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HomeMy WebLinkAbout10538-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No... 5'1'04'39 ........ Date ..... .~¥pPi.:L. '7 .................. ,1930 · THIS CERTIFIES that the building ................................................ Location of Property 165 ~,'.!J.l~on }load., Cutchogg. c~ :L¥, . ...... House No. Street Nam/et County Tax Map No. 1000 Section 103 .Block 09 ...Lot 007 Subdivision .............................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ,T.~??.:q.~.y.../4 ....... 19 5©. pursuant to which Building Permit No .... .1.0.~.~ .8. ? .......... dated ...... ~..~ .rl~.~?.y...7 ............ t9.30, was issued, and conforms to al/of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ............ 9 .n.c..:?:~.:~:~: .:.~.,?!~. _.t.ng. ............................................. The certificate is ~ssued to . P~ul arid Joan Sohu] tz ................. io¥.'o;,'d,~':~&'~ ................... of the aforesaid building. Suffolk County Department of Health Approval . .1.0..T..S.O.-..0~..A.u.p~:..1,2.!..1.9.8.0...R.o.B. ~.r.t..A.: Villa UNDERWRITERS CERTIFICATE NO .... .~.../47.17.~.¢ .................................. Building Inspector Rev 4/79 F01%~ NO. 2 TOWN OF SOUTHOLD ~UILDING DEPART,hAEhiT TOWhi CLERK'S OFFICE SOUTHOLD, hi. Y. BUILDIhiG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 10538 Z Date ....~ ................... 19 .... premises Iocoted o~ ~.~..r..× ........... ***-~-..***...-c. .......................... >, ..................... 7* ....... [' ............... Building Inspector. :-~. / ~.. ,/? / / 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 fi{led in Wpewriter OR ink, and submitted in dup{icate 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 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 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. For existing 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, 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 required to prepare a certifmate. 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 ....C~ ( .~...~_. ............... New Building ............. O}d or Pre-existing Building ............ Vacant Land ............. Location of Property . .I..~-~... ~1_~.~.~3..~(..~1,~ ......... .~...~.. ?~..[~.O.~..~...~..' .~.'. · House No. Street Hamlet Owner or Owners of Property . . , .~..~.~, .~.,~4~.~,..~,~,~. ~.~3.~,.~'..~. ................. County Tax Map No. 1000Section .. 103 Block OCj Lot 007 . Subdivision ................................ Filed Map No ........... Lot No .............. Permit No.[10.~?~.~. ~ Date of Permit ['l' .~.l · .~.~. .Applicant ~J~. ~t.~j~,t,.~, .~..O.['~'~'.. ~=~' Health Dept. Approval q 0-~2 ,Labor Dept. Approval Underwriters Approval .[~. ~.I.7.~ .......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ~ Fee Submitted $ ...... ~.: .0.0. .................. Construction on above described building and Rev. 10-10-78 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 featu res. 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 installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approva~ of completed site p~an requirements where applicable. For existing 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, 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 required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancv on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 New Building .... '~ ~ ..... Old or Pre-existing Building ... $5,00 Date. 3./.4~..-~.....~. / ...... -~-~ Vacant Land -~ Location of Property .I.(,? ~...~,d. I.A. ~, c.~ .I,¢., .~. ~. ...... .C:..L.~.'~, ¢.171.Q ~; ,bt.~ ..... /:-..' ?...e, ./,,. /',/.~ House No, Street Hamlet Owner or Owners of Property ............ C~.'~..'. '. ......., ................................. County Tax Map No. 1000 Section .. L~'..~ ....... Block ..... ,~. ........ Lot .... ..~. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./..¢~. ~. ~--. Date of Permit/./.~,/~..Applicant .... ~..?~..~ .... Health Dept. Approval ,/J~..~.~.~., ."~. ,~.. ~,. ,Labor Dept. Approval ........................ Underwriters Appro~val, .~..¢/,, ¢~Z~.>~,~ ....... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .... ,, .¢¢~... ............. Fee Submitted $...O-~ .~.~. .................... Rev. 10-10-78 THE q~len.fied by,tl FIELD FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY cop FINAL iONAL COMMENTS: I hereby certify that I have prepared the plans and specifications for the above referenced project and, together with the following informatlon~ they are, to the..be~_, ; of Yolk State EN~-~ ~ acceptable ~*fl~','~ '~ DISTRIBUTION ~ ~,~ater USE~ /Heating Only my knowledge and belief, in compliance with the New ffATION CONST~J3CTION CODE inted January 1, 1979 by the ~ (~00) P~ta~; ~. __ P~ - Oil Electric Steam Cooling 0nly ~tg. & Cooling,, Split ~ys. A. The contractor shall furnish and install construction materials such that the following '~" values are not exceeded: 1. Roofs ~. Floor over U~heated Easement 3. Exterior Ii'ails 4. Glazing 8. Entrance 6. Perimeter Slab ~ 7. Floor over Crawl Space / B. Heating- Design INDOOR tAr Temperature shall he Cooling- Design 1NDOOR Air Temperature shall be C. Heating- Design OUTDOOR Air Temperature shall be .,Z~/~ Cooling- Design OUTDOOR Air Temperature shall be _/j~ D. Design he~t loss/heat gain through each exterio,r facade in BTU/HR. - $~E ATTACHED SHEET E. "R" Values of Insulating Faterials- As indicated on the Drawings. F. NU}q]ER OF ZONES: THEI0'0STAT R~:GE ~ff'~ ~y'~ DO~,~STIC HOT ~¢A'~q ~A'~R: Type: .~ CLAES I with automatic controls- Rangel to 140 F install ~th shut off switch ~. Electrical lightin~ and pow r des'gu data are in accordance with Section E405.~ of the CO~. I. DEG~ DAYS :~ 'sheet No. 1 The conbractor shall furnish to bhe o~er wrlt~en main~enence instructions for all equipment which requires prevent~tlve maintenance for efficient operation. The contractor shall furnish and install adequa%e ventilation in accordance with No¥. Sta~e Building Construction Code and NoYo ~tate Buxlding Construction Code Manual~ latest edib~onso AIR LCANAOE~ E×terior joints around window and door frames; openings between valls and roof/ceilings and between wall panels; openings at penetrations of utility services through walls~ floors,-& roofs~ and all other such openings shall be caulked~ gaske~ed~ weather- stripped or other~se sealed. The contractor shall furnish and install mmnufactured doors and windows which have infiltration loss rates ( at 25mph wind velocity ) equal to or less than those listed below~ IIIND01~S, 0.5 cfm per lin. ft. of operable sash crack S1~INGING DOORS~ 1.0 cfm per sq. £t. of door area SLIDING GLASS DOORSI 0.5 cfm per sq. ft. of door area FIREPLACE D~,~PER: 20 cfm Furnish and install tight fitting, non combustible fireplace doors. and install ~ dampered duct in fireplace sides Furnish or in hearth ducted from the/outdoors. Insulate supply ductwork in unheated basement or crawl space with insulation with vapor barrier with R= 8.0 or greater. Insulate piping in all unheated spaces and slabs with 3/4" thick suitable insulation for all pipes 1" and less in diameter° sheet No. 2 of _.~ LOCATION FROM ALPHABETICAL LISTING OF TAX ROLL BOOK-- PAGE SCHOOL DISTRICT NAME OF OWNER(S) OF PROPERTY ~_~ ~ ~f~, z~.2 AS ON TAX ROLL OR LATEST DEED f/~.:~..~,,~. ~- ~ . MAILING ADDRESS ~ ~ _.. .,~ , ~ ~:/~ __ LOCATION OF PROJECT-PROPERTY TOWN TAX MAP DIST. # SHEET # COUNTY TAX ~...I000 /K3: 0 ~ Dist. , Section Block Lot SUB DIVISION NAME MINOR FILED MAP # FLOOD ZONE~( APPROVALS OF: LOT ZONED DISTRICT MSL) COUNTY HEALTH DEPT. UNDERWRITERS_ PLANNING BOARD ZONING BOARD OF APPEALS WETLAND-TOWN BOARD D.E. C. ASSESSOR CARD PROPERTY FILE CARD, Use other side for Property Description and other information. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Application No ................................. Disapproved a/c ........~_.~................._.__~ ................................... :'. ........................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .............. '{ ')'4 ......................... ' ' 9'~"J~' ' INSTRUCTIONS a. This application must be completely filled in by typewriter o~ 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 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 apphcant. 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 cede, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary inspections. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..................................................... .............................................................. Name of owner of premises .................................... ~ .................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's Ucense Plumber's License No ..........-..~.....~..:..~...?.. .................. Electrician's License No ........... ~..~.~ ......... ~~'~ Other Trade's License No ............................................... 1. Location of land on whiqh proposed work will be done. Map No.' ........................................Lo~o .............. ~ ......... Street and Number .~...~..~.~.,~...~ ..................... ....... ~ .......... Municipali~--~ 2. State existing use and occupancy of premises and intende~ u~and occupancy of proposed construction: a Ex,s,tmg use and occupancy ..................................... ~~Z.....~ ~.~ .............................................. b. Intended use and occupancy ............ k......~..i.~...~.~.~L.~ ................................. / 3. Nature of work (check which [applicable): New Building~ · ................. ddition .................. Alteration ................ Repair .................. Removal: .................. Demolition .................... Other Work ................................................... ~ i ~ (Description) 4. Estimated Cost ....~..0,.'~.~..(~....0.(7) ...................... Fee ........ ~.....~..=..~..~'.....;.; ........ .. ........... ; ........... f .................. F~k~, ~,~ ~ ~_,~ (to be paid on riling this app,ica~i%n~..~ ?~ ~. ~f~t ~J~of ~~ ..... ~'.~.ff.~.~, of dwe,, ~ ~, ~ o, ~ch f~oo, ..~...Z.'Z.~ If garage, number of cars ..... ~......~ ................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions.~ ~s, ~ront ..,,~ ....... ~...~ ........ ~ ..... Height .......... ~ ....... ~u~er of- Sto~es ..... r~...~ ....... ~ ............... ;..~ ................... ~ ............................... Depth ..~..~ ................ Meioht ............................ Mumb~r of S~ories'. .................... ~ .......... ~ ~ tt 8 Dimensions o{ entire new cohstruct,on: [toni ......... ~..I .................... Reor ......... ~..[ ............ Dopth ....~....~... ~ , [ '/ , Height ...~.~ ........ Number~ of Stories .................... /.~ ........................................................................................... ¢. S,ze of ~o,: ~,o,, ................. ~ .................................. ~e,, ...... ~....~ ................ gep, h ..... ~ ....................... 10. Date of Purchase ..~.....~l.~.~..~ .........................Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction vi'olafe any zoning law, ordinance or regulation: ........ ~.~. ....................................... 13. Will lot be regraded ~...~ ....... Will excess fill be removed from premises: ( ) Yes ( ~o 14. Name of Owner of premises~~..~.~.'Addre~ ................................ Phone No.~..~.~.~ Address ...~ ........ ~ N ......... ~ - ~ c bs . ~....~..,~ho,, o.~E~. Name of Architect ..~ ......... ,......~.J....[~ .................. PLOT DIAGRAM Locate clearly and distinctly al.I buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lol STATE OF NEW~ YORK, ................................ ~.lj~.~.J...~...[...l~...~ ............. being duly sworn, deposes and says that he is the applicant (Name of indi~idua 'sinning contrac0 above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dQly authorized to perform or have performed the said work and to make and file this app cat on; that ail statements contained in this applfcetion ore true to the best of his knowledge and belief; and that the work will be porto?meal Jn the manner set forth in the app ication fi ed therew th. Sworn to before me this ' Notary Publ~~u-u,~- ,.' (Signature at applicant) ...................... wILSON nov/ or formerly B. Ber(]en 115 RoAD nov/ or formerly pool R. Render nov/ or formerly J 8 E smith nov/ or formerly G. 5chloer Serviaa~ HEALTH DEPARTMENT- DATA FOR APPROVAL TO CONSTRUCT ~NEAREST WATER MAIN__Mt -+ ~4'SOURSEOFWATER PRIVATE~PUBLIC ~('SUFF CO TAXMAP DIST/oO0 SECTION Jo.~ BLOCK q LOT ~THENE ARE NO DWELLINGS WITHIN I00 FEEF OF THI~ PROPERTY OTHER THAN THOSE SHOWN HEREON ~X* THE WATER SUPPLY AND SEWADE DISPOSAL SYSTEM FOR TRIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERV}CES -~ . APPLICANT ADDRESS NOF~ · = MONUMeNt' [] -' $1'AKE' -'- -.' SURVEY .FOR PAUl $C/-/ULTZ ~ JOAN $C/'/U£TZ AT CUTCHOGUE TOWN OF SOUTHOID SUFrO~K COUNTY. NEW YORK '/ MAY 28, 1980 DATE O~c. 1.9, 1979 SCALE / "= 50 ' NO 79- YOUNG a YOUNG AND LAND SURVEYOR NYS LICENSE NO 12845 HOWAI~D W YOUNG, LAND SURVEYOR NYS L~IC/NSE NO 45893 400 OSTRANDER AVENUE RIVERHEAD,NEW YORK WILSON nov/ or formerly B. Bergen nov/ br formedY J' 8 E. sm i th F oAD , ,~., I1§,00~ ~ or former now or formerly 6. schloer HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT ~NEAREST WATERMAIN MI + ~SOURSE(?FWATER PRIVATE~PUBLIC_- ~SUFF CO TAX MAP DIS~OO SECTION Io~3 BLOCK ~,,.LOT ~ ~ · N-THERE ARE NO DWELLIN(}$ WITHIN I00 ~EET OF THIS PROPERTY OTHER THAN THOEE SHOWN HEREON ~THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FORTHtS RESIDENCE WILL CONFORM TO THE STANDARDS OFTH~ SUFFOLK COURTYDEPARTMENT OF HEALTH SERVICES ~ APPLICANT PROM F,E.L~ OBSE~ VAT~p,~ a,o OR OATa~OBTA~NED~ FROM OTHERS SURVEY ~OR PAUl SCHULTZ ~t JOAiV SCHULTZ AT CUTClYOGUE TOWN OF SOUTHOID J SUFFOLK COUNTY, NEW YORK ALDEN~ W YOt~NG~PROFESS~ONAL ENGINEER ~ND L~ND SURVEYOR NYS LICENSE NO 12845 HOWARD W YOUNG, LAND SURVEYOR SCALE I '-- 50' ~o 7'9- ?'$9 400 OSTRAN£ RIVERHEAD, NEW YOE L20u ROAD wiLSON nov~ or formerly B. Ber~'Ten = 2 I, 850 sq. ft.. lireo ' now or formerly poul R. Render no,/ or formerly J' 8 E. Smith now or formerly G. schloer 170 H~LTH DE'PARTMENT- DATA FOR'APPROVAL TO CONSTRUCT OTHER THAN.TMOgE ~WN M~O~ ~ /~/ J/ ~ OF H~ALTH SURVEY FOR PAUL SCHULTZ ~ dOAN SCHULTZ AT CUT~CHOGU£ TOWN 0 ~F SOUTHOLD t SUFFOLK: COUNTY,, NEW YORK ~UNAUT~OR[ZED ALTERAtiON OR ADDITION TO THIS SURVEY (S A ;VIOLATION OP SECTION 7209 OF THE DATE SCALE NO ~9- 739 NEW YO~X STATE EDUCATION LAW ~COPIES OF~THIS SURVEY'NOT BEARING THE LAND SURVEYQR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE ~ON~51DERED TO BE~A VALID TRUE COPY ~GUAF~ANTE~S INOICATES ~EREON SHALL RUN ONLY TO TO ADblYtON~L INSTITUTIONS OR SUBSEQUENT PURPOS.~'' A~D ARE NOT T~ 8E USED TO ESTABLISH PROP~R~Y L~NE$ OR FOR ~HE ERECTION OF FENCES 1 Y UNG s YOUNG -ALDE~ W YOiONG, PROFESSIONAL ENGINEER MOWA~RD W YQUNG, LAND SURVEYOR NYS LICENSE NO 45893 400 OSTRANDER AVENUE RIVERHEAD,NEW YORK OV/NERSHIP OF DOCUMENTS 'THESE DRAWINGS AND SPECIFICATIONS ARE INSTRUMENTS OP SERVICE FO~ PROJ2CT NO. 7~/? AND SHALL Rr-MAIN THE PROPERTy OF TD:E ARCHITECT WHETHER THE PROJECT FOR WHICH THEY AgE h'AD_'- IS EXECUTED OR NOT. THEY / .... T_ ~E US[D IN ANY OTH;:R PROJECT EXCEPT BY 'WRITTEN AUTHORiZATiON OF THE ARCHITgCT~' B U i LDi~,,~G 'D~PAR/J~ ~NT BE C'~MPLETE FOR C O. ALL CON~TRL]CTION SHALL MEET THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR i,4¢..,¢ M~, ,'PAl) L ~¢v,,, HImHA~ ,~,, Ac-e, HFc~,S.T J~? '/e Iff I ! I¢ .I It :I --% L.I~W I I I I