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Home My WebLink About10991-zFORM 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 ........ ' ........................................ Location of Property . .890. ~loore.a. Larva. (h;knden..Aver.) ....... ~;~Og~.e.,..~0K .~rk House No. Street Hamlet County Tax Map No. ] 000 Section . .10 9 ....... Block ..... 0 3 ........ Lot . .0. Q 8 · ~.?. ........ Subdivision..C.qq .n.~?.y., .C.l.u.b., .~.a~.a.~9.~ ...... Filed Map No...6.7..3.6..Lot No....6 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated Noveraber 19 19 80 pursuant to which Building Permit No. 10991 Z dated ... p.e.c.e.$.b.e.v..t~ ............. 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 Family Dwelling The certificate is issued to ..... ~.i.1990..a.n..fl. ?.r,a..n.k..~a.~..t.e.r.i.n..o ....................... of the aforesaid building. Suffolk County Department of Health Approval ...~ 0 .-~.0.-.9 0.,. 3t,. k,..¥ ~.~.~klg. !~.,.~. ~. ~[.0./.5 ./~ 1 UNDERWRITERS CERTIFICATE NO ..... N 5 3 ~.ZT. 1 ..................................... Rev. 1/81 FORNI NO~ ~ TOWN OF SO~THOI.~D .UILDiNG TOWN HALL SOUTH'OLD, N~. Y. BUILDING FE~IT (THIS PE~IT MUST BE ~EPT ON THE COMP[fiTIO~ OF THE WORK Building Inspector. ~e~ ,....L4/.6......~.:... Building~lnspector No. 1O991 Z Permission is hereby granted to, .~,'/,".c~"~,.~,.~ ,~:~'~'C/~/ . · A,.~'. .~../..~. ........................ L...;...., ............ ........... C~.~~,......~,.~ ....... ~ at promisos located ~ .... ~ ......... ~ ~' ........................... ...... : ~ ~.~...LE.~/s...~,..~,..,.....~.~.~.~9.~..~.~-.% ........ ..................... co~ ro~ ~op ~o. ~000 so~.o~ ..X~.~ ........... m~k ~,...¢~ .......... [o~ purs~u~nt to opplic*tion dotod ;...,~. ..,~...,, 1 ~ ond :opprov~ by tho 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 bui[dings 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 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 ./ Date / ~//,~ ./~. ~ / New Building V/ Old or Pre-existing Building ............ Vacant Land ............. Location of Property .:~.'?,~.~...,~. ??..L-~..,~.. Hou~ No, Street Ham/et Owner or Owners of Property County lax Map ~o. 1000 Section .... 4¢.~ ....... Block .... ¢~ ........ Cot.. ~ ~..~ .~.7... Subdivision--(~d~rX/~2u~ .~'W~ ~2J' . ,Filed Map No. ~ ¢ .Lot No, ......... Date of Permit , cant .................................. Health Dept. Approval ...~'~..(~. ~ ........... Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval . ..~ ................. Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $...-~..~.~'~.~ ...................... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR CITY, ~5 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT was examined on and found to be in compliance with the requirements of this Board, FIXTURE OUTLETS SWITCHES FIXTURES FEEDERS RANGES ;OOKING DECKS OVENS DISH WASHERS EXHAUST FANS OTHER APPARATUS: E R -V I C 1 -Smok~a Detector 1~-4 ..Skw H.W.H~ relic. Ro~a l~a~;~s:,5-1o~,12~l.0L~4 3-.Skw, 1-.375TM A, ~N G NO, OF NEUTRAL.5 OF HI-LEG 1 OF NEUTRAL L£c: 6o7-~ This certificate must not be altered in any manner; return to the office of the Board if inco~.rect. Inspectors may be identified FZELD ~N~ECTZON COMMENTS i. FOUNDATION (fist) FOUND~T~0N (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY COQE ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application No../..~. ~ ~..//. ....... Disapproved a/c ............ ~.~..i 2 .................. ~f (Building Inspector) 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 promises 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 cod_~housing code, and regulations, and to admit authorized inspectors qn premises and in buildings for necessary ics~l~ion~. t ~ (Mailing address of al~cant) is owner, lesse~chitect, engineer, general contractor, electrician, plumber or builder. State whether applicant Nmne of owner of premises .....'~-../.~..~.-.~. · .~.../.../.-'.~..~, .~../,~. .... .~/~, .~. ~.;7~'. ~.../..A~..0 ................... (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 ..... ~: ..... k~_> ......... Plumber's License No. Electrician's License No../..~.~,~..~.../~.?...' ....... Other Trade's License No ...................... 1. Location of land on which proposed work will be done...~..~A/..~...'~. ~....~.4~?..~.. ~. c~..77....7t~...-~. .......... County Tax Map No. 1000 Section ..... /..o. ~.. ........ Block .... .~. ,-~ .......... Lot ~.o. ~....Z~.. Subdivision .&.~.~.r*f...~..z~.~.~.. ~.~..~..~..r..~..~. .... 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 ......... 2f ./-Tq?. ~...,fo...x~./.~....f~,~...&~'. (~. .................................... b. Intended use and occupancy . ...~. J.~ d. -~...~.---..'5:/....d.' ..~. .......................................... 3. Nature of work (check which applicable): New Building ......... Addition .......... Alteration .......... Repair .............. Removai .............. Demolition .............. Other Work ............... 4. Estimated Cost ..~..7(fl '(~J(~JO "~ /t'~ (Description) · .f.../. ........... Fee ..................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units....~. ~ .X~.. ...... Number of dwelling units on each floor If garage, number of cars ..... i ................................................................... ~ 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 with alterations or additions: Front ................. Rear .................. Depth ....................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ..... ~.( ....... Rear .... ~..~. ....... Depth ./.~..~.~ ....... Height .... ,.z~.. ........ Num.~ber of Stories .... ~:/ .......................... _. ................ 9. Size of lot: Front ...~P~¢...: ........... Rear .... ~..~ f. ............. Depth .../.~.7 ............... 10. Date of Purchase ........... i ................. . [qame of Former Owner .~/'.~.~.ff/.Z.q.d...~...~..~..~. ...... 11. Zone or use district in which pr~mises are situated ..... Z'd ~ ............................................. 12. Does proposed construction violhte any zoning law, ordina,n, ce or regulation: ....Z~.q5 ....................... ,,--* · 13. Will lot be regraded ..... ~,f.~ ................... Will ex~c~ss fill be removed from premises: Yes ~ 14. Name of Owner of prerm~lses ~../, .... 5~....~..~?.. ~. Address ~ .~,~. ¢~,,~v4,sav~,~,-Phone No...~. ............. Name of Architect ...-/yf~...~.~.4q'?..~'...77..77.~../~/...~.,?Address ..."~..~.: 7.. ~.' :.".[:..-Phone No ................ Name of Contractor ~' .~.~'.~. Address /¢ .~. e.<~ . Phone No. PLOT DIAGRAM Locate clearly and distinctly allI 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, ~ S COUNTY r~F..~.q ~,~..o. *K'.. ~' ...... . ./~...~..--.~. ~ ./..~..~'..F. ~..,~..g?..~.-.~..~.. ....... being duly sworn, deposes and says that he is the applicant (Name .... ~' of m&vldual s~gmng contract) above named. He is the .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ail statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to b~fore me ti)is i ........... day of. ~., 19 ..~. Notary Public, N.84o$4' 2qg. ql ' Lo/' HEALTH DEPART MENT - DATA FOR APPROVAL TO CONSTRUCT w NEAR[ST WATER mAI~__MI. -+ # SOURCE OF V/ATER~ PRIVATE V~PUBLIC __ NOTE' SUBDI II/SION MI~P F/LED IN THE OFFICE OF THE CLEt~K OF SuFFOIJ( COLINTY ON OC~ 17, 1978 AS FILE NO. 6736 THE LOCATION OF WELL(W)~SEPTIC TANK(ST)~ CESSPOOLS(CPI ISHO~R HEREON SURVEY FOR FRANK C~STARINO LOTNO. 6, "COUNTRY CLUB ESTATE. g" AT CUTCHOGUE TOWN OF $OUTHOLD SUFFOLK COUNTY, NEW YORK JUNE Z, 1981 MAY 21, 1.981 NOg 1.7, 1980 OATE. OCT 28, 1980 SCALE: I = 40 ' NO. 80 - 585 Ii,ii, AUTHORIZED ALTERATION OR ADDITION TO SURVEY f~ A VIOLATION OF SECTION 7209 OF THE YOUNG e, YOUNg ALDEN W. YOUNG, PROFESSIONAL ENGINEER ANO LANO SURVEYOR N ~.S, UCENSE NO. 12845 HOWARD W. YOUNG~ LAND SURVEYOR N.Y.S LICENSE NO 45895 -% " CL [,, Lot ~ SURVEY FOR SUFFOLK COUN~ DEPARTMENT OF H~LTfl SERVICES ~ ~/~ FOR APPROVAL OF CONSTRUCTION ONLY AT ~~ DATE~ ~ ~ /~ DATE {{[/~ HS REF. NO./~°~'k'v, SUFFOLK cOUNTY, NEW YORK NO. APPROVED HEALTH DEPARTMENT-DATA FOR APPROVAL TO C~STRUCT A~D ~ HIS BEHALF ~ THE TITLE COmPlY, ~ S~F CO. TAX MAP ~ST I~ SECTION fo~ BLOCK ~ LOT ~.[~ HEREON, AND TO ~E ASSlGHEES OF THE L[NDI~6 ~~~. ,THEWATER ,UP~YA~SEWAGE DIS~AL SYSTEM FOR ,H,S RES lOE~ ,DISTANCES SHOWN HEREON FROM PROPERTY LINES /~rZ NDER AVENUE SUBDIVISION MAP FI~ED IN ~E OFF/CE OF THE CL~K OF III ALDEN W. YOUNG, PROFESSION AL ENG I NE E R SUFFO~COUNTYONOCEI~IgYSASFILENO. E7~E ~ AND LAND SURVEYOR N.Y.S. UCENSE NO. 12845 IIHOWARD W. YOUNG, LAND SURVEYOR ~L~T~W~L(W),SEPTICTANK(ST)eCESS~OLS(CP)SH~NHERE~ ~ ~ ~ N.Y.S. LICENSE N0.45893 . *ARE FR~ FIELD OeSE~ATIONS ~0 OR OATA OBTAINEO F~OM OTHERS