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Home My WebLink About10972-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall 5outhold, N.Y. Certificate Of Occupancy No. Z10624 THIS CERTIFIES that the building ................................................ Location of Property ...1.8..4.0..T.h. ?..S.g.~.?9.d., ......... ~.~.~...N?.~.~..on, New York House No. Street Hamlet Connty Tax Map No. 1000 Section .... 0.3..0 ..... Block ....... 9.2 ...... Lot 058 Subdivision Pebble Beach .Filed Map No..6.27.6..., .Lot No. 115 conforms substantially to the Application for Building Permit heretofore filed in this office dated November 13 19 pursuant to which Building Permit No. 10972 7. dated.....N°vembe ....... v.........19 ...... . 19 .8.0., 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 ......... Private One-Pamily Dwelling Vincent J. and JoAnn Casa The certificate is issued to ..................... [o~n.e~.~f.~,~/f~ ................... of the aforesaid building. Suffolk County Department of Health Approval 10-S0-82, 7/7/81 Robert A. Villa, PE UNDERWRITERS CERTIFICATE NO .... ~ 5. .2 .8 ~."/'. 8. ...................................... Rev. 1/81 TOWN OF ~o~, ~ TOWN HALL SOUTH'OLD,,;N'. Y. BUILDING' PERMiTi: (THIS PERMIT MUST BE KEP:F ON THE PRE~IS~S COMPLETION OF THE WORK A~THORIZE UNTIL EUL N? 1~o972 Z Permission ~s hereby granted to.~ ·: ......z 7;~ ~/.~..e.:. ..... zz . ~o ..~.~.~.~..~.~.~.....~.~ ....... ...a.~ .............. ~.~ ...... ~ .......... ":~ ........................................ ~t p~eml~ located ..... ~ ...................................... ~ , .................................................. :~""~;~7 ....... ...... .~.~ ........... . ~ ........................ , . . CoubW T~x Mop No. 1000 Section ............ ~loc~ ~ ~. ........... LOt No....~-...~. ...... ~ ' · · z~~/~,.~, pursuant to ~pphc~hon d~t~ . .. .~ .... , 19. ~nd 9pprov~ by the BU I~Ing I~spector. Fee ;..a.a~.....~ .... Rev. 6/30 - FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, hi.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructioas 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 ~Jrvey 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 Lo 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 certificate of occupancy $1.00 $5.00 Date ....~. ,/,'. ,~.. , ~/..g'.! ........ ! New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ............ ~. e. ~ ,~ ' House No. S~reet Hamlet Owner or Ownersof Property. . o CountyTax Map No. lO00Secdon 0 ~0 ............... Block . O ~ Lot ................................. p,,o ........... LotNo .............. ~ermit So.1~5.? ..... Oate of ~ermi~ .~, · .Applic~at . . .~,.. .~ Health ~eOt. A~Oroval . .Q.~. ~ Q.'7 .~ ~ ..... Labor Dept, Approval ........... Underwriters Approval .~ ~ 2 g~ ~ ~ .Planning Board Approval , ' · v ..... Request for Temporary Certificate ..................... Final Certificate , Fee Submitted $...~.. ~ ................... Construcfioa on above described buildin~ ~pe~mit mee~s al~ ap¢lieablo eod~s and re~u~afions. ................. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC. ITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the e~ctrical equipment as described below and introduced by the applicant named o~ she able appl~atlon number in the premises of VL~t J. ~a, ~ Sl:r~, L,I . 7~md & to~ Way~ ~t ~ioa~ was examlned on ~ l.l£y Z[~ ~ FIXTURE OUTLETS RECEPTACLE! 27 35 2? [~ 2nd rt. Section030 moth 2 and found to be in compliance with the require~nents of this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT DRYERSr- FURNACE FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: C AW, G OF HI-LEO NO OF NEUTRALS 1 AW, G OF NEUTRAL 4/o ~.'x~ale Elec, C~t. Inc. RR1 Box ISa ~ ~,, Matticue.k, M.Y, 1.1952 This certificate must not be altered in any manner; return to the office of the Board if FOR THIS GENEI~AL MANAGER Per ' Inspectors may be identified ,by thek credentials. NOT ALTERED IN ANY MANNER. FTEI,~ INSPECT-ION FOUN~A~ZO~ (~s~) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY COQE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180~ Application No...~.~. ~. ~.~.~2~~ ....... Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT Date .[.~.~.t..3 ........... , 19 .~?. 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 necessasi'ns~cti°n~s'~ $ }'[~o .-~.. ( 'g ure of applicant, or name, if a corporation) ?. (Mailing address of applicant) ' ' State whether applicant is owner, lessee, agent, architect, enli~neer, general contractor, electrician, plumber or builder. Name of owner ofpremises '.~. i ~..cA .w..~.. :~...?.°. .~..~..iq....C...~..$..°~... ................................... (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. ,~.0.~. r~...0.\~,[.~.o.. Electrician's License No..~..~.l).~....Q~. ?¢. yS.~....~. ~,~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done .... (~.t..~..I,. ! .~....~. 5.". .c ....... ~..~..~ ................ .....a ................... House Number Street Hamlet County Tax Map No. 1000 Section . .~..~.~. Subdivision .CA g..t,! fL. h~. B.C...~..~ .~.r..~. S ........ 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. at of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ......... ] .... Demolition .............. Other Work ............... ~/ ~O~ (Description) 4. Estimated Cost ...... ....................... Fee ............................... (to be paid on filing this application) 5 If d elling mber of dw lli ~dnit N mber of dwelli g units on ea h floor · w , nu e n s ............... u n c ................ If garag mber of a.~ .~.~. 1 e~, e~ nu cars ....................... 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 .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wi}h alterations or additions: Front ................. Rear .................. Depth ...................... .Height .................. ~ .... ISlumber of Stories ...................... 8. Dimensions of entire r~ew constructmn: Front .3. ~..&..~.q.t .~q..~ ~e~lr~ .............. Depth ............... Height ................ Numbez of Stories... 3~,,..: ........................... ,~..,.~ ............... 9. Size of lot: Front ...y 2 ]7... ~..c_~. ....... Rear..."/.q~ .q'.O ........... Depth .~-~..~ .~... ~../ .......... 10. Date of Purchase ...g ].'~q..! .................. Name of Former Owner ............................. 11, 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 ......... i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .... . ............... Address . :. ......~ ........... Phone No ................ Name of Architect ~l~.*,q].~. .~.~.5..~..~ .~ ........... Address ~.~ ?...q.q.J...~..~ ..... Phone No~.! h .O')..~':. q .'..q. q7 ~ Name of Contractor .~-.. :~.... I~.q .o ~.~(., ......... Address 1 .'[ .~..~.~t& ~¢.,:'~¢/~hone No:I.B.g .-..~/.4 .g...~... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, an& 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 YI~RKn ..... · ..~'.~~:~ ........ being duly sworn, deposes and says that he is the applicant (Name of ind~duaFsigh~g contract) above named. ~ He is the ..................... i ..................... ' .............................................. (Contractor, ag;hr, of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file .this applicationi that all statements contained in this application are true to the best of his knowledge and belief; and that the work will b~ performed in the mann{r set forth in the application filed therewith. Sworn to before me this : Notary Pu~Jic,.-~ .7(. ...... County ~,, ~.~2~,~,lk ~,w~ ~>~ (Signature of applicant) HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT Iai _+ #SOURCE OF WATER: P~iVATE aPUBLIC__/ N MAIN N SUFF CO. TAXMAP DI~I¥'T~o0 SECTION 050 BLOCK 2__~ LOT-'~ .- NTHERE ARE NO DWELLINGS WITHIN I00 FEET OF THIS PROPERTY AUDRESS SUBDIVISION NAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON *JUNE II~ 1975 AS FILE NO. 6800 N-' MONUMENT SURVEY FOR VINCENT d. CASA & JOANN CASA LOT 115, "MAP OF PEBBLE BEACH FARMS" AT EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK MAR. I0, 1981 DATE: DEC, II, 1980 SCALE: I" = 40' NO. 80-625 iYOUNGa YOUNG OOST"A"O'"AVE",O/E RIVERHEAD, NEW ALDEN W, YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N,Y.S UCENSE NO. 12845 HOWARO W. YOUNG, LAND SURVEYOR N.Y.S. LICENSE N0.45893