The URL can be used to link to this page

Home My WebLink About10304-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-25581 Date MARCH 9, 1998 THIS CERTIFIES that the building. Location of Property 5700 ALVAHS LANE House No. County Tax Map No. 1000 Section 101 Subdivision ADDITION TO ACCESSORY CUTCHOGUE, N.Y. Street Hamlet Block 2 Lot 18.4 Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 18, 1979 pursuant to which Building Permit No. 10304-Z dated JULY 9, 1979 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 ADDITION TO EXISTING ACCESSORY BUILDING AS APPLIED FOR. The certificate is issued to WESLEY SIMCHICK (owner) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED Rev. 1/81 N/A N/A N/A /uildzng Ins~ec~r~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTH'OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NOV 10304 Z Date ........................................................, 19....,1 Permission is hereby granted to: ..............0 . .. ... '......... .... ............ .. `... rG 7 /( r' < <_ C ICJ Y ................................................................................ ................................................................................ to .......n.. . . ................(: ............ .......,nrr../....... �../..... ............�r�.'.(:�.........J..........�1'........ ................................................................................................................................................................ at premises located at ✓ 7C (' ... v� /1 r f A ......................................................................... ............................................ C/ I (- F 1 (' !, C/ lz. ................................................................................ ................................................................................ ................................................................................................................................................................. Nr . (( -7 9 pursuant to application dated ............................. .0............... 19 and approved by the Building Inspector. Fee $........................ / /%rl . ... Building Inspector 1 �l 1 Form No. 6 TOWN OF SOUTtIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of waker supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildin~ - $100.00 3. Copy of Certificate of Occupancy - $20.00 4. Updated Certificate of Occupancy - $50°00 5. Temporary Qertificate of Occupancy - Residential $15.00, Commercial $15.00 Date ........ ~[..~. ~.~ ff ..................... X New Constructiom ........... Old Or Pre-existing Building ................. 5700 Alvahs Lane Location of Property ' ~ggq~ House No. Street Hamlet ~0nwer or Owners of Property .... Estate of Wesley Simchick County Tax Map No 1000, i01 00 Blo. U 02.00 Section ..... · ...... ... ~.........o.. .... Lot. Q~QQ~ ......... ... .. Subdivision ' Filed Map Lot No 10304 Date Of Permit Applicant iPermit ............................. , ............................... Health Dept. Approval.' ......................... Underwriters Approval ......................... Planning Board Approval Request for: Fee Submitted: Temporary Certificate ........... Final Certicate...X. ....... $ ~25.00 ~ John ~AP'PLICANT Simehiek, Executor FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ..... . .~.~...~., 197.~. ~ Approved ..~.~ q19 7.~ermitNo [~t9~7 _ ....................................... -- .......... ....... APPLICATION FOR BUILDING PERI,lIT Application No./~ ?..~./. ........ ~ 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 commenced before issuance of Build~ng 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 avai/able 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 cyd~, and regulations, and to admit authorized inspectors on premises and in buildings for necessary insp~ctions/q /// ~ ~ / o~" · ~ '~? (Signature 94~jO/licant, or name, if a._~rk6B~tion) (Mailing ~l~ess of ~pp~lcant) ~,~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Cas 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 .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... l. Location of land on which proposed wor~ will b%d, one. ~ .~?..~.. House Number~5 County Tax Map No. 1000 Section ./.(J..} .......... Block .e>~ ............. Lot .~. ~"-/../.~07-.,~ Subdivision ............ '~' '(iq'a~) ................ Filed Map No.. 'X ......... Lot../'/¢~x' ......... 2. State existing use and ocT~pancy of premisea and intended use aAadRccupancy of proposed construction: a. Existing use and occupancy..~ .~? .~...~.: ................................. b. Intended use and occupancy ..'..~.~. ~ ........... . ....................... ~ ............ 3. Natureofwork (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ........ .z ..... Removal .............. Demolition .............. Other Work ............... · ~7 ~/ J _ } (Description) 4. E:stimated Cost....'~. ~ .'...'~. ...................... Fee..~. Z.~.'.(.~/.. .......................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each ilo, or ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nat~tre and 'extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front...~z2. ......... Rear .............. Depth . .o~..~ .......... tteight .../~ ........ Number of Stories ...... ~. ........... : .~.~ ................................. Dimensions offs,me structure with alterations or additions: Front . .~ ....... i ....... Rear .................. Depth .. ~,~.~ ............... Height .. ~ ............ Number of Stories ..... /. ................ 8. Dimensions of enfire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........... : ............................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. !)ate of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated..,f{ .--..,~. ~,..79.~. ...................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .. ~J~. .......................... 13. Will lot be regraded .... i~, · ~J'~' .................. Will excess fill be removed from premises: Yes N~o 14. Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ............ ....... Phone No ................ Name of Contractor .......................... Address ................... 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.4~.,RI~ ./, ~, ,~ S S C OUN~~- .............. being duly sworn, deposes and says that he is the applicant (Name~of~al signing contract), 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 ~ .......... ....... . ............ ...) /, , , } III! lid mill I ,; SSUE DATErIMMiDD/YY) ,. j ` PRODUCER p . j ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY s AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVER. fi ROY H REEVE AC;Fh!CY INC: AGE AFFORDED BY THE POLICIES BELOW. r MAIN ROAD . MATTITUCK N Y 119S COMPANIES AFFORDING COVERAGE { COMPANY ROYAL GLOBE INS CO. LETTER A t COMPANY _ INSURED LETTER B Rion NEW ENGLAND LOG HOMES COMPANY OF LONG ISLAND LETTER C PCt. BOX 914 COMPANY D Ul A 2 4/� RIVERHEJ` D NEW YORE; J,�.901 LETTER COMPANY BLD(;.DERIM Pi;LETTER E • THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY r PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH ".cvs RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. +r CO POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD,YYI DATE IMM;DG!YYI EACH OCCURRENCE AGGREGATE (� GENERAL LIABILITY F'L.U}-}725_50 1 01/88 j/01 /89 BODILY ?..• COMPREHENSIVE FORM INJURY 000 is ; Y PREMISES/OPERATIONS '�.. PROPERTY pr, UNDERGROUND DAMAGE EXPLOSION&COLLAPSE HAZARD 25Q �F• Y PRODUCTS/COMPLETED OPERATIONS { Fc CONTRACTUAL BI&PD i •r, COMBINED ,.; X INDEPENDENT CONTRACTORS Y BROAD FORM PROPERTY DAMAGE PERSONAL INJURY PERSONAL INJURY ti=' AUTOMOBILE LIABILITY BODILY _ INJURY - T (PER �'i'• PERSON) ANY AUTO BODILY INJURY ' ALL OWNED AUTOS (PER ACCIDENT) 'ryh HIRED AUTOS PROPERTY NON-OWNED AUTOS DAMAGE GARAGE LIABILITY COMBINED EXCESS LIABILITY _ •Bice __ UMBRELLA FORM BI&PD - COMBINED f.. OTHER THAN UMBRELLA FORM ,_ STATUTORY .-;;• WORKERS'COMPENSATION �s d`_ c AND )EACH ACCIDENT) ✓•,' ` EMPLOYERS' LIABILITY (DISEASE-POLICY LIMIT) (DISEASE-EACH EMPLOYEE) OTHER ;• DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS f F - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED S(6�i`!1._Y SIMC:HIC:l: BEFORE THE EXPIRATIO ATE �FHT REOF, THE ISSUING COMPANY r, WILL ENDEAVOR TO M ( DAYS WRITTEN.NOTICE TO f• _' AL.VAHS LANE THE CERTIFICATE H •^.2 NAMED O T E LEFT, BUT FAILURE-�O CUTC�HOGUE" NY 11 r'u� MAIL SUCH NOTICE- � L IMPOS GATION OR LIABILITY F ANY KIND UPON T - :TS OR REPRESENTATIVES. -AUTHORIZED REPRE LN ROY H REEVE A N Y Ito S FORM NO 1 TOWN OF SOUTHOLD BUJLDING DEPARTMENT ; ,, TOWN HALL SO�U;THOLD, N.Y. 11971 ;.T E L.: 765-1802 Examined . . : a ` . .Cj{, 19 Application No. !. . . . !. . . . . . �3o �/ Z� Approved . . . . . . <<1: . .1 19 .7. ermit No. . .�. . . Disapproved a/c . . . . . . . .. . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . j . . . . . . . . . . ?7�j,�. �-v► uilding Inspector) APPLICATION FOR BUILDING PERMIT Dat 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 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 co' e, and regulations, and to admit-authorized inspectors on premises and in buildings for necessary insp ctions. nature of hcant, r name, i a c r ation) (Mailing a ess of app ' an -State whether applicant is owner, lessee, agent, architect,' engineer, general contractor, electrician, plumber or builder. . . . . . . . . . . . . . . . . . . . . . . . .. J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises �/ .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . on the tax roll Zoriate'st deed) If applicant is a corporation, signature o ly authorized officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name and title of corporate officer) Builder's License No. . . . . . . . . . . . . . . . . . . . . . . . . . Plumber's License No. Electrician's License No. . .. . . . . . . . . . . . . . . . . . . . .. Other Trade's License No. . . . . . . . . . . . . . . . . . . . . . 1. Location of land on which proposed work will be done. (�. . . . . . . . . . . Hou Nui g-�eAHamlet County,Tax Map No. 1000 Section . ./(} .�. . . . . . . . . . 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 . . � �. . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy ` � . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . 3. Nature of work (check which applicable): New Building .. . . . . . . . . . Addition . . . . . . . . . . Alteration . . . . . . . . . . Repair . . . . . . . . . . . Removal . . . . . . . . . . . . . . Demolition . . . . . . . . . . Other Work . . . . . . . . . . . . . . . / Xv (Description) 44. Estimated Cost . . . . . . . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (to be paid on filing this application) 5. If dwelling,'riumber of-dwelling units . . . . . . . . . . . . . . . Number of dwelling'uriit's oh'each-floor-.. . . . . . . . . . ..... . If garage,number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixed occupancy, specify natIre and`extent of each'ty_pe of use. 7. Dimensions o fisting structures,if any: Front . . . . . . . . . Rear . . . ... . . . . . . . ., Depth . �� . . . . . . . . . Height . . . . . . . . . . Number of Stories . . . . . .I. . . . . . . . . . . �,. . . . .'. :. . :. . . . . . . . . . . . . . . . . . . . . Dimension f erne structure with alterations or additions_: Front . . .1... . . . : . . . . . . . Rear . .. . . . . . . . . . . . . . . Depth . . :�e. . . . . . . . . . . . . . . Height . . �?? . . . . . . . . . _.-Number of* Stories . . . . . . . . . . . . . . . . . . . . ... 8. Dimensions of entire new construction:-Front . . . . . .. . . . . Rear . . . . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . Number-of Stories'-.'. . . .. : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . . . . Rear . . . . . . . . ... . . . . . . . . . . . . Depth . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . :. Name of Former Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . . ./�.-Z a . . . .'. . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: . . .N.a. . . . . . . . . . . . . . . . . . . ... . . . . . 13. Will lot be regraded . . . . No . . . . . . . . . . . . . . . . . . . . Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .Phone No. . . . . . . . . . . . . . . . Name of Architect . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . ... . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . .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. 1U - L V/' 14 S STATE OF N K S.S COU�j Y�O . . � being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. P/k/ Heisthe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (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 ' i. . . . . . . . . . . . . . . - .day of. . . . �-. . . . ., 19 o Notary Public, . . . . . . . . . . . . . . . . . . County ` BABETTE C. CQNI, . . . ... . �OTAIIY PUBLIC,Siato of NQ Ya (Signature of applicant) Suffolk County Xb. 52-579290® Commiaaion Ekyirbs March 40, i8 ¢I �J 12��p�� OG