HomeMy WebLinkAbout10272-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N.Y.
Certificate Of Occupancy
No .... Z~.I~I? ........ Date .... Fpl0~tleZT..29 ................ 19 80
THIS CERTIFIES that the bufldBg ................................................
~mtion of ~pe~ .... ~5. O~OO~ ~l~e .................... ~X~,. ~.,.Y ~..
~o~ ~o. ~ H~I~
~W T~ Map No. 1~ ~ion ... 9~ ...... Bilk ...~ ........... ~t ....... ~ ........
Sub~on..Cea~ .Beach. P~k .......... FHed ~p No ......... ~t No....~ ........
confo~s subst~t~y to &e AppH~on for B~g ~t h~tof~ ~ '~ ~ ~ ~t~
. .. J~e..~9 ......... ,1~9. pm~t to w~ch B~g Pemit No .... .~027~ ..........
~ted ... ~e. 20 ................ 1~9., w~ ~, ~d c~fo~s to ~ of ~ ~m~ts
of ~ appH~ble prov~iom of the ~w. ~e o~up~cy for w~ch t~ c~ifi~te ~ ~ ~ .........
........................ ~e .F~y. ~ell~g .................................
~e ~ficate 2 ~ued to ... 0~. ~e~. 'L~.t~ ................................
of the afor~d b~d~.
S~fo~ Co~ty ~m~t of He~th Ap~ . .9-B~8 .... 2/29~... ~.. ~ .V~a...
~ER~ERS ~RTIFI~ NO ......... ~. ~7q59 ...............................
Buildin~ Inspector
FORM NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTN~.ENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
10272 Z
Permission is hereby granted to:
............ ~. ..................................................... ~ ................................ ..: .......................... :..~...~.. ..............
...... ~¢...4 ...... ~..o.,. ............ .¢.~?.~ ........ ?~.~.C.2 ......... i~.~.~.....~ ....... ~.!..'.: .......... ?. .....
pursuant ,o application dated ............................. ~.U...~...E ....... (?, 19~.~.., and approved by the
Building Inspector.
,ee
............ ........
'Building Inspector
THE NEW YORK BOARD OF FIRE UNDERWRITERS
~ BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK. NEW YORK 10038
THIS CERTIFIES THAT
only the electrical equipment as d~scril~d belo~ ~n~ i~ktr~duced b~ t~ appllc~tt n~. ~d En~the ~ application ~umber in the premises of
in the following location; ~Basement ~ 1st FI. [] 2nd FI. Section Block Lot
was examined on ~l~b~l~ 7 p ].980 and found to be in compliance with the requirements of this Board.
~XTU.E I 28 24 ~xj~s.~ ......
OUTLETS ECEPTACLES SWITCHES ~NCANDE$CEN1 VA~Oe
DRYERS FURNACE MOTORS FUTURE APEUANCE F~EDERS
AMT. K. W. OIL H.P. GAS H. P. AMT. NO, A. W. G.
,
RANGES
1 11'
SPECIAL REC'PT.
1 $0
EXHAUST FANS
DIMMERS
I AMT. WATTS
SERVICE DISCONNECT J NO. OF I S E
AMT.]. ].00AMP' TYpEcb C~. 1~'2W 1 ,e' 3Wx 3~'3W 3~'4W ~. ~C~COND.~
OTHER APPARATUS:
1-G.F.C.Z.
R V I C
A. W.G. NO, OF NEUTRAl S A.W. G,
OF NEUTRAL
1. 5
OF CC. CaND.
3
Ruland gXe¢. Co. ~"~ I ,~/
~.0. k)x 143
~ctiC~, H.~. 11952 L~e.242i ~,, .ll~~_~__
This ce.ificate must not be altered in any manner; return to the office of the ~ard if incorrect. Insp~ors may ~ identifi~
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATi MUST NOT BE ALTBRB'ri IN ANY MANN~R~
765-1802
BUILDING DI~PT,
INSPECTION
FOUNDATION :[ST [ ] ROUGH PLBG.
FOUNDATION 2N'D [ ] INSULATION
[ ] FRAMING
[ ] FINAL
7G5-'~802
BUILDING DEPT.
INSPECTION
FOUNDATION 1ST
FOUNDATION 2ND
FRAMING
ROUGH PLBG.
INSULATION
FINAL
INSPECTOR
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
.......... ....
(Building Inspector)
A. PPLI~ATION FOR BUILDING PER,MIT
INSTRUCTIONS
Application No. f.~...~-.7.~ ...........
a. This application must be completely filled in by typewriter o¢ 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 o~
areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application.
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 ail 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)
.........................
(Address~T';~;ii;;;;~'fi ...... 7"' ....................
State whether applicant is owner, lessee, agent, orchitect, engineer, general contractor, electrician, plumber or builder.
· ..................................
................................. .....
Name of owner of premises ..~_,~ ........................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No ..... ,.~..(.;',,~,. ....... .c',/~,...?,....~ ..........
....... :...Z~
Plumber's License No. -~' ..!...~.'~..I. ....................
Electrician's License No...2...~.L~.....~........~.r;.. ................
Other Trade's License No .............................................. ~ _ ~ ._ r~ ii
· ~o o ~ r~ [.~ t;~ _.7. ~
Location of land on which pro osed work will be done.· ~ N .:~ ........ ~q.. .................. ~o. ..................
Street and Number ..t~,~..'7~......~.~..:....(..~...~.. ........ ~.-~..~1..!¢.:.~.~.~, .................
/ Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b. Intended use ond occuponcy ........................................................ : ...............................
3. Nature of work (check which applicable): New Bullding' ......~..x.. ....... Addition .................. Alteration ..............
Repair .................. Removal .................. Demolitior ..................... Other Work ................................................ ....
4. Estimated Cost ....,~.....~ ............................................... Fee '-~ ~4' ~ (Description)
(to be paid on filing this application)
5. If--d~velling, number of dwelling units ............/.. .............. Number of dwelling units on each floor ............................
If garage, number of cars ........... ~7 .................................................................................................................................
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 ........ '7 ....................... 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 ......... .~...'2~¢.. ................. Rear ......... ~..~ .......... Depth ....~..?. ..............
Height ....~...~.! ...... Number of Stories ......... ~ .....................................................................
9. Size of lot: Front ...... .~...0..~.fl ...................................... Rear .....~/...O..f.P.. ................ ; ........ D,epth .../....7...,,3... ...................
10. Date of Purchase ..,)t.~..7../...~...~....~.~ .................... Name of Former Owner .~........C.°.:.~.~" ----
11. Zone or use districtL/in which premises are situated ..... J~.~...m ............................ ~ ,~ -,w',t ................../¢ ...........
12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~&.~7........-7[~.~.~. .....
13. Will lot be regraded ......(~r.A,~r.. ........... Will excess fill be removed from pre?.ises: ( ) Yes (/~) No
to. ,
14. Name of Owner of premises ........................ ~.... ............ Address ...................... l......~,. Phone No..~..~..~:'..~..~..~....~.
Name of Architect ~
...... : ....................................................... Address ................................ Phone No .......................
Name of Cgnt.rgctor ..................... Addres : '. Phone No.'7..S....~..~.(e..~.~...z=.
PLOT DIAGRAM
Locate clearly and distinctly oil 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 coat, er lot.
h,,Z,w, -6'01
STATE OF NEWeY-~R~' ~t'. lcs
COUNTY OF ..%...~.~u~..j~......~'~ .~
......................... (~.~.~-~'fi".~--,,~.. ........ .~...~.~.~.i~/~,~.l ............. being duly sworn, deposes and says that he is the opplican~
(Name of individual signing contract)
above named.
He is the ........................ i'. ............. i~L~...~.~a~t,~...~.. ........................................... i ..........................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and js duly authorized to perform or have per(armed 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 belie~; and
that the work will be per~ormed in the manner set forth in the application filed therewith.
Sworn to before me thi~ /-x ~ .-~
....day of ............... Faf/ff ? fi _ n
Notorv Pub,c,. ........................... ...... .....................
C~ ~~t~..i~~ (Signature of applicant,
ELIZABETH ANN N~VILL~
r~OT^RY P~JBLIC, ~l~e of New Yfwlq
No. 5~-81258§0, Suffolk CouD, fy,.
Term Expires March 30, ]gd~_..~,~
Sane/
7
O ~./N
5
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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 featu res.
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 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 $5.00
3. Copy of certificate of occupancy $1.00
Date ,.,~, ,~,,;.,'~,.~/..~., ......
New Building .... .~. ....... Old or Pre-existing Building ............ Vacant Land .............
Locat,on of Property ................. ~ .rr.r.. ~~. p~ .... ~ ....
Countg Tax Map ~o. 1000 Section ............... Block ............... kot ................
....... ....... .......
Cermit ~o. [ 0 .~"-- ~~ate of ~erm~ ~/~/~Applicant. ~~ .~.~' · ......
...... .................
.... ~ ............. ¢lannin~ Board Approval ~ ~ ...............
Dnde~riters
Approva}
... ~
~equost for Temporarg Certificate ..................... Final Certificate ~
Fee Submitted $..~.~ ,~, ....................
Construction on above described building and_pe~it meets all ai~plic~ble codes ~nd regulations.
COUNTY OFSUFFOLK
DEPARTMENT OF HEALTH SERVICES
July 3, 1979 }~-0
Mr. Olin Harper LeCompte
General Delivery
Mattituck, New York 11952
Re:
Board of Review Hearing
Application to Construct an Individual Sewage Disposal System and
Private Well, Property E/S Oakwood Drive, 90' S/O Shady Lane,
Southold, Town of Southold
Dear Mr. leCompte:
At the hearing held on June 5, 1979, you had an opportunity to present your
appeal of the department's ruling on the subject application.
In accordance with the provisions of Section 220 of Article 2 of the Suffolk
County Sanitary Code, the determination of the Board of Review is as follows.
Based on the information submitted, that the application be approved as pro-
posed.
Since the determination of the Board of Review submitted to the Commissioner's
office on June 28, 1979, has not been reversed or modified by him, it is there-
fore deemed to be the determination of the Commissioner.
Very truly yours,
Chief Engineer
Bureau of Environmental Health
HWD/lst
cc Mr. Robert A. Villa, P.E.
,~6wn of Southold Building Department
P
DATE:
FEE:"
NOT!Fy'BUILDING DEPARTMENT -.'~
765-2660 9AM to 4PM FOR
ED INSPECTIONS: -" ,
1.'BEFORE BACKFILLING FOUNDA- .. '.
TION OR START FRAMING ' - ' ~ :,
-~-- ~-'27"Tr~AMING 'IN~PECTiO~' ' ~ ' '
3. BEFORE COVERING PlP, i~S F ANY KIND ,
4. FINAL WHEN JOB; C~OMPLETED . , , , :. -
NOT RESPONS BLE FOR DESIGN .
'OR ~Oi~,Ku~.llON ERRORS: ' ' ' '" ~' ' "' ' :'~ '
5. ALL CONSTR"'uCTION MUST MEET '
REQUIREMEi'~TS CF.N~.y. STATUE CODE
4..