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Home My WebLink About10620-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z10562 Date J~x~,~'. 8. 19.81 THIS CERTIFIES that the building ................................................ Location of Property ..... 1.2. 9 3, ,L.~. ~..~.19, ,N ,~ .o,k..~ 9 .~.d., ....... ~..u .~9.h.o. fii.ug, t.. ~. 9.~.. ~..o.?.R.... House No. Street Ham/et County Tax Map No. 1000 Section .... .1.0.3 .... Block ... t~ ........... Lot ... 1 ~ ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building permit heretofore filed in this office dated ·..H.a.~.c..h..2.4. .......... 19.8.0. pursuant to which Building Permit No... 11).620. g. .......... dated ....... gp~'.l,J,..4., ............ 1 ¢1.0.., 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 ......... .................. .~r.~.v.a..~.~..qn. 9.-.r.a.~..t .~X .p .~.e.~.~A..nS .............................. The certificate is issued to .... H~,~.:[O. ~,r~d. C&~O~;[~tt .~ta~.~.~ ...................... of the aforesaid building· Suffolk County Department of Health Approval .......... UNDERWRITERS CERTIFICATE NO ....... ~..52. 0.6.3.t~ ................................. Rev. 1/81 Building Inspector FORM NO. 2 TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10620 Z Permission is hereby granted to: ......... ............ ...~.C ~.4...,..~ Z~ .................. t ............................................................................................ ~ ....................................... ~ .................... at premises located at~.~.......~.~.,.~.*..~.~*f Building Inspector. Fee 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 2. Final approval of Health Dept. of water supply and sewerage dlsposal-(S-9 form or equal). 3, Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buddings, 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 buddings (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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelhng or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date.. , .~ .Iff. ~..~ ............. New Building ,. ~ ........ Old or Pre-existing Budding ............ Vacant Land ............. Location of Property ....... .L,.~ House No, Street Hamlet Owner or Owners of Property . .~...~. ?...~..~. ~..~..'~.0....~...~, .~.~..~,i~..~,~. ..................... County Tax Map No. 1000Sectlon ...I.~ ........ Block ....~ .......... Lot...j.~. .......... Subdivision ................................ Filed Map No. l.~'..0.1~...Lot No .............. Permit No. [0.~. ,~.~... Date of Permit .~l~/~.O...Applicant..(,~q.,.[ !~. '.~..e~..~.,.~..~.~..~. ,,.C.~./..~.~..~.~),_ Health Dept. Approval . .I .O..~.O.': .~-.~ ......... Labor Dept. Approval ........................ Underwriters Approval..~'.~.0.~ .~.~ ............. Planning Board Approval ....... ~ ........... Request for Temporary Certificate ..................... Final Certificate .., ~ ............... Fee Submitted $..t~) ......................... Construction on above described building and permit me,ts all applicable codes and regulations. / Applicant . . ."~~.~. '. ~,~ . .~,. ................ Rev 10 10 78~ ' ~'/ ' '' ' COUNTY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES DAVID HARRIS, M.D., M P.H. COME ISSlONER The attached approval was issued subject to the notation conbatned below our approval st~,~. ~uld ym~ please type the following coadit"Lon of approval ou the f~a! ~ of 0 as ~luis will ensure that any ~uture owner ;~ll be made a~;are of the ~ftrate problem. '~rivate well with hish uitrates - see He~]th Department note on final Thank you~ Robert Ao '~lla~ P. E. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRI~IT~ ~r~ ~85 Jo.. 5T.EET, .EW ~0"", ~V~O~ ,0038 only the electr~fal ~p~e~ p~ d~ri~qg.bq~tro~ by j~a~~ th~l~ati~ n~ber in the premises of FIXTURES RANGES OVENS FIXTURE SWIFCHES OUTLETS FLUORESCENT VAFOR 20 22 ~0 DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUIIURE ~PPL~ANCE ~EE[~E~S UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V J C A W G NO OF HI LEG A W G NO OF NEUTRALS A W G OF CC COND OF Hi-LEG OF NEUTRAL 2t0 1 2/0 I GFGI I SnDke D~tec~or 103 Bri~od I~ne Pl~Lnvic~, N, Y~ 11803 Th;s certificate must not be altered in any ,manner; return to the office of the Board y Inspectors may ,be FOUA~DAT ION (1st) FOUNDATION 2. ROUGHF~ & PLUMBING (2nd) INSULATION PER N.Y. STATE ENERGY CO E FINAL ' -- ' ADDITIONAL COMMENTS: 765-t802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~,'~ ROUGH PLBG. FOUNDATION ZN'D I- ] INSULATION FRAMING [ ]FINAL REMARKS:, /, * * DATE /'~//~-- FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examine¢~./~./..~' ,t./ , 19 20' Approved?~ v,ff,~_~ '~ .... , 19~ No.~/d~?~..'~ .~ ............ ... Permit ......... Disapproved a/c ......... ~ ..................... APPLICATION FOR BUILDING PERMIT Application No. ,F~)d.'.~..O ........ INST RUCTIONS 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 th~s 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 applica, nt agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized mspectors on premises and ~n buildings for necessary in~ections, t . ....... ............. (Signature of applicant, or name, if a corporation) (Mltfiing address of applicant) State whether applicant i~ owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises....~..~..~7'....Q:.~...~. ~..'9=-~. ............................. (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 ..... . .A~/.//'..~. ............. Plumber's License No.....~......~...~..~.~7 ........ Electrician's License No. '/ ~/~ 5- Other Trade's License No ...................... 1. Location of land on which proposed work will be done ......... ~.~..~..'.~..?.~.. i~ous~ Number Street County ~ax Uap No. ~000 Sectm ....... ~. ~ ..... mo~k ~ rot ~ }~.. ........ Filed ..... ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ...... .................................... ........................................... b. Intended use and occupancy ..... ~....~~. 3. Nature of work (check which applicable): New Building . . Addition ...... Alteration .... Repair.. ............. Remoyal .............. Demolition .............. Other Work .............. . ;~ ~ ~O (Description)' 4. Estimated Cost ....... .~. ?./. ~ ........ Fee...Z .~.'-.~ ......................... (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................ If garage, number of cars ..... :.°-d~cx... ~ ............................................... 6. If business, commercial or mixed occupancy,~pecffY*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 w~th alterations or additions: Front ...... ~ .......... Rear ............ Depth ~ i Height .~.. Number of Stories .. ' 8. Dimensions of entire new construction: Front ..... ~. ...... Rear ..... ~.-~. ....... Depth ...~..'~. ........ Height ... ~.. ~....~.... Numbe. r of Stories ..... ~'~ '. .............................. ./ .............. 9. S].ze of lot: Front ....................... Rear ............. Depth ......... 11. Zone or use district in which pre~nises are situated .... . .~'..~. ~ .¥ .................... 12. ocs proposed construction violate any zoning law, or&nance or regulatmn .............................. 13. Will lot'be regmded ..... '~..~--~. .................. Will exc_e~s ~11 be removod from premises: Yes 14. Name of Owner of premises?)~., .~..~9,~. .... Address .~. ~.. Phone No.~L:~7 .~.~. ~3. 7 .')).~.. ,-~ PLOT DIAGRAM Locate clearly and distinctly all Jbuildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. ! STATE OF NEW YORK, 'S.S COUNTY O~ ....... ~ .........., ......... .~..'t2~-.¥ ............... being duly sworn, deposes and says that he is the applicant i (Name of individual signing contract) above named· He is the ......... . .c~..~ ............................................................... (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 all statements contained in this application a~e 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. Swam to before me this Notary Public, . .O....lOde...c~...~...~.~.. xr~ .. County NOTARY PUBLIC, ~t~l~ of Now York ........... ,~J,X~J, .~ ,J ,~ * ....... No 4677753!~ Suffolk County (Signature 9fapplicant) Comrmsslon Exp~re~' March 30, f9 ~:~ ~ j Z'(X~D A AREA OF I~LOT * /-~ 000 ~ I~f FLOR /~9/ ~ ~ENT / 4 7~ ~. FT ~ GARAGE DATUM THERE IS ~ S~CE WATER WI~ ~ FEET ~ THE ~. ~_' z~v'.,~ - ,,v,~cc N/F SPERRY 89° 5 ' 30" E ,,9~' ~mo.-14, 9. ~ 150.00' 0 ~ /vo 6,jE- 5'0' ~ ~ ~oc.47-,o~ 100.05' $ 89°59' 30" W N/F OYSIANIK THE WATER SUPPLY AND SEWAGE DISPOSAL ~STEMS FOR THIS R~SIDENCE WILL CONFORM 10 THE STANDARDS OF THE SUFT:OLK ~Y DEPARTMENT OF HEALTH. SERVICES. 33' 150.00' $.00' DIA. TYPICAL PRECAST SEPTIC TANK NO SCALE TEST SURFACE 4' ~FD. TYPICAL PRECAST LEACHING POOL GUARANTEED TO L ,~e~N'~ ED LAND 125 ROUTE 25A ROCKY POINT. N.Y. 11778 I MAP OF LAND LOCATED AT EAST cu-rCHOGUE TOWN OF $OUTHOLD COUNTY OF SUFFOLK SURVEYED FOR 20' T - NAIL O - .,"E S~T~C~s L0CaTm~ 0~ w~ u~. ~ I SU~OLK ~ TAX MAP ~ Ill Il I1 IThe sew~ce disposal ~d wa%e~ supplF /0 ,tO be s~tisfactor~-~ I Chief of ~eneral En~neert~ ~. ~ ~ ~ Services 100.05' 33' · ' HXGI~ NITRATES - l~ater not to be us~d-for l~eparatlO~J ..... ~ ~ of baby lo--la or use by infants~der · / ~ . / ~ / ~ ~.10~19; ~1 ~' N ~ 54.~'' ~ 3z.3' ~ . ~ I ~~ TO ~ 4.8 .... u · r~,. S 8g°sg'30'W oo 150.00' ~ X EAST C~OO~ / m [. / .~ ~,~ I ,~ ~ ~o I N/fOYSIANIK / (*( ~ I*l I TOO PtOM%Illg PIASIM',H tJO ~CA bF., 7 lCD 1L I'AHK EOOF FKAVIIH6 FRDFPP-I'N tlr/8. -- 0 154Z.7O To -~ IOO. O B,O~ °00~ ~0"~ ONt B OF 5oFFol.,l< MAP oF LAd[? s o i~' F--.¥ F.;¢' ¢,'1' Towh OF .eOoTHooP , tt'Y bFf'rbF... HE/..F,, I~AP SITE. P~APt ,~:Abp.,.: "~ p__Ol.O'' .9 / SOHKEPt LiV I"'1 (~ r OAK FODOI~. / / Abb SI'ROCTDF-AL,~ F_.,L,F./..,'1'~IF_.Ab. AMp MvoCHAtII(.AL WORK SHAbL COMPLY WrTM CoOVE,~HIH~ C_J~OF.,~ A5 APMl~r81'g~6.,~' ~"f THF_. LOF-AL,. ~olbPlN~ O~'FICIAb5 AHG' %HAOD ~F~ COMSIpBK~.P A~ pAF. ff OF q'H~.B~' c'Or/~Tff, OCFIOrt ]7oCOMGHTB. / ~M~PRO~FED AS I~ 'FEE: 7z- %~9Y: ~ NOTIFY BUILDING DEPARTMENT 7654802 9 AM TO 4 PM ~ FOLLOWING INSPECTIONS: ~. FOUNDATION - ~O REQUIRED FOR POURED CONCR~E 2, ROUGH - F~MING & PLUMBIN6 ~. INSULATION 4. FINAL - CONSTRUCTION MU~ BE COMPL~E FOR C. O. ALL CONSTRUCTION SHALL THE REqUIREME~S OF THE N.Y, STATE CONST~UCTION & ENEBGY CODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRU~ION ERRORS. MASSALI I"l H O0 5F_.. blTl'bg, h/E/J< F, OAp, P-.Ab1' COTCH O~OF_, P~w, by 5E..~(mIO ZOP, I P'ATF_.,: JAI>~OAk~/_:SQ ALAPl FBL~ AR(::H/I'~I' l=t ~ (¢JZ)&89-4081 (ZlZ) ~Tq-qo$3 ' ,J U __, +lDtOI~ '~07 O~ CHIMNey F d 'L 9~UTIfl ~.LCVATIOH ~ ~-AbUM-/~O'[T~5,AL.C K I'TCHE, i'~ LA'fOOT