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' '~
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