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Home My WebLink About10243-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..Z99.69 .......... Date .......... .~Y..1.5 ............... 1980. THIS CERTIFIES that the building ................................................ Location of Property h . ~.o.~.l?fl. y~.e. lq. . ~.v·e. rl. g.e.,. ' ~ ~. .a.~.~$.~.lgql~ . County Tax Map No. 1000 Section ...9.6. ....... Block .. ? ............ Lot..2..0 ............. Filed Map lqi~' .-1~ Lot No Subdi i io - ." .. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... l~l~'..23 ......... , 19Z9. pursuant to which Building Permit No. J,02.6.~.Z .............. dated . ~T1Jxle. 1 .................... 19.7..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 ......... ..... 8. pr.~v.a.~.e.. O.n.e.-.~..~..~.Z.y., .r..~..e3.~..~.ng ........................................ The certificate is issued to ..... .A.d.e..l..e..V.:..D.e.e.k. }.ng.e.r. ................................ (owner,,.leseeeer-ter~ of the aforesaid building. Suffolk County Department of Health Approval .~.~.r..i.]...i.~., .]..9.8.0. ~..#.9..:5. pr.tr.7, .R.o~e.r.t' A..y.~na UNDERWRITERS CERTIFICATE NO.. I~I669265 ....................................... High Nitrates - Water not to be used for ~reparation of baby formula or consumption by infants under 6 mos. ef age. Building Inspector Rev 4/79 FOF,~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMEIqT TOWIq CLERK'S OFFICE SOUTHOLD, iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N? 102~3 Z Permission is hereby granted to: ....... ~f~. ~.... ~,~ ...~.~ ~.~.5~Z~.~..~...~:~....O~,~...~ ...~. ~/Zx~¢ ........... .............................................. ~.~: ..................................................................................................... et premises Ioceted et ..... ~.~.~/~. ~.y ........ ~ ..~. .. pursuant ,o application dated ......... ¢(~.,¢;2...~...Z~... ................... , 19Z.~.'., and approved by the Building Inspector. ~ee ,~!...~o.. ..... FORM NO. 6 TOWN OF SOUTHOI-D Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter 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 supplv and sewerage dispose[-(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 propertv 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, C. 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 Date .... ~'j~/~..o ............. New Building .,, ~ ....... Old or Pre-existi. ng Building ............ Vacant Land ............. Location of Property ~o. use~..~N~).~....~,~?, .~'.~..~./. ~. ~.. ~;~~.~' ...... . Ham/et Owner or Ownersof Property ..~ 0. ~[..Q: .......... ~ ................................. County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ............................. 7. · .Filed Map No ........... Lot No .............. PermitNo /~.,~ji~ .~Date of Permit .~1./~.~? Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. described building and per t e a ca ~ons THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ ~1~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Date ~ Application No. on file T.,S CE.~,~Tz8. ].~80 032.~83 N 4 69265 o~y the electrical equipment as described below and introduced by the applicant named on the abo~ application numKer in the premises of ~b~ta Deeid.~, als Somdvt~ ~,~., 2500' e/o Sa~-.s~ v.~r~, t,~ct~__,,~__, ~.I. wosexamine~ 2~, [] 2nd Fl. Section Block Lot and found to be in complianCe with the requirements of this Board. OUTLETS ECEPTACLES SWITCHES INCAN ENT FLUORESCENT VAPOR MERCURY DRYERS I FURNACE MOTORS RJTURE APPLIANCE REC'PT SERVIC~ DISCONNECT I NO. OF I S R ~'~T METER ~,~v,p TYP~ EQUIP 1,~'2w i,e'3w 3~'3w 3,e'4w · ' ' OF CC. COND. OTHER AFPARATUS: EXHAUST FANS ~MMERS & 6OO NO. ~ NEUTRALS A.W.G. ~ NEUTRAl 11o i.-G.F.C.I. mac. l'Umace ~ Track lafl~md Elec. ~o. P.O. Bax 1~ ltl~'~.icu~, N.Y. 11~2 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by Fir credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT Bi ALTERED IN ANY h E~IN--ER. COUNTY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES DAVID HARRIS, M.D.M.P.H. The attached approval was issued subject to 'the notation coutained below our approval st~,p. Would y~m please type the foll~.~'ing condition of approval on the ~nal C of 0 as this will ensure that any ~uture ~ner ~_~l be made aWa~fe of the nitrate problem. "Private well with high nitrates - see Health Depar%ment note on fLual su~'ey. Thank you~ Robert Ao V~!la, P. E. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 (Bc'ilding Inspector) APPLICATION FOR BUILDING PERMIT ' INSTRUCTIONS a. This applic, ation must be completely filled in by typewr, it~r or inink 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 promises 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, build~ng code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessaw j~sl~c~ions. ,// ~ ~ (Signature of. applican~ or nam,~ if a 6orporaffon) ../~.~./~ .~.......d.~ ~..~..<~ .,.~.:. (Mailing address of applicant) State whether applicant is/9,~ner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... 16dM~ ~ ............................................................ ~ N b ~' e./~ r,~ ~ .......... Name of owner of premises/~..0 ................. ~. .......................................... (as on the tax roll or latest deed) Builder's License No ......................... Plumber s License l'~o..~..r., .................. ''/ Electrician's License No.. Other Trade's License No ...................... 1. Location of land on which proposed work will be done. ~r- ................................................ House Number Street ~ Hamlet ' .................... County Tax Map No. 1000 Section ...~. ~.'g. [.~...~..~ .... Block Lot ................... Subdivision ..................................... Filed Map No. -~r .... -.' ........ Lot .......... ~' .... (Name) 2. State existing use and occupancy of premi, ses and intended use and occupancy of proposed construction: a. Existing use and occupancy .... ~~.~ ............................ b. Intended use and occupancy .................................... 3. Nature of work (check which applicable): New Building ..../~.. .... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... / ~ ~ ~"~:~ (Description) 4. Estimated Cost .... .t~.~./. ~ :~ .................... 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 c~s .... ~¢.~ ........................................................... 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 ........................................................ I)~ensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height .......... ~ ......... Number of~fies ...................... 8. Dimensions of entire new construction: Front .... J~ ...... Rear ...~ ~ ..... Depth . ~.~ ......... [?ight ............... Number of Sto~es ....................................... ~ ................ Size of lot: Front . ./~.~ ~...~ .......... Rear ..... ~ ............ Depth . .~. ~ .~: .......... Date of Purchase .... ~..~ ~ ................. Name of Fomer Owner . ~ ....................... Zone or use district in which premises are situated ..................................................... Does proposed construction ~hte any zoning law, ordinance or regulation: .. ~ ......................... Will lot be regraded ...... ~ff~: ................... Will excess fill be removed from pmo~eJ: Yes ~ Name of Owner of premises ~ ~/g.*~.~. Address .~ ~. ~ ....... Ph~ ~,~x&~O~. Nme of Architect .. ~*~q .~WM~ .... 7 ...... Address ~.k~ ...... Phone N~ Y.~f4 ..... N~e of Contractor .~. ~.[ ~. ~q t~ ~.. Address(q~ :~.~ ~. Phone No, ~¢~ .Z~ ..... 10. 11. 12. 13. 14. PLOT DIAGRAM Locate 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/ ~,~ j/ ~ COUNTY OF'~//'~' ' ~~~t~./----t'.Ja'a · .......... .t~..o~. ~..~g2.J..~,.~ fig. ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above nameS. ~~~ He is the ...................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e ~d file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work. will be perfo~ed in the m~ner set forth ~ the application filed therewith. Sworn to before me this .............. ..... ....... ,9 N .... / // _ LICENSED LAND SURYE¥ORS ~REENPORT ~W YORK SUFFOLK CO. HEALTH DEPT.'APPROVAL H.S. NO. STATEMENT OF THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS For THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF TH SUFFOLK COUNT¢ 6EPT~ Or ~E~LTh s~v~ces- ~o~ .pp~ov.~ CONSTRUCTI~ O~Y H. s. ~E~. NO.:_~-- ~ _ SUFFOLK CO. tax MAP DESIGNATION: DIST. SECT. BLOCK PCL. - OWNERS ADDRESS: DEED:L. ~ a ~ TEST HOLE STAMP SEAL SUFFOLK CO. HEALTH DEPT. APPROVAL LICENSED LAND SURVEYORS GREENPORT NEW YORK H.S. NO. STATEMENT OF INTENT ThE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM tO THE STANDARDS OF THE SUFFOLK CO. DEPT. Of HEALTH SERVICES. SUFFOLK COUNTY DEPT. OF HEALTH SERVICEs - FOR APPROVAL Of CONSTRUCTION ONLY DATE:. H. S. REF. NO.: APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: ~!$? SECT. t]LOCK P~L. :DEED: L. 4 9,,'~ p: l,,~l- ~/.~.~.:t-,.~ TEST HOLE STAMP SEAL . '- , ' . ' ",~ ', , . ~ ~' ' SUFFOLK CO. HEALTH DEPT. APPROVAL ~ ~] /~ ~. ~;~/~/~'~ 'J' t~~ ' ~ ' ~ ~ ~ ~ SYSTEMS FOR THiS RESIDENCE WILL ~~ ~ V- ~~ ~/ ~ ~~ ' -' ' ~ ~ ' ' CONFORM TO THE. STANDARDS OF THE ~ ~,~ ~" / , ' /~ SUFFOLK CO DEPT OF HEALTH SERVICES. ' ~ , / ;,'~ , ~ . , / ' SERVICES -- FOR APPROVAL OF ~-; ' m S* ~/ ~] ' ' * ~ , ~ ' CONSTRUCTION ONLY High Nitrates - Water not to be used for preparation of baby ~ ~ ~ . ~ · ~ - ' / ~ ~ ~ ' ' / APPROVED - - -r~ , - '- "~ -~';;'";~ % ~ .... - ~ ~FFOLK CO TAX MAP DESIGNATI · r " " LICENSED LAND SURVEYORS ....... /~ ~. ~ GREE~RT NEW YORK High Nitrates - Water not to be used for preparation of baby formula or consumption by infants under 6 mos. of age. R~RIC~ VAN TUY~P.C. _ LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL _S!ATEM_ENT .O_F_ INT£.UI THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE. STANDARDS OF The SUFFOLK CO. DEPT. OF hEALTH SERVICES. (S) APPLICANT SUFFOLK COUNTY DEPT. OF HEALTh SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE: h. s. REF. NO:_ _? - "~ ':~ ':_~¥ ........ APPROVED SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT BLOCK PCL. OWNERS ADDRESS: --I SEAL 'L 0 ~v4~ ~.. ~.~.~ .... APPROVED AS NOTED 2. FRAMING INSPECTION ~ ' ...... ~ ............. -~ ................. ~ ~. J 4. FINAL WHEN JOB COMPLETED '1 ~"~' I1 .... 1 £ ; ) -4 AQUEBO,~UE I~A_tN I~OAD - RT. 25