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Home My WebLink About10799-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y, Certificate Of Occupancy Z10781 Date November 18 ., 19..8.1 THIS CERTIFIES that the buildh~g ................................................ ;9 .. .0...o.a.l.t.a..~.r.e. Wa)', Matt:t,t. uck~ New York Location of Property//~s . ' ....... ~/e~t' ..................... County Tax Map No. 1000 Sechon 100 .Block 1 .Lot 32 Subdivision Saltaire Estate .Filed Map No.. 4682 Lot No. 30 conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .d.u.~7.. 8.4 ........ , 19. ~.0pursuant to wkich Building Permit No....~0799.7~ ........... dated ..... ~..u,l.7. 2. .9 ............... 19...8,0was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ?r~vate One Family Dwelling The certificate is issued to .... .H.~. c..h.a.e.~.. ¢!~.fl.. ~.o?.e...~.e.n.~..y.n .......................... (own~,>,rd~x&~toX~r~ x x x of the aforesaid building. Suffolk County Department of Health Approval 10-80-52, 10/!6/81~ R. A. Villa P,E, N51~697 UNDERWRITERS.CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN C:LERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~0799 Z Permission is' hereby granted to: ................................................................................ ~4/ E N ~ I~ Y /~ ....... ~.o........~.....~ ........ ~..(.2f ................................ ...................... ~!.V..F,,,~.H....¢.~..~ ........ ~.~2,~ .... I i ~o f ~o ..... ~.u.L ~.~ ......... 6 ....... ~.~.v..&T.~ .......... ,~ .N....~. .......... tL ~.~.~.~,.¥. ......... ~.~.~.~ !.~....~... . ...... ............'~~'""~ ................. ~,7 :/'"~" "~'"5~'~" ~'"" ........ ~'"~"~ ................ pursuont to application dated ........................................................ , 19 ........ , ond opproved by the Building Inspector. · / ooO - /oo - 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 ptan 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 requ ired 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 $5.00 Date ...Op.~q~f~'..3,9~..3,9~ ..... New Building .. ~ ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ............. ~.3:~ .e.~'.e...~.a~r. ....~.e,.:~ .~.~..~.~. ~p.~e~ .~.ep.. House No. Street Hamlet Owner or Owners of Property ..... ~[~J~e.e~L..~; ,l~ei~,e..~l'e~"lA ............................. County Tax Map No. 1000 Section .. [.0.(} ......... Block .... ~. .......... Lot...#. ~.(~ ........ Subdivision ................................. Filed Map No. ~.6.~ ..... Lot No. #..3.(~ ........ Permit No. 10.-~Q-.52. Date of Permit 7~.29~/J~.0..Applicant . .Vi~.ez~$. G~.eda]~,~. I~e,..l.v~ .... Health Dept. Approval . . .0.~$~. ~1,~. ~. ~[.~[ ...... Labor Dept. Approval ............... ,h[~ ..... U ndervvriters Approval .. ~e,~,. ~.~,,. ~,~.~- ...... Planning Board Approval ........... ~..~ Request for Temporary Certificate ..................... Final Certificate .... ~'" ~i~ ~ ~'~ Fee Submitted $..~,00 ....................... Construction on above described build,ng and/,~mit~meets a,~.ti..c~j~le j~desand regulation Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW Y~)RK 1OO,38 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of :,,~u~t.~re, Way, ].6~Fd~ r~O W~e Cr~t A~, ~.~L~:~u~ in the following location; Basement 1st FI. 2nd bL Section Block Lot wasexamlnedon t2~.~:C~ 2(~ ]~SJ~ andfoundtobeinco,nphancewiththerequirementso~thisBoard. FIXTURe- FIXTURES RANGES COOKINGDECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS RECEPTACLES SWITCHES INCANDESCEN~ FLUORESCENT ~CU~YvA~ A~T K W ' ~T K W ~T K W ~T K W A~T H P ,;u 3/ 35 :¢0 :% 1!,,4 1 1.2 DRYERS_~ FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIALREC'~ TIME~[OCKS BELL UNIT~EATERS ~ULTI-OUTLET DIMMERS SYSTEMS [ 3O SERVICE DISCONNECT NO OF S E R V I C E ~ METER OTHER APPARATUS: ~fJ2~k~2.~? ?ltered in ony ~anner, return to the office of the Board if ~ngo~rgct. Inspectors moy b~ THIS COPY OF ALTER[ED IN ANY Examined Approved . ~ Disapproved a~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18013 'ermit No../. 9..7..q. ?. APPLICATION FOR BUILDING PERMIT Application No ................. 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 buddings on premises, relatmnship to adjoining premises or public streets or areas, and giving a detaded description of layout of property must be drawn on the diagram which is part of this appli- cation. c. The work covered by th~s applicatmn 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 in_spl~ctio~ns. (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of co.orate Builder's L~cense No. ] Plumber's License No. ~/~ -- Electrician's License No....~.~.~. ....... Other Trade's License No .................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. 1000 Section .... ZF.~..0 ....... Block .......... /J ....... Lot.. (Name) 2. State existing use and occupancy of pre~nises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy /~/d~. L../../~.~.. 10. 11. 12. 13. 14. property lines. Give street and block interior or corner lot. STATE OF NEV YORK, COUNTY OF ~,~k..TY' .,~-.~ .~../~. .... S.S (Name of individual sigr ~ng contract) above named. He is the ..................... (Contractor, agent, of said owner or owners, and is du~y authorized to perform or applicationl that all statements contained in this application are work will be performed in the manner set forth in the application Sworn to before me this .......... .~.¢~t/t~.......... . .day of ............. NOTARY PUBLIC, State No. 52-452d, Z Ouahhed in Suffoi~County Cemmission Expires Uae'ch 30, 19S~ Nature of work (check which applicable)' New Building .[~..... Addition Alteration Repasr .............. Remoyal .............. Demohtion .............. ~ther Work ............... o~' ,~ ] .- ~C/ (Description) Estimated Cost ........ .gt... [ ........................ Fee ...................................... I (to be paid on filing this application) dwelling, number of dwelling ~nits ............... Number of dwelling units on each floor ................ If If garage, number of cars ..... i .................................................................. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... .Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ......................, Height. ......... ~ h ......... Number of Stories ...................... Dimensions of entire new construction: Front .. ........ Rear .... $. ......... Depth .~ ............ Height ............ Num er of Stories ........................................................ Size of lot: Front .... ~'o 6 t, Rear. Date of Purchase ............................ Name of Former Owner ............................. Zone or use d~stnct m winch preauses are s~t ated ......................... '~;'i~ ........................ Does proposed construction viol~te any zoning law, ordinance or regulation: .... ~.: .......................... Will lot be regraded .... ~..~". ,-5. ................ Will excess fill be removed from premises: Yes N~o Name of Owner of premi~ses~. ?i.~... ~?..6.'.~..Y'.A].. Address ............... ~.. Phone No ................ Name o.f Architect .... D..o¢~..~P...~ .~..~.~..ltl. ....Address . ~..O..o.~-..Z~p...~.~, ~/Y~/. rhone No. ? .~.-9..--.3. ?././.... Name of Co tractor ......... , ............ I 14~.. Address ...X ..... 6~/~ rd .k'. · Phone No ........... ~... PLOT DIAGRAM Locate clearly and distinctly all I buildings, whether existing or proposed, and~indicate all set-back dimensions from mmber or description according to deed, and show street names and indicate whether lng duly sworn, deposes and says that he is the applicant rporate officer, etc.) ave performed the said work and to make and file this me to the best of his knowledge and belief; and that the Lied therewith. (Signature of applicant) ~- Water not to be used for preparation of baby · formula or consumption by infants under six months of age. HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT ADDRESS TEL NOTE I-~ MON~IMEN~- SUBDIVISION MAP FILED I~1 THE OFF/CE OF THE CLEt~K OF SUFFOLK COUNTY O~ AUG ,~, 1966 AS M~P NO 4~82 SURVEY FOR MICHAEL ~VENGRYN ~ ROSE WENGRYN LOT NO ZO "SALTAIRE ESTATES " AT MA TTITUCK TOWN OF $OUTHOLD SUFFOLK COUNTY, NEW YORK DATE SCALE NO APRIL 24, 1981 JULY/8, 1.9~0 I -- 40' 400 OSTRANDER AVENUE YOUNG YOUNG "'VE"" AD,.E'YORK ALDEN W YOUNG, PROFESSff)NAL ENGINEER AND LAND SURVEYOR N Y.$ LICENSE NO 12'845 HOWARD WYOUNG, LAND SURVEYOR NYS LICENSE NO 4§893 ,._. 2o,oO ' \2 The water suppl~ and sewage disposa~ Co~ty~Department of Health Service~ SUFFO£K COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAL 01; CONSTRUCTION ON£V APPROVED ~ ~-'- ....... HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT W NEAREST WATER IAIN__MI - RSOURCE OF WATER PRIVATE__PUBLIC__ N BUFF CO TAX MAP DIBT ~OC~ SEC TION J~ BLOCK ~ LOT ~ ~THERE ARE NO DWELLINOS WITHIN IOO FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON ~ THE WATER SUPPLY ANOSEWAOE DISPOSAL SYSTEM FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES NOTE m -- MONUMENT' SUBDIVISION MAP FILED IN THE OFFICE OF THE C/ ER/( OF SUFFOLK COUNTY ON,dUG 3,196G AS MAP NO 4G82 THE LOCJ~TI~N OF WELL(W), SEPTIC TANK(ST)~ CESSPOOLS(CP) SHOWN HERECN SURVEY FOR MICHAEL WENGRYN 8 ROSE WENGRYN LOT NO. 30 " SAI TAIR£ ESTI~TES " AT M~-T/FUCK TOWN OF SOU/HOLD SUFFOLK COUNTY, NEW YORK DATE ,/IJtY 18,, 198,0 SCALE / "-- 40' NO 8,0 - ,578' 1i1, V/~ H Ik I/~_ V~ H Ik If'D_ 400 OSTRANDER AVENUE i /UUI~I~3 8~ /UUI~I~.~ RIVERHEAD, NEW YORK l~m ALDEN W YOUNG, PROFESSIONAL ENGINEER ~ ANO LAND SURVEYOR N Y.S LICENSE NO 1~845 ~ [] HOWARD WYOUNG~ LAND SURVEYOR ~ ~ NYS LICENSE NO 45893 ' :i12~ T CERTIEICATE .i 765 ]802 9 AM TO 4 PM FOR TH ~OLI OWING INSP[CTIONS- 1. FOUNnATION - ~0 REQUIREI FOR POURED CONCRETE ~ IN~IJLAT~ON ALL O~'e~P',~CTION SHALL MEE' DONALD A. DENIS A.I.A., I:I.C. ARCHITECT L I I /I ~TTIo DONALD A. DENIS A.I.A.~ ARCHITECT