HomeMy WebLinkAbout10307-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y,
Certificate Of Occupancy
No.. ~.~.2.5.9..2 ......... Date ... ~u~ 6 84
THIS CERTIFIES that the butlrll~g.. J~g,r. qkt~5t. ~99~ ...............................
1120 Little Neck Road Cutchogue
Location of Property ................................................................
House No. Street Hamlet
County Tax Map No. 1000 Section 09.7. Block 07 .... Lot 026.8
Subdivision .... .X. ......................... Filed Map No....X ..... Lot No .... X. .........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... .gg.n.e.. 5 ........... 19.7 ~pursuant to which Building Permit No ..... 1.0..3 .0.7.. g. .........
dated ..... 0'B J-,Y.. 1, ~. ............... 197.9.., 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 .........
an xnground sw~_mmxng pool.
RICHARD & MARIAN SCOTTI ~
The certificate is issued to ...........................................................
(owner,'Ye'~a,'crr'term'trt)
of the aforesaid building.
n/r
Suffolk County Department of Health Approval ..........................................
UNDERWRITERS CERTIFICATE NO N 439238
Building Inspector
Rev, 1/81
FOI~M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE P'REMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 19307 Z
pursuant to application dated ........ ' ....~.. .................... , 19. end approved by the
Building Inspector. .~/
FORM NO. 6
TOWN OF SOU't'HOLD
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.
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
I//~'~'~//~ t~' fi'''~ Date . .,,,~..' ..... .~. ....
New Building ~,b'?, ........ Old or Pre-existing Buildingx ............ Vacant Land ...,~.. -~c .~. ·.
Location of Property f~o'u~-~ ~/~,' ....../~ ',/"'M~I ,,. f/~,-~~ .... ,''i:' ~ '~' ' ' '~' ' '~'' ' '~' ' ' ~~
Owner or Owners of Property .... ¢...~. ~ .~,~J~-f...,z'~p~.. ~..~'..... ......................
County Tax Map No. 1000 Section ............... Block ............... Lot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No ........... Date of Permit .......... Applicant...J.'.~./~.....~.. ..............
Health Dept. Approval ........................ Labor Dept. Approval ........................
UnderWriters Approval .... ,~-~, ~.%- ............ Planning Board Approval .....
Request for Temporary Certifica~te ..................... Final Certificate . ' ' .~"~.......... ' .....
Fee Submitted $ ........ .~ ....................
Construction on above described building and p~mi~meets al~pplicable codes and regulations.
Apphcant .....['/~, '~'¢ -.--:!.; .,~,~,~ ... ,~..... .............. ..
Rev.
10-10-78
FORM NO. 6
TOWN OF SOUTHOLE)
Building Department
Town Hall
P~outhold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and submitte~plic=t= 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 featu res.
2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings.
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/ land
3. Copy of certificate of occupancy $I .00
use--?re-Existing C.O. $15.00
Vacant land C.O. $ 5.00
New Building ..... Old or Pre-existing Building ............ Vacant Land .............
Location of Property . ~[~.C~ ........ t....~....~...~.~...~.~.~,.~. .CU..~,.~
Hou~ No. Steer Ham/er
Owner or Owners of Prope~y ....... ~ ---- ''~.~..~.~'~....~.~~ . ........
County Tax Map No. 1000 Section ... ~.~.~ ..... Block ..... .~.~ ..... Lot...~.~ ~.~ ....
Subdivision ......... ~ ...................... Filed Map No... ~ ...... Lot No. X
Permit No. ~0~ Oate of Permit .~.L~/~.Applicant .~..~~.~ ....
H pt App pt App
ealthDe . roval.............~ ........... LaborDe . reval .. ......................
Unde~riters Approval ............ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate . .~ ..................
Construction on abo~escribed ~ ~ ~,~'meets al,
' 'g ~,; ~7~plicablo codes and regu ,ations.
~ App cant .~Y. ~./~.~~
eo / .......................
..... F
FOR~ NO. S
TOWN OF SOUTHOLD
, Building Depa~tment
Town Clerks Office
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
inspector 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 eq~-~l).
3~ Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, a certificate of Code compliance fram 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 property 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
formation required to prepare a certificate.
C. Fees:
!, 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
/
New B~lilding ................ Addition ................// Old or Pre-existing Building ................ Vacant Land ..............
.................................,//.~~/ .~ --j~, .. ~ . ~ , ~.~ , ~/~"'""""~' ~ ....... ~.~.~./..~.~..~..//.~?._~_..~_~.
Subdivision ................................................................ Lot No......-~...-. Block No.....-~....f.. Mouse No..-Z~.. .........
Permit No../~.,.~.~...~..~ DateOf Permit .'~'../,.~!ZT.2..Applicant ~/-,4~.~~.: ........
Hea th Dept Approval ...... ..~....Z~ .................. Labor Dept Approval ..,.~.. ,~..~ ~.-. ......... ?. ..........
Underwriters
Approval
.............................................. Planning Board Approval ...~..A//~,,~ ......................
Request For Temporary Certificate ................................ ~ Fined' Certificate .....................................
Fee Submitted $ ...J........].~'~.'. ................... //////- ~./ "
Sworn to before me this Applicant ..... ~,- .~...~.......~~,- ~--~ ~---,~
................ day of ............................................ (stamp or seal)
Notary Public .................................... County
TOWN OF SOUTHOLD
, Building Deportment
Town Clerks Office
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
Inspector with the fo~lowing; for new buildings or new use:
]. 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 equ~l).
3. Approval of electrical installation from Board of Fire Underwriters,
4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and
installations, 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 property 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 in-
formation 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
/, ...... ............
New Bt~ilding ................ Addition ........ ?~ ..... Old or Pre-existing Building ................ Vacant Land ..............
Location Of Property ../../....~....~.......,~....~....~...~.../ ....... ~..~~o.~...~
Owner Or Owners Of Property ..... .~...~,,~,,.,..,~.~'Z,,f..,E3~...~ ........... ' .............
Subdivision ............... ~..?:,~.~ ........................................ Lot No......-~.. ..... Block No.....-~..../.. House No..~ ........
Health Dept. Approval ....... ..~...../.....~..~.. ................... Labor Dept. Approval ...~..../...~...~...~ .......... ../. ............
Underwriters Approval .............................................. Planning Board Approval .,..,~..//~,, ......................
Request For Temporary Certificate ................................. ~ Final Certificate ..........................................
Fee Submitted $ ...~... ...........................
Construction on above described building and~e~~ c~es~nd/~e~ulations.
Sworn to before me this
................ dayof ............................................
Notary Public .................................... County
Examined .~
Approved ..~
Disapproved
FO~M NO. !
TOWN OF $OUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
$OUTHOLD, N. Y.
Application No ......
/
Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date ........ 41.tllze...5. ......................... , 19..~.~ ......
INSTRUCTIONS
a. This apphcation must be completeiy 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 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 all applicable laws,
ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections.
j~S~ig;ature of applicant, or name, if a corporation)
..........................d .......... q_.: ....
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
...................................... ..............................................................................................................................................
Name of owner of premises ..B. iclz~r.d...az~d..~ax'.[lllz..g.',...~.~.e..t;.~ ............................................................................
If applicant is a corporate, signature of duly authorized officer.
Builder's License No ........... ~,~.~,;~. .....................................
P umber's Ucense No ......................................................... ?*Z - O 7 --' O ?
Electrician's License Ne, ....g...[..e.?t....~..~..~.~..[.¥. ...................
1. Location of land on which p:oposed work will be done. Map NO.~..;.J~...~Lv...'<...~...X..~.~.~MZ~T....;,...Lot No ...... ~'. .................
Street and Number .......... J~;kJi~.[~l..l~.~ll~..~t~.~.(iJ.......~.../.(.~(~)...... ..................................... ~.~.~ ........
· ' Muni~ality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ........................... ~.e~i.~e~c,~ ................................................... ,. .............................
b. Intended use and occupancy .................. ~.[0~.....[~.'....I~¢L'..~......~~i ........
3. Nature of work (check which applicable): New Building ....................... Addition ..................... Alteration ...............
Repair ......................... Removal ......................... Demolition ........................ Other Work .~.oo.l..a~d..~;ea~7.e..
(Description)
4. E st i mate d Cost ..~....~).0.(}.* .............................. Fee /-~-~L~-)
(to be paid on filing this application)
5. If dwelling, number of dwelling units .....3, .......... Number of dwelling units on each floor .........................................
If garage, number of cars .........2, ................................................................................................................................
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 ....... 5J) ................ Depth ...... 2§ .........................
Neight ........................................................... Number of Stories .............2. ..............................................................
Dimensions of same structure with alterations or additions: Front .......................... Rear .........................................
Depth ............................................. Height ......................................... Number of Stories ........................................
8. Dimensions of entire new construction: Front ......................... Rear Depth .................................
Height ............................................... .. Number of Stories .........................................................................................
9. Size of lot: Front .....]-...~.0. ............. , ............. Rear ....... 3~..~.~. ............................ Depth ....... ~J~.6. ....................................
10. [)ate of Purchase ........... .~./.~[/.7..?..' ........ Name of Former Owner .......... N.O.~;..~ho.Ta3 .............................................
11. Zone or use district in which premises are situated ........... ~3q.l;;...(~;C~X~.g~l .........................................................
12. Does proposed construction violate any zoning law, ordinance or regulation: .......... ~.~. .............................................
13. Will lot be regraded _~. ............................ Will excess fill be remo. ved from ~.remises; [~3; Yes [ ] No~ _
er of e ises Richa~'d J, Se. ottJ, . /~ ~ ~ '~ ' .~ i
14. Name of Own pr m .......................................................... ~..J..~..~,.....~.g...~......d. .......... ,...~../.....~....~: ....... ~....
(Address) (Phone No.)
Name of Architect ........ ~DXt~ .............. i .....................................................................................................................
(Address) (Phone No.)
Name of Contractor .... ~eJ.~ .......................................................................................................
(Address) (Phone No.)
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed~.~l~.~dicate all set-back dimensions from
property lines. Give street and block number or description according to deed~.'an.d~h~w street names and indicate wheth-
er interior or corner lot. ~.~z'
STATE DE NEW
COUNTY OF
{Name of indi~Mual ~i~7~.. z~ ~on~c~)' "'~" "
He is the ............................................ ~ ....
{Contractor, agent, corporate officer,
of said owner or owners, and is du~y authorized to perform or have performed the sai
statements contained Jn this application are true to the best of his knowledge and
set forth in the application filed therewith.
Notary Ter~ 't'x~re~ ' MeraR'
being duly sworn, deposes and says that he is the applicant above named.
to make and file this application; that all
the manner
(Signature of applicant)
THENEW YORKBOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
3S JOHN STREET, NEW YORK, NEW YORK 10038
~te Jane 26, ~979 App,ica,onNo. onf, e 0257?? N ~.~:?q8
THIS CERTIFIES THAT
only the electrical equ/pment as d~scrlbed lmlow and introduced by the applicant named on the abo~ application number in the pr~rni~s of
~'~r. & !'~rs. R~ehard 8ehotie,Llttle Neok Rd.,Cutchogue,L.~.
in the fallowing location; [] Basement [] Ist FI. [] 2nd FI. OLlttl ~ (.lO Section Block Eot
was examined on J uvlo ~ 1 1 I ~ 7 C~ and found to be in compliance with the requirements of this Board.
FIXTURE L I I FIXTURES [ RANGES ICOOKING DECKS I OVENS I DISH WASHERS EXHAUST FANS
DRYERS I FURNACE MOTORS I FUTURE APFUANCE PEEl)ERS GPECIALREC'PT TIMECLOCKS I ~ 1UNITHEATERS MULTI, OUTLET DIMMERS
Panelboards: 1-2tlr. 60amy
(Swimming Pool) This cevt, lfloate covers oomplianoe at
Inspection only, .,'~eeau~e of unusual environments it is advisab.le
to have fr~quen~ test and/ol' ~epal~s made by a qual:[fled
l~,orton
~attituek,N.Y. 11952
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
f 8 ¢~.ff.
bo ,,40 ·
~reO ¢:40'u
AreO ~.40, 04v
sa.ft.
$.50
THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD
OBSERVATIONS AND/OR FROM DATA OSTAINED FROM OTHERS
vAC4N1'
TEL
SUFFOLK COUNTY DEPARTMENT OF I~EALTH SERVICF. S
FOR APPROVAL OF CONSTRUCTION ONLY
DATE HS REF. NO.
APPROVED
i¢o0~E
FRAIL
NOT£ ;
· = MONUMENt"
SUBDIVISION MAP h~L£O IN TNE OFPIC~
OP THE CI EHK OF SUFFOIt¢ COUNTY ON
NO~. ~0,197.~ AS FIlE NO.
NEAREST WA TER MAIN- $ MIL ES
WATEt~ SUPPL Y- PRIVATE WEllS
YOUNG & YOUNG
400 0STRANDER AVENUE, RIVERHEAD, NEW YORK
ALDEN W YOL}h~,G HOWARD ~,'
su~w~ Fo.:
t~ICHAt~D .d. SCOTTI ~ MA~IA~ C. ~COTTI
~o~ ~o. ~, "~,~ ~ .~o~.~"
EAST CUTCH~UE [sourHo~o SAVINGS B4NK
TOWN OF SOUTHOLD ' '