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Home My WebLink About10170-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No...~ge~.~. ......... Date ... THIS CERTIFIES that the bu~d~g ................................................ ~tion of ~ope~ ~ ~2~. ~e~d .D~e ................... ~au~ho~d,. N..Y .. ~t H~I~ ~ty T~ Map No. 1~0 ~cfion ...T9 ....... Block .... ~ .......... ~t ...... .1.~ ........ Sub~on · · .~. A~ea ............. F~ed Map ~o. ~ .... ~t No... ~ ........ confo~s subentry to ~e AppOrtion for B~d~ Pe~it heretofore ~ed ~ ~ offi~ dat~ . .. t~:il..il ........ ,1~. p~nt to w~ch B~ Pe~it No .... ~TOZ ........... dat~ · · · April. ~.6 ............... 1 ~.., w~ i~d, ~d confo~s to ~ of ~e ~u~m~ts of ~e app~ble prov~ions of ~e ~w. ~e occupancy for w~ch t~ ce~ifi~te ~ i~ is ......... ............... ~lv~Ie .~..i~li. ~11~ ................................ ~e ~ffificate h ~ued to ...R~0..~l~~~ ~ ........................ of ~e ~or~d b~d~g. Surrom cowry Dep~m~t of He~th Appro~ ..... ~r~T~ .... ~ ~!~/~ ............... ~E~WRn~RS C~eT~F~CATE NO ............. ~. ~9a~7 ........................... Building Inspector Re~ ~'O]R,M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 10170 Z pursuant to application dated ................. .~...l~./. ....................... .., ~9.7.~..~., and approved by the Building Inspector. Fee $..~....~...~ .... FORM NO. 6 TOWN OF SOUTHOLD BuiMing Department Town Hal~ $outhold, 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 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 buiMing. 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 ~and use 3. Copy of certificate of occupancy $1.00 $5.00 Date.. '~'/'..~/':Z .4~. ............ New Building ...X .......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ~o.~ I.'~......~.~ .~..~.. ..... .~.~. ! ?~r~(... Owner or Owners of Property . . i~J-J'.r3. ~.~.~. ~ ...... j~/~.~....Lr.(~ ....~.~.~,[ ..t~... .................. -- County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision .L..~.~. ?.1~.~..h. . .~. ~.E.&..~.'~..'.~]]:¥.~/.~.Flled Map No ........... Lot No. Permit No. I.(~ [ i.'~.'0. .... Date of Permit ~Z'./~,~./F/?..Applicant, ,~,~-,(,~, .... ~-,~[~ .[~ ?:/..-L~.. ......... Health Dept. Approval ~ S~''~ '''L'd! ...Labor Dept. Approval Underwriters Approval ~.,~,~', ~, ?,' ,~..~, ........ Planning Board Approval ..~...~..~ .......... Request for Temporary Certificate ..................... Final Certificate .~... ................ Fee Submitted $ ............................. Construction on above described building and ~p~r~ mee~s'~ll aptplicable codes and regulations. Appl,cant .... · · · · · · .......................... Rev. 10-10-78 --~ ~ 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 Fines, 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 certihcate. 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 1/?/~.0 Date ......................... New Building ...... ~. ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ......... .]'~.e.e.~ .~?.d. ?.?.i ?.e. ....................... ~.~. ~.v.'.e.~ ........... House No. Street Hamlet Owner or Owners of Property ..... ~,a..p_,~.a.~ ~?..~?...~.~.'.Q.~..~.~,...~,~.~ ......................... County Tax Map No. 1000 Section ... ?? .......... Block ,. ?. ........... Lot..~?. ............ Subdivision ..... .~.e.e.~,.~?.~ .A..e.z'.e.~ ............ Filed Map No ........... Lot No. 98 Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 Applicant .................................................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~D~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~,. SepCemb.= 17, ].979 .~p,,..,,o.~o.o./,., 030132 N 449.'2:!7 THIS CERTIFIES THAT ~vas examlned on ~ ~ ~L;~ !I ~ / ~1 and found to be in compllance ~vith the requirements of thlz Bo~rd. 21 5 21 21 DRYERS I FURNACE MOTORS I tuTU. RANGES 'i EXHAUST FANS DIMMERS S~RVICE DISCONNECT NO. OF S METER NO. O~C~CO~O. 1 100 CB x °ql~f~S:applt~eee teeder.:2-2 14,1-2 ].2 1-OffCl l- S~oke 0eteetoz R V I C C~F CC. COND. OF HI-LEG 3 1 OF NEUTRAL 5 John T. SatpaMno Zac. 102Oak Ave. ShJ.rley,N.Y. 11967 Lic.334 This certificate must not be offered in any manner; return to the office of the Board if incorrect. Inspectors may be credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY. OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .... . .~.Z./.~. ......19 ..~i Application No..[.0. -/..TQ ...... Approved .... ....... 19 7. Pe mitNo. . APPLICATION FOR BUILDING PERMIT ~/ Date..¢/./( ............ 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 lot and of buildings on premises, rela~tionsh~p 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 he 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 Tow~ 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~ousing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessa~ inspeff_tions./ / (Signature of applicant, or,fid'me, if a corttKoration) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, contrac lectrician, plumber or builder. Name of owner ofpremises ~t~/~.2.~..~....~.6(.t../-L.O/0ff.. & ..~ .... ~./-tE~. ............................ (as on the tax roll or latest deed) If applic~n/t is~orp/~ion, s~ature of duly aufihorized officer. ...... .... (Name ~nd title of,4'orporate officer) Builder's License No ........................ Plumber's License No.~.~g ¢~....~../?/~..-~./.A../~./~ Electrician's License No..~'~ .~... · .~. ~.~ifft~/~...° · '.'t~4 c Other Trade's License No. ':. .................... 1. Location of land on which proposed work will be done.. ~4./~ .... .~. ·(d4.~..~.. ~). ..... .~. ~-4 .I/?._~. ........ · .3.t l .... ........ ........... House Number [~o2-~' - J.V:~cwPtg~ ~Ft.S~treet Hamlet County Tax Map No. 1000 Section ........ . .'-~..~. ..... Block ...... ~ ......... Lot...~. .... ?? .... Subdivision..c..~.~.e..~5~. ·a4. (....~......a77. ............. Filed Map No. 5.-..~..f. ~ ....... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed constructinn: a. Existing use and occupancy ..... .~. & .~./~..~ ............................................ b. Intended use and occupancy .... l ............................ 3. Nature of work (check which a~plicable): New Building .......... ~ Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ......................... Fee ....................... ~ (to be paid on filing this application) 5. If dwelling, number of dwellin~ units ............... 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 .................. 10. 11. 12. 13. 14; property lines. Give street and blocl interior or corner lot. Depth ................... .... Height ...... , .... [ ............ Number of Stories ........ 151 '~" ........ Dimensim}.s ~[ entire new construction: Front.. ~..Q.: ....... Rear.. ~.~. ...... Depth .... ~. ......... Height ./.':~. .......... ~. Nu~nber of Stories ...... Date of Pnrchase ....... /. '~'i'/~ ................ Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction vi61ate any zoning law, ordinance or regulation: .... ~. ~...--7 .................. Name of Architect ......... 1 .................. Address ................... Phone No ................ Name of Contractor ........ : .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from : number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, S.S ' COUNTY OF ......... fT) ...... · · \1 - ............ i ........ being duly sworn, deposes and says that he is the applicant ~ (Name of individual signing contract) above named. He is the of said owner or owne~, ~d is d~ly authorized to perform or have perfomed ~e said work and to m~e ~d file this application; that all statements cofit~ned ~ this application are true to the best of his ~owledge and belief; and that the work will be pe~fo~ed in the m~fier set forth in the application filed therewith. Sworn to before me this : .. /Z ;f ' ................ ...... , , ......... p..., ..... ~~ ~~ ~:T~ % co,~ov ~ ' / ~OTABX ~,~Ic. ~t~t~ ot lte,v Vo~k , (S~natur~of app ic~t) ~ , Suftolk Count~ ~o. $2-5792~0 ~J t j Commi~ion g~r~ M~ ~ 19 ~ . / The 9ewa~e d~spo~al ~d ~er 9uppl~ fao~lities for this location h&Ve been ~e~ if ~neral Se~ice~ SUI~V~Y FOR ' S*N_D'RZZO eulLom6 co. LOt ~8 "LEEWARD ACRES AT BAYVIEW" YN OF SOUTHOLD COUN;TY, NEW YORK HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT ~ NEAREST WATER eAIH-~ MI -+ N SOURCE OF WATER PRIVATE ~/ PUBLIC-- BUFF CO TAX MAP DIST SECTION ,. BLOCK ,, LoT ~TRERE,A~[ NO DWELLINGS WITHIN IOO FEET OF THIS PROPERTY OTHER ,TITAN THOSE SHOWN HEREON! N THE ~ATER BUPPt. Y AND SEWAGE DIS~!OSAL SYSTEM FOR THIS RESIOENC~ WILL CONFORM TO THE STANDARDS OF~THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES AFPLICANT~ NOTE. B = MONUMENT ~ ~ SUBOIVI SION MAP FILED IN TH~ OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JUNE4, 1971 AS FILE NO. 5599 ;4 ~ LOCATION OF WELL(W), SEPTIC TANK(.ST}R OESSPOOL$(OP) SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND ORDATA OBTAINED F~OM OTHERS ORIZED ALTERATION OR ADDITION TO THIS A VIOLATION OF SECTION 7209 OF THE STATE EDUCATION LAW OF THIS SURVEY NOT SEARING THE LAND R~S,INKED SEJ~L OR EMBOSSED SEAL SHALL ONSlDEREO T~ SEA VALID TRUE COPY . INDICAT~O HERICON SHALL RUN ONLY ~0 WHOM THE SURVEY IS PREPARED BEHALF TO THE TITLE~ COMPANY~ GOVERN- AND LENDING INSTITUTION LISTED TO THE A~SlGNEES OF THE LENDING GUARANTEES ARE NOT TRANSFERABLE INSTITUTIONS OR SUBSEQUENT ARE FOR A SPECIFIC AND ARE N~T TO BE USED TO ESTABLISH LINES OR FOR THE ERECTION OF FENCES : 0CT. 1,1979 DATE FEB. 5,1979 SCALE 1"=50' NO 79-45 YOUNG a YOUNG A~DE~ W, YOUNG, PROFESSiONAL ENGINEER AND LAND SURVEYOR N ~S UCENSE NO 12845 HowARo ~YOUNG~ LAND SURVEYOR N.~S LICENSE NO 45893 . 400 OSTRANDER AVENUE RIVERHEAD~NEW YORK / 1 / / SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICB8 DATE APPROVED FOR APPROVAL OF CONSTRUCTION ONLY HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT ~ NEAREST WATER ~AIN 3-~Ml -~ R SOURC~E OF WATER PRI~TE /' RUBLIC I N SUFF CO TAXMAP DIST/,,"Yz-"~SECTION~BLOCK ~7 LOT /~ ~THERE ARE ~ DWELLINGS WITHIN I00 FEET OF THIS PROPEBTY OTHER THAN THOSE SHOWN H~REON N THE WATER GUPPY ANO SEWAaE OJS~SAL SYSTEM FOR THIS RES1OEN~ WILL C~FORM~O THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT NOTE.· = MONUMENT SUBDIVI SION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JUNE 4, 1971 AS FILE NO 5599 ~ THE LOCATIOH OF WELL(W)~SEPTIC TANK(BT)~ CESSPODLS(CP) SHOWN HEREON ARE FROM F~ELD OBSERVATIONS AND OR DATA OBTAINED FI~OM OTHERS SURVEY FOR RANDAZZO BUlk'DING CO. LOT!31~ "LEE WA~RD__ACRES AT BAYVlEW" AT BAYVlEW TOWN OF SOUTHOLD SUFFOL~K COUNTY~ NEW YORK DATE' FEB 5~lg7g SCALE 1"=50' NO 79-45 N UNAUiTH~IZED ALTERATION OR AODITION TO THIS SURVE~ [S*,A VIOLATION OF SECTION 7209 OF THE NEW YORK ~STATE EDUCATION LAW ~COPI~[G QE THIS SURVEY NOT BEARING THE LANO SURVE~YoR~s iNKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO SE AVALID TRUE COPY NSUAR[ANT~[ES INDICATED' HEREON SHALL RUN ONLY TO THE PI~RSO~ FOR WHOM THE SURVEy IS PREPARED AND ~ HI~ BEHALF TO THE TITLE COMPANY, GOVERN- MENTAl. A~ENCY AND LENDING INSTITUTION LISTED HEREO~AND TO THE ASSIGNEES OF THE LENDING INSTIT(JT~O~I, GUARANTEES ARE NOT TRANSFERABLE TO ADI~ITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS ~DI~;T~NC~S SHOWN HE~REON FROM PROPERTY MNES TOEXISTN~ GTRUCTURES ARE FOR A SPECIFIC PURPOSE ~tND ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES OR FOR THE ERECTION OF FEHCES YOUNG a YOUNG I ALDEN W YOUNG~ :~OF ESSIONAL ENG ANDL~ND SURVE' ~Rk Y.S MCENSE N HOWARD WYOUNG, LAND SURVEYOR · NYS LICENSE NO 45893 ALDEN W YOUNG~ PROFESSIONAL ENGINEER AND LAND SURVEYOR N Y.S UCENSE NO 12845 400 OSTRANDER AVENUE RIVERHEAD~ NEW YORK ., 'APPROVED AS NOTED : N~T~ DE~ME.T AT 7~:26~0 ~JAM ta 4PM FO~ REQUIR' BEFORE DACK~ILLI~G FOUHD~'* T~ON OR START F~A~NG F~AMIflG B~FORE COVERH'~G p~P~S OF ANY KIND FIHAL WNEN JOB COMPLETED NOT RESPONSIBLE FO~ DESIGN OR CONSTRUCTION ERRORS ALL CONSTRUCTION MUST MEET, ~QUIREMENTS OF N.Y. STATE CODE AND TOWN HOUSING CODE & ZONING " t -r,