HomeMy WebLinkAbout10123-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
UPDATED
CERTIFICATE OF OCCUPANCY
No Z-20077 Date JULy
THIS CERTIFIES that the buildin~ NEW D~ELLING
Location of Propert~ 16365 NEW SUFFOLK AVE.
House No. Street
County Tax Map No. 1000 Section 117 Block 6 Lot 32.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MARCH 8~ 197_~_9 ~ursuant to which
NEW SUFFOLK, N.Y.
Hamlet
Building Permit No. 10123-Z dated MARCH 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 ONE FAMILY DWELLING WITH ATTACHED GARAGE.
The certificate is issued to
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROV~_L
UNDERWRITERS CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
SUZANNE CLARKE
__ N/A
N-442051 - JULY 18, 1979
BOARD OF APPEALS #2501 DEC. 21, 1978
PLANNING BOARD APPROVAL OF LOT B, JAN. 9, 1979~
Builc~n¢
/
Rev. 1/81
FO~i~ NO. ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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? 101~3 Z
Permission is hereby granted to: ~
// _ /t/) .. Z
....... ~z....~.~.~ .,~. ~ ...........
~o ..................................... 'Z..'.' .......... i .................................. ~ ....................................................
Building Inspector.
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
THIS CERTIFIES that the, building ................................................
LocationofProperty / .~ ~. ~ ff AI t:"I/v/ ,~Id~'F~L ~ A I/..£I N£ ~
House No. Street Hamlet
County Tax Map No. 1000 Section ..... 1.1.'7 .... Block ....... (o. ...... Lot...'~.~?. r., ?f..~..~... ,
Subdivision ............................... Filed Mhp No ......... Lot No ............ '..
conforms substantially to the Application for Building Permit heretofore filed in this office dated
............ .~(/. ~.~.t..8..1719 .~.~ursuant to which Building Permit No.. !.0..[..~.~...~......
dated ................ /~.0 ??, ~4...9. 19 7.~. 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 .........
... ~.. ~.1i'.L~/~.7£ .... .tg.N ~... ~./~..~.t .~X' .... ~ ~./..~.t~....~-. ....................
The certificate is issued to ....~.0..~..~.~..1~.~ .... .~.L..~.-~. ?'...t~"~. ...........................
(owner, ~
of the aforesaid building.
Suffolk County Department of Health Approval .... .~...~..: ................................
UNDERWRITERS CERTIFICATE NO....~..q.Y..~'...0.~.1 ..................................
.............
Building Inspector
Rev. 1/81
THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
Ob 85 JOHN STREET, NEW YORK. NEW YORK 10038
~t~ Jul:,, 18, l~?~ ,,pplic~tiona, o. on/il,~ o~687 N 442'''~''~
·
THIS CERTIFIES THAT
onl~ the eJeetr~al e~iu~prnent as de~ribed ~elow end Jn, trodlt~ ~ the a~pI~c'~a~t ~amed on tb~.~oove application number i~ the premises o~
Suzanne Clarke, New Suffolk Ave., New Sufro~Jc, L.~.
in the followlng location; [] Basement
.,,,s e.,,mined on July 16, 1979
[] 1st FI.
[] 2nd FI. Section Block Lot
and found to be in compliance with the requirements of this Board.
RANGES rOOKING DECKS OVENS DISH--WASHERS EXHAUST FANS
FIXTURE RXTURES
OUTLETS SWITCHES FLUORESCENT
DRYERS REDERS
SYSTEMS
OTHER APPARATUS:
E R V ! C
1
;~uzanne Clarke
Fifth & Main (~ox 87A) _
New Suffolk, N.Y. 1195b
J ALANAGIR '~,,
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 BI ALTERED IN ANY MANNER.
Form No. 6
TOWN OF SOUTIIOLD
BUILDING DEPARTHENT
TOWN IL4LL
765-1802
APPLICATION FOR CERTIFICATE OF'JoccuP,\NCY
\. This application must be filled in by typewriter OR ~n,d to the building
~i, qs~_~c__t~ith 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 water 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 C~anpliance from archiuect or engineer
responsible for the building.
6. Submi~ Planning Board Approval of COmpleted site plan requirements.
;- For existing buildings (prior to April 9, 1957) uOn-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 g ~ld~og Inspector shall state the
reasons therefor in writing to the applicant. 'u' '
:. 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 Building - $100.00
Copy of Certificate of Occupancy - $5.00 OVer 5 years ~ $10 00
~ ~ Certificate of Occupancy - $50 00 tzal~ '
~ ~emp°~~cupa~--~7~Y ~' ~5.00, Commorcial ~.00
ato ........... /
e,d Construction .... ' ' '/' ' ' ~' ............. ......... Old Or Pre-exzstxng Building.. L/ .........
ocation of Property../.~.~.~..ST.../.¥~.~/. ~kJlZF:ok~.. [~.~.~. ........ ~,JJ'~.¢'/ ~ ~ I'~'?.O..C..~.
House No. Street Hamlet
or Owners of Property.. .
·
~unty Ts~ ~ap ~o ~000, Soet~oo. /./. .7. ....... ~loc~ ..... ~', ........ ~ot..~..~.~,_ .......
:bdivision ..... ' ' · ·
..... · ............ Filed blap .......... Lot ....................
.~m~t ,~o.l.Ola3./~, ..... ~ato O~ Po~m~t ....
' ' ............ npplicant .............................
1th Dept. Approval ...................; ...... Uuderwriters Approval ............
Approval ................., .......
uest for' Temporar. Certif' / ~,0~ ~//OI
Submitted: ~.;'.O.?.,.9.q .... . ............... "
2.1 ' ......... ':"::ii'.'-
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 si,milar 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 ~ines, streets, buildings and unusua~ natura~ 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.
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...~.~.~...[..~l./.?.~['.~- ·
New Building ............. Old or Pre-existing Building I~ l.'t-~.t~..~,O~'JsVacant ~and .............
Location of Property .... ~. ..... ~. ..... ~.~.~...lYi~.. ~'P.~.I.~ ..... ~Tt .,&../: .........
House No. Street / ~ J~ ~ 7 Hamlet
Owner or Owners of Property . . ~.~ ~ ~.~ .............................................
County Tax Map No. 1000 Section ........ Block ... ~ ......... Lot ................
Subdivision ................................. Filed Map No~ .......... Lot No ..............
Permit No..J.O.J.~. ·~. .~. Date of Permit .~/~/'7. ,~.. ,Applicant , .~'~. ,2~, .vi, ?.~.....C/q..~..~.~ .........
Health Dept. Approval ....... .M.J ./~ ............. Labor Dept. Approval ........................
Bequest for Temporary Certificate ..................... Final Certificate ......................
Fee Submitted $..~..~.~..O.0. .....................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant ..... ;/~.~'/~'~;,i '~' ~f/'"~/~-' '
Rev. lO-lO-7a C~ ~ fl ~ ~
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
'FillS CERTIFIES that the, building ................................................
LocationofProperty /~..~l, ff A/h-tM` SUFFDt.~ AVE
/¢&Js; 'Wd ....................... 's't,:o;; ...... '1 ................ h3,~iel
County Tax Map No. 1000 Section .... ! !.7. .... Block ....... (-9 .......Lot. ~"~,wr ~,f 3 2..,
Subdivision ........................ ! ....... Filed Map No... ' .Lot No ..............
conforms substantially to the Application for Building Pernfit heretofore filed in this office dated
............ .p4...~-~.c.f.~..0, 19.7.~pursuant to which Building Permit No..( .0. ! .~.3 7-
dated ................ /Tr..~. ~f~ [4...~.. 197.9-, was issued, and conforms to all of the ~'equirements
of the applicable provisions of the law. The occupaucy for which this certificate is issued is .........
.../sr...:P.~. ! .¢..,%-(. ~ .... ~.n..6.... t--7.0 ~ .~.qT. .... ,b..w.¢ ~.c. ! ./'4..~:.. ....................
The certificate is issued to ~0'Z. A r~ N I~,~L A'~I<' ~'
of the aforesaid building.
Suffolk County Department of Health Approval ... ~., .'~.; ...............
UNDERWRITERS CERTIFICATE NO ..................................................
~Set~'p..~ ~VAL OF LoT 'B JA~ 9 1~'79
Building Inspector
Rev. 1181
TOWN OF SOUTHOLD
OFFICE OF BUILDING INSPECTOR
TOWN HALL
SOUTHOLD, N. Y. 11971
TEL. 765-1802
August 1, 1980
Suzanne Clarke
16365 New Suffolk Avenue
New Suffolk, New York
Dear Sir:
This is to notify you that Building Permit No.
issued March 8, 1979 to S. Clarke
will expire on September 8,
10123Z
If~more time is required to complete the job and obtain a
Certificate of Occupancy, you may apply, by letter, for a
six (6) month extension.
If the work is not completed and the Certificate of
not issued after the six (6) month extension period,
than required to apply for a new building permit.
Occupan0y
you are
Very truly yours,
GEORGE H. FISHER
Sr. Building Inspector
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
............. ...... _ <-: .
.................... -~ ...... .2 ~. , . l / ' ' J--~..~,~
........
Inspector, with 3 sets of plans, accurate plot plan 'o~e. 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 T6wn 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.
(SignatureUof applicant, or name, ifa corp ration)
. .¢..7 ~d .~.~. 9..W.
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.~
..... ................... .; .............. _ ...........................................
Name of owner of premises ,q' (,/2..~1FJ~ ~ ~/"~/~ ~'/'~ ........
(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. ~"~';~,.~'~(/,K2 d4[~/'
Plumber's License No .... ~/..~.., .~(-,~7 X ~-~'47~/.~'~2... ~.
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done..~.~.~..~....~.01..~..~.Q .L..~....l~..~..~/.~....~...~..~..t~.. ........
...S~.t.:'~o fit.. 1~... ............................................................................. .^ Vt
House Number Street Hamlet
f_
County Tax Map No. 1000 Section ~1~ Block 1~ Lot
Subdivision ..................................... Filed l~lap No ............... Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
5.0.~at. 00e~/~O' .......
a. Existing use and occupancy ...-~.~. ,.-. .................................... ,, ..............
b. Intended use and occupancy ~ 4.~.. ~ .O.h})/'· P..1~/..~.~. ~.t.~ .~. · .~. · ! .t~df?. ! ~ .~) ................
3. Nature of work (check which applicable):_N~w. Building .......... Addition .......... Alteration .~7 .... d~,. ·
Repair .............. Rem ov~ll ~..g. ?. ,~ .~, ......D~molition .............. Other Work~ ~.~.~(~.
.~ ~ (Description)
4. Estimated Cost ~0~, ~q~r~ ......... ' Fee .~. 7 .............................
(to be paid on filing this application)
5. If dwelling, number of dwelli~l~nits .. { ............ Number of dwelling units on each floor... -
If garage, number of cars - . ............................
6. If business, commercial or mixed occupancy, specify nature and extent of eac~ Wpe of use ...... ~ .............. '
7. Dimensioy~ existing structures, if any: Front ~.~ ~ ....... Rear ...~.~ ....... Depth..~. ~. .........
Height .~.~ ............ Number of Stories .. ~ .................. ~:. ~ ..............................
Dimensions of ~e structure with alterations or~tions: Front ...... ~ .......... Rear~ 3. ~ ...........
Depth ...................... Height .... ~.~ ...... ~ ....... Nu~ej ~ Stories ...~. ~..~. ~ .......
8. Dimensions of e~tire new construction: Front ...... ~... Rear . .~ ........ Depth .~ .~ .......
Height . .~ ........... Ncm~er of Stories./.~ .... , ....... ~ ......................... t ...........
9. Size oflot: Front ...~,~ .......... Rear ~j~ De~th
10. Date of Purchase ~. 1~7~ ."
. . '.''''. ...... . ..... ~ .....i' "~ - ~ t, ~ ~
11. Zone or use d~stnct ~n which premises are s~tuate~ .~...~.q ~.. ~ ~0... {.~ .... ~ ~ ~ ...............
12. Does proposed construction violate any zoning law, ordinance or regulation: ..~ ...........................
13. Wfll lot be re raded ~ Willexc ssfill e removed from premises' ~ Yes N~a
Nme of Owner of pr;~i};~ ~ '~" X'ddres~ ~~O~F ~Y~hone $~l~'r$VZ61h*
Nme of Architect ........................... Address ..... ; ............. Phone s~ ({
Nme of Contractor ~0~. ~ ~~ ........ Address ~gg.~.P.O ~ r .... Phone Nog ~.~
PLOT ~, O
Locate and ~I build~gs, [whether existing or proposed, ~d, indicate ~1 set-back ~men~ons from
prope~y lines, street desc~ption according to deed, and show street names and indicate whgther
interior tot. ~ ~r~
~ ~ ~ t~o0~
I , ~ O/me ~s,
, .....
· eing duly sworn, deposes and says that he is the applicant
I ~me of individual signing contract)
abov~ named.
w~e is the .... :~'. ........ :' ~-;~;r::~r:: ~:~;, ~;;;;;a~: ;~i~:;,'~t:.~' j'-dW ....................
.... n to m~e and file ~s
of said owner or owners, ~d is duly authori ed to perform or have perfo~ed the sa' ork a d ' '
application; that ~1 statements contained ~ this application are true to the best of his knowledge and belief; and that the
work will be perfomed in the m~ner set forth in the application filed therewith.
Sworn to be me this~
..... ..,
Nota~
~AMEIA CHIN'LL~R ~
,0. ~.~oo (Signature of applic~t)
APPROVED AS NOTED
HO'IWY gUIL~t,bS ~FPATLTMENT AT
765-2660 9.L~A ~o 4PM FOR REQUIR,
'I'~ON O~ 5';? 5'.T ""~,
~ BEFOP. E COV:~ H'5 9:~;5 OF ANY KIND
4. FINAL W,':L"N JO3 CC~L,'~PLEI'ED
NOT RESPON~~E;LE ,"-OR DESIGN
OR CONST~UC'fIUH ERROP. S ~
5. ALL CON~LU ...... H MUST MEET
REQUIREMENTS C;~ N.Y. STATE CODE
,wi T'/./ c ~'~-~u c
N/O/F ~'
N/O/F lA'OF
199.99,
23,386 SQ. FT.
20~09'
SURVEY OF PROPERTY
A T NE W SUFFOLK
S~FOLK COUNTY N Y
1000 - 117- 06- 32
N. 8,¢" I0' 00" ~. ,o,,v,,.,-, ~,~ /
192.56,
NEW SUFFOLK A VENUE
SCALE.. 1'~40'
MAY 3, 1991
CERTIFIED TO;
SUZANNE CLARKE
TOTAL AREA = 60,549 SO. FT.
P.
MAIN ROAD
SOUTHOLD, N Y. 11971
LIC. NO. 49618
P.C.