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HomeMy WebLinkAbout10724-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. 7.,.1 .1.2.8.2. .......... Date .... 9.~.Eo.V..er..2.~ ................. 19 .8.2. THIS CERTIFIES that the building .............................................. Location of Property .6.5.Q ..... '7.~ ~.~ p.q~.~ .a. ?,.o.e., .d..(.P.v. ~:..~d. :..1.5.~ ! .... ~ .o!~.t.h.o...l.d ........ House No. Street Hamlet County Tax Map No. 1000 Section ...Off.?. ...... Block ...0.6. .......... Lot .. ~.1.0. ........... Subdivision ..... X. ....................... Filed Map No...X ...... Lot No..X. ........... conforms substantially to the Apphcation for Building Permit heretofore filed in this office dated · .4u..n.e..1.0. ........... 198-9. pursuant to which Building Permit No...!.0..7.2.4..Z. ........... dated ..... 4 p.n.e..1 .,3 ............... 19~9., 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 . .a. ...... one-family dwel]ing wit, r~ s non-habitable second floor. The certificate is issued to .... ~q .b?r.t.. ,? :..&...C.~..r'.q ~..g:..C., ~...e.~.e.n..~ ? ..................... (owner, ¢ee~e-~ of the aforesmd building. Suffolk County Department of Health Approval 1. .0.-~.q-..3.1.,..5. ./.2.5/.5.2.,..~o..b.e....~.... y.~. ~. 3...a.,.. UNDERWRITERS CERTIFICATE NO ........ i.t. 5.6.7.0.99 ................................. Building Inspector Rev. 1/81 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? 10724 Z Date Permission is hereby granted to: ...~.E~.?.Z...&....L ...... ~:~.!.~?~ ..A....(.~. ~ ~ ~ ~v at premises located at ................. .~. ................................................................................................. approved by -the pursuant to application dated ............................... ~/./- ................ , ........, V Building Inspector. Fee $ ........................ Building Inspector FOI~M NO. $ TOWN OF $OUTHOLO Building Deportment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector with the follow~ng; 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 end sewerage disposal--(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 installations, a certificate of Code compliance from the Architect or Engineer responsible for the building, 5. Submit Planning Board approval of completed site plan r.equirements 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 oll 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 formation required to prepare o 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 of occupancy $1.00 Se t.lO 1~82 . Date ..~* .......... ~ ...................... New Building**.....,****,..**..,][ Old or Pre-existing Building ............................ Vacant Land ............................ ....... T aposa Rd. Southold, Location Of Property /+ (P . ..~....5...). ................................................................................... Ro, bert A. & Carol A. Clements ...................... Owner Or Owners Of Property ......................................................................................... pc-i_ ~' Sect. Subdivision .................. D~st..lOO.O ........................ Y,~ No...Q~..~.... Block No.....~ ....... hlf~i~ No.~,~ ........ Permit No 1072.~Z Dote Of Permit .6~.1~./.,80 Applicant Robert A. & Carol A.Clements Health Dept. Approval ..~...0:.....~.,C~..~..~....(.~..--..2.~.~.2.-).Labor Dept. Approval ................................................ Underwriters Approval ..~..~.~.7...0.09 ........................... Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ~.'[~.~].. ............................. Fee Submitted $ ..~..,...0..0. .......................... Construction on above described buildir)g~ permit meets all applicable c,o~es and regulations. · Sworn to before me this ........ day of ......../.£ Nora Pub,,c ry .............. ,~'~.., .~, .O..~/~,. ....... County June 19, 1980 COUNTY Of SUFFOLI< DEPARTMENT OF HEALTH SERVICES Mr. Robert Clements 7B Division Street Holtsville, New York 11742 Dear Mr. Clements: Re: Board of Review Hearing Application. to Construct on Property S/O Main Bayview Road, Bayview, Town of Southold At the hearing held on May 23, 1980, you had an opportunity to present your appeal of the department's ruling on the subject application. In accordance with the provisions of Section 220 of Article 2 of the Suffolk County Sanitary Code, the determination of the Board of Review is as follows: Based on the information submitted, that the application be approved pro- vided: (1) a Reverse Osmosis unit is installed according to specifications submitted to the General Engineering Unit; (2) the sewage disposal system is located in the northeast corner with the well towards the northwest corner at maximum distance from new and existing sewage disposal systems (approximately 90 feet). Sinc~ the determination of the Board of Review submitted to the Com- missioner's office on June 18, 1980 has not been reversed or modified by him, it is therefore deemed to be the determination of the Commissioner. Very ~ruly yours, H. W. Davids, P.E. Chief Engineer Bureau of Environmental Health HWD/lst cc Robert A. Villa, P.E. lliam Wickham, Esq. wn of Southold Building Department UNDER THE ENVIRONMENTAL CONSERVAIION LA~, E AR1~CLE 1S, (p~o'l~ctlcm of ~ate~) [] A~T~CLE 2S, (T~dM PERMIT ISSUED TO Robert A. Claimants For: Frank J. ~ietta 7-B Division Street, Holtsville, New York 11742 Little Peconic Bay Construct a one family dwelling on lot no. 10, Map of Ba~iew, Setback of home is to Be 50'. Variance is requested for the cesspool. Project site is located on Little Peconic Bay, Southoid. C--~-MM~I [Y NAME (City, Town, Vdlage) )TOWN Southold i Southold COUNTYsuffolk IFIA COMMUNJTYNO. JDAM NO. JPE~ITEXPIRATION12/31/80 DATE GENERAL 1. The permittee shall file ~n the office of the appropriate Regional hours m advance of lhe time of commencemenl and shall also notify promptly in writing of the complehon of the work. CONDITIONS 8. That the State of New York shall in no case be hable for any dam~g~ or mlury to the structure or work herein authorized which may be caused b,~ or 9. That if the display of hghts and signals on any work hereby authorized is not otherwise provided for by law, such lights and signals as may be scribed by the United States Coasl Guard shall be installed and mamlamed by and at the expense of the owner. 10. All work carrmd out under this permit shall be performed in 11. If granted under Articles 24 or 25, the Department reserves lhe right to reconsider th~s approval at any hme and after due notice and hearmg to be lust and ~qmtable. If upon the expiration or revocahon of th~s permit, modff~caUon of the wetland hereby authorized has not been compleIed, applicant shall, without expense lo the State, and to such extent and in s:.ch 95-20-4 (9/75) (SEE REVERSE SIDE) 16. Applicant shall be liable ~or any damage to adjacent x*ater~ay resulting from any phase of the permitted construction. PEtLMIT ISSUE DATE Da~i~ J. LatVia, ~.?~Z~:~,.~, ..~,~V~J~£aS. 40, S~, Sro~y ~ook, m' 8/24/79 cc: U.S. Army Corps of Engineers IqYSDEC Law Enforcement - Region I £ Robert Clements 7-B Division St. Holtsville,N.Y.t1742 December 16,1981 Mr. George ~isher Tomn of Southold Building Department Main Southold,N.Y.11971 Dear Mt. Fisher, As per our phone conversation I am requesting a six month extension on my bu±tding permit. The permit nu'mber is 10724Z, located at 640 (pvt. rd. 15A) Takaposa Rd. Southold. Due to the present credit crunch I have found it taking longer to complete my home than I anticipated. I appreciate your assistance in ~his matter. ~ ~nk you, Robert Clements THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR!C~ITY'~ 85 JOHN STREET, NEW YORK, NEVi/ ~RK 10038 THIS CERTIFIES THAT only the electrical eou{prrtent os ~scribed below andintroduced by t~ aoollc~t ~}he above application number in the premises of in the/ollowlng location; [~ Basement ~ 1st FI. ~ 2nd FI. Section Block Lot was examined on J1J~ ~ ~ ~82 and found to be in compliar~ce with tke requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS DIMMERS SYSTEMS NO OF FEET S E R C AWG OF NEUTRAL 2t0 P.o. Box a87 GENERAL MANAGE~,' l~ock~t l~t, N.Y. ~778 Per ; not b~ o ler~d m any monn~r; r~lurn *o lhe off ce FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ........ .~..{~.. ,/.¥?19 ,~,.~ ..... Approved ..... I ......... , ly... femur I~o.: .......... Disapproved a/c ....................................... : ...... . (Building Inspector) APPLICATION FOR BUILDING PERMIT Apphcatlon 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 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 this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wilt 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 ne~'~e>ions~ (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 corporate officer) Builder's License No ......................... Plumber s License No ......................... rlclan 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 ....... ~..~7 ........ Block ~ Lot / o / Subdivision.. . /x//.~. ......................... 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 0',4 e,~,/T ~ ~ b. Intended use and occupancy ..... ~..>~.~ .... .'~.~?..~?')(.. /~ ./~r._~)t/¢ 3. Nature ofwork (check which applicable): New Building ~ Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... ' ~{-~ Oq ~ iZ-~' (Description) 4. Estimated Cost o Fee . (to be paid on filing this application) 5. If dwelling, number of dwelling flnits ...... /. ........ 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 structure~, if any: Front ............... Rear .............. Depth ............... Height ............... 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 ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ..... /.~/.o../. .......... Rear ...... /./.°A f. ......... Depth ... ~./.q.~.. ~..~..,%'. ....... 10. Date of Purchase ........ /..g.;?..~. .............. Name of Forn~, er Owner ....~..'~.~..~..:~.,~. ............... 11. Zone or use district in which premises are situated .... .~.~. ~.~.b.g~..~.~ ~ .................................. 12. Does p~oposed construction violate any zoning law, ordinance or regulation: .... ,a:,. ¢ ......................... 13. Will lot be regraded ....... -~' i ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises .~..~..~L'~'....c:.t.~..~.. ~.r.. Address .~'.~.~.....~..~..r- ...... Phone No. ?~. ~.: ?. ?. ~..c?.... Name of Architect ...S~-..~/~.~..~. ............... Address ,~.~?.f... ~ .,z.,~. ~ .... Phone No..7.~.~.-,~.~. ~ .~... Name of Contractor ......... i ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ibuildings, whether existing or proposed, anti. indicate all set-back dimensions from property lines. Give street and block fiumber or description according to deed, and show street names and indicate whether interior or corner lot. STATL OF S.S cot . .OF. --.'/~-..l~,~ .................. being duly sworn, deposes and says that he is the applicant (Name of individual sign!rig contract) above named. He is the ........... .~..c,( .a-.~:...r'~..i ..... . .............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 to the best of his knowledge and belief; and that the work will be performed in the mann¢ set forth in the application filed therewith. Sworn to before me this ............ .day ot...I 'h"' Nora u .b{ic ............ ~.. ~ I [LIZARd ?~.N~ ~[tt~ ~"~¥1~ ' ' ' (Signature of applicant) ~ NOTARY PUBL ¢,State of New York No, 52,8125850, Suffolk C*u~.,.,_._ lerm ExlarestMarch 30, 19.~..