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HomeMy WebLinkAbout10687-z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...... .Z10S.1.9... Date.... .J\1.n.e. .~.,..................., 19.. .81 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property ..... .21.5. .!?vt... .Rd.,. .Ikt 0.,. .Sou.t.hold.,. .New. .YQrk... . ..... ... .. House No. Street Hamlet County Tax Map No. 1000 Section ... .087' . . . .Block ... 0.01 . . . . . . . .Lat . . . {>.OJ , ~. .& .003.. 2 Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map Na. . . . . . . . .Lot No. ............. conforms substantially ta the Application for Building Permit heretofore filed in this office dated . . . . . . . -May. .1.5 . . . . . . , 19S0. pursuant to which Building Permit No. .. .1068.7. . Z. . . . . . . . . . dated .. .May. 2.1 . . . . . . . . . . . . . . . . . . 19.80, 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 . . . . . . . . . . . . . . , . . . . . . . 'Deck- 'acidi.t1on. .to. Dw.el1i1.ng. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to .., '~evin' 'Boet"p,ess<>.n . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ fawner, Jessee or tenant) "'---------- of the aforesaid building. Suffolk County Department of Health Approval .....N .tR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . !<I/.~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . ...C.~:..o/..?f~?;~.... Building Inspector Rev, 1/81 ! _ ,;, ..1- ~'" .. h " . ii. ' FORM NO. 2 TOWN OF SOUTH OLD 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<1 10687 Z Date ........y;:9y..........dl........ ,.., 19f6. Permission IS hereby granted to: ......... t:T;f'U.I.I.Y...... t:!bl.';.(<?r.f) ~Q N... . .:tI....;?7:2.....&.Z..l?.::..tI./O....,.. /SCl.K ,1'5':> ,.......sg.~T..HQ.?.f2..=&..':1..'" . to ..{!Q.I!.I..QI.(~CT........J.kz;/~"".M/.?/2,i.:ri.Q.i:U......lQ~..EY.I.5.Tl.N1"""'" . .......D.r..ki!;...lll..tU.Ej............,........:............ ,.', ....................... ,........... ...".... ....,.....................,.,. at premises located at ......::?..7:i::..,....PY.T.....I2b.....-:#.../.'O'.I......:iO"(,/.T/:/Qi...o....::fV:.(.. .............,.................................................................................................................................................. ,............................................................................. ...................................................... .......... ............. pursuant to application dated ....,...UA.~...,.I5'.... ..,..........., l~Q., and opproved by the Building Inspector. Fee $.I.:i...=..... ;! ; ~J.........~.~....... uilding Inspector " k FORM NO.6 TOWN OF SOUTHOlD Building Department Town Hall Southald, 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 tapographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 farm or equal). 3. Approval af electrical installation from Board of Fire Underwriters. 4. Commercial buildings, 'ndustrial buildings, Multiple Residences and similar buildings and installa- tians, a certificate of Cade compliance from the Architect ar Engineer responsible for the building. 5. Submit Planning Board appraval of completed site plan requirements where applicable. B. For existing buildings (priar to April 1957), Non-canforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty shawing all praperty lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement af owner or previous awner as ta use, occupancy and condition af bu ildings. 3. Date of any housing code or safety inspection af buildings ar 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 af occupancy $1.00 0/~,dll/ Date.. .. ., .................... New Building ... . . . . . . . . . . Old or Pre.existing Building .. oX. . . . . . .. Vacant land ............. Location of Property~ ~.1~. .f!f!;~V.1::6.. f!..~: . ~ ! p. . ~(r. ..~!>!-';:!1.. H"MJPf!:- ..~.'?:, A~ !-<;:!~,,!L () House No. Street Hamlet Owner or Owners of Property . J<.6. YI i'.). .f .l!./~f!:E;tJ. . .~~.~~~.~ ~.~>."!. . . . . . . .. . . . . . .. . . . . . County Tax Map No. 1000 Section.. .Q1.1........ Block... ~~. ~....... Lot.!'. f?+.'!I:~.'!J,~. Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Filed Map No. ......... .Lot Na. ............. Permit No. .'.(j.~~.1. .~. DateafPermit ,rd-?-.I/"I.q.APPlicant. K.f,V/I)1... f!l1?~.I!-;~f.:>' i>.qN...... Health Dept. Approval . . . . . . . . . . . . . . . . . . . . . . . . Labor Dept. Approval ..........,............. \ (, Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval. .. . . .. . .. . . . . . . . . . . . . rIa Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . . Final Certificate . . . . . . <<. . , . . . . . . . . . . ',' \~ ? \ \ \ 'if 'If I Fee Submitted $ .$...9.<:...................... ~\:; : I \J IT) Constructian on above described building and permit meets all applicable codes and regulations. j ~ \ !*/~\ Applicant.... ~.~.. ..................... .~: Rev. 10-10-78 , I ; ,d" '- 1 J , h,,~, .1, i~_ FIELD~NSF~CTION DATE CO~~ENTS. ~ _ _ J_____. ',.. . 'lJ 1. -- ~ () HJ~ ,,'''____'_ .._____,___~._._~_ ___..._____________ 1-3 C)!) FOUNDATION (1 s t) ~ N _. _ ._ ..._ 0 - -.- ~;1.ii tA/... - j - 7': _.. _...3-' ./h -A . N V ' , I~~ FOUNDATION (2nd) 0, j"( ._ ~~ t __ - . 1\" 2. - . ROUGH FRAME & ~ ~ PLUMBING ~ ~ 3. - ~ ~ _ ill INSULATION PER N.Y. - ~ ~ ~ STATE ENERGY co:r;m u:.r:~ 4 -'7.-- .. , If ~ ~ . ~~ - 5'7/1 'q / ~ e1J ,,~ . - ~ () FINAL I -.. L. _-r: / L;/' - r ~ ../_ ... ~'/ ./ ~ .' /, _ h'.L_ .../ "'.... ~ Vi /ej/ .0:), ',t7(!!?~/,../- / (~/// ~~ .. , ADDITIONAL COMMENTS: ,,:9" / ,,"= ~ ~ i1 ,..___, _.. ,___,___ .. '"I ~ ~ , !i5I:,.. S.~ - 'i " 11>........ IT ~.~ " i:! f- ':.r: . ill " , ~ \ t:J ill ~ . 1 ~ ' ' ~ <; J1,' 4, ~ ,,' I :j i --x:.::.r. J t. ~ A.J G '5 i?lfGC/ I ('l tF Q I -;:::.' j " ! 18" A/'!lOVc ~Ye,q()E ~ " ,I i ~ I I. i J \;:;-0". ' I""~"' ....'".w,'".~,~".".._._w~_.. ,- , . t,-w--;~a :-~-"-'-r-"'-- J. Il,olit'r J 14 I j I. -f\ " i 'I I ! r ) ! J ,,\ " j EILI::JTI tJG,\ l-t .:Zi'- F ,r l~g,:~_-7'~\ 7.'(..'; i J i ,"'I I I' ~E/II/..)G", !~, ~ i 19~O I .1 $I \ " ,j , .... ,~_w' .__,_ , ' ",,1M I . +- . I " ,I\} . I I ' ! ' IX : ! ,'() I It\! ! ~ : ( .... . . ! , ! -. ' :~. ~ ( #l 1 ! · J.'~)lt 7- 6 I , , '1::' : , , I '^!( 1 , , . , I!" ! , i: I;:"" t ,.'" I I ' I h, ! ,;j, ! ) ! ' I" t ~ , I , ': i~ r 'i.", ! I I , " ".. ' ''1:\ ' I I , i'iJ ! ,i !')!o..--,!~_.. ; I f i: I "t'J~\ i " j I I I 1=""" '" ",.j t I I ,i t" ;:.-...... , " , I I ! _,.,' ..__~,~_ ............. "" n.""'~..'".''' '-"""~--~"""""'" i ,..- ""-'"~---' --,,,,, ", I It ' 1/ ' ~ 4)( (!)' G' Ire 121f{.~ ?LAU - Of'''120 DECK. r~t)i,){7"'o.) , i . , . J, \0 1'0' II i 5C/Jd;v- . Ie... .-;r , i I ., , it ' ," ," , ,""J,",1. j I. i ( ~, , ",..> ... ....,_ "- do, < , . Ji::c "-'.<1. Hal,_ ,., "'''''"' ,&1iC_~ 'jV .. , "" -- FORM NO.1 ift/L- I ~) TOWN OF SOUTHO'-D BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined J.#:;.<(. . r;{.( . . ,,19ft:? Application No./d%.,7. . . . . . . Approved II -<!.<f r/.. (,. . ,,19m. Pennit No. 19 {f.1 Z Disapproved a/c. . . . .' . :-. . . . . .................... . .- . . . . . . . . . . . . . t:UUA.- . . ... .. ...... ..... ..,.. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date. . ..M4~. ./ ~)' . .. .,19!f.Q INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in tnplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. i b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets i 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 Pennit. d. Upon approval of this application, the Building Inspector will issue a Building Pennit to the applicant. Such pennit 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 Pennit pursuant to the Building Zone Ordmanee of the Town of South<;>ld, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alteratians, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordmances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in buildmgs for necessary inspections. . . '~~~;~~;r~ .~t:;~~~n~~e', ii ~ ~~~~~;ati;~)' . . . a.o.k.-. .~~.$,. ~~~:':"N ~.~.t?,.. N..Y:..t. !'!.'?.1. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or builder. . ..... . . . , . ' . ~ t<? ('J .i{.~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . Nameofownerofpremises ,.I<.~.YJ.~... t. ./:C.('r:'!:f!.!'?.. ~~~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. ,........ '~-:-- . . . .4~ ~ - _.~---- Plumber's License No. ...............,..',.... .- Electrician's License No. .",'.........,....... - Other Trade's License No. ,.........,...,...... 1. Location ofland on which proposed work will be done. . .~;$1.~.. 'f:~.l.Vf\.-r.~ . ./!...i?:. .tr:/C!/. . .. . . .. . .. . . . . . . . . . . . p f: F: ' . , .C! F. . . . . . . . :-$:<! 'h 1"11 . .I-!.ft.I!,.(/J.t?f4 . . .~. "i' . .~o.~ 'T./:i.q h 1::>. . . . , . . . , . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . .q~7, . . . . . . .. Block .. QQ. f. . . . . .... Lot .OQ$...I. i-r::IQI;,..2.- Subdivision. . , . . . . , . . . . . . . . . . , , . , . , . . . . . . . . . . . . . Filed Map No. .............. Lot.,............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy . . . . f? c. ::;. /,I:).if: .I<,I.(...C:. . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy ... .~.I!' .0.<;, . . -uf. .~(4:.... AO./ll. G.J?!. . . . . . . . . . . . . . . . . . . . . . . , r i i . Ii -, ',-1.- .J. ) 3. Nature of work (check whicb aP1?licable): New BuHding ......... . Addition. . . . . . . . " Alteratian ........ .,. Repair .............. Removal.. .. . . .. . .. ... Demolition .............. Other Work .. ~~x K :'. I$.)!: I'? 4. Estimated Cost. . . . .-If ~ P.Q. '. . . . . . . . . . . . . . . . . . . . . . . . . Fetft. ~~. . . . . . . . . . . . . . . . .(~~~~~~~i~~~ . . (ta be paid on filing this application) 5. If dwelling, number of dwelling units. . . . . . . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . If garaie, number of cars ..... i. . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If busitjess, eommercial or mixed occupancy, specify nature (!Ild extent of each t~'1 of use . . . . . . . . . . . . . . . . . . . . . 7. Dimensions of existing structures, if any: Front. . . .-.:I.I! ~ . . . . . . . Rear ... ~. ....... Depth. .<i2.J$ ~ . . . . . . . . . , If' Height ..:J............ Number of Stories. . . . ,:/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , Dimensions of same structure with alterations or additions: Front .~..., NI.e: . . .L.U. (;14~ (~.){. ,,,: . ~.~<:*: !~. ~ Depth. . . . . . . . . . . . . . . . , . . . ,. . Height. . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new constrpction: Front. . . . . . . . . . . . . .. Rear . . . . . . . . . . . . . . . Depth ....... . . . . . . . . Height ............... Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of, lot: Front. .. . . -:7.'7. ~ .1. . .. . .. . .., Rear....... ':1.1. /. .. ........ Depth ... ,.s.l!:... ... ... .... . 10. Date ofPurehase ... A P.I?H-.i, . ./.".1:1."". . . . . . . . . . Name of Former Owner f.!..f,.(3,("e, T. . . (!) Po t;.I?q..tf-!4~.~1)1 11. Zone or use district in whieh prdmises are situated. . /?~. '~'" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Does proposed construction violate any zoning law, ordinance or regulation: ... .N9. .. ... .,. .... ........ .... 13. Will lot be regraded ...... R.f! . . r K . . . . . . . . . . . . Will excess fill be removed from premises: Yes )(No 14. Name of Owner of premises . ~;!~ ,. . ."I~N .~t?~~~~~~,~".~Q!o':"'N~.L.,.b. Phone No. '1.4.f/",5.?S~. Name of Architect .. . . . . . . . .. . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . Name of Contractor . . . . . . . . .). . . . . . . . . . . . . . . . . Address .. . . . . . . . . . . . . . . . . . Phone No. . . . . . . . . . . . . . . . PWT DIAGRAM , Locate plearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block humber or description aecording to deed, and show street names and indieate whether interior or corner lot. I oft: /?'b . ~~ pe.,,>lI' q11 , ,,01' i It fl.11>" N" I , 4b' .r ,3 <X. t')t.I~-(\~&.. ",\,.I.. .:10- bW'" )\'~1 5'EE .PiA,u'5 .. 1"1' ,) .. f/F;-(~W/T;'; " () '" -' .... .... C? .. ~ ~ 0,.1' STATEOFNEWYO~A if( . ss COUNTYOF..':;>;I.!.. ..'C!......i. J ,K*-VoJ .$0 /?Ri9.I::'s sOb' dId d th th . th r t . . . . . . . . . .. ................".................... emg u y sworn, eposes an says a e IS e app Ican (Name of individual sigbing contract) above namyd. ' He is the. . . . . . . . . . . . . . . . . . . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i (Contnrctor, agent, corporate officer, etc.) I of said owner or owners, and is d\jly authorized to perform or have performed the said work and to make and file this applicatioq; that all 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 before me this '-/I... i . .. . .. .., . .. . . . /~. . .. . .day ~f..~. .. . . .. ..,19!!? Notary Public, ~. {;-k~''-.: .Gettnty , " . , \)'~ ' NOTA;~~~~lic ~OWALSK' .....~ .. .. .. . .. .. .. .. .. .. . .. . .. . .. .. I I. atoofN,wYor~ (S' t f r t) , I No. 52-4524771 Igna ure 0 app Ican I I QUtllifh~(j In Suffolk County Commission Expires March 30. l~.pt