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Home My WebLink About10208-zFORM NO. 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... Z104'32 Date Ap~il 2, 1~.1. THIS CERTIFIES that the building ................................................ 840 Manor ~Iill Lane, Cutchogue, N.Y. Location of Property ............................................................... House IVo. Street Ham/et County Tax Map No. 1000 Section 108 .Block 03 ..... Lot 013 o 011 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... l~lay..10 .......... , 1979. pursuant to which Building Permit No ..... ~ 02.Og. g ......... dated ..... ~l~y.. 19 ................ 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 ......... Accessory Stable and Corral The certificate is issued to ..... R.a. ~p.h..l.J ,, .a.r~ .d. ~.a.n. 9..~.~m, .b r.u.~.~. ....................... [owner. le~$t~c, zeaan~. of the aforesaid building. Suffolk County Department of Health Approval ...... ~J ./B ................................. UNDERWRITERS CERTIFICATE NO. N / R Rev. 1/81 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PF, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10208 Z Permission is hereby granted to: ........ . .~.~....~.....//.~c~..o. ~..,..-... ....... ....... ~i~ ....... .~.~......(~ .................... ,o....C<~.~.~.~..~...../..~...?.~.~7 ........ ~...:..~..~......~...c~z~/.c~ .......... at premises located at..~....~...~.~ ....... ~..~.~..~.~.~...~..,..~....'~..~.~..w ....... ~./~...~..../../..~..9..~..~.~>.z~:, pursuant to application dated ........... ~.../...~. ......................... , 19.Z.?.', and approved by the Building Inspector. Building Inspector 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 dlsposal-(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, occ~!pancy and condition of buildings. 3. Date of anv 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 ...................... New Building . .~..~-~.. ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property .~.~..O. , , , ./~.. ;t3 .o.~., t4;.~.~... ~n~ ............... ~ou~ No, ' Street or .... ......... Subdivision ................................. Fded Map No ........... Lot No .............. Permit No.~. ?..~.O...~?¢-Date of Permit-~./.d..~.O. .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. Memorandum from .... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 November 12, 1980 Jane M. ~rmbrust P. 0. Box 628 Cutchogue, N.Y. 11935 Re___L B.P.-#1 0208Z Dear Mrs. Armbrust: Upon receipt of your letter dated November 4, 1980, requesting a six (6) month extension on the above permit, this permit has been ex- tended until May 10, 1981. As of that date, the job should be finalized. Enclosed is an application for a Certificate of Occupancy. Please fill it out and return to the above office when you call for a final in- spection. Very truly yours, ~GEORG~ H. FISHER ~r. Building Inspector mw encl. TOWN OF SOUTHOLD OFFICE OF BUILDR~G INSPECTOR TOWN I4ALL SOUTHOLD, N. Y. 11971 765-1802 October 10, 1980 .. Jane M. Armbrust P. O. Box 628 Outchogue, N.Y. 11935 Dear Sir: This is to notify you that Building Permit No. 10208Z issued _ ~y 10~ 1979 to same will expire on ~ovsm~oer 10, 'IVS'0 .... If more time is required to complete the job and obtain a Certificate of Occupancy, you may apply, ~y letter, for a six (6) month extension. If the work is not completed and the Certificate of Occupancy not issued after the six (6) month extension period, you are than required to apply for a new building permit. Very truly yours, FISHER ~ Sr. Building Inspector GHF/mw FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined... ~:?../..rd. .... , 19 2 .~ Approved...~.-]-: . ./~ ...... 197~. Permit No. Date ,~), .......... :: 19... 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 bhilding 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. . . . . :¥ .... (Sigffature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· (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 ...... .,.-~-h;A-.~. ........... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No .................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section ...... tt.~..~.'. ..... Block .... ..~. ~ ......... Lot.,. ~ f)~ y.O..O..'~..... Subdivision ..................................... 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 . .. d)/~/_f::. ~-~../'~/(}d f<.ct4~,~.. , ..... b. Intendeduseandoccupancy :: i :':'"~'~;'J) '/~c(;" ));~f';'f~ 3. Nature of work (check which applicable): New Building.?..~.~ .... Addition .......... AlteratiolL_ .... .~,... Repair .............. RemOval .............. Demol~ion .............. Other Wo~. ~ ~ ~ ~ . ~ (~ (Description) ~ (to be p~d on fil~g this application) 5. If dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ I~gara~e number of c~s 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. D~ensions of existing structurgs, if any; Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth ..................... ~.. Height ...................... Number of Stories ......... ~.. ~ ......... 8. Dimensions of entire new construction: Front ..... [~/ ....... Rear .... ~. ........ Depth ... ~ .......... 11. Zone or use district in which pr~mises are situated ..................................................... 12. Does proposed construction vi~e any zoning law, ordinance or regulation: . .j~ ........................... 13. Will lot be regraded ........ /~.O ................. Will excess fill be removed from premises; Yes No 14. Nme of Owner of premises .................... Address ................... Phone No ................ Nme Of Architect ....... ' ................................... ~ .. ~ ................ Address Phone No. Nme of Contractor ' Address Phone No PLOT DIAGRAM Locate clearly and distinctlg ~1 buildings, whether exist~g or proposed, ~d, indicate ~1 set-back d~ensions from prope~y ~nes. G~ve street and block~ number or description according to deed, and show street names and indicate whether /~te~r o~orner lo,t. .olaf A~ STATE OF NE~r~pJ~, . //~ ~ S i ?SO COUNTY OF ~.C-r. ~ ,~ ' ~' "' ~.~.~..~..~(..~- ~(-c/~-~,, ~ ..... being duly sworn, deposes and says that he is the applicant (~- (Name of individual signing contract bhbhb~ve named. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements conltained 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 /Dm Notary County o.....~ ,. s.,ro~k Cou~.,/c~-/) ~/ - (Signature of applicant) Pool Well I ocotion $CA&~ I "-' 40 ~ lnset' C- t - Th~ sewcqqo disposal mt~d ??~er's':pp]Y faotltttes for this J.c~,a',;o,~ have been Inspected by th~.s departb~,onb and found to be sati~facto~ ~' (~ ~ ~ Chief of Genorat Enginoerin~ ......................... Services ,Ir- ~ b. fide" ~ forCSrW ¢0¢ of ELIJ~H~ LAN~ ~YS ~le. 252' ~ = MONUMENT REFERENCE' M/NOR SUBDIVISION FOR THEHE A~E NO DWELL INGS WITHIN I00 'OF THIS P~OPE~TY, NEAREST WA TE~ MAIN- 4 Mit ES WATER SMPPLY-P~IVATE WEL~S TEST HOLE 0. o TOP SOil AUG. $, 1977 YOUNG 8, YOUNG 400 OSTRANUtR AVENUE, RWERHLAD, NEW TORVEY FO~: .......................... RALPH L. ARMBRUST & JANE Mi ARMBRUST Ar CUTCHOGUE -'-&-A;TJ~,~T,ff'E'F; USLIFE TITLE INSURANCE COMPANY .................. I OF NEW YORK