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Home My WebLink About10525-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. 79973 Date Juue 11 ,19 80 THIS CERTIFIES that the building ................................................ Location of Property 780 Beebe Drive, Cutchogue, House No. Stre~ ....................... h~r~iei County Tax Map No. 1000 Section . .0.9.7. ....... Block . 9.7.. ........... Lot 0'1 'I Subdivision . . .~.O.O..8.e..C.O.y.e. ................ Fded Map No ......... Lot No. 'I ?_ conforms substantially to the Application for Building Permit heretofore filed in this office dated December 'I~ 19 .7.gpursuant to which Building Permit No. .10525.Z ............. d-?'* 'D~cember 18 al;ec~ ............................ 19.7.9, was issued, and c;n}orms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ....... O..n?.-.F.~, .m.i.l.y..Private. ~wel~J:.n..g. ?.J:.~.h. ?.~. ~.c.h.e.¢..fl.a.~.a..g~... ...... Karl & Dian Groblewski The certificate is issued to ..................... [o~n'e'r,'l~s'sde'~r't~a'n't) ..................... of the aforesaid building. Suffolk County Department of Health Approval .... ?-. ~,0.-.1. 1..6 ............................. UNDERWRITERS CERTIFICATE NO ..... .P.e.lq.d.* .rig. .................................... Rev 4~79 FO~-~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10525 Z Building Inspector, Fee $..~.. ~....~. ..... 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3, Copy of certificate of occupancy $1.00 $5.00 Date .... ~' ~ ............ New Bud ng ~ . .. Old or Pre-existing Building . Vacant Land . Location of Property .H~u.s~..N~o..~. . . . ~.~. ,I,~ t~. ~,¢. . . . .~.. ./'~.~ .... ~;'~' '~' ' '~ f'/' ' '~' ' ..............H~t~ie't Owner or Owners of Property ......................... ~ ........................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................ Filed Map No ........... Lot No .............. PormitNo. / "') ~'~""~' Date of Permit /.¢~/..~..Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. ~e~/~a¢t¢ ~a~l~ ~ ~ Construction on above described building an pp nd Applicant .............. 1020 GLENN ROAD SOUTHOLD, NEW YORK 11971 (516) 765-1335 Southold Buildina Department $outhol~,New york 11971 ~uno 10.19{~0 o Gentlemen; %~inds W~y Buil~{ing Corp. !ms just finish~ constructing a new hem® oa th~ East si4~ ef B~be i)rive in Cutchoque,N.y. Th~ property ~ home will be my new resi~enee~ aa~ it is my u~erstan~i~ that tko st~p bctw~ the ~inett~ are~ ~n~ th~ laundry ar~a ~mcee~s the h~i~ht allowe~ by ~e~. I,h~r~by~ r~l~as~ the town of Sout~ol~ a~,or the Town of Seuthol~ Building Dep~tm*mt frem m~$ r~spo~sibility for s~i~ st~p. Very truly year Karl Gr obl~wsk'~'~'2 PATRICIA M. THOMPSON NOTARY PUt;LI(;, St_~t~ of New york No, 52.4652331 Quahflcd in Suffol~ County Co~,~.lss~an ~.×p~ras March 30, THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy 85 JOHN STREET, NEW YORK, NEW yORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant nan~ed on the above application nunzber in the premises of K~r] Grob~awz[ci,e/s Beebe Dr. ~300~ s/o Antler Dr.,Cutcho~t~N.Y. in the folloroing location; ~ Basement .~.~e~,,,.,i.ed,,,, 3ttrte .5, 1980 ~ 1st FI. [~ 2nd FI. Section Block Lot and found to be in cornpliat~c~ with the r~ecluirements of this Board, FIXTURE FIXTURES RANGES OVENS DISH OUTLETS SWITCHES FLUORESCENT 21 19 DRYERS SYSTEN~S NO. OF FEET EXHAUST FANS OTHER APPARATUS: Notor~: i~-F t~GFC£ S E R V I C guland Elec. CO. Box 143 Mattl~uck,N.Y. 11952 TNs cerhflcate must not be altered in any ~anner; return to the office of the Board Lie.242 be idenhfied by credentials, ANY ~ F~ELD~INSPECTION FOUNDATZOM (~s~:) FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CO~E COMMENTS FINAL ADDITIONAL COMMEN?S: " FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . ./.~.. .... ,1977 Approved~. [..0~.. ..... 197~. Permit No./.~. ;~. ?...~. ~ (Building Inspector) -- APPLICATION FOR BUILDING PERMIT Date ......... ./.~./.~. ....19).~. INSTRUCTIONS a. This application must be completely filled in by typewriter or injnk and submitted in triplicate 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 issue 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 described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. ~ ..... ....... (Signature of~pplicant, or name, ffa cogporatzon) .... .... (Mailing address of applicant) State whether applicant is ow~r, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ...... ^ ................................................... Name of owner oSpremises./(/~1/~..~.. ~./.~' .~...5)/g~.t~./~=']t¢/~l.~ ·r ..................................... (as on the tax roll or latest deed) If applicant~2%a corporation, signature of duly authorized officer. _ (Name and title of corporate officer) Builder's License No .......................... Plumber's License No. ~. ,~'. ff~./~..../f?/~/.~.~.~/Rt¢'~'''~' Electrician's License No.../.~...t .~./q"~..O..~.~'~. 4~'./{.~Yc ~, Other Trade's License No ...................... 1. Location of land on which proposed work will be done.... ~/a+¢..~. ~./'~O ~./~&,-~.~;~.~Ot.f~./r~.. ............. 7 ............................................... .......... House Number Street Hamlet County Tax Map No. I000 Section .... '6~'. ~'7 ........ Block ....0.7 ............ Lot...C3./../. ............ Subdivision .//~.O. {~/.,~..~ .~.~.~.. .................. Filed Map No ............... Lot / (Name) 2. State existing use and °ccupancy °f premises and intend~s~ ~d °ccupancy °f pr°p°sed c°nstructi°n' a. Existing use and occupancy .... ~' .~..~% ......................................... b. Intended use and occupancy ...~.~..~...~..,'/~~ ................................................. 3. Na re o ork (check which a cable): New Building ....... Addition ................ Repair .............. Removal .............. Demolition .............. Other Work ............... ' (De ipti 4. Estimated Cost.... . .......~ ...... ...... ... Fe . . ........................ I (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, spec~y nature and extent of each type of use ..................... 7. D~ensfons of existing st~ctur~s, ifany: Front ............... Rear .............. Depth ............... Height ............... Number of Sto~es ........................................................ D~ensions of same structure ~ith alterations or additions: Front ................. Rear .................. Depth ................... ~... Heig~ ...................... Number of Stories . . , ~ I . Height ...... ~ ........ N, um~er of Stones .... ~ .......... x ................. ~. ~ .............. 9. Size of lot. Front ..... /6.~.t.%'.~ ....... Rear ..... ]~, .G .......... ~epth .. J ..... . .............. 10. Date of Purchase .~...~..'O ~ ............... Name of Former Owner ~.~.l..~L~.]~.~ ........ 11. Zone or use district in which premises are situated...'~ ................... ji.b ........................... 12. Does proposed construction viplate any zoning law, ordinance or regulation: . .,r .......................... 13. Will l°t be regraded ... ~.~ ....... ~ ......... 6 · · Will excess fill be removed from premises: Yes, 14. N~e of Owner of premises ~.~,'~ ~.~l.~&~. Address ~ ~. ~9~.q ~. ...... Phone No. ~ ~.~Z ~ .~ ~... Name'of Architect . t~ ....... . .................. Addres~ ........... ~ ....... Phone No ................ N~e'of Contractor ~,.N~.t.~-- / ~.. Addr~ss~ .~ ]~.~ ~t~.. Phone N~6~../~... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW coum¥ s.s ............ ~ ~ ~ ~.' .~ [ ~ ~. Q~ ~ .......... being duly sworn, deposes ~d says that he is the applicant (Name of individual sig~ing contract) above named. He is the ............... ~~ ........................................................ (Contractor, agent, corporate officer, etc.) of s~d owner or owners, ~d is drily authorized to perform or have perfomed the said work and to m~e and file ~is application; that ail statements contained ~ this application are true to the best of his knowledge and belief; ~d that the work will be perfo~ed in the m~r er set forth ~ the application filed therewith. Sworn to before me this . .... /.~.~,~'~/ ...... :,. ,da~ .... ~ 19 .~ Notary Ptlblic, State of ~ew Yo~ ' n ount ~ ~ [~gnaiure o~ appucant) , ~0, ~Z0~449~3 Suflol,k C 00mmlaaton Expires Marc~ 2~ ;-4 / !, 17 t The sewage RODERICK VAN .T~UYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK sUFFOLK CO HEALTH DEPT. APPROVAL H S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS fOR THIS RESIDENCE Will CONFORM TO the STANDARDS Of THE SUFFOLK CO. DEPT Of HEALTH SERVtCES. (s} APPLICANT SUFFOLK COUNTY dEPT OF HEalth SERVICES - FOR APPROVAL OF CONSTRUCTION ONLY DATE h. S. REF. NO APPROVED SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. OWNERS ADDRESS' DEED: l.~t TEST HOLE STAMP SEAL ...................................... THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS For This RESIDENCE WILL ' CON FO R m ~T~ ~ ~ n ~R ~ ~F~ H E :~ SUFFOLK COUNTY Hi ~. ~EEF-NO.. NO. - .. , ~ APPROVED. ..... TEST HOLE sTAMP ! ............. ..... VAN TUYL, P~C, ON ° E. L.. E W A'F I.ON° {' i OU i '41 -i 0 P, ,CP, 0 ",/' A ? 0 lX