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Home My WebLink About10619-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No..Z...q.0.2.8.7 ........ Date .... Dec, ember. 3, ............... ,19.80 THIS CERTIFIES that the building ................................................ Location of Property ...~.90 Bri.dge Lane, Cutcho~ue, N.Y~,/et Sou. ~o: ...................... 's't~ ............................ County Tax Map No. 1000 Section 097 ·Block I .Lot 17 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this' office dated · .A~. r. .i .1. .2. ,. .......... , 19..8~). pursuant to which Building Permit No... ~I..C~].gZ. ........... dated .. AR.Z?:L1. ~ ................ 19..80was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... P.r. Lv.e. e. ne-. r ly..dwelLLng ............................................ The certificate is issued to ....O.eg..l?g.e..&..L..o.~..s.s...L..il! .dig..e?. ................. '~'..~. ....... of the aforesaid building. Suffolk County Department of Health Approval .~..1..0/r..S..0-~.2.7'. ~Rc~l)eFft; .A,..V..~,.%l&... ~/~80 UNDERWRITERS CERTIFICATE NO... }16,93.6.1~) ...................................... * Nl~hNitrates - Water not to be used for preparation of bal~y formula or consumption by infants ~/der _6z m es. of age. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW~,I GLERK'S OFFICI: SOUTHOLD, N. Y. BUILDING PER/v~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10619 Z Permission ~s hereby granted to: ....?.~..4..~.~.~....r.~.,.....A(:.~.:. ...... Fo...c..~ ~.~z .~.~..c ~.... ~ ~.....~.z.~ ~...r.~.... ~.. z/.. ~..~ .............................. .................... at premises located ct .~.....~...~-. ........ pursuant to application date ............................. , ., and approved by the Building Inspector. ................................... :.~ ~' Building Inspector FOItM NO. 6 TOWN OF $OUTHOLD , Building Depu~traent Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, end submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: l. 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 installations, a certificate of Coda 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 property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner os to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent formation required to prepare a certificate. C. Fees: l. 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 New Building ................ Addition ................ Old or Pre-existing Building ................ Ya¢~nt L~nd .............. Location Of Property .. ,~..?.,,~......~,,.,,~.?,.,~..,,~,,..~,,'~,...,,~.,.~,,,,'~....~.,.~. ...... .,~..,.~,,.,7~,,,~:~.~...~ .................................... Owner Or Owners Of Property (~9~'~ ~ ,/_~f~//_~?' ~-,/,.~...~,,.,~...,~,,,~,,,,. ....... / / No ............. ~No ............. Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .............................................. Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Fined Certificate .......................................... Fee Submitted $ .................................... Construction on above described building and permit meets all applicable codes and regulations. App,,cont ................................. GR£ENBR HOM. ..I,NC. ............................................................. Sworn to before me this ~>~/ ~~ ~)~'~, /~. ................ day of ............................................ (stamp or seal) Notary Public .................................... County ~0.~6 ~ /? ~/'~ ~L] / ~' FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, 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 d!sposal-(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 1~57), 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 requ ired to prepare a certificate. 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 .De~em~. 2,. 1980 ......... New Building ............. Old or Pre-existing Building ...Gl ........ Vacant Land ............. Location of Property .~assa'Q. ][~:)~3tc. ~ w · C~-ohog~e~ .................................... House No, Street Ham/et Owner or Owners of Property . .~.a]., .d.ed.. ~....' .[~...J.,c.~...a~.'..~.e.~.~., .Ct...~y~..(~..~.c.h .................. County Tax Map No. 1000 Section . .3..3.8. ........... Block ....6 ........... Lot... 7 ............ Subdivision ................................. Filed Map No..3..5.6 ....... Lot No..9.~ ........... Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ....... , ................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....Z ................... Fee Submitted $...5...0.0 ....................... Construction on above described building and permit m, eets all~apj31ica~bl~e~odes and regulations. Applicant ~ ~~ ~ ...... .......... COUNTY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES DAVID HARRIS, M.D., M.P.H. The attached approval was issued subject ts the notation contaiued below our approval st~,~. Would yon please type the foll~.~LUg condition of approval on the final C of 0 as bkis will ensure that any Future o~rner ~.~lt be made awa~.e 'of the mitrate problem. '~rivate well with high n~tYa~es ~ see Health Department note on final survey. Thank yon~ Robert As Villa, P. E. (51E) 727-4700 THE NEW YORK F- ~1,- . , 85 JOHN STREET, NEW YQRK, NEW ,Y~ORK = ,~_-~),~t,~ September 17, 1980 ~een ~i~ ~mes.,. e/s ~idge ~e,~>900' ~.~.,.~.~do. Sept~ 15, 1980 ' andfouadtobe~cotnpllan¢ 28 42 ~' 40 28 OARu .OF FIRE ;,UNDERWRITERS BUREAU OF ELECTRICITY, I;I-q~ ~*~ ~-~ EXHAUST FANS UNIT HEATERS MULTI-OUTLET DIMMER~ SYSTEMS SERVICE DISCONNECT PER ~ ~Future Appliance 1-G.F.C.I. 1-4.5~3~ Hoe Wa~er ~ ': ' eph Crocomb ' ,~Box 1175 ~ ' ;,,.' ,,, 'i Center Moriches FOUkrDATION ( 1 s_t_! FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY CO~E FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examine,~.~,'.r.--.. ~..., 1.~.. Approved,~.F.X',.~...:...., l~...ee=itNo./r~&'~..~ Disapproved:~-/~':: ...................... .~ ..... .// (Building Inspector) ~PklC~TIO~ FO~ B~I[DI~G ~E~MIT INSTRUCTIONS Application No./.~-~."/. 7 ........ Date ................. , 19 a. This apphcation must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate pIot 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 ~nust 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 apphcant agrees to comply w~th all applicable laws, ordinances, building code,j~o_u~itlg,c_oC~,~n~reg.ul_atio~s, and to admit authorized inspectors on premises and ~n build~ngs for necessary inspectipns. (Maihng address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .~..~..~'~.~.,4..&..C.~.~.:.P...w_~..~...,~.. ...... ' ............ ' ........................................ Name of owner of premises . .~..~..~...~. ~....~...~.....~.~..~.~..~.~'....~,'~,~..~./.~/, ..p..A~..~. ..................... (as on the tax roll or latest deed) If applicanLis a~orporation, sign~ture of duly authorized officer. ...... ...... (Name and t~tle of corporate officed~ Builder's License No ....................... Plumber's License No ....... .~. ('.7..~..~. ......... Electrician's License No .... .7...~..~..'~.~. ...... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................. ~..V:. ?~ ...... ~/~.....,4'..,E../~ ~.. ~.: ........ ~ .r:~e ¢ ~. ,... M,. ?.,. .......... House Number Street Hamlet County Tax Map No. lO00Section ....0.?..7. ....... Block .... ./. ............ Lot .... (..7. ........... 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 ..... ~.~46~4 .~?~ ~/~.~./~.~ ............ b. Intended use and occupancy ........................................................ 3. Naturq of work (check which a~plicable): New Building ......... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~-~' i -~tr- ~ ~O (Description) 4. t,stimated Cost ...... ~.././.t~4. q-d .................... Fee ..... t. ................................ J (to be paid on filing this application) 5. If dwelling, numberofdwellingiunits....~..~.~. ....... Number of dwelling units on each floor ................ If garage, number of 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 ........................................................ I)~mens~ons of same structure w~th alterations or additions: Front ................. Rear .................. Depth ................... !.. Height......... ~.. ~.. ~2~.'i,' ' j .... Number of Stories .......... ~ 8. Dimensions of entire new constrUction: Front ....... Rear ...~.~..~.~.... Depth ...,.~.qS. ~ ;;~' ' '.. q ..... tteight ............... Nu~tber of Stories ..... .O..A/.~'. ........ ~ ....................... ,'..j. ~ ....... 9. Size of lot: Front ...... g~..~/, ........... Rear... ~O.6,..~. .......... Depth ,~/.~.,.~.~....1~. ~.../.~.,..~.~.. 10. Date of Purchase ....... /'~. ~.~. ................ Name of Former Owner . ~. '~/~J]~.~....-~. ~. g.~.~../~../ ...... 1 1. Zone or use district in which premises are situated .... .~>..~..././~..~.~(..~-~.. ................................... ]2. Does proposed construction violate any zoning law, ordinance or regulation: ...~t..O. ......................... 13. Will lot be regraded ..... ~. _.O, .v ....... ..,....._ .....Will exce. ss fill be rem_oved from premises: Yes 14. Name of Owner of premises ~. ~.~.~..~../.3/.~A/..~..'~... Address .I/~.~..~)(..~,f..~'.~...r~... Phone No. ~ ./9../.-~. Name of Architect ~._~... ~ ~.d~...~ ........ Address . ~.~. bt2'~.~ ..... Phone No ................ Name of Contractor~:~.~g~,4q.~f .~./.~....-~..*~.g./.WCAddress .. ~:',d~.~/~./i0 ...... 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. ' O STATE OF NEW YORK. COUN,¥ ./C-. .... , s.s ·''~..~.~.~..~(..~....--.~?.--~..~...~. · .. . , . . . . . . . . . .~ ..... ..... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is ........... , ................................. I (Contractor, ageht, 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 all statements contained in this application are true t6 the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworu to before me this~ ~~-- .day o~ .~.~.~./.~'.. 19 eD ....... ? ........... JA~ r[~rt~' (Signatur cant) NOTARY PUBLIC, State of New York No. 52-4665418, Suffolk County,.~ Commission E~pJre~ March 30, 1 - N.46° ~O'OO"~:. - ;3',6.6Z 0 I SUFF~LK~O, HE~'~ETHH.~. NoDEPT':APPROVAL ...... SYSTEMS FO~ THIS R~E~CE WILL CONFO~ TO ITHE " O0" ~; . - 3~6.6Z /IHigh Nitrate. - Water Wot to be ~.ed for~ 'preparatXon of baby formula or consumption' infant, under 6 moa. of age. ~x~ 05 1980 ChZef of General ~gineeri~ ~VAL .~}TATEMENT OF INTE#? THE WATER SUPPLY AND ~'W~tI~G[ DISPO~AL b'YSTEM4J FOR THIS R E~l ~[][EN CE WILL CONFORM TO TI4E STA[ffDAJ~I:~d~' OF TI-II: · SUFFOLK C43._ DEPT. OF bl~ALTH ~RVIC~. (s). , : . ,. SUFFOLK COUNTY . OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE: .................... H, S, REIt. APPfflDVED: CO. TAX MAP D£SIGNATtON: SECT BLOCK' PC;L. ~T~_ ST. P..,~ i"T sTAMP A~A: 1.402 ACJ~E$ THE .WATER ~JPPLY AND ~WAGE CONFORM TO ~HE 'ST,ANDAR~ OF SERVICES -- FOR A~OVAt OF CONSTRUCTION ONLY SUFFOLK CO. , AX MAP D~SJGNAT~ON- D~ST, . SECT. BLOCK - PCL. i T "Al~era(;on of [his Document cxce'D!' h'F an /h,'h,[e,: t or ! icen:,ed Profes- b~b:,n }20q, SJbdivision I'!. f' btatc Edocatiort La',~, -FLOOD.. DLAN F LDO I Dr2- NC[ for C UTC..:. PLAhl, DLUNE~IN(::~ DI'AC, D_.AI~I ~-. LiNDNC iD._ N~=-W YO,~K' DLUMBING DIAGEAN MO q' CA L-g- FpU.,~-iQN - TWO c~NSTP UCT$ON MUST CONSTRUCTION & EN~Y NOT RE$¢ONSI~¢E ~OR ALL ¢=L[:CTP..IC P&R LIL,..'3 NE'.; hi 6 o¢ r-L) ~ Oq N A J ] ~'- 4" 4-o 4'-0" ON I r~"x E~ '~C,P~ ~- -J ~ILL IN/ ~£0" ' ~ r ',or_ BASDIflL-NT PLAN . DOUESLG UP ALL ~LOOP-.~.AM~ UNDI~R ALL ~..-AD..IFIG ~ PAI~ALL~-L PARI ITIONC. '~4- G O,C, Z'~ 4 INGUL. I LALLY ~RC,or C.BWALL- o ~L-C, TION t~Aqr=-HE-NT PLAN, qC-CTION ~F_sIOr-=NCE /o~- MD_,¢ MP:S (~Ol~Gr-E- [_, L C. UTCt IOOUT=, NIz=W YOP__I~ l kl D N r.E- D... AIJI~P,.T A. SACCO A.~ GORDON K, AHLERS ARCHITECTS & 5455~ MAIN ROAD SOUTHOLD, N ,BAS&MENT PLAN, -DDONT L- Lz=VAT_LO N -~LA%N 0V,E'D_ ALL-~--XT,~,,P. IOP., OPrcNING-g l~lc~ CH lt~ N~-Y C L VA"r ON I TO pR,,~V~.NT P.~RSON~ I~U~INIk~G [NT0 ,~ASkt CAUSING, ACCIC)J~NTC;. ID__ ["r A~ ~Lr=VATION L~FT SIDE ........ _~ L r= VAT Ia ....... lq ~¢AZ~: Y4'~ /: 0" ScL/',,~ /209, bLIbdivislorl N y. Stale Education I~ r=Al~ ~ Lr~VATt 0 N, ,L-D,-r-T ~ I DE- ~, J~ I GFI T ~ I DE- Qf:::glDF=Ncr-r-E fo,- Mq ~ MAg. GEOQGE- r=. LINDNEI~ CUTCNOC.~U~, NF=,W YOD,.,K.. ~ LgVATIONg ALBERT A. 5ACCO, AND GORDON K. AHLERS ARCHITECTS & EJ~IGINEER$ 54655 MAIN ROAD .~DUTHOLD, N Y. 11c~71