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Home My WebLink About10663-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin8 Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... ....... Date July 49 ., THIS CERTIFIES that the building .. pool Location of Pro rt 925 ~eresa Drive pe y .............................................. Hattituck House No. .qtreet ............ h~ie~ County Tax Map No. 1000 Section '1 '15 . .Block '1. 5 .Lot 009 Subdivision .D.e.e.~...H.o.~..e..C.~.? .e.k..~.? .~.a?.e.s....Filed Map No. ~25e .Lot No. 38 conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... A.~0.~.]:...2.~ ...... , 1~80. pursuant to which Building Permit No... '~ OE~63Z ............ dated .... Hay 8 1 ~r/5.O, was issued, and conforms to all of the requ/rements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ..... imgr, ound. Loool ............................................................ The certificate is issued to .............. BO~ & .NARCY. B~)R'~.T,TO ................... (owner, of the aforesaid building. Suffolk County Department of Health Approval ......... N/~L ............................. UNDERWRITERS CERTIFICATE NO ................. N/4-~&960 ......................... Building Inspector Rw.l~l FORM NO. 2 TOWN OF SOUTHOLD 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? 10663 Z Permission is hereby granted to: ~Z~.~, ~,,/~',~ ~/,~,~ . ~c~.~'..,.~.~.~......~... ...~..~z~~ .... ~ ..... .... ~.~.~o~..~....~..,~.. ~o ....~.~.~.o c.~ ...... z~.~.z~~ ..... ~z~ ~.~....T~& ........... ......... ~.~......~..~..,...~c~o~o~ .................................................................... ~t premises Iocotod ot ..~...~~' "~'7 .......................................................... pursuant to opplic*tion doted ...~.&--...~.~ .............. , 1~0', and opproved by the Buildin~ Inspector. Fee $~..~....~ ....... FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This apphcation must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buddings 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 ~nstallation from Board of Fire Underwriters. 4. Commercia~ buddings, Industrial buildings, Multiple Residences and similar buildings and installa- t~ons, a cert~hcate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planmng Board approval of completed site plan requirements where applicable. B. For ex~sting 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, buddings 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 reqmred 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 ,..~.a-Xo, b..&.,. ~..8.& ......... New-Building ,(~, .~!~.~.(' ...... Old or Pre-existing Budding ............ Vacant Land ............. Location of Pr, operty .9.~. ?.b.e?,e.s.~.. p.~.~.¥.e.,..~..1;.t;.:~.~..~ .o~. ,~.e,w..~.o..~'~ .... ~.J.?.~2. ........... House No. Street Hamlet Owner or Owners of Property . . .~.a,~o. ~r, .~.e.~. ~.o.~.~. ~.o .... .¢! . ~.] }. ~.. .......................... County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision ................................. Fded Map No ........... Lot No .............. Permit No...w .LP.% ,-./. Date of Permit ..... ; . ;~ .Applicant . .D.u. ~.~.~.%e...2P.o.o.~..C,o ............... Health Dept. A~proval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Tern po ra ry Certificate ..................... Final Certificate . . .%.~..X ................. Fee Submitted $...~.: .0.0.. v~. .................. Rev 10-10-78 Construction on above described building and permit meets all applicable codes and regulations. Apphcant ,' :/:l .~.. ~/.8, ..................... FORM NO 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ............................... . .~,o...~....~..~....q. ~¥~ ........ PLEASE TAKE NOTICE that your application dated .~(.~.. ~ ~ ..... ,19 .~. for pe~it to construct..l/d~~.. ~~ ................. ~. ........ at Locat,on of PropertY.Ho,so:g:~.,o ...... ~~:~'~t~,t'~ ........ ~ Z (~<]C~./UH, mi, t ~ County Tax Map No. 1000 Section .............. Block .............. Lot .............. i~ ~t.~a k~witk ~ ~i~a~o~ o~ t~e ~oilowi~ ~ro~as./~~.~q~ ..... . .<:~/~.. ~:e...NrqC~.e:~..~:...~.~ .......... .. '.,:~ ~...:~ :...~ ................................................. RV 1/80 FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (lst~) INSULATION PER N.Y. STATE ENERGY COpE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF Fi'RE UNDERWRITERS ][:)1%~ BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Robe~rt Be:~to~'e].lo,, 925 Theresa Dry, Matcituc~ in tke followlng locat,on; ~] Basement ~ ~t r~. ~ 2ad rt. ou~ide Section Block Lot was examined on ~t y ~ ~ ~ ~t ~ d 0 and found to be i~ complla,*ce with the requ,re~r~ents of this FIXTURES OTHER APPARATUS: SYSTEMS NO OF FEET E R ¥ I C E NO O~E~C~COND A W O A W G NO Or NEUraALS OF CC COND OF HI-LEG (Swimming Pool) This cer~:kJ~icate ,~ova~a eo~li~nce a~,:~he dace inspeeCiononly. B~,eause of unusual environments it is advisable to have frequent tes~ and/or repairs made by a~qualified perSon~ AWG OF NEUTRAL I .L)~ t~ox West t~lip, Th~s certificate must not be aJtered ~n an /i795 return to th GENERAL Lie. 2566 g office of the Board if in, Inspector~ be may ~dentlfled by rtrLw No, t Path k FO~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..Z~...~...7.....~ ............. , 19..~.~. Approved ./~..4~....c.~.......~... ............. , 19...~...~.. Permit No. /....~...'~..-~...~..Z .......... D~sapproved a/c ................... ~;:. ............................................................. ^pplico.on ............. APPLICATION FOR BUILDING PERMIT Date .......~..~...gz;.)..~ ....... ..'~z...-~.. .......... , ]9.....~..~.. INSTRUCTIONS a. This application must be completely filled in by typewriter o~' in ink and submitted in triplicate to the Building Inspector, with 3 sate 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 ofproperty must be drawn on the diagram which is part of this application. 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 necess~nspe~/t~ons. ~)t~,~ ........ i~;';;; ';F ';~'~F~. ~'; ~' ';' "~';';~';';;;;i;;;'i ........ ......... ....... .... (Address of applicant) // State whether applicant is owner, lessee, ~(~'en~architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .................... !..~...( ......................... Plumber's License No ................................................. Electrician's License No ............................................. 2 Other Trade's License No ............................................... Location of land on which prop,_osed work will be done. Mop No ............ .~..~....~ .................. Lot No ...... :.~....~.. .......... Street and Number ..... ~.~.~........~k!.~.~.c...~T.~.~. ...... ~ ........ ~.~...?../.~.~..c.~ .............................................. Municipality State existing use ond occuponcy of premmes and intended use and occupancy of proposed construction: o Exisiting use and occupancy . ..~...~.~.~L~I ~)~;/U~.~ ~ b Intended use and occupancy ......................................................................................... ~. ..................... ~J....'~...-~ 'TO co 9~ 3. Nature of work (check whichi applicable): New Building.......~...~.~...~T.., Addition .................. Alteration ................ Repair .................. Removal i .................. Demolition .................... Other Work ................................................... ii ~.../...~... ~ (Description) 4. Estimated Cost .....~..~.. ......... ; ....................................... F ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelllng units ............................ Number of dwelling units on each floor ............................ Jf garage, number .of ' 6. If business, commercial ,or ,mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structqres, if any: Front ...........~...,,~.~.. ......... Rear ........ ~.~....~-. .............. Depth ....~..,0. .......... Height ......... ./.~..r. ....... 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 ................... ,..'zJLg.. ....... Rear ........ ~ ............. Depth ...... ~ ........... Height .................... Number of Storms ..............~. ............................................................................................... 9. Size of lot: Front ................i ......................... /"l'"O" ..... Rear ........................ ./~,.O.. ........... Depth ........ ./...~......~.. ........... 10. Date of Purchase ............ ' ........................................... Name of Former Owner ........................................................ 1 1. Zone or bse district in whichjpremises are situated .............. ..~...~ ......................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation: ......... ~ ......................................... 13. Will lot be regraded . ........~.....O.. ........... Will excess fill be removed from premises: (~-)- Yesn. ( ) No 14. ~ Name of Owner of premise~ ....k..(~...°...~... ........... ...~.~.....¢~L .3~?Address ...,.~..~,.~-~.i.~..~.,~.~, Ph~on~Le .No ....................... Name of Architect ..............,~ ............................................... Address .:~.~;.~;,.,.~;[~.~_.~ ...... .Phone No ....................... Name of Contractor ~..v.~..~.i~.....~..e..'?..F..& ......................... Address ./..Y..~...~......z~....~....~TO/.~. Phone No...~...~...~.,::./.~...o..O, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Gwe street and blpck number or description according to deed, and show street names and indicate whether interior or corner lot. SI'ATE OF NEW~YO~,~_ I e c .................... .~-~....f~,.~.[..L.4=.......~...~.~,L~,~.,, ........................... being duly sworn/deposes and says that he is the applicon! '(Name of individuol"si~hing'controcf) He is the .......................................................................................................................................................................... (Cbntractor, agent, corporate officer, etc.) of said owner or owners, and is db y authorized, to perform or have perforrr~d the said work and to make and file this app ication; that 611 statements contained m this application p~"~rue t/5 t~e'be~r-6f,,his knowledge and belief; and that the work will be performed in the manner set forth in the appli~:atiojh filJd Jhere~v~th. ) Sworn to before me this "I . I / . QulJlilld Ih S~ffolk County No, ~12.4648995 POOL 765-180:2 9 AM TO 4 PM FOR THE !NsPECT!ONS: FoLLOWiNG TWO REQUIRED ,]. FoUNUATION - FOR p~URED coNCRET~LUMgiN~ ~. P. OUG~ _ F~M1NG & 3. INSU~T''ON coNSTRUCTtON 4. FINAL - C.O. BE coMPLETE FOR ALL coNSTRUCTioN sNALL ~ = T OF THE N.Y. THE R,EQUIR=M:N 'S STATE coNSTRUCTION & ENERGY -- NOT RPsPONSiBLE ~0~ CODES. ~ ~ ,~g~lON