The URL can be used to link to this page

Home My WebLink About10133-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z9656 Date A~g~t; 3.(1~ ...... ,1979 THIS CERTIFIES that the building ................................................ ,_~tio,~ o~ ~p~ ,~.~:.. ,,~. ~, .~.,~, ........... ~',~o~-,~ .... Street Hamlet County Tax Map No. 1000 Section ....0.8.6. ..... Block ...0.1 ........... Lot..p~r.t~ .gJ~..q:],0.. Subdivision... ~ ........................ Filed Map No.. ~...Lot No ..... XXX~. .... conforms substantially to the Application for Building Pormit heretofore filed in thi~ office dated ·..~.a. ~'~.h..]~ $, ......... 19.7 9pursuant to which Building Permit No.. ~..0.l,:~ ~1~ ............. dated ........ .N~...r.c..h..~.9. t ......... 19.7.9., was issued, and conforms to all of the requi~mmts of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... The cartificate is issued to ....R.o.b.e.~..~..~. :..R.~cjg~.~l' ................................. of the aforesaid building. suffom Cou~y Oop~m~nt of He~th A~o~..S./.2.9/.7.~. ............................... UNDERWl~rr~SC~RTIFICAT~NO ........... .~.~.a~.~.o..~ ..... . ..................... BuUdin8 ImI~tor TOWt~ OF SOUTt'IOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PI~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10133 Z .,. ,, . ~...:..:.~ . ... .-m,>~..~:...~..~.:......,/. 7 q~ . ~o ...~~~.....~-..~~....~-~~...~>.~~ ...................................................... ,t premises ,ocoted pursuont to opplicotion doted ........... ~..~..~.~ ........................ , ] 9~., ~nd ~proved bY the Building Inspector. 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 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 a~l property lines, streets, buildings and unusua~ natura~ 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 certificate of occupancy $1.00 $5.00 Date...~ .~ .'~..~.~ .(? .~. '.~..~. ......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property "~.~."~"~ ~?/,~.~-X/~,'~,,· .d,~,~-/'?.~;~. · ~' ~ ~:%' ....................................... House No, ~ ~ Street Owner or 0wners of Property ..~~.~-,~~." County Tax Map No. 1000 Section Q~ ......... Block . .~.~ ......... Lot ................ Subdivision ................................. Map No ............... Lot No~. ~..~. Permit No~ ~ Da~ of Perm~~, .Applicant ~/~.~. ~~ .... . *or *,t. .............. Unde~riters Approval. ~~.~ .......... Planning Board Approval .~ ............ Request for Temporary Certificate ..................... Final Certificate ~. ................... S bmitted $ .................... Construction on above described building andT~it ~,~s all~a/le co ~/~_~J lations. Applicant ~,, ~Jq.,..~:~-~. · · · .~'~. ~.: ..... ~ THE NEW YORK BOARD ~'~ BUREA ~J OF ELECTRICITY o.t, Jul~ 30, l ~n Ponds Const.~ W~ll Rd. ~'as~xa,nitiedorl J~l~ Q~ .logo , ~ 14 DRYERS FURNACE MOTORS - FUTURE APPUANCE FEEDERS SERVICE OTHER APPARATU : -- Motor~ :l-Fr' hp 1-G.F.C.I. 1-Smoke Detector *Future Appliance Feeder/s:'l-2#14, E R V 1-2#12,,lr3#10, 2-3# uava~lere Electric 28 KeJaro Ct. Centereach, N~Y,.'%l1720 Lic.73~-E This certificate must not De altered in any manner~ return to th~ office of the Board if incorrect. Inspectors may be: identified b ii _ . I :redentid ~ T>Lc~l~li~lhldq I- I IX-J A / -0 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 E,,amined .... .'-pplication mo. . ./.<--'. ./.:.-Z ....... Approved .. ::.: 19. :.ermit No.. :..:..: -: /_ APPLICATION FOR BUILDING PERMIT 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 code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary insp~ections. .... (gignature of applicant, or name,(lt~ a corporation) ....... Z/. .q. .L~. >. .~.~. ,~.x~/. . .~L~ :.~. ~--. ........ C (Mailing address of applicant) . ,,o..e,e-,v' .,,~o,.~. '7" /Y-/ /?P' ~Y"' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, pldmber or builder. ..................... ~...~'..~..~. ~ .............................................................. Name of owner of premises /~P .~. ~..F~..._~../~. ~/.O~.,~ .o./. i.~. .......................................... (~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 .......................... Plumber's License No .... ~.~ . · . .~-~.~'.~.~'-ff Electrician's License No .... ~.~ .... ~.// ....... .Q.. Other Trade's License No ...................... ~d~-c~ ~) Location of land on which proposed work will be done. W. ~.~....~. ~.. ~,~-.-~'.../~o../.~..~. ................. .................................................... .P...~..c. ~,~.:..~.. ..... ~:/ ............. House Number Street Hamlet County Tax Map No. 1000 Section .... .O..~. ~. ....... Block ...... ~. ........... Lot ~.' .~.~. ?..~.. ?..~..v. (. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... '~. ~'.~...c:!?-.~...~.. ................................................. b. Intended use and occupancy .... .~...~'../~../.~./../-.~....~...k~. ~..g-&. ]. 4~. ~ ........................... 3. Nature ofwork (check which applicable): New Building .....~..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ o ~zr/,~ ~ (Description) 4. Estimated Cost.. ~.~.0. t. o..O..o.f.- ....................... Fee ..... --~. ............................... (to be paid on filing this application) 5. I f dwelling, number of dwelling units ...... ! ......... Number of dwelling units on each floor. ' If garage, number of cars ...... '~ ................................................................ 6. ]f business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front... ~ ........ Rear .............. Depth ............... lteight .... . .~..' .......Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. ...................... Numbe,r, of Stories ................. Depth ...................... Height ' 6L ~ .... ' ' 8. Dimensions of entire new construction: Front .... ~. ..... Rear ....7.4 .~ ........ Depth ~... '7.&.~{~... Height .... ~Y.~..~ ....... Number of Stories .... ttf./.a~Z.. .............................................. 9. Size of lot: Front ..... d'.-,g-. O. ~ ........... Rear ...... /.~..g.: .......... Dqpth . .~1. Or.~ ............... 10. Date of Purchase . f.q..~.~..~. ~...../P.. tx'.~..7..~ .... Name of Former Owner ~ct .~..~.7..~..o.f. ~,.~.q..~....~.3..~.*~ 1 1. Zone or use district in which premises are situated ~' ~ ........ . ................................. ~;. 12. Does proposed construction violate any zoning law, ordinance or regulation: .......................... /~... 13, Will lot be regraded ....,,~..O. .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises /~:. ~. !.~'..~:q.~..~. .... Address ,/'~.o..~(?..c.,~. ~.~(...~ .~..e-Phone No. ~??.?./~...~./... Name of Architect . .7~.Jz.o..~,~..~....~...~2 g.t,)(. .... Address ................... Phone No. Name of Contractor ~./.~..~.0.~. ?.~...~.o..,r.~ .;r~?.q2'..~ddress /~..~.~e~. ~..~.v..~,~ 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 YORK, , ~ COUNTY OF ~'~ "~ ........ .d/.~.~.~'. ~'. '. '2'.~. '..~.c~...~.. ?..."~.... being duly sworn, deposes and says that he is the applicant (I~me of individual signing contract) abow~ named. ,eisthe .......... .......................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work ~d to m~e and file this 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 before me this ........................ day of ..................... ,19 .>,~/~]~f~/~~. ............. County '~/~ ~ ~ ~.~o~, /~ Nora,~ f~~~ ~ Public, ...~~~~~ ..... , (Signature of applicant) 8uttolk County bio. 52-STOgS0fl Commission Expires March 30, 15 ~ ~' I (~a~+) C .J. a.~ ~,.~,-ve~j~d Jul,! ~ ROOEmCK VA T_.U_VL. P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (si APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES - FOR APPROVAL OF CONSTRUCTION ONLY DATE: H, S. REF. NO.: APPROVED: SUFFOLK CO. TAX MAP DESIGNAT~I~:oF DIST. SECT. BLOCK PCL. OWNERS ADDRESS: DEED: TEST HOLE STAMP SEAL ALBERT A. SACCO AND GORDON K. AH~ ARCHIT~5 &ENGINEER$ p A I j · APPROVED ~S NOT, ED NOTIFY BUILDING DEPARTM[ARTM~ ATAT ED INSPECTIONS: 1. BEFORE BACKFILLING ~:OUNDA- TlON OR START FDAMING 2. FRAMING INSPECTION 3. BEFORE COVERING P~'ZS OF ANY KIND 4J FINAL WHEN JOB COIAPLETED NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS 5. ALL CONSTRUCTION MUST MEET REQUIREMENTS OF N,Y. STATE CODE :. 4XF¢ p, plZ,, 4 4L ~'" T 7' Iff L£" il ; I ~l 'd'- ¢¢" 4. II 6 'F., T i L E J2