HomeMy WebLinkAbout10437-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N,Y.
Certificate Of Occupancy
No..Z992,9 ........... : Date .~ ....... .A,p.l:.i.1...2.~# ............. ,19 Il.0.
THIS CERTIFIES that the building ..............................................
Location of Property 7645 Bridge Lane .......
House No, Street Ham/et
County Tax Map No. 1000 Section ...8.4 ........ Block . .,], ............ Lot .. 6~ ...........
Subdivision .l~.y],~,~..e~. ~iltt;~ta~ ............ Filed Map No.. 639.0..Lot No. 2, ...........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
October 4 t , 197.9.. pursuant to which Building Permit No. 1043721
dated ...O.~?.°.b?.r..1..0 ! ............. 19.79., 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 .........
............... .
The certificate is issued to Raymonct anrl Diane Kl~k
[o~'n'e'r,'l~$'sde'~r't~a'nt) .............
of the aforesmd building.
Sufiblk County Department of Health Approval . .$.~..-$.O?..'7~. ~.t~ti~ft. ~:g'~ll . 11#..J.91ilD ......
UNDERWRITERS CERTIFICATE NO....N. 4..6.6.3.0.8. ......................................
Rev 4/79
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTH'OLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
No. 10437 Z
Permission is hereby granted to:
.......... .~ zC~. z .~1..~.....~, .C.. .........................
... ,,',~ ~ ...(.,-M/~e .x~,~ .....
~o...¢.o..~.~-;~.~c.,T.... ~ ./,,~:......~.~.~.~ ~-7 ...~.~-,~,,~ ..................................................
et premises located at'~.,~.ff~(~.......~;~id.~.~T.-./J~..~.-..C.~.~-e~/~Cgc~¢.~_.--~4,./...~ .....
.~Z~...~~ ........... ..~....d.~o ......................... /.."z'" ...... &. .....................
pursuant to application dated .....~.~.C;e'~'~.~......~r. ............... , 19'~.?..., and approved by the
Building Inspector.
Fee $.~.~.f.. ..............
t~U~lamg spector
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-180;3
ExammedOg'-~...[..O...r.., 197.
ApprovedOC.. ../.o. ..... 197 ,ermit No.
................................
(Bu~ing Inspector)
~PPLIC~IIO~ FO~ BHIk~I~G P~ll
Application No./~.~..~..'~.. Z ......
Date .O..c?/.--7...~.. ...... , 197.?
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 tot 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.
....2.~.0..~. ,..~! .C, ..............................
(Signature of applicant, or name, if a corporation)
299..M.:l,.r~ .rpl fl..t,..P, or.t..J, eATt.er.~ ora..a.t~ ,. 31.,,Y,
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................. ~.IDD~ .~ .......................................................
Name of owner of premises . Ra~rl~.orkcl. ~B.d..D.. $¢r~.0..~Pl~J< ..............................................
(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. .836P .................
Electrician's License No ...... .9.11E ..........
Other Trade's License No ......................
1. Location of land on which proposed work will be done. lde.st, s£de. Br.!ltge..[a~e. 21[19...7.0 ! .North ......
74. ff.~.., of. x ladle...Rd.. ................................ 0. utchogue ............................
House Number Street Hamlet
County Tax Map No. 1000 Section ..... .~[t .......... Block . .1 ............... Lot.. 6.~2- .............
Subdivision. Iq sC..a£. $.y.lore.g. ~ags.to-q ......... Filed Map No. . .6~90 ....... Lot ·..2 ...........
(Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........ smd iT. &and .................................................
b. Intended use and occupancy construction of a one family dwelling
3. Nature of work (check which applicable): New Building .... :Ir .....Addition .......... Alteration ..........
Repair .............. RemoVal .............. Demolition .............. Other Work ...............
4. Estimated Cost ..... $17.,.000j ......................... Fe ............................
I (to be paid on filing this application)
5. If dwel!ing, number of dwelling finits., on.a ......... Number of dwelling units on each floor.., or~a ..........
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 stmcture~, 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 construction: Front ..... 40 !. · · ~ ·, · Rear . ~(~ ~. .......... Depth .. 28.' ..........
Height .. ~.2. ~. ......... Number of Stories ..... QO.o ................................................
9. Size of lot: Front . .~50! .... ; .......... Rear .... 3~0! ............. Depth ..... 2.9.11 ............
10. Date of Purchase ...8/1.~/7.81 .......... . ........ Name of Former Owner .............................
11. Zone or use dmt tmwinchpre ~sesaes~tuated...~e,s.Lde~Lal .....................................
12. Does proposed construction violate any zoning law, ordinance or regulation: . .no ............................
13. Will lot be regraded · ·. Y.. ~i ........... Will excess fill be removed from premises: Ye~s No
14. Name of Owner of premises .l~a~rm.o~ud..K:e. uk ..... Address Bo~:..l~D. M i:13, .R~l~hone No ................
Name of Architect Ecl .E~&okg off. ............. Address ................... Phone No ................
Name of Contractor ~x' ~ :tm .Tr~e., .............. Address 200. P~ In~.o} · g.g .... Phone No.7.3P. -0g30 ......
P~t Jeff. ta.
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 mmber or description according to deed, and show street names and indicate whethor
interior or corner lot.
SEE ATTACHED SURVEYS
STATE OF NEW Y~OP~. ,~ / o ~
COUNTY OF .~... :~"°
·. }~[k,X - C-~FX \ (,r I being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named.
...... .~.¢.; . . . . , . . . . . . . . . . . . , . . . . . . . . .~' , ..................
(Cohtractor, agent, corporate officer, etc.) ~
of sakl owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
apphcatlon;ithat a!lstatements contained in th~s application are true to the best of his knowledge and belief; and that the
work will bd performed in the manne~ set forth in the application filed therewith.
Sworn to b6fore me this
.................. day o~. .~..~ ..... , 19 .~./
Notary Public, ..~.
pub ia, State of. New - .~1
Notary ..-,~aaa~,'a SuffOlk Cou/ltY~]
County
(Signature of applicant)
,%45° 31' 30~'
>+ > 0
22? OILED
g BRIDGE LANE
TO ~
~ NYT 20 ~ NYT
EARTH PAVING
FORM NO. 6
TOWN OF SOUTHOLD
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 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 features.
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 Aprd 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-ex~sting dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date.. ,~..-'~../..~"...~,~. ~ .......
New Building ..... .~ ....... Old or Pre-existing Building ............ Vacant Land .............
Location of Property . . ?.. ~.~5..~ .T'.~.~.ge...~.a. qe. ..................... C.t~'[;C~o.~°~.,, .N · ¥ ........
House No. Street Hamlet
Owner or Owners of Property . . . .R.~ .~.o..~¢...a~, .~..D.J=et..~.e..~.~. ..............................
County Tax Map No. 1000 Section ..... .~ ........ Block .... ,'] .......... Lot ...... (~, 2 .......
Subdivision...S~.~OT'.e.'[; .]~.'b.~'~e,~ ............. Filed Map No .... ~3.90..Lot No .... 2 .........
Permit No. 1..0~.~.~..~... Date of Permit '[.O~/~,O./.?9.Applicant ....... ~.]~..T~NC ...............
Health Dept. Approval...¢ ,"T..~...~'.. ,-'?.7, ~., .Labor Dept. Approval ........................
Underwriters Approval ~..~.~'6.,,7. ?..~ ........ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .... . .~..,. ............
Fee Submitted $...~.~..~ ...................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant .~.~.~. i ,~,. ,'~-, ~.C-,:... , .~, ;~,..J~.. ~ ..............
Rev. lO-10-7a
~ THE NEW YORK BOARD OF FIRE UNDERWRITERS
' /' ~ BUREAU OF' ELECTR,ICI~rY ,
omix t~ electr~e~.~p~ent ~ ~s~e~4 ~w and ~ntr~u~ b~ the ~h~t,~ on t~ ~e appl~t~o~ ~umb~r m t~m~z of
Arjim,w/s Brxdge La.,1500' n/o M~ddle Rd.,Cu~dhogue,N,Y. ' ,
Januar-
i SW~TdHE$
11 28 13 11
DRYERS FURNACE MOTORS
1980
[ '] 2nd FL Seeti~u Dlock !~ ,,
FUTURE APPLIANCE
TIME CLOCKS
NO oF F~I~1
DIMMERS
SERVel
I-GFI
1-Smoke'Der>
fged,erS:t~2
12,1-3 8
4
Will3'fovd & Werner Elec,
104 LOregom Ave.
Medford,N.Y. I~763
This ~tifl¢ot~ must'r~t be altered n any manner, return to the office of the Boot'~
Lic. 9,11
f be dentifed by
~FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHO/D, N. Y.
NOTICE OF DISAPPROVAL
To ,a"_~/'~T .~].~. ~. ....... /..~.....6~...., ...............................
..~.~...~'.~_,~o.......~...: ................................
...... ......
PLEASE TAKE NOTICE that your application dated .... ~.~....~ ..];~. ................... , 19 ........
for p-e~n;~ ', ..... .:::tr"ct ~.'-...~....~....C~..~../~...~./~..~t the prem,se}s located at ...~.~..Z~..-~. .................
Mo~'.~./.~..~.O.../.....~'..~...~. ...... Block ...... ..~..../.. ............. Lot ~ ~', 2J i , , is
~,k, c~p~cI disapproved on the follow, ng ground~ ?~....~....E~.......~.~...O/./.~.(..~...~....''
Building Inspector
- _ - ZONED RESIDENCE q (J MAP OF SYLORET ESTATES
AREA OF PLOT t2.O 0I SO.FT
SU ,FOLK COUPI'PY HE!'LTtf DT'IPILRTPAL+N2 PROP 1EI FLOOR SG FT. JUNE 8, 1976 MAP N0.6390
R
PROF 2'E" FLOOR SO, FT. GRADE GRADE
DATL 'I�..._�-j_ 1��_ fi,. 7•. ' r17. -li_ r.So..:..T3 PROP BASEMENT 54. FT. i'nnEn. AS "'"n'm.
CO CRETE REO'D`'�,Ux,
PROP GARAGE SO FT. a2'MAY• DO
DATUM Asa✓Men o
THERE IS NO SURFACE WATER WITHIN
. . oua2 200 FEET OF THE PLOT 3" a•
- -- PITCH IH%I
4
49.5'
PIE
1°2 N 47040' 20"' E m a'
MAP-
291.341 0090
EXISTING-290.87' IOI.IS' 8 DIA
O DIA.
0 N TYPICAL PRECAST
a o z z SEPTIC TANK
O NO SCALE
° o $ TYPICAL PRECAST
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NO SCALE
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N F• ODIS,D.xA.l E.P C. D.
EXISTING-289 Y Z
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a" MAP- °a. UNITED STATES OF AMERICA-FARMERS HOME ADMIN.
3 COMMONWEALTH LAND TITLE INSURANCE CO.
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AASIM IryC. —1
FELLETY. MAP OF LAND LOCATED AT
J,..A
SUFFOLK COUNTY DEPT. OF HEALTH SERVICES b QT�pp p L pAND. EyT/SIIT Ig pgTa OCI CUTCHOGUE
FOR APPROVAL OF CONSTRUCTION ONLY THE EAJEMILI IIVI RE51DENCEAWILL DGONFORM ~Q
SYSDATE H.S.REF.NO. Tp THE STANDAR�g OF SUFFOLK COUNTY O TOWN OF �SOUTHOLD COUNTY OF SUFFOLK
APPROVED DEPARTMENT OF HEALTH SERVICES. Orr
1� SURVEYED FOR
Ol
ww<Onx. sINElmve —
V
N
DATE: 7- 2 3-79
T - NAIL O - PIPE Z 10= 30,
LICE — .91A3 SCALE
SU Y X LICENSED LAND SU VORS
- ETANE • - MONUMENT TEST HOLE LOCATION OF WATER UNE$ WELLS• 1000 B4 I 5,2 25 ROUTE 25
SFFTIC TANKS AND CESSPOCIS NOT GWIII El - nr_ J-FJLVAI- I_OCATION _ - 2-L4-80 ROCKY POINT, NV. 11778 M.,P No. 14931
nwr ccrT al.u_ .. - -_ __ - _ - __ - `---_ __- _- -
ZONED RESIDENCE MAP OF SYLORET ESTATES
AREA OF PLOT __d2,oOf SO.FT JUNE BL1976 MAP N0.6390
PROP 10 FLOOR SO. FT. "
PROP a FLOOR SO.FT. GRAM 11 GRADE .
PROP BASEMENT 90. FT Mxrv. WVER S ?mWw.. I 4PROP GARAGE $O. FT. AMAx. ^'��$: ,
DATUM Aji meo .
THERE IS NO SURFACE WATER WITHIN N '3 !'
.,_ 200 FEET OF THE PLOT. �� 3!
`v
TCH LAI/f
4 9.5'
°Z N 470 40' 200 Ea% MAP-
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EXISTING-ZVO.S7' 101.15f ,DID. 17 P
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EXISTING-2B➢.49' Z
pp 289.97' a 100.00, a GUARANTEED TO
a- MAP- °a. UNITED STATES OF AMERICA-FARMERS HOME ADMIN.
3 1 COMMONWEALTH LAND TITLE INSURANCE' CO.
w
NXM. Aax M '"` MAP OF LAND LOCATED AT
•6 COLLEGE ROAD
NFL° OP — Nv nna TaP=D9sD A
SUFFOLK COUNTY DEPT. OF HEALTH SERVICES UT Ems , zV ' TR1N Op CUTCH06UE -
FOR APPROVAL OF CONSTRUCTION ONLY TH ,y/pETE �SNU� P Y A��lpaFD $N � f'Q _
DATE H.S.REF.NO. I SSTTyypp LL M OF T �F O TOWN OF SdU'tH;dld COUNTY OF SUFFOLK ua
APPROVED AEPART ENT OF ALTH S RVI COUN O� 9URSEYED FOR
W.R. SISnAIw
DATE, 7- 23-79 ;S
G EE&EMED
E U Q Z scALE: 1�'=30' dT - NAIL a - RIVE LJAND S YOF75
_ 125 ROUTE 25
- STAKE - MONUMENT TEST HOLE, LOCATION OF WATER LINES WFALS� I GD !4 I E.2 ROCKY POINT, N.Y. 11778, MAR no. 149 3 I
SEPTIC TIES AND CESSPOOLS NOT GUAiANTEE6 DIS . SECT. BLK. LOT I FINA LOCATION -14-80 -
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