Front .... /. .......... Rear .... : ......... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... ~ ........... Rear ...................... Depth 10 /)ate of Purchase Name of Former Owner 11. Zone 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 . .~ ....................... Will excess fill be removed from premises: Yes i4. Nmne of Owner of premises ~.:.~4~-..~ .... Address ,~r*~q'k O .e.~..~. ~Phone No. 1~.~ ~,,4~. ...... Name of Architect .......... ~ ................. Address ........... .~p.~...~..0 .~hone No ................ Name of Contractor .'~,.~..i,_~.~.\v.o,~.~ ...... Address ~,~. [~e[[ll~,~,~[ ./.,~... Phone No. ~.-.~O. ~... , 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 ~umber or description according to deed, and show street names and indicate whether interior or corner lot. <K2~ O~o~ STATE OF NEW¥ORK~ , ~, COUNTY OF. 7~..~.+7. OL.g a.a ............ (,~h/~.~.S...~.~ .T~/~ ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .... ~ .................................................................... (Contractor, agent, corporate oi~ficer, etc.) of said owger or owners, and is dui3, 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 manne~ set forth in the application filed therewith. Sworn to before me this .......... .... ..... , ~otary Public, State~f New York . No. 52-4682750 .............. Quahfied in Suffo Co nty OCCUPANCY OR USE IS I~,]IA~FUL Wi~¥ C~iTt'iFICATE OF OCCII~:dCY iNSULAT, ~%T~UCTiON ~UST FINAL ' ~J' '~ g ~ FOK C.O. NTS u It F~ I:'o0"rllv~ ] /4 '- 0"