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Home My WebLink About10432-z l~O~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN 'GLE~RK'S OFFICE SOUTHOLD, ~. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10432 Z Building Inspector. Fee $. .. FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall $outhold, 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 featu res. 2. Final approval of Health Dept, of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrmal 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 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. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 .... Date I /. ................... New Building ............. Old or Pre-existing Building ............ Vacant Land Location of Property.. ,~: ~).d..~...~..., .~..f.'., .¢~.-~..,, ..~...~.t ............. . .~..~,..~.~..~.~.~.../~.~... House No. Street Hamlet Owner or Owners of Property /I,~/~.j ~ ~ -~ //'~-e-/5-~ ~ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. '/.0. ~. ~..)m . Date of Permit .~i .~.~?.~.~'...Applicant..../~..~ .................. Health Dept. Approval .., ....~.,-~. ,o..~. ?., ~ ....... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Cerl;ificate ..................... Final Certificate ....................... Fee Submitted $ ..................... Construction on above described building and~ts all applicable codes and regulations. THE NEW YORK BOARD OF FARE UNDERWRITERS ~-- ~3'[~[ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW '~ORK 1003's -.~ bec. e>~ar /.7~ i~Y9 ~,c~.oa~o.o~/,~ 050353 N THIS CERTIFIES THAT only the electrical equipment ~ ~scribed below artd introduced by t~ applicant ~ed on t~ above application number in the premises of W~i.Llam ~iuath~ So~dv:L~w Ave~ ~ Sal~ai~e Way~ in ~he follo~i~g location; ~ ~ase~nl ~ 1st FI. ~ 2nd FI, Section ~lock Lot ~as examined on ~ce~b ~f ~ ,. ~ ,~ 9 / ~ and ~ound to be in complla~ce with the r~quirements of tbis B~ard. FIXTURE FIXTURES OUTLETS SWITCHES FLUORESCENT i5 26 1~ t5 DRYERS FURNACE MOTORS VAPOR FUTURE APPLIANCE FEEDERS OVENS EXHAUST FANS IME ~LOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS S E R OF CC COND 2/0 V I C E NO OF HI LEG A W G NO OF NEUTRALS A W G OF HI-LEG OF NEUTRAL ?./o l~$moke Datector Lite Thru certificate must not be altered return to the office of the Board if ~ GENERAl. MANAGER COUNTY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES DAVID HARRIS, M.D., M.P.H. The attached approval wes issued subject to the notation contained below our approval st~,~. Would ysu please type the follo,,~g condition of app,-oval on the fS~al C of 0 as tlLis ~:i~l ~nsure that any future owner ;~ll be made aware of the nitrate problem. '~rivate we!l. with high nit.a~es - see Health Department note on f~[al survey. (516) 727-4700 COMMISSION Set~ A. Hubbard Chairman Lee E, Koppelm.~n D/rector ot Plannm9 Su££olk Count7 Department JOHN V.N. KLEIN, County Executive Veterans Memorial Highway Hauppauge, L. L, N. Y. 979-2918 11787 Town of Southold Board of Appeals October 5, 1979 Pursuant to the requirements of Sections 1323 to 1332 of the Suffolk County Charter, the following applications which have been referred to the Suffolk County Planning Commission are considered to be a matter for local determination. A decision of local determination should not be construed as either an approval or a disapproval. Applicant Municipal File Number Joan Keinath New York Telephone Co. New York Telephone Co. 2593 2596 2597 GGN:jk Very truly yours, Lee E. Koppelman Director of Planning CHIEF PLANNER 5 L d FO~ ~0. 3 TO~VI~ OF 50UTHOLD BUILDI~IG D E PAP, TM EI'~IT TOWN CLERK'S OFI~ICE sOUTHOLD, FI. Y. NOTICE OF DISAPPROVAL TOWN OF SOUTHO~.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×omined 6/Z.L...?. .................. , '~.:~ ^pp,eot,on No. /..<Zy.J~ ........... Approvedxl~K....'f-rr~..'~'/P~ ....... ~.. ................... , l'Z~. Permit No., .~.~...'.~....~..~......~... ..... D,sopp:ov;¢. ,/, ...................................... : .......................... ................... ................... -¢~-- "/ ~ Dote ........... ~..../.......~: ........... , INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Eee accordiDg 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 ofproperty must be drawn on the diagram which is part of this application. 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 o 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. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ~..~..:..~...*.~¢.~..~.~ ....................................................................................................................................... Name of owner of premises ./~.(.¢,.~;./.¢J.~...~......~...o...A:..~... ........ L(.'.¢..( .Z~....~...~.../.~. ...................................................................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............. ..?.....~....~... ....................... Plumber's License No ........ ~..-...'.~..Z ........................ Electrician's License No ..... .~./.....~...~..::'...~'E'. ................ Other Trade's License No ............................................... Locahon of land on which proposed work will be done. M~p No.' ..~..~....O..~..~.. ................... Lot No Street and Nu be ......... ~, ................ i~).....~.. ............................................................ ZY} ....... /..~.J ................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exisiting use and occupancy ................. ~ ................................................................................. b. Intended use and occupancy ....................................... ~..~... ................................................................................... 3. Nat0re of work (check which, applicable): New Buifd~ng ...... ~ ..... Addition .................. Alteration .............. Repair .................. Removal! .................. Demolition ........ ~. ........... Other Work ................................................ ' ,.~..M~.y ~-' ~ (Description) 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 nature and extbnt of.each type of use ............................ 7 Dimensions of ex~stmg structgres, if any: Front ........................... Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. D~mens]ons of same structure w~th alterahons or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ............~";'7": ......... 8. Dimensions of entire new cohstruchon' Front ..... ~,.f ........................ Rear ....... ~ ............ Depth ...... ~'. ................ Height .....~..~ ........... Numbe[ of Stones ..................~ .............................. ~ ................................................................... ~ Date of P~e .~.....~...~ ....................................... Name of Former Owner ~.~.o.~a.~......~.~?r~..~.~. .... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction [elate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from premises: ( ' ) Yes ( ) No 14 Name of Owner of premises ~ ~.,..~.~.~..J~.~.(~.~.Z.~ Address ,&4./F.?,.:7,L.(..~;..,~.....'~... Phone No.~.~.g.~ Na4~e of Architect ......................................................... Address ................................ .Phone No ....................... Na~e of Contractor ....... ..... m'....':;~ ............. :..:...:...; .................... Address ...... ~ ........ ~. ............... Phone No. ' PLOT DIAGRAM .~" Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-~ck dimensions from property I nas Gwe street and bi'ack number or description according to deed, and show Street names and indicate whether interior or corner STATE OF NEW,,%ORK~ COUNTY, OF ~-- ~ '-- ~' (Name of individual si~ning dontracf) being duly?;vorn, deposes and soys that he ~s the applicam above named. , He is the ........................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du., y author zed to perform~,or have performed the said work and to make and file th.s application; that all s~tefr~o[~il~9~in t~s~qBp.¥~[ion ar~ct~'(e,~to the best of his knowledge in,d bellef; and that the work will be perfo-'~med in'the manner s~t fo"r~ in the application :l~l'ed therewith. of opplicant) BABETTE C, NOTARY PUBLIC, State of N'ew York Suffolk County No, $24~?,92800 ~ * Comrnfs.,~i~n E×p~e~ M~:ch 30, ,,1¢ ' 10 nov/ or f°rmerly F. KrupSl(I 00' High Nitrates - Water not to be used for pre,paration of baby formula or consumption by in~fants under 6 mos. of age. & ?0' Sorvla~$ HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT w NEAREST WATER iAIN NI -+ WSOURCE OF WATER PRIVATE~_/PUBLIC__ ADDRESS TEL · = MONUMENT SURVEY;FOR JOAN KEINATH AT MATTITUCK TOWN QF SOUTHOLD SUFFOLK COUNTY, NEW YORK DATE SCALE NO DEC 19,1979 JUNE 21,1979 JUNE 8,1979 1"=50' 79-302 N.UNAUTHORIZED ALTERATION OR ADOPTION TO THIS SURVEY~ I$ A VIOLATION OF SECTION 7209 OF THE NEW ¥O~K ~TATE EDUCATION LAW HCOPIES O~ THIS SURVEY NOT BEARING THE LAND SURVE~OR'~ INKED SEAL'OR EMBOSSED SEAL SHALL NOT BE;CO~SIOEREO TO ~E A VALID TRU~ COPY m~X~STm~ ST~UCrU~ ~[rO~ AS~ECmC PURPOSE AND ARE NOT ~O BE USED TO ESTABLISH PROPERTY LINES OR FOR THE ERECTION ~ FENCES q/YOUNG YOUNG ALDEN WYOUNG~PROFESSIONAL ENGINEER ANOLANO SURVEYOR N Y.S UCENSE NO 12845 HOWARD WYOUNG, LAND SURVEYOR NYS LICENSE NO 45893 400 OSTRANDER AVENUE RIVERHEAD~ NEVI/ YORK wATF_R eL- ,, 5.17 10 *,o or formerly F 00' LOAM & 70' SUFFOLK COUNTY DEPANTI~ENT OF NEALTH ~EEVIgES FOR APPROVAL OF CONSTRUCTION ONLY DATE ~4 d~/?/ HS REF. N0. APPROVED ~ ~ ~ HEALTH DEPARTMENT-OATA FOR A~PROVAL TO CONSTRUCT # NEAREGT WATER mAIN~MI -+ R SOURC~,~F WATER PRIVATE _.~_/PUBLIC __ N SUFF CO, TAX MAP DiST IOO0 SECIION ~ BLOCK '~ LOT I s, XTHERE ARE HO DW~ELLINGS WITHIN t~O FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON H THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RES1 WILL CONFORJI~ TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH VICES m = MONUMENT ~ TH~ LOCATION OF WIlL(W), SEPTIC TANK(STi~ CESSPOOLS{CPI SHOWN HEREON ARE FROM FIELO OBSERVATIONS AND OR DA~I'A OBTAINED FROM OTHERS S U RVEy: FOR dOAN KEINATH AT MATTITUCK TOWN OF SOUTHOLD sur oc cou. WU~U~HO~IZEO ALTERATION OR AODITION m mis SUR~Ey ~ VIOLATION ~SECTION 7~09 OF THE NEW YORK ~TATE EOUCAT[ON LAW MCOPI~S ~ ~HIS SURVEy NOT BEAR~G THE LAND SURVE~OR'~ iNKED SEAL'OR EMBOSSED SEAL SHALL NOT BE COnsidERED TO BEAVALID TRUE COPY WGUAR~NT~ES INDICATED HEREON ~ALL RUN ~LY ~ THE~SO~ FO~ WHOM THE $U~EY IS PREPARED AND ~' HIS[ BEHALF ~ ~HE TITLE COMPANY, GOV~N- MENTA~ A~NCY AND LE~OING INSTITUTION LISTED HERE~ A~ tO THE ASS)GHEES OF THE LENDING INSTiTUTI~ GUARANTEE~ ARE NOT T~SFERAaLE TO AOOJTIO~AL INSTITUTIONS OR SUBSEQUENT ~OIST~C~S SHOWN HE~,EON FROM PROPERTY LINES ", OUNG a YOUNG ANDLAND SURVE~ )Rt Y_S UCENSE~ HOWARD WYOUNG, LAND SURVEYOR NYS, LICENSE NO 4589B dUNE 21,1979 DATE dUNE 8,1979 SCALE I"= 50' NO, 79~302 4000STRANDER AVENUE RIVERHEAO, NEW YORK ALD~EN W YOUNG, PROFESSIONAL E~/GINEER AND~LAND SURVEYOR N Y_S UCENSE 'NO 1284§