HomeMy WebLinkAbout10200-zFORM NO, 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No.. Z98~0 .......... Date ..... J.~r~ua~.. ~.~ ................ 19 80
THIS CERTIFIES that the building ................................................
Location of Property . 2{0~....West;..Cedar..Poirt't; .D~£v.e ............ SOUthold~. N. Y.~
House No. Street Hamlet
County Tax Map No. 1000 Section ...090 ...... Block ... 2. .......... Lot ..... 22 ..........
Subdivision. C~.~12. B.eaoh. l?.ark ........... Filed Map NO ......... Lot No... 1 ./4~. .......
conforms substantially to the Application for Building Permit heretofore filed in this office dated.
· ?.p. ?.i.1. ?..8 ........... 19.79. pursuant to which Building Permit No .... 1..0.~.0.QZ. ...........
dated .... l~&]r..9 .................. 19 .?9, 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 .........
............... ~ri.v. ate. O. ae. F.e~il~. ~ellin~ .................................
The certificate is issued to ...... (]}ler~. F,. Hei~lll~rlll .................................
(owner,~
of the aforesaid building
Suffolk County Department of Health Approval .~tg.-S.()-. 2~i .... '1/.1.8/80 .... [~,. A,. IJ'121.1a.~..
UNDERWRITERS CERTIFICATE NO .......... ~1../4.~.08~ ..............................
Building Inspector
Rev 4/79
*"Private well with high niyrates - see Health
Department note on final survey.,,
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
COMPLETION OF THE WORK AUTHORIZED)
N? 10~00 Z
Permission is hereby granted to: .-~ . ~ /
...........
...... Z,~.~....//.~.-~ ..............................
~.r~/~.~,/~. -- ~- ..~.. ...............
~o ....~'.o..~...s....z~r,~..u..c~ ~ ~.~.£~.a.~.~7~ ..... o..~.~ ..,~.~..,..~..~......~..:.~..~-....x...Z./~..,~...
o, ~re~ses 'oeated o~ ..¢ .......... ~......~.~ ...................... ~....*..~.Z~....~.~...~...~ ,
Building Inspector.
Fee $.J..~....~ .....
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:
I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual
natural or topographic features, r
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. Commerc al buildings, ndustrial buildings Multiple Residences and similar buildings and.,,installa-
tions, a certificate of Code compliance from the Architect Or Engineer responsible for the bu!ldi~g,
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-
t~on 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.. '.~..~..~..~. ,~..,.!9..~. ·~, .....
New Building V/ Old or Pre-existing Building Vacant Land
Location of Property ~)~/' ~'~.~ .C.~I~?~.(;~ .~.~;.~..~t'~.~)~i~.~=::--~')
House No. Street Hamlet
Owner or Owners of Property . .~. ! .~. ! .~,'~.l...~., .[~..~..t~...)..~ ~,~. ,~.~....?.. ...................
County Tax Map No. 1000 Section ............... Block ............... Lot....~, ,~.~ ........
Subdivision...~.~.~)..~, .~.. ~ .~..~. ~.~). ........ Map No ............... Lot No. t ~c .~
Permit No. ~, .(~. ,~.., .(~.(~.. Date of Permit 5.-.~. :.~..~. .Applicant ..~...~, .~..~..~.. fi...~..~'.'~.~, .~. · ,~..~..~. · .f~
Health Dept. Approval .~t~¥1.(i'.~ ·O. .~ 7 .~.O.: .~.~. .Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate "-"-' ...Final Certificate ,~,~ ~
Construction on above describedApplicantbUilding ~and permit meets ~]~ .... '.
Rev. 10-10~78
:able codes and regulations,
FOR~ NO. 6
3'OWN OF SOUTHOLD
Building Delmffment
Town Clerk~ Office
Southold, N. Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building
Inspector 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
installations, 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 property showing aH 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 in-
formation required to prepare a certificate.
C. Fees:
1. Certificate of occupancy $5.00
(~ertificate of occupancy on pre-existing dwelling or land use $5.00
opy of certificate of occupancy $1.00
Date ...~..a..~..?..a...z..~... ~ ,2..:....~ ?. ?..0. ......
New Building X Old or Pre-existing Building Vacant Land
Location Of Property ~.~..O...~.~!~C`.e.~a..~?.~`.~?`~.``~?`~`~e`~`~``?```e~`~`~`/``~~L.~ ........................
Suffolk Co. Tax Map~ 1000-92-2-25
Owner Or Owners Of Property ..G.~.e...q..~..~....~.e...&..c].~.m...a.D...~. ............................................................................
Cedar Beach Park -- 148
Subdivision ................................................................ ~o~ No ............. 81ock No. ............ House No .............
Permit No ..................... Date Of Permit .................... Applicant Glen F. Heidtmann
Health Dept. Approval ............................................ Labor Dept. Approval ................................................
Underwriters Approval .............................................. Planning Board Approval ........................................
Request For Temporary Certificate ........................................ Final Certificate .............. ~ .........................
Fee Submitted ..Z..:..O...O. .........................
Construction on above described building aj~d~'p~rmit meets all qpplic.c~91e codes and regulations.
Z )
Ku~oiph ~[. Bruer; ~ttorney rot Appl~can~
Sworn to before me this /
................ day of ............................................ (stamp or seal) i~
FO~M NO. 3
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
NOTICE OF DISAPPROVAL
Fde No ................................................................. Date ........~..~.~.. ~.,~ ................................... , 19..,7,,9
.......... 5 .o..u...t.b.o...z. ~.,... ~,... ~.~ ................................
PLEASE TAKE NOTICE that your application dated ...... .AP..~.~.$....J..8..~ ...................... , 19.~.9...
for permit to construct .p..~.$.Y...a.¢..e....~W..e..~..~..:~:PJ~at the premises located at
...... .D~..e.....~..e.~..~ ................................. Street Southold, N. Y.
Map .....C..e, ~?.....~...e..~..~..~. ...... Block .................................Lot ............ J~f) ............................ is
returned herewith and disapproved on the follow, ng grounds .....C..0.~qS.J~.~Q.~.:~O..~..P.~..~,I~8 .............
....... s..~bm .i..¢.t.e..d ...~.~ .~...~.o..~...o..o.~.p. 1.~. $.e... ~n d e.t. ail....do...n.o..¢...fu~.ni s h ......................
...... .s...qf~$ .q..J,..e. n .¢.....J,.n~P.~.a..t S.9.~...~.q~....e. ct~ $.~m..e.~.~... hc ~n g...~.~ ~...~... ~.~n~z ..........
with N.Y. State Ener~r Code. ~/~¢~,b
...... SEE.. RZI)F~.. ~.d.. &...~.2...a.~t at c h ecl..h e~.ew.i.~hF.~ ..................................
~Buflding Inspector
Glenn F. Heidtmann
Spec. #6
Cedar Beach
Southold, N. Y.
COMMENTS
Drwg. #1
Foundation Plan (Slab)
~.~DNo detaili~ for concrete slab on exterior,
raised, flush, footings, foundation).
rwg. #2 indicates 'deCk or slab' - require
~ details for both to be approved.
~o footings for bearing ~artitions are shown.
'~/No details of plumbing given, (soil lines under
slab, location of house trap, e~c.).
Drwg.
Drwg. #3
#2 First and second floor plan
.~nte~ior stairway does.n~t show size in width,
or give riser and tread details. Open or close
sides, handrail details..
~/Detail of balcony railing not shown.
3. Collar ties for living room required if cathedral
ceiling.
~/No Smoke Alarm Detectors shown for the sleeping
areas.
~/Kitchen is incomplete, sink, cooking range, re-
~ frigeration, cabznetry not shown.
~/Dimensions for exterior deck not complete.
Front and rear elevations·
Roof at chimney requires ,cricket.
No spread footing for fireplace foundation.
Rider Sheet, cross section. No detailing for
.~air flow to control conden~ion.
reas of walls, ceiling, rafters to be insulated
not shown.
Drwg. #4 Elevations, north & south
Concrete stoop & step, no foundation and footings
shown. Detail of risers and tread for step not
shown.
RIDER #2
PLAN REVIEW: Glenn F. Heidtman
Spec. #6
Cedar Beach
Southold, N. Y.
COMMENTS
Mew York State Energy Code
1. Type windows to be used, (wood ar aluminum
frames)
2. Type exterior doors being used, (insulated,
wood panel, with storm doors)?
3.Service water heating equipment, classification,
rating for efficiency.'
4. Detail for fireplace air supply.
5. Details for slab insulation not clear.
Memorandum from ....
BUILDING INSPECTOR'S OFFICE
TOWN OF SOUTHOLD
TOWN HALL, SOUTHOLD, N. Y. 11971
765-1802
LAWRENCE M. TIJTHILL
April 27,1979
Chalet - Spec # 6 Cedar Beach , Southold
Design temperature - ~nside
Design degree days 6,000
Insulation "U"
70°F Outside ioOF
Area Loss
.... sF
Walls R-!3 I07 1,026 4,300
R3of B-19 .05 2,304 6,920
Slab per~,~r
R 5°0
Factor 35 x 124 If 4,350
Windows dbl glass .69 208 8,600
(thermal)
Door aS per code .40 18 430
i~ lilt ration ( volume ) . 018 12,168 .13 , 1.CO~
37~700
Per cent of glass 17%
Exterior duct to be provided fro fireplace
Heating & service water oioes to be insulated as per code
Thermostat as per code
Weathers stripping - all windows and doors
Caulking as per cod~
E~etric heating to be used
COUNTY OF SUFFOLK
DEPARTMENT OF HEALTH SERVICES
DAVID HARRIS, M.D., M.P.H.
The attached approval was issued subject to the notation
contained below our approval st~,~o. Would yon please type
the foll~.~ing condition of approval on the fUmal C of 0
as bi-&is will ensure that any Future oWner will be made
aware of the nitrate problem.
"Private well with high nitrates - see Health Depar+.ment
note on final su~'ey.
Thank you,
Robert Ao %"~lla~ P. Eo
FORM NO. 1
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined...~..-..?..~ ...... 19.7. ?
Approved.. ~.?..~."~ ........ 19.7..~Permit No../..Cfl.~.~ ~--~
Disapproved a/c ............................... ./
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Application No.../.~.'..~..~..~. ......
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, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the dia,'am 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 applicant, or nmne, if a corporation)
(Mailing address of applicant) --
State whether applicant i's owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ....... ~//.~f.W~. ...........................................................
(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 ..... ?.0 ..................
Plumber's License No.. ~.~. ~?...~....~.4.~. ·~. ....
Electrician's License No..~.~.?...d~...~..~..~./2/O
Other Trade's License No .....................
1. Location of land on which roposed work ~will be done...~'.'.~"f'.O.?~.~.'~...0~'~-~. ~~ ..........
.................................. ii ;;i 7 .................... ......................
House Number
County Tax Map No. 1000 Section ...~.~ ........ Block .... O.d ......... Lot .... ~ ..........
Subdivision...~. ~C~ .............. Filed Map No ............... Lot..~.~. ......
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ..... ~ ........................................................
b. Intended use and occupancy ..... ~'/.~..~¢ .~q~ ..............................
3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work .............
.I ~30 -'~ ~O ~ (Description)
4. d Cost
Estimate ,~ ~
........... ....... : ................. 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 extent of each type of use .....................
7. Dimensions of existing structur.es, if any: Front ............... Rear .............. Depth ...............
Height Number of Stories
Dimensions of same structure w~th alterations or additions: Front ................. Rear ..................
. Deptt~ ...................... Height .................... :. Number of Stories ......................
8. Dimensions of entire new construction: Front ...... ~ ....... 'Rear ............... Depth ...............
Height ..... [~,~ ....... -Number of Stones ..... [. ] .................................................
· .F - D . ..
9. S~zeoflot. ront ....... .~.(:~.~ ......... Rear ...................... epth .... ~...~...~ .........
10..Date of Purchase .... ~'] ~('"Y~' I '~'Q'xl' '~ ......... Na_me of Former Owner ..... [.,....~.~_,~.~.~ .k~ ...........
11 ,' Zone or use district in which premises are situated ~'.~ ).~ .............................
12.~ Ooes pr'o~osed cofistruction vi41ate any zoning law, ordinance or regulation: ...t, hr.,D ......................
13. Will lot be regraded . . . ,~...~.. ...... ,, ........... :. Will excess fill be removed from premises: Yes
14. Name:of Owner of premises ~oJ: .~.o..o.~ tq)T(~ 00'Address ...-~9.~ ~... Phone No....~.. ~?A?.~..~.
Name of Architect . .' .x~..0~:~.W~..~..t~ ~.C~ K ~.. Address ...~.O .~.xo~ o~ ~.. Phone No ................
Name of Contractor ~.~1~3~.~).~° ~ ~o~.3 Address . .~.~.~,~.~$.O.q~9.-~,. Phone No..~.~.,P-: .~..'~.¢.(~.
PLOT DIAGRAM
Locatel clearly and distinctly all 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 YORK,
S.S
, (Name of individual sigdng contract)
above named.
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and file this
application; that, all statements cont[ined in this application 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
ELIZABETH ANN'NB/ILLB ~ (Signature of applicant)
NQT~,RY PUBLI~, State of New Yol~k
No 57-8125850, Stfffolk Cou~lty
form Exmres March 30. 19d¢~
. Breparat{o~ of baby for~la or co~sumpt:o~
"' ~' by infants under 6 mos. of age. ~FO~K CO. OE~T. O~ MEALTN
' : ' ~' " ' ' "" ' ' ~ ~FF~K cOUHTY DEPT. OF H~ALTH
: SERVICES - FOR APPROVAL OF
~ ~OVED
~ ~' . ................... ' SUFFOLK CO. TAX MAP
. .~"" ,. ' .' ' .. . ~ ' .. ~1~ ~ ~ ~
TEST ~LE ST~
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