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HomeMy WebLinkAbout10270-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z J0~6 Date Augus% 28, 19 80 THIS CERTIFIES that the building ................................................ Location of Property 66.8~... ECti~ah' s Lane ~ ................................. h~ds'e No. ' ................ Street ~fl~UCk H~miel 4 '11 County Tax Map No. 1000 Scetion J00 .Block ............... Lot Minor Deerkoski 156 Subdivision .............................. ~F~z~ Map No ......... Lot No conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .F[a.y.. ?? ........... 19.7.9. pursuant to which Building Permit No .... '1.9.2_.7.0...7, .......... dated ........ ,~1~..rl.e..~ .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 ......... ......... .Pr.l.v. 0..t,.e..Qn..e.-.~: .a,¢. $.ly., .~..e.~.l.$.ng ...................................... The certificate is issued to ..... l~J.e.:l.o.~..B.o.I~.!~.O .8~.i. ..................................... (owner, F~I~X~Y:JY. of the aforesaid building. Suffolk County Department of Health Approval ...... ............................ UNDERWRITERS CERTIFICATE NO. N /460275 Building' Inspector Rev 4/79 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CQMPLETION OF THE WORK AUTHORIZED) N°. 10270 Z Permission is hereby granted to: f"d'~'":'"":~ .........~ ~ ........................................ :'. c/~ ~ ~"5"~: ~r -) ~o ........... ~t.'.t.~..~ ....... .e. ...... ~t? ~m c~ r~,~ ~,r b~.,,~L~ ~,~,~ ............................ ~2~ ~. ..................................................... at premises Io~ated at F~ ~-I ,&/~ pursuant to application dated ~'//-J v -2 ~ 19Z.~,. and approved by the Building Inspector. Fee $.,,,2'-.2....0.C. 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 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 Enginee¢ responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. Bo 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 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 .... ~.1~, .~2.~. ~ -~ ~ ...... / New Building ...... [~.f f..~,~Q[d or Pre-existing Building ............ Vacant Land ............. Location of Property .............. ~ ................................................. Hou~ No. Street HamNt Owner or Owners of Property / ~ ....... ~'2 ...... County Tax MapNo. 1000 Section....... Su~?~... ~.~g~ ................... ~ ~ap No .... 156 .... Lot No... ~ ......... Health Dept. Approval .., ,~. :-, ,~, .~,-,~ .~. ~,, ....... Labor Dept. Approval .. Underwriters Approval Al ~/~"~ ~ ~ .Planning Board Approval Request for Temporary Certificate ..................... Final Certificate . Fee Submitted $..~.7..~ ~..~,. ................... Construction on above described building and permit meets all applicable codes and regulations. Applicant /~-~ '"~ .................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELE~ Jo.. ST" 'T--"EW ,OO S THIS CE~IFIES THAT o~y t~ e~t~a[ ~ulpment ~ ~ ~ a~ int~ by t~ ~i~t ~ on t~ a~ ~t~ num~ in t~ p~mlses of He~an ~rkosk~, v/s g~aa ~, 2000' n/o C.R. ~27, ~uck, L.~. w~ exami~ on a~ fou~ to be in compliance with the requirements of th~ B~rd, FIXTURE OUTLETS 17 ~ECEPTACLES 3O SWITCHES RXTURES DRYERS I FURNACE MOTORS I FUTURE AEFUANCE FEEDERS AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. RANGES 16.3 ECIAL REC'PT COOKING DECKS OVENS DISH WASHERS AMT. K.W. AMT. K.W. U~T. K.W. TIMECLOCKS BELL IUNITHEATERSUNITHEATERS MULTI-OUTLET II SERVICE DISCONNECT I NO. O~ I S R V I C METER A.w.O. 1 ZOO cb x 1 3/0 OTHER APPARATUS: F=lec. ~,.oom Heate=s~4-1.SKW,l-l.25KW,Z-1.0KW,~-. 75k~W,l-.§~O~ Moto~J a ~ I-F 1-G.F.C.L 1-Smoke Detecto~ 1-4.5K~ Hot Water Heater EXHAUST FANS DIMMERS AMT. WATTS I ]/;w o NO. OF NEUTRALS OF ~E~J~AL Ruland ~;lec. Co. P.O. Box 143 MmRALMANAOIR Mattituck, N.Y. 11952 Lic.242 ~- 11 Per This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY. OF ClRTIFICAll MUST NOT BE ALTERED IN ANY MANNER. _~ I O ~'7 0 cZ___ ;Z ~5 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL,: 765-1802 Disapproved a/c . . .~] ........ ~ ............. ............................... 4 (Building Inspector) APPLICATION FOR BUILDING PERMIT Application NO~ .................. Date ..... U.~Z..2.~ ....... 19..7.9 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 tc~ 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 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 name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Owne~' Name of owner of premises lte 1 on Berkoski (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 .......... ./~. 8.-. I.t .I .......... Plumber's License No .......... 8. (29. ?. ......... Electrician's License No. 242 P, Other Trade's License No ...................... 1. Location of land on which proposed work will be done ............. ..................................... .............. ..... ............ .......................... House Number Street Hamlet County Tax Map No. I000 Section ........ .1.0.1. ...... Block ..... .1 ............ Lot. ~ ~_Oe~' l!~-Map No. /~ (o Lot Subdivision .................................................................. (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 ......... 0~n.e..~.m.i.l.y.. ~.w.e.~.~..~ .n~g. .................................... ~ 3. N~tture of work (check which applicable): New Building ... X.X .... Addition .......... Alteration ........ :. Repair .............. Removal .............. Demolition .............. Other Work ............... '~ 7 © (Description) 4. Estimated Cost ......... .~.g,9. +,.0.09 ...................... Fee ...................................... (to be paid on filing this application) 5. I~lwVelling, number of dwelling units .... ,~ .......... Number of dwelling units on each floor ................ If garage, number of cars ........... 2. ............................................................ 6. If business, commerciai or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... tteight ............... 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 ..... .~9.~ ....... Rear ..... .~.0! ....... Depth ... 2~.~ ......... Height ............... ~umber of Stories ...... .~. .....-' 'l ......................................... 9. Size of lot: Front .... .J..5.0 ............... Rear ...... ?.5.0 ............. iPee~tehr ./~bi. 2~C)o.0g.~/~)~.' .......... 10. Date of Purchase . ~'la~.eh. 215.~..19.7.9. ........... Name of Former Owner .Felix. 'lleertcosk~_ ........... 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ...... ~.e~.ij.e ~.e.n. ....................B.e.r.k.q..k.~. Will ex~e~ fill4 r~be removed frOmphonePremiseS:No..2.9.8.-~ 8. 4..6.BYES xx No s ' u e on I~oad 14. Name of Owner of premises .. Address . .Gutctt. o~ue ....... · ..... Name of Architect ........................... Address ................... Phone No ................ Name of Contractor . . .N.o.~.m..ag..~ .a~.~qo.k. ......... Address .~.,..,I..a~.e.~.p. qr.~. ...... Phone No..'7.22-.3.9~1,2 ...... 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 .... COUNTy~r~//-" ~ -r~J'~-~f~' ~'~ . being duly sworn, deposes and says that he is the applicant (Name ofifidividual si~nin~ co~ t (Name ofindivi ua signing con ract) above named. _~'He is the .. ~ (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 ......... ..... ........... Notary Public, .....~. ........... County Area = 1.000 Acre ~. N, 26~02'40"~t 130.00' now or formerly Peter ~ Felix Deerkoski NOTE: system f~r this residence will ~on- ~ ~MONUMENr form to the standard of the Suffolk G~%~ De~artmen% of Health SURVEY FOR ~FFOLK COUN~ DEPARTMENT OF H~LTH SERVICES ~L~ ~KO~K/ ~.~,/~ JUL Y 28~/9~8 FOR APPROVAL OF CONSTRUCTION ONLY AT MAT~ITUCK B~TE JUNE30, 1978 APPROVED ' '~ * COPIES OF T~IS SURVEY HOT BEARING THE LAND DEB RTM___.DATAFOR App._..._ T_ C_NSTRUC. " THE PERSON FOR WHOM THE SURVEY iS PREPARED, H~LTH Y~"~¢~. ~ ;J ~ I a RIVERHEAO,NEW YORK ,, ALDEN W, YOUNG,PROFESSIONAL ENGINEER ' ' ANDLA~D~URVEYORN,Z~.LICENSENO. 12845 'HOWA~ W. YOUNG, LAND SURVEYOR '~EL~TION~WELg(W),SE~IC T~K(S~e~SP~LS(~ISH~ H[~O~ L N.Y.S~ L~ENSE N0.45893 " or' O~~ ~ \~ ~._ \ %%% ; · o~, ~ ; ,~.. ~OAD (CR'27) · = MONUMENt . ~ ~ ~I S~RVEY FOR] ~ ~1 .~T ,MAT~ITUCK ~T~ NEW ~OR~ NO. 78-376 , / , ,~ ,~ ~ ' ' ~ ~ J. ~ARANTEES~INDiC~T~D H~REON SHALL RUN ONLY TO ............ t .. : .. .. , ~ ' ',~/~LJl.; J~ ~, ~ J 'ALDEN W.~OUNG,PROFESSIONAL ENGINEER · IlANDLANDSURVE~ORN.~S. LICENSENO.,2845 '~mE~T~),s*~t~(~t)~~ ~~ N.~S. LICENSE NO 4589~ .~ . , , ..... ~m~-L ~.~ , , :, . NOTIFY BUILDING DEPARTMENT AT 765-2660 9AM to 4PM FOR REQUIR- ED INSPECTIONS= I. BEFORE BACKFILLING FOUNDA- TION OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERING PIPES OF ANY KINL 4. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS "F N.Y. STATE COD~ .?