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Home My WebLink About10246-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTM£NT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No.. ~---. ~.7 .~. ~9 ...... Date .................... ~.C.T...~..~..., 19Y~. THIS CERTIFIES that the building ................................................ Location of Property ....7...~,~5 ........... /~.t?.~.E.l'q.. ttVF,...~X.w.~.N. Stolx/ ~ .q2..-r.c~.1064)~- House No. '~'tle~t ............. Hamlet County Tax Map No. 1000 Section ..... .O..~ .Block ....... ~.-~ ..... Lot ... ~. .......... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .]y/./)..'~...~./, 19 ?f~pursuant to which Building Permit No... I .~! ?. I/. .6. ~ ...... dated .............. ?!.{ .k/.E.....~.... 19 .~.?, 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 ......... ·..~...~?i~ ! g./3. 7. ~- ..... .(.. ~ .... ~ .h.,:i. [ b.'(. .D t~.L ~. I: ~. ! .~ (~.... The certificate is issued to r~ ,[z IYI~ ~ ~_- H ~t.I /~ I ...................... io¥,,'e;','~ ...................... of the aforesaid building. Suffolk County Department of Health Approval . '.e./.2.~/? ~ .... :i~...~ ....... .~. ........ UNDERWRITERS CERTIFICATE NO .... .~... ?. ~ .~. ~. ?...~ ............................ Building Inspector Rev 4/79 FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Nm. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10246 Z Permission is hereby granted to: /~ ...... ...... ..... ,~ ,,~_~z.....,.,,.,~:....,._.....,..._ ................. ~.~ ~. ~Z~ . Z~ c. to ...~.~,:~.~ ............... ~ ............. ............................................................................................................... ~:~~ ...... - t /' pursuant ,o application dated ....... ~Z~....~:/__ .................. 19.:~'" and apprqvedz by the Building Inspector. Fee $.....~x~ 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. B. 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 land use 3. Copy of certificate of occupancy $1,00 $5.00 Date..~?..~-.~ .~..~ .(~ .~.. New Building J Old or Pre-existing Building ............ Vacant Land Location of Property ~..~ ,'~oL House No. Street Hamlet Owner or Owners of Property ,~,, County Tax Map No. 1000 Section .,. ~.~. ,-~, ...... Block .,. ,/, ,-~,, ........ Lot .... .~..? ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No/~ .~,~, ,~. ~ Date of Permit ~'.":~:'? ?, .Applicant ~,~, .~??.~-~,...~-.. ~, ,/~. ,~,/.Z~,/, ,/:,)-~, ,~ Health Dept. Approval :~..:~, ~ .(~.~, ,~, · .~.-;? ~' :I. ,'~. Labor Dept. App royal ........................ Underwriters Approval ....................... Planning B~ard Approval. ..................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ~ ~ ¢~ Rev. 10-10o78 Construction on above described building and permit meets all applicable codes and regulations. Memorand~lm/from . . . . ~, ? /o ~. ~ 2_~I~1~ INSi'~CTOR'S omc~ . TOWN OF SOUTHOLD TOWN HALL, SOUTHOLD, N. Y. 11971 765-1802 /7/r /~~ ~~) FORM NO. 1 TOWN OF SOUTHOLD *" BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1803 Examined.., .~_./~. ....... ,1977 Approved....~./..~. ...... ,19,.~. Permit No./.~..~. · · .~..~ Disapproved .......... ./f. ....... /. APPLICATION FOR BUILDING PERMIT Application No..~...~...~.. ...... Date~./.O.)/.. :3.../ ...... , 19'?..fi) 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 diagram which is part of this appli- cation. c. The work covered by this application may not be commenbed 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 inspec~tions. (Sigr~(ture of applicant, or na~ne, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as oa the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co,orate Other Trade's License No.. ~' -' .................... 1. Location of land on which proposed work will be done./~./~.'. · .~../..~.¢:g'...'~?..~.~..~. q.~?..t~..~.~.~ ./..~.~. f-.'~ ..... ..................................................... ................... House Number Street Hamlet County Tax Map No. 1000 Section ..... ./.o..~. ........ Block ...../:~ ........... Lot...~. ............ 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 ........ .~5.~/~'/~/~'~. · . .......... ..................................... b. Intended use and occupancy ... Z..Z~.?t.~ .%~. .L),(.'.. '.~. y.~'..~7.~- .~. ~..~1<'..C~.. .... '. ............................ 3. Nature ofwork (check which applicable): New Building .....l~..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ,~.~ (Description) 4. Estimated Cost...,~.~(-f~.,..~. ......................... Fee..'.~.~..T ............................... / (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, spegify 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 .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ..... 7.'..~w.~. ....Rear .. '.)...Iff ........ Depth .,,,qO.: .......... Height ..... ~ ........ Number of Stories ...... ./././.k:' ............................................. 9. Size of lot: Front .... .~-L,o..o. ............ Rear ..... ~..o. ?. ............ Depth .../.'.,;~..". .............. 10. Date of Purchase . ./.yO.~..c/.~ .... ./~. '?..~ ......... Name of Former Owner ............................. 1 I. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .Z~.?. .......................... 13. Will lot be regraded .... .~.~., .................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .~.~../../..Af./.+?.--y. ...... Address O~'~'.~.%~?.%.~'~.p. ~:,J... Phone No ................ Name of Architect ~.~-.~::~.. ?./~..~. *~...b~. ....... Address .~. '.qr. '.t~.: ./.~, . ./?. -~... Phone No. Name of Contractor'2~,'.~..~.~..~/~'. ~<,':~lt~ ./~..c~.... Address ~ff~. ~d¥~.*. :/..~.,-j.a. Phone No. ~."~.'~. 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, ................. ' .......... being duly sworn, deposes and says that he is the applicant · //(Name of individual signing contract) above nan~erd. He is the..~..~. .... /.~.ff../..~./.~.z(..~.~.....~./,'..,s...~..~.~. p .~.~.../'../L< ~ ............................... (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 contained 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 ......... .~../ ............ dayof ..... ~.~-~. ......... , 19 .~.~ ,// ~,,,/ l'qotary vublic, . ~ .................. County '~?0..-~ ~ '~,~~,~ /./' o. ., . _ ...... /t--~'-" Iqo~a,.ty?u~l,~c, s2.ato,oo!~o~ '-'~'~-~-~-'~'// n /' ~ Si~natur, e of aoolic~ant) Commm~onExp~resMarch30, 19g5~/ /~*~ .r~r ~ ~,./',,S,t-~,~,-~w~',~r, /ff~_..._ ' - :,, -¥ .... . SUFFOLK CO. HEAI.TH DEPT. APPROVAL H.S. NO STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL, CONFORM TO THE STANDARDS OF THE SUFFOLK/~Zg.~DEPT. OF~JCEA~y~H .~R, viCEs. SUFFOLK COUNTY DEPT.' OF SERVICES_ -- FOR APPROVAL CONSTRU~ ION ONLY SUFFOLK CO. HEALTH DEPT. ,APPROVAL H.S. NO. STATEMENT OF INTENT CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (si SERVICES -- FOR APPROVAL OF SUFFOLK COUNTY DEPT. OF HEALTH CONSTRUCTION ONLY SUFFOLK CO. TAX MAP DESIgNATIoN: OWNERS ADDRE~: TEST HOLE STAMP SEAL · ,5~Z'~7' - ~ ~z ~3,,, 10W ' ~.~ *~ . ~ ~'~k ~ ~~. ~ ~.~~: ................................... ~ ............ ................................. - ..... ~ ............................ ~~,~ .,~ ~ ~.~/~ ...................... ..................... ~ ......................... :~.:~' .':.~-'~:~:Z .~':~%:~2'~,~;:' ~,~ ,,~7" '-...::,:7-' : ~ .~" .: -:'7 ALBERT A, SACCO ~N~ GORDON K, AHLERS ARCHITECTS ~ EN~INEE~S ,, Archl[ect and Engineer's Seal Signature My good for initial use of ~sions to or re use of dlawmCs o~ ~ch~',c~ or [nDneer's Aoorovaj voi~ Seal and S~gnature on same. ALBERT A. SACC,O AND GORDON K. AHLERS ARCHITECTS 8, ENGINEERS 5a655 Ma,N ROAD SOUTHOLD, N, Y. 11971 APPROVED AS NOTED DATE, ~ -- ~E-- 7~ "Ah%rmion of this Document oy ;~n Arebtect or Licensed Profes. sf',nal Engineer, is Se,:don 7209, Sulxhv~sion ~'L 'f, State EdLicabon NOTIFY BUILD:NG DEPARTMENT AT ?6542660 9AM to 4PM FOR REQUIR. ED INSPECTION5~ 1, BEFORE BACKFILLING FOUNDA- k , ,/, ~-iqgT L-LOO HOLDF. N Ave. PLAN NR.tHRS. ALl--RED 14ALIKIAS N,C~oSS~D. CUTCFIOGU.D. N,~ % _,0 DRAWN ~y : ~, CHDCK&DBy: DATA--; ,:l--Zg-Tff FII~ST FL.PLAN ,~R~-S,{or I"IP..¢He$.FIALIIOAs I [ I Architect and Engineer's Seal and Signature only good for imtial use of drawing. Changes, alteratmes or re- visions to or re-use of draw~egs w~th- out Architact or £ngmeer's Approval ~oid$ Seal and Signature on same. "Alteration of this Document except by an Arch:~ect or Licensed Profes- sional Engineer, is illegal". Section 7209, Subdivision 2, N.Y. State Education Law. ALBERT A. SACCO AND GORDON ARCHITECTS & ENGINEERS 54655 MAIN ROa, D K. AHLERS SOUTHOLD, N.Y. 11971 f-UTUR'~ ~COND rbL00~ PLAN J~r.-SIDLNC-E-for HR,¢HD.?,ALFI2rrD FIALIKIAg ~OLDeN AV-r::.,~LN,C~OSC~ DD, Cu'T'ClaO~Ue-,N.Y. PROd ~.CT :47fl02 Dp. AWN ~Y: T,D ~HEC. K~D 15¥; ~DAT~; 4-25-~'~ 'FUTUI~.L-- ?_.ur~ [-L.PLAN ~-S.~cor ~g~RS, J~ALiKiAS Architect and Engineer's Seal and Signature only good for initml use of drawing Chenges, alterations or visions Lo or re-use of d~awmgs with- out Architact or £ngmeer's Approval voids Seal and Signature on same. "Alteration of this Document except by an Architect or Licensed ProJ~es- signal Engineer, is illegal". Section 7209, Subdivision 2, N. ¥. State Education Law. ALBERT A. SACCO AND GORDON K. AHLERS ARCHITECTS & ENGINEERS 5~r655 MAIN ROAD SOUTHOLD, N. Y. 11971 POU NDATION DLAN ALFD D 14ALIKIA CUTCH OGU .~ N,Y, PROJECT: 47qo?_ DP_AWN I~Y: T.D C~4r~CK~D ~¥: G,K.A DAT~: 4.7_5-79 cj CALE-- FOUNDATION PLAN ':l ~E--$.'~o,, MB.¢H~S,14ALI K lAG Architect aod [ngmeer's Seal and Signature only good for initial use of ~rawmg Oranges, alte~atmns or re- ,~lslons to or re-use 'of drawhlgs with- m.,t Amh~t~ct or Engmeer's Approval '~ Seal aod S~gnature on same. ~.~eratlon of this Document except by ~n Architect or Licensed Profes- lionel Engineer, is illegal". ~ $ecl, lon 7209, Subdivision 2~ N, Y, State Education Law. ALBERT A. SACCO ARCHITECTS & 546'~5 MAIN ROAD AND GORDON K. AHL~.RS ENGINEERS SOUTHOLD, N. Y, 11971 FiC)LDE-Iq C__, ~0 S S g.r=CTI 0 N H E,~, H RcJ. ALFRED ¢ N.CR0 ~JAL1KIAS ~P. C uTc~qoGU&,H.Y. PDOJE-CT: 47fl02 ODAWN BY * CHECI(,~-D DAT~:4-85-Tq qCA L.~. : ~/g'=i'.O" SH4ofG Architect and Engineer's Seal Signature only ~'ood for initial use of drawing. Changga, alterations or ~- 6sitars to or re-use of drawing~ ~ out A~chitoct er [ngineer'~ ~ voids S~al and Signature ~ m "Alteration of this Document by an Architect or Licensed slonal Engineer, is illegal". Section 7209, Subdivision 2, N. Y, State Education taw :- il ~RONT ELEV. ' k~fteet aed Engineer's Se~l and ~mature only good fo~ inff, al use of ~lrawlng Changes, alterahnns or re- ~sions to or re-use of dr'~w;ngs with- Architect or Eegineer's Approval ~ids Seal and Signature oe same. .... ~!~ration of thts Document exes-p: II~ an Architect or Licensed Profes sional Engineer, is illegal", Section 7209, Subd~ws!on 2, N Y. State Educabon Law. 1-...10 L.D E" N AVE-, CNO~TH ALF~r- · D h-IALIKIACj CUTC H O G U'E- ~ Itl.Y, ALBERT A. SACCO AND GORDON K, AHLER$ ARCHITECTS & ENGINEEP. S ~L655 MAIN ROA(~ 5OUTHOLD. N. Y, ~; H~Od~CT: 478 0~ ScA~e: '/~", F-O' DP,.AWN ESY; T. ID. C. H 6-C K'8'D ~Y DA, T-E-' '. 4-~5'7~