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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 : t~r~. ~ ~" ~ ~ . '1 ~ ~/~ ~ ~ ~/~ -"' ~DD ~L~IOD "~- A" '"' ' " " ' ~ ~". I ~" i~~" Je" ~ , Jot water dlstri~uting uAM  , )I , ~ , o~typesKorLonly GARRETT A. STRANG architect Main Road RO. Box 1412 Southold N.Y. 11971 516- 765 - 5455