HomeMy WebLinkAbout12148-zFORM NO. 4
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Zd595~ Date .: .................. 19
THIS CERTIFIES that the building ..... ?.~.d...~.~.q~.y, .~.d.d..i.-b.i.q~. ~ ....................
Location of Property .,.. ~35 ............ .C.a.m.pi ~n..e9.1.~' . .R.d.. ...........FI.~.~.~..5.~.u. qk....
~ou~e No. Street Hamlet
County Tax Map No. 1000 Section ..... '1.2.3 .... Block .......... .5....Lot ....... .2.~ ........
Subdivision ............. ~ ................. Flied Map No .... .~.,..Lot No ....... .~. .....
conforms substantially to the Application for Building Permit heretofore filed in this office dated
...... ?~brua~.y..q .... 19~33. pursuant to which Building Permit No ..... ! .2.'l.~.~.Z. ..........
dated ...... ~.e.~.~..g.~TX .9 .......... 19~. 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 .........
.... 2~ .~t ~.. ~¢~'~$9.n..~.o..e.x. 5..s.~.5.n.~. ¢.w.e.~..1.5.n.g: ............................
The certificate is issued to ...... J.O.~. ~... ,8~, JUDITH L .ll}l. CH .
" ' ?o',;,~,~ .....................
of the aforesaid building.
Suffolk County Department of Health Approval .................... ~T/~, ..................
UNDERWRITERS CERTIFICATE NO. NT05q 67
Building Inspector
Rev. 1/81
BUILDING
Pe ~r(nissio~ is hereby granted ~to:
(THIS PER/WIT MUST BE KEPT 0N :tHE ~R~i ~1',
COMPLETION OF ~H£ WOl~ AUTH~I~IZEI~)
;
at pYemise's
~3U1¢~ Tax Mop No. lO00 Sechon.
and: ~approved by the
FORM NO. 6
TOWN OF SOUTHOI;D
Building 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 ~1111~ 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 sewerag~ 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.
B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing"
land uses:
1. Accurate survey of p~'operty 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
$15.00
4.Vacant Land C.O. $5.00
Date
.............
New Building .: ........... Old or Pre-existing Building ... Vacant Land .............
Location of Property . .~.~...~... .... ~)..'~..z~......'~..~..'~.~.°. ,ff.~4. ............................
House No. Street Hamlet
Owner or Owners of Property ............................................................
CountyTax Map No, lO00$ection .............. Block .. ~ ~' Lot.
Subdivision ............................... Filed Map No ........... Lot No ..............
PermitNo ~'~\q~= DateofPermit<,~)~'~ Applicant
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ....................... Planning Boar royal ......................
Request for Temporary Certificate ..................... Final ~ertificate .......................
Fee Submitted $....~...~...., .~...c?...~..~..7~.~.
Construction on above described building and permit("~ ,/fi/_. ,~ ~me-e'~l appllcable~_~des and regulations.
Rev, 10-10-78
~OMMENTS ~-
FIELD I~qSP~]TION
1.
FOUNDATION (1st)
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION FER N.
STATE ENERGY
q,ODE
FINAL
ADDITIONAL COMMENTS:
I'v~ ATT ITU ¢ I~" '
THE NEW YORK BOARD OFf FIRE UNDERWRITERS
BUREAU OF ELEC'~RI~ITY
85 JOHN STREET, NEW YORK,!NE~W YORK 10038
only the e~trieal equipment ~ describ~ below and int~uc~ ~y t~ eppli~t ~mm~ on t~ able appllcatio~ ~umber in the p~mlses of
John Lynch, Re~ve Ave., off C~p ~eola Rd,, .0~attit~ck, ~JZ~
in the following location; ~ Basement ~ 1st FL ~ 2nd FI. garage S~otlon aiD& ~t
wusexaminedonA~Hg~ ~r3.98~ andfoandtobe~ncOmp~iancewlththerequirementsofthlsBoard.
FIXTUR~ FIXTURES RANGiS OVENS EXHAUST FANS
26 ?.5 26 26
DRYERS FURNACE MOTORS FUTURE
UNiT HEATERS i MULTI-OUTLET
SYSTEMS
NO. OF FEET
D/MMERS
¢ E
iApplication Received
Disapproval Issued Permit # .
19, .~ 19
FORM NO, lO
APPLICATION FOR DEVELOPMENT PERMIT
In the Town of Southold
Type of Development PrS>o~ed:
Addition and/or Alteration~
Other (specify)
~ew StrucBure (including storage tanks~]
Flood Proof Below Base Flood Elevation[]
2. ~ Elevation Data in relation to above mean sea level of:
(a) Lowest floor elevation, including basement ~ feet ~ inches
(b) In a V Zone, bottom of lowest structural member fee~-' inches
4. Owner of Premises /F · ~ ' --
~. Location of Property:
County Tax Map No., District, 1000, Section /Z: Block (p~-~ Lot(s).~.Z.~-
Subdivision '- Filed Map # ~ ' - Lot(s) ~
Pez~uission to be ?~Owner as aboveI INew Owner
l--I~rnder Contract]--]"Lessee ( t Contractor
Approval from other(s) before Permit is issued:
DEC /7/~
HEALTH SERVICE
WETLANDS (Town Board) ~ ....
ZBA
BUILDING PERMIT . , , , - PLANNING BOARD , , -,, ~
0wn~~"'0wne'~r Contract)~, Lesseel I, Agentl--~, Con-
tractor~, and egret'-to comply with all ~pplicable sections---of the Code
of the Town of Southold; Comuty, and s~ate and to admit authorized in-
spectors to premises authorized to perform or have performed the said
work and to make and file this application, that all statements contain-
ed in this application arc true to the best of my knowledge and belief
and that the work will be performed in the mannerset forth in the
STATE 0Fp~__
COUNTZ o __ss
SWORN TO TRIS / DAY OF ~ 19, ?)3
~y ~ublic
ELIZABETH A~N N~/LLE
~OrARY PU~LIC, State of/New
No. ~'812~8~0, Suffolk C~ ~.,
· Term E~e~ March 30,
Appl~c~t, s ma~llng
address ~d phone ~
if not given above:
4180
P.O. BOX 728
SOUTHOLD, NY
11971
FORM NO. ~0
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
(516) 765-1802
TOWN HALL
MAIN ROAD
SOUTHOLD, NY
A~PLICAT,ION FOR DEV$~0PME~.T PERMIT
I
Instructions: The application to the Building Inspector includes (each
in duplicate) 1. Fo~rm No. l0 filled out in ink or typewritten, 2. Sur-
vey of premises withlelevations above mean sea level, 3. Drawings of pro-
iposed work. The application must give complete information to show that
the proposed can comply to the Local Law No. 1-1980, Chapter 46 of the
Code of the Town of Southold known as "Flood D~mage Prevention Law" of the
Town of Southold. The applicant must submit approvals that any.other
agency requires.
General Standards as required in Section 46-17 of the law to minimize flood
~amage:
:A. Anchoring of structures, including tanks and mobile homes
B. Use of consthuction material and methods
C. Design and 16cation of utilities
D. Su dlvlsmon proposal with drainage, public utilities design and
base flood elevations
.Specific Standards aL required in Section 46-18r
A. Residential $onstruction
B. Non-residential construction
C. Mobile homes i
The iapplicant must s~bmit plans and specifications as well as any other
information requested by the Building Inspector to substantiate the facts
that the structure has or will have the lowest floor, including basement/
cellar, elevate.d abo~e the base flood ~elevation or; if per~nitted by the
Federal Regulatmon, that: 1. such structure is flood proofed in such
manner that below the base flood level the structure is water tight with
walls substantially ~nd impeEneable to the passage of watei% 2. that
structural components are capable to resisting hydrostatic and hydrodynamic
loads and effects of!buoyancy, 3. applicant must sub~it certification by
a regi?tered profess$onal engineer or architect that the standards set
forth in Section 46-18B (1) (2) (3) of the Southold Code are sati e '
~ . sfid.
.Coas.ta~.l H.i.~h Ha.zza~d are_a.a (V Zone) 46-19. Applicant shall submit plans,
specmrmca~mons mnc-uding the required certifications and such other in-
formation as the Building Inspector may require in that ~he provisions of
46-19 are complied with. Mobile homes are prohibited. The lowest portion
of the structural me,bets of the lowest floor cannot be lower than the
base flood elevation Iwith all space below open except breakaway walls.
~and dunes. If sand ldunes exist on the premises and the applicant pro-
poses t° alter same, !plans and specification must be shown in detailed
nature of any altera$ion submitted.
~u~ld~n~ Permit. A Sumldtng permit is also required for any structure.
Both a Development and ~ Building Permit must be issued before any work
can start in a special flood hazzard zone. A written disapproval or a
permit must be issued within ten (10) working days.
During construction, ~ithe inspector shall be notified in time so he may
make the required inspections.
Upon completion, the irequired certification fo the final elevations and
work must be submitted before the approval to use or occupy can be
approved.
(Fill 8ut the form on the back of this sheet)
4/8o
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
Examined . .~..~-.'~....? ...... , 19 .ocT.-~ Application No..../.~./..~:'..~.. ......
ipproved.--/.. .... ......
Disapproved a/c ~~~ . '2~ ........ ~ ........
~ APPLIOATION FOB BUILDINg PEB~IT
Date ......- ~.~ , ~9 ~
· ..........
a. T~s application m~t be completely filled ~ by typewriter or in ink and submitted to the Bulldog Inspector, ~th 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot pl~ showing location of lot and of build~gs on premises, relationship to adjoining premises or public streets
or ~eas, and giv~g a det~led descrip~on of layout of prope~ must be drawn on the diagram which is pa~ of this appli-
cation.
c. The work covered by tNs application may not be commenced before issu~ce of BuildNg Permit.
d. Upon approval of this application, the Building Inspector will issued a Bulldog Pe~it to the app~c~t. Such permit
sh~l be kept on the premises available for ~spection ~rou~out the work.
e. No build~g shall be occupied or used in whole or N p~t for any PurPose whatever ~til a CeNificate of Occup~cy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the BuildNg Dep~ment for the issu~ce of a B~lding Pe~it pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, N~w York, ~d other applicable Laws, OrdN~ces or
Regulations, for the construction of b~d~gs, additions or alterations, or for removal or demolition, as ~erein described.
~e app~eant agrees to comply with ~l applicable laws, ordinances, bnild~g code, housing code, and reg~ations, and to
admit authorized inspecto~ on premises and ~ bulldog for necess~ inspec!ions~~~
(Signature iff applic~h ~me, if a corporation)
State whether applicant is owner, lessee, agent, architect, engineer, general 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 ..... ~... ~t~.Z .~. ..........
Electrician's License No. ff./.Ff~ .............
Other Trade's License No ......................
1. Location of land on which proposed work will be done .... j~..~.. .... ~ · .~..~..~.~..
House Number ~'~~' Street Hamlet
County Tax Map No. 1000 Section ... I~..~. ........ Block .... :~. ~ ....... Lot .... ~. ........
Subdivision ..................................... Filed Map No ............... Lot ............... (Name)
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 ........ / .... .~....~. ~ .~./~. · ....... ~...4..~...~..~.. ................
3. Nature of work (check which applicable): New Building .......... Addition .......... AlterationS.. ........
Repair .............. RemOval ......... .:... Demolition .............. Other Work ...............
4. Estimated Cost .................... 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, commercial or mixed occupancy, specify. Aaature and extent of each type of use .....................
7. Dimensions of existing stmcture~, if any: Front .......... ~.W Rear .. ~.~ ....... Depth. ~g.~. .........
Height ............... Number of Stories .......... ~ ................................ ~..
Dimensions of same stm_ cture with alterations or_ad~t.ions: Front . .~..~]~ ........... Rear . .~ ............
Depth ........ .~. ....... .. Height .... ~.. ~. f..~.. ~ ....... Number of Stories.. ,~ ..................
8. Dimensions o_f e~t~re n, ew~construction: Front...~..~ ........ Rear..~ ~. ........ Depth .. ~ ........
Height ...~.~.~....~..'~.. Number of Stories ... ~. ............................... ~, .................
9. Size of lot: Front ....... ~'.=~}; ._ ......... Rear ..... .~.~. ............ Depth ..... ~.~ .............
10. Date of Purchase ..... .P..~.'~.I~I~ ................ Name of Former Qwner . .~. ~/.~fi~ ,~l~t~ ~. ~. ........
11. Zone or use district in which pr~mises are situated... ~.~.~ !..~al~'~a~..~. ~. ~. ............................
12. Does proposed construction violate any zoning law, ordinance or regulation' ~.O. ......
13. Will lot be regraded ......... i.~ ................ Will excess/ill be r~moved from premises: Yes
14. Name of Owner of premises .~.1~¢~r Address .~.R'aa~[/'~2a..~.. Phono~,,~.~.~
Narne of Contractor ......... : ................. Address ................... Phone No ........... .~'.~.~
PLOT DIAGRAM
Locate clearly and distinctly all ibuildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block humber or description according to deed, and show street names and indicate whether
interior or corner lot. SLo_~ ~ -~ ~ u r ~
STATE OF NEW.,yOI~/~,a S S
COUNTY OF.. ~-~. ~....~"~. ..... ~ '
............ . ........... being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
He is the ............... ~ .....
' (Contractor, agent, corporate officer, etc.)
of said owner or owners, and is dul~ authorized to perform or have performedthe 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 leith in the application filed therewith.
Sworn to before me this
Nota~ . County'
............................
~o. ~.8~2~s , ou,a~ (Signature of applicant)
ii
III
- i'-1
-FD L~ ~ BhC~ ~ O~
76~1~'h~ 0 AM 'FO 4 PM FOR THE
1, ~OHIF ' IgH - TWO REQUIRED
GARRETT A1 STRANG
architect
Main Fload P.O. Box 1412 $outhold N.Y. 11971
516- 765 - 5455
7
GARRETT A. STRANG
Brahitect
Main Road RO. Box 1412 Southold N.Y. 11971
516- 765 - 5455
GARRETT A. STRANG wwm~
Main Road PlOl BOX1412 Southold N,Y, 11971 ~A~ ~.~.~ ~ov. /smez~ ~o~ ~o~
GARRETT A. STRANG
Brchitect
Main Road P.O. Box 1412 Southold N.Y. 11971
516- 765 - 5455
DATE
516- 765 - 5455
. ,.. ...... ,.. ,i .. .~ .....
GARRETT A, STRANG
architect
Main Road P.O. Box 1412 Southold N.Y. 11971
516- 765 - 5455
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GARRETT A. STRANG
architect
Main Road RO. Box 1412 Southold N.Y. 11971
516- 765 - 5455