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Home My WebLink About10377-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No ....z.9.779. ........ Date ....... ~9.0.~.~.b. 97..? .............. 19.7.9 THIS CERTIFIES that the building ................................................ 166~ Albo. Drive. .......................... Lame. el.. N.Y. Location of Property ~s'o '~'d ...... Street Hamlet County Tax Map No. 1000 Section .... ~. 2.~. .... Block .... 0.~ ......... Lot ..... .0.~.~. ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... /~1~.~. 2./4. .... 19 7.9. pursuant to which Building Permit No ......... ! 05.7.7.Z. ...... dated ...~.Llg3~8~. ~.0. .............. 1979. , 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 ......... ............... ?.v.~.v. ,~.~.~., .~..~. ~..~.x.~, .~..~.%%.x.n~ ................................ The certificate is issued to Kei~h ..................... io¥,;~;, ~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .... 8./..2./4./.'7..9. .... 9.-..~.07.7.9. .................. UNDERWRITERS CERTIFICATE N Building Inspector Rev 4/79 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? ~0377 Z Permission is hereby granted to: /~ ................................................................................................. i ............. ~~_.:~ .... pursuant to application dated ....................................................... , 1c) ........ , and approved by the Building Inspector. BulldOg 'InspecTor 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: I, 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 end 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 featu res. 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. ,~.~-~/~'./i .Z..~'. ..... Building ..J~'~.,~....~..... Old or Pre-existing Building ............ Vacant Land ............. New Location of Property ................................................... House No. Street Ham/et Owner or Owners of Property ~...~.~'....~...~..%~ .................................. County Tax Map No. 1000 Section ,../.~Z'.~..~. Block .. ~.,/.~,~ ........ Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No,~..~.~. ~.~.. Date of Permit, . /4 . .? Applicant .................................. Dept. Approval ... ,(.~.?.._~3_~ .Labor Dept. Approval Health Underwriters Approval. ~...~. ~.~-.. ~. ,c~ ~;~ ..... Planning Board Approval ...................... Certificate . .~ ........... Request for Temporary Certificate ..................... Final Fee Submitte ........................... Construction on above describedApplicant ~' ·/'J~'~Y',~. · .~. · ,~.~, · .~?,~building and permit meets all appliq, able ~regulations. AD DITJc~K/AL ~onerete Gra~e ~labs Slab-on-Ground Construction: Perimeter Wall Foundation wood frarne 'I'7'~ insulation ~- reinforced or masonry/)(' R27 RI'-7 /concrefe slab wall_.__/ [x~ ~-~?; : ~ - ..:~T [ ~ I nth crushed ;fane- > ;%>" ~' '''~ 'z if used below frosf llne msulahon ,slab barrier .6" m~nimum InsulationMIn dwellings, insulation h to be of the rigid type and the following materials and minimum thicknesses are acceptable: Cellular glass enclosing sealed-in gas: -slab dipped, after cutting to size, in roofing molsfure pitch or asphalt; 2 indies thick for R1 barrier and 1t2. Use wire ties for attaching to masonry in a vertical position. fill (;lass fibers with plastic binder: dipped, after cutting to size, in roofing pitch or asphalt; % inch thick for RI and R2. Cane or wood fiberboards: dipped, ' after caring to size, in roofing pitch or asphalt to form heavy coat; ~ inch slab thick for RI, 25/~a inch for R2. rnohfure Hard cellular rubber enclosing sealed- barrier in gas: ~ inch thick for R1 and R2. fill For attaching to masonry in a vertical position, coat with asphalt or pitch or use cement keys or metal ties. (See also text entitled, "Concrete Slabs on Soil," part 3, page 10). ;nsdat;on .rnolsfure barrier fill CODE MANUAL I '-8" mtn. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ~ ....... , 1977 APPLICATION FOR BUILDING PERMIT Application No./~J-~. 7.2 ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in.ink 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 m buildings for necessary inspections. ~' ....... (Signature o~appiicanr, o a , ' p ' ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elegtrician, plumber c~.bUilde~) I .~ ..~'kt..~..-f..c..-:2ry...~M.. ..... 7//.t~,....'-.M. ................................ ,1' ' ',~ ....... '(/'. ....: ........... (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..~..d? .C)..~?../.~...~.~. ...... Plumber's License No. ~ j~,- ~Z~ Electrician's License No...Z/..C~ .~...~.-..Z ........ Other Trade's License No ..................... ---~/-/~/-~ 1. Location of land on which proposeS work will be done..~Z~....~..~..'~..~....~.,'~.~.~). 7/~'/ ~'~'/~ ~-ff~' · ..... ..................................................... House Number Hamlet County Tax Map No. 1000 Section : ................. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~sting use and occupancy ....... /~.,~ ........................................................ b. Intended use and occupancy ~E~ ~'~ 3. Nature of work (check which alSplicable): New Buildin .gCC., .~ ./.~ . . Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... , .~.~..~.~..~ ..-f. (Description) 4. Estimated Cost...~....~. ~ ........................ Fee ........................... (to be paid on filing this application) 5. If dwelling, number of dwellinglunits.. /. ........... Number of dwelling units on each floor ................ If garage, number of cars .... ; ..... ./. ............................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..... ].~. .......... .... Height ...................... Number of Stories ...................... 8. Dimensions of entire new const[uction: Front . .'~...~. ......... Rear ...'~..'~ ......... Depth .~../ ........... Height ............... Number of Stories ............... ~ ........................................ 9. Size of lot: Front ..../.~.O.. ! ............ Rear.· ~.q~.././a ............. Depth . ./.'t'/~.~/7../..~.-..O. ..... 10. Date of Purchase ..... /.~. ~. ~. ................. Name of Former Owner ........................ ; .... 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will' lot be regraded ?d~.. · · '.'.. ~..,, ........... ~,... Will excess fill be remov~d, from~pr~n~e~:] Yes Name of Architect ......... ! ................. Address ................... Phone No. Name,of Contractor~. ~tY/lt.~/-,-. ~¢r~ ess ~...~O"d ~ No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from umber or description according to deed, and show street names and indicate whether ' property lines. Give street and block interior or corner lot. STATE OF. NEW YORK, ' ~ couNw pF ...................... being duly sworn, deposes and says that he'is t;he"applicant (Name of individual sig~ing contract) above named. i (Contractor, agent, corporate officer, etc~) of said owner or owners, and is drily authorized to perform or have performed the said wprk'and to make and file this application; that all statements contained m th~s apphcat~on are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this i Notary Public, . .............. County r0slde~¢e will ~ ' 3356 Ho,,te ]l~ Medfo~d, L 1., N. Y. 11'763 SUFFOLK COUNTY DEPARTNENT 0F HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE _HS REF. NO. APPROVED MAP OF PROPERTY TOW. ~UARANT~D FILE NO ~ . the I~nihng institobon G-za,~.'~s am ~I transferable to addlbona! institulio.~ et DONALD J. -- SUCCESSOR TO,- ! RICHARD WILHELM AMI) ASSOCIATES LICElqSED LAND SURVEYORS CeWl:er A~riche,, Iq. Y. 1193a Brentwood, lq. Y. 11717 ~*u[e~enes U $. Standa~ ~onumen~* Shown Thus .... I ~b I" ~=~ ~ Sta~, Shown Thus ........... A