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HomeMy WebLinkAbout10117-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N,Y. Certificate Of Occupancy No...Z.9.B..9.5 .......... Date ..... .Ma. rg.h. ?9 .................. 19.8.0. THIS CERTIFIES that the building ................................................ L ..... 1295 EliJahs Lane Mattituck, N.Y. ocauon o~ vroperry h36s~ ~io ........................ 'S't/obi ....................... h3d4el County Tax Map No. 1000 Section ...1.0..8 ...... Block ...0.6.. .......... Lot ...... .7,.7. ....... Subdivision. ~.Z.~.O9.h.~..I~.9.rl.e..~..8.t.a.~..e..8 ...... Filed Map No ......... Lot No..~./~.e.q~..1... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...M.a.x].qh...2 ..........,19 .7.9. pursuant to which Building Permit No ..... .~ .0fl.1.7..Z .......... dated ...1~..a.v?.h...2 ................. 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 ...... :'.. .............. O.n..e..v..~. ;.x.y...~. ?y.~. ;.ng..w.;.~h .4 .*.t.a.e.~..e.a. ~a..r.a~e.., ................. The certificate is issued to Peter g. Victoria ..................... ?o'~.~,~¢.~ ...................... of the aforesaid building. I/22/80 Suffolk County Department of Health Approval ...9.--.~.Q-. ?.~ .....2/.1.6./.79....R:. ?.,.. y.i.]:l..a... UNDERWRITERS CERTIFICATE NO .......... .1~../4..bt6..2.6.~' .............................. *Upper floor not completed (non-habitable~ Buildlng' Inspector Rev 4/79 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10117 Z Permission is hereby granted to:i/ ....~©:.:......~ ....... /.~.~..~ ..................... ....... ../....~.h:.:~ ........... .... .~:~:.:/..~..~.~~ ........... : ....................... ~ ...................... ~... ot premises locoted ,t ,~,, .~.. ...... i ..... pursuont ,o oppl,eot,on"~,ea ...... Building Inspector. Fee $. ....-~.. ....... Buil~ding~'lnspector THE NEW YORK BOARD OF FIRE UNDERWRITERS _ BUREAU OF ELECTRICITY 'l 85 JOHN STREET, NEW YORK, NEW YORK 10038 o.., AdsuSt 20, ].979 .~.p.~.,,,,o. No.o,,,f.,, THIS CERTIFIES THAT only the electr~d equipment as described below and introduced by the applicant named on the above application ~umher in the premisef of Peter J. VLctoria, w/s E,].tgOS Lane, ].b00~n/oRC.2$, Natt:Lt:uck,N.¥. was examined q~u ~ LJS ~ ].Os ].979and found to be ln compliance with the requirements of thls JJoard. .x,u,,, t...A,:lE, w, .x..,s , jA.O?w' ,:oo...o.:.sI ov,.s r D...,W,....S OUTLETS S S CriES INCANDESCENT.FLUORESCENT V~F~ ,~4T. K.W. ,~,W. K.W.~ ~4T. K.W. DRYERS I -- -FURNA~':IT MOTOR~- ~ I FUTURE AI~UANCE FEEDERS PECIAL REt'FI TIME CLOCKS BELL~UNIT HEATERS MULTI-OUTLET A,~T. K.W. OIL H.P. GAS H,P. &T. NO. J ^,W,O..~.~T, J ~,W ~V,T..~,~PS, TRANS. J ~.V,T. J E:. p, J i~S.Y~i~/~S t SERVICE D~SCONNC-~T IO.O~ ~ETER 1 150 CB x Hot:ors: 1 frac.hp i GFCI [smoke detector I C E EXHAUST FANS AMT. H.P. DIMMERS CRC* A- W.O. NO. OF HJ-~O A- W. G, NO. OF NEUTRALS A, W. O, NO. COND. OF CC. COND. OF HI-LEG OF NEUTRAL ]./o ]. ~/o Ruland E, lec. Co. P.O. ~:~x L43 Nnt:tituck,~1. Y. 11952 lic. 242~ J MANAGER 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 CERTIFICATE MUST NOT SE ALTERED IN ANY MANNER. q:f '~OU G H FP,.AI'.,.",.F__- ICl FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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. 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 cert[ficate of occupancy $1.00 $5.00 Date j~.. ,~.;..~..~/. ! .~...~'..~. .... New Building ..... ~ ...... Old or Pre-existing Building ............ Vacant Land ............. ...... ........ Location of Property ................. ~ ............... House No. ~ Street Hamlet Owner or Owners of Property .~?-,~..-~..~;~.~.' ..... [ .~.'..~...t~.l. (~..~; .~, .............. ~?,.~ ...... County Tax Map No. 1000 Section ,..-/..~?.c~. ....... Block ..... .~..~ ..... Lot.. Subdivision .g~-./~i'/?. .... '. :~..~/.?~'.~ ./ .... ~ ~../...Filed Map No ........... Lot No .............. Permit No. JO//~. -~,~ Date of Permit .~.~./~. ~...Applicant Health Dept. Approval .¢}.-~ .~..O. '.-..J.,~. ........... Labor Dept. Approval ........................ Underwriters Approval. ~. ?...~. ¢.? ............ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ... ~ .............. Fee Submitted $, .~.~. · ,~-~. · ./) .......... Construction on above described building and permit meets all a~able codes and regulations. Applicant. ~~..~..'.~.. ~ ................. FO~ NO, TO~/N OF SOUTHOLD BUILDING DEPARTMENT' TO~/N CLERK'S OFFICE SOUTHOLD~ N. Y. Examined ....... , proved .......... ................... , ,c)7...F... ,e,m,t No. ........ Application No.-.g..~)..../.-./-..Z ........... APPLICATION FOR BUILDING PERMIT / / Date ................................. ..'~...Z.~..//.~..~.~' , 1c) ............ 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 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 o Certificate of Occupancy shall hove 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 a[terations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections, ......... ................................... (Signature of'applicant, ar nome, if a corporotlon) ..../...u ................................... ........ .............. 7--: ............. (Address o aFiplic ) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ...... /...~x~, ..~....~,. ....... ..?.:.......~'../.~...~.~./.'..~.. ...................................................................................... If applicant is a corporate, signature of duly outhorlzed officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No. Electrician's License No .... Other Trade's License No ............................................... 4s%/'..V~g/-./.~ L ~r/-~~'- ,.-., 1. Location of land on which proposed work will be done. Mop No.: .~..~Z~..,,~..s.......~.~..f...~T.,~-.... Lot No ..... ::~.,:. ............. Street and Number ...(,Z~..~..~.. ...... ,~-~/..~.-~,~.~../.~...~...,~....A(....~.. ................................................... 4~..~../Z~./.../...r¥..<.-...~.. ....... Municipality 2. State existing use and occupancy of premises and in~er, ded use and occupancy of proposed construction: a. Exisiting use and occupancy ........... ..~..~l~.~...~...~.....' ................................................................... /......&;. ............. b. intended use and occupancy ......... .,~, __ -- ,~,,.- ~r/..~,..~..~..4~.~..~...~,,~,~./.~.~..~...~...~...C.-- ~ /x/~"7~/~~.../,/...~....~.....~,~..~...; 3. Nature of work (check which applicable): New Building ....... ~ ...... Addition .................. Alteration .................. .. ~, Repair .................. Removal .................. Demolition .................... Other Work (Description) ~0o c 0~ ~ 4. Estimated Cost ~. ~.~ b -ee ~/ .............................................. .... (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 ............... ~ ....................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of some structure with alterations or additions: IZront .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ..~...~.........~...~ ...... Rear ........ ~..f~-. ........... Depth ......~../,.,(~.,.~ ...... Height ...,-?.[...~ ....... Number of Stories ......... /...~/.~- ............................................................................. t'", ................... ........... ..................................... ........... ........... ........... J0. Date of Purchase ..,~...~...~,',.,.,~-.~.- ....... ./.,~.-?.~. ............. Name of Former Owner .,.U..~. ....... ~ ................................... 11. Zone or use district in which premises are situated ........................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ....~..~. ............................... 13. Will at be regroded ..... k~.~..S-.;~ ......... Will excess .fill be removed ~fron~ premises: ( ) Yes (~ No -- . /~, /,,~ o~' ~ Adc ress ~. ~'.~T.~,., ,~,.((fC~,.~..~.f/g Phone No. 14. Narne of Owner of premises -,~.~-.~.~.~'....~..(~'~"~" ...................... Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly anti 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. ~, O~' 00'7.0°,7 qTATE OF NEW(~Q~(/J ~ J~'J ~¢ S Eou~n-¥ x)r~.~.Z_~ ' .... ~~.~~ ................. being duly sworn, deposes and says that he is the apphcan .~ (Name of individual signing contract) above namecl. -- · - ........ ....................................... .... ~-F ......... 7 .... (Contractor, agent, corporate officer, e of said owne~owners,~and is duly authgnze~ to,?rfor~ o/.~a~,r.~r,~J~l ~o~d~ ~k~e~ this application; that allJstatements contained m tins appucc~u, u,= -,~ ,u ,,,~ ~ .... ~ , tbm the work will be performed in the manner set fo~h in the application filed therewith. '~wb..~ m~ythis ~ / . ........ . ~-g;~~ ................. Co,n~, ~. ~.:...~ ............................... Nota~ Pubhc,~ .............. z .... ~ - (Signature of applicant) I %-'°oX / o, --"T NOTE: ~ = MONUMENT SUBDIVISION MAP FIL ~O IN THE OFFICE OF THE C~EBK OF SUFfOlK COUNTY ON FEB. 14,1974 AS FILE N~ 60~5, o~ JAN 22 1980 ~. ~. ~. ~;5~ PETER~J, VlC,-~,~, DEC,6, 1979 LoT~5-~LIJAH S ~ANE ESTATES, SECT. I" MAY I, 1979 , FEB, 7~ 1979 .... AT MAT~ITUCK ' -; DATE : JULYLS.1978 ' ' Lace. "' on ..' ~.. ~U....~LO' ; SCALE I" =50' facilities for this loc~tion ~e F~ ~ to be satlsfactor~.~ ~ ~ ~ ~j ~ *u~*~{z~o ~LrE~&~;ORAO~mO~ TO r~s GUARANTEED TO: T ~ '''' I ' ' i NEW YO~K'S~A¢[ EOUCATi~ ~[~W ' COMMONWEALTH L~D TITLE INSURANCE CO. Chief of Genera[ Engl~eeri~ - i ~o~}~ ~tHi~ Su~YE:y ~'~!~6 rHE.LANO RIVERHEAD SAVINGS BANK H~LTH DEpARTMENT-DATA FOR APPRovAL TO CONSTRUCT [~[ ~*N~[~5~'~ .THERE ARE NO DWELL N.~'W THIN IOO FEE~ OF THIS PROPERTY INSTI~j~Ii~RA~TE[~ ~RE N~'~RANSFERA'L' o~,E, THA~ ~,OSE SHOWN ,E,~ON. ~ ~[T,'~'ms ~u~ W~ ~, ~eS~UEN~ . APPLICANT ~RO~ ?: ' -~ ~, '~, ' - ' z~T~ AVENUE '~" · Y{~U~ a YOUNG '~1 Ye "K ~:~~1, A~DE ~;YO~NG, PROFESSIONAL ENGINEER ' -%. J ,5 NOTE: · = MONUMENT SUBDIVISION MAP F/LEO IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON FEB. 14~ 197'q AS FILE NO. 6065. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY A,E No.. APPROVED ~ ~ HEALTH DEPARTMENT- DATA FOR APPROVAL TO CONSTRUCT -X-NEAREST WATERMAIN ~-MI. + N'SOUBSE OF WATER: PRIVATEV/PUBLIC_- ~E SUFF. CO. TAX MAP DIST. SECTION BLOCK LOT ~+THERE ARE NO DWELLINGS WITHIN I00 FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON, ~1~ THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE WiLL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES SURVEY FOR PETER d. VICTORIA LOT 5 "ELIJAH'S LANE ESTATES, SECT. I" FEB. 7, 1979 AT MATTITUCK DATE . JULY 28,1978 TOWN OF SOUTHOLD SCALE: I" :50' SUFFOLK COUNTY, NEW YORK NO. : 78-457 ~ UNAUTHORIZED ALTEI~ATIOB OR ADDITION TO THIS SURVEY IS A VIOLATION OF SEC~TION 7209 OF THE NEW YORK STATE EDUCATIONLAW ~ COPIES OF THIS SURVEY NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIBERED TO BRA VALID TRUE COPY NGUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY iS PREPARED, ANO ON HiS BEHALF TOTBE TITLE COMPANY~GOVERN- MENTAL AGENCYAND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. .X-DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTI~IG STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT, TO BE USED TO ESTABLISH GUARANTEED TO: / COMMONWEALTH LAND TITLE INSURANCE CO. APPLICAN'T't~-~ ~ i~ ~O,C~'(~ PROPERTY LINES OR -- ~x~ ~' ~" ~J ~ ~ ~.{.~- I . FOR TBE ERECT}ON OF FENCES. ADDRESS ' ¢o,.,, 'TE,. YOUNG YOUNG ANb LAND SURVEYOR N Y,S. LICENSE NO 12845 HOWARD W. YOUNG, LAND SURVEYOR 'N-THELOCATIONOFWELL(W},$EPTIC TANK(ST)aCE~SPOOL$(CP)SHOWN HEREON N.Y.S. LICENSE NO 4589S ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. , , 400 )ER AVENUE RIVERHEAD, NEW YOrK _. I 9.0 "' 0"