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Home My WebLink About10586-z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. . . . . .~H)O.Q9. , . . . Date. , . . . . . , . . J:uly. .1. . . . . . . . . . , , . . .. 19.80 THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . , ' . . , . , , . , . . , , . , , . , . , . . . LocationofProperty .... .20.3S.'J:'p,wn.a:.e.r.\)or. ,L~ne..,............ .Southol.d. .N.Y. House No Street Hamlet County Tax Map No. 1000 Section .. .6.Q. . .. . . .Block ....1........ . .Lot . . . . .)0. . . . . . . . . . Subdivision. , . , . , . ' . , . . . . . . . . . . . . . . . . . . . . .Filed Map No. ..... , .Lot No, .,...,....,.. conforms substantially to the Application for Building Permit heretofore filed in this office dated . . .~!1r.~1?-. ~ J . , . , . . , ., 19~P. pursuant to which Building Permit No, .. .105B.6Z. ,. . .. . .. . . dated " ,l1~:r~j:J, .13. . . . . . . . . . . . . . . . 19~O. , 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 . . . . . . . , . ......,.. ,f;t'~.~/.101i!il. ,Ql).~, ,~u.y. .JNdl1ng .(oolie-X'. and.to.undat.ion)......... The certIficate IS Issued to ..,.,."... ,a.~ ~.8, .411),...1:' . . . . . . . . . . . , . . . . , . . , , . , , . . . . . . . . . . . (awnerl ~~~)k X1IOaucJ of the aforesaid building. Suffolk County Department of Health Approval ....."....... ~IR , . . . . . , . . . . . . . . . . . . . . . . . UNDERWRITERS CERTIFICATE NO. . . . . . . . . . . . . . . . . . . . . ,:tilR . . . . , . . . . . . . . . . . . . . . . . . . ~ :7Y/~ ......,................................ . Building Inspector Rov 4/79 , , . ~ L ....i " .h,",4j~1tL4 ;1-1< _,_<', FORIII 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) f1/lfi f) ~ N~ 10586 Z Date ............................,..........,........,......., 19....,... Permission is hereby granted to: 1.,-1"" L !?ft'f./-rE (, II(''''C _-/' 't)f-'~ v[ hE I..J'T , " ................................................................................ ~ TnI' II !JDl ff;:... ............................................................................. {.' Ie f: t. ^- I ;0-,.. 0; T N ',,/ ................................................................................ to ...... ff.(.'.!.'..!?...... f:\..,... f..!; .~'.!'/. :?~. 7.:.. ~',:,:,.,....". L.: t.~.:!.~.. ~~...,.,~.:':. ~ .-:. ~.~. :.~.,....,.~?.l< '.':.'. ~. (,.~. :.~, ~.. ................................................................................................................................................................ . 20 3 5 T~ I'" N H A 1<: ;3 c ,<:;: L.1>. at premIses located at ............................................ ....."........."..........,.........................,.......".......',.,...,. SI'CI( ~I C' I ,) f'J, I. ................................................................................................................................................................ ................................................................................................................................................................. M^ i( [;'0 pursuant to application dated ............................,..,....,..,..,.......,..,.., 19........, and opproved by the Building Inspector. t:\) /S',. Fee $........................ }.,vrJ ;;." "-~ ~ t)7~""k~ ~' ^/ ~ Vp /~7~J~ ({'(XJ - ? (~ - (-30 ............................................................................... Building Inspector -~, ..#- -'. ~ , . r(Jk>~ ' , -- ~ .. ...--~.. FORM NO.6 . TOWN OF SOUTHOLD Building Department Town Hall South old, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This applicatian must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tar with the following; for new buildings or new use: 1. Final survey of property with accurate location af all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage dispasal-(S-9 form ar equal). 3. Appraval of electrical installatlan from Baard of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect ar Engineer responsible far the building. 5. Submit Planning Baard approval of completed site plan requirements where applicable. B. Far existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty shawing all property lines, streets, buildings and unusual natural or topograph ic featu res. 2. Sworn statement of owner or previous owner as to use. accupancy and condition of buildings. 3. Date of any housing code or safety inspection af bu ildings ar premises, ar other pertinent informa- tian required ta prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling ar land use $5.00 3. Capy of certificate of occupancy $1.00 Date.. .. ....... ... ....... . ... , New Building. . . . . . . . . . . . . Old or Pre-existing Building .....x....... Vacant Land ............. Location of Property. . . ?1,J;3;i. .T.QUjI'J .f:I?l.DP.r. .L.2jIl~. . . . . . . .5.Ql.Jtbold. . N...Y.... . . . . . . . . . . . . . . . . , House No. Street Hamlet Owner or Owners af Property ... .MJ:IO.. ~j..I;.a. .I~cjJ.eJ;'. . . . . .. . . . . . . . . . . .. . . . . . . . .. . . . . . . . . . . . . County Tax Map No. 1000 Sectian ..... (Of,. . . . . . .. Block . . . .J: . . . . . . . . .. Lat... 3D. . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . .Filed Map No. . . . . . . . . . . Lot No. ... ,......... Permit No. ~P?S.6..4.. Date of Permit . ;,/'J..;,I.8.Q .Applicant RI.4rft~8. HPME. .1MP.fJDVEMEN.T. .GO.. mc. Health Dept. Appraval . . . . . . . . . . . . . . . . . . . . . . . . Labar Dept. Approval ........................ Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . .Planning Board Approval ,....... . . . . . . . . . . . . . . Request for Temparary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . . ..X . . . . . . . . . . . . . . . . . Fee Submitted $. . .5..0Q. . . . . . . . . . . .. . . . . . . . . . Canstruction on above described building and permit meets all applicable codes and regulations. Applicant. . t=:rn.e.s.t .F.. . f.1ich.t.e.r.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Richter Home Improvement Co.,Ine. Rev. 10.10-78 (! () 7- (rtJV r . '7/t/?6 ~ #: ,f'/7~ I ;&..~./Ie /7c:2C>? , '.. ,.... ~ '.d1 ,Ii .~L. i ------- -------- .J U I L -r:?~ 1><:..1 ,G:. ? E 1"2. r~'!Ll T ~ ; ,,/-tJ ,_ _ .__ _..__ ' ___ ~_.~~ 'u _ .- -- =O:_~;,>-='==O'~ ......- \m_ ~ I t= I.- D IJ'-.1 S' PEen oJ...., J[)I'>E,;!. CO I'-A,\./\ C 1-..1 T 5 {7J <:) _ . _ . "1 - .-~==_. . 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'.' / ,.... , ,C,.. "''', ",:. <, ,,' .. ' " ,. " .,...{ ,.... >0.. ," ., . J , '" :ft" , .., . ' ~ . ,,' ' 1';'[' ,: :' ~/v '" IV ._ ' q,,,, = d .1 " ~.. . .. -.I v" .,' . p. r' ,~,., ",If I. ... I' rn y , ~~' , ~ " ~ - \ > ,;"... ~.:..' " n " V " ~ v _ <J t:org-. Cb #. ~ I 1,~ " ~ _ 0' ~ ~ ,;.. ~' ~ " ,'-' ~' ..A" t!- \\ ()"I",,./'tI ~m~: F., ,,, 0 0 '\ I" ~" ,~,- " ,-;:T.'i':,4~1~~'3"" ~ ' \ '^ , ' ' , ," <{; ":! , ..J I / . P..,">1 ~ , ' \ ~ ..' ',~,:' I \ t " , \,.~~ ,," \~.. , "JI , , " n:, ' " · ,. -;, ';"" ....:/ " , . . '':'" Q ,. ~ , ,," . ~ ,'. ~~,' ; _ 'Il :.. ..'"II .. ~. , ,,',' '"" " . " ' ". ,.",' rc '" . j" ,oj, ,.p- i . c'::Y "; ?';'. ~ ,..:.;.,,':' t'~~ , ",'"," . " ' ~ .' ... " _ ,... :t ,.' ' , " , " ,.." y" . "," ,~' ' f~)~tt.'f~;/ .;"..,' I~,tz\' ,j ..,,, ,,,,, ~{" "",,'" ' ' ." ~ " ' , 1[('\ :,,:~,!i'''\k: ,: "i ,/ ,>" ; " ~. .. ':S,. ,'" ' > ....' ...",..' . "., ,'. <. .I~ .,,,' ~~ ., " ' .- ~ , , ,"_ ",. ,,' ~' , ," " "" , 0/' , " '.' ' " ' '... ' "..." . ,,' ' p.'" .. ' , '.~' C :s;: ,"':, ,.,.\.' . . '~ O .",... . ., >-' ,," ,,- .- . ,l ' ,,_.. \. r- .\ . ,- ,. I ' , . ,I- _ ',,~, ' " , ! .. I . J. bl,,1-f I . .'.,...."'; , f...-. - /" ,.....- . " .../ ~' . ,- ~-- -J. - .,/ -----' , ~ < h 66 " ~ ,_ ___ . · ' ".;P , ,,' ef;pf'#"'> , . HjJ.~O" '1" . ,,~5~';.""'" - -<~ . o~;;;:.---:' ~ " --- - ' .-" I ..-J.~~" ~----,... /~d"'- I itJ~1 ..--" J 1 ~~/'>/~ (fee ,,-. _ . /.%>""" /~cP . I ....... ../~~~-......c:~""--~~ .... _I ""::::,,, /'/::;;_/ _/ / __.." 0 ,.. _"';:% _ . /.._ ___,/ . ' r, =,/;/;,?'/// ...--~/""",,/ f':7 e:'.. '"" . //// ,./"/r P , / , ,,:. 1: -it:: -. /g.c FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined. . . . . , . 7:1.0. ~ :19. r.v Application No. . /.~ S. ~0. . . . . . . JntA-1 f,? Y'?' . (0 5' fr" -z.-- Approved. .. .........,..,19... Penmt No. . . . . . . . . . . , Disapproved a/c. .. . . . . . .~. , . . , . .. . , . . . ,. ,..,...""...........,.......... ,..~'" ~~ ....,.. ,......~~...04:. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date. , ' , . . . . .~ . . ., liP. INSTRUCTIONS a. This application must be completely f111ed m by typewnter 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 Pennit. d. Upon approval of this applicatIOn, the Building Inspector will issue a Building Penn it to the applicant. Such pennit shall be kept on the premises available for mspection 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 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 necessary inspections. \ , , . . ,8./~.h,I:~.)( .#~)/! ~c. .J-J?I/!, ~~...; , . . . . . (Signature of applicant, or n}lme, if'; corporation) ,.. {~)X~~.'Y""(~, .J:~/.,.,....,.,....." (Mailing a dress f applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (;J eft / \1"" ,--"'" ...... ):".~.1J.... .c~ }1.. .Y:..L~. . ~::'.V............................. f. .r:'~<-}Y~~Y.. :::''', ........ i ' P t AJJ It!. / OAE:.'3(,")/~.i ,":; lo'>n z- Nameofownerofpremlses ...../ . t.. .:1..... .',.. .. Y...,..,...... .,',,:.... ~.. ':( .. ~c"""'" I (as on the tax roll o~ I;!'test;qe~ ' .. ,I, - , . N;i',Y;-~,_,:J~' ',,:"',!I '\1 IfapZ)tisac01ration'Sig~tur1~authorizedofficer. j';,'. :'j.y; ',;.0 (H,' I~i[ If /t I, ~ ,,, 'I" P , , V ~ nld,'\I, .,' ,""", ,u"!..--" ! -d .! , .., \! , , ,- - ....~!..Y.~.. ..r..,'f:....f.-..~..../......( ",(., "I ,I '. """\. J _" , , \- J if ~. (Name and title of corporate officer) i l'IC ':.,. Builder's License No. . .;;'/i. .11-1;. . . . . . . . . :?, I>-:'l;:--,C:- 1 ~}v\'rHn :1. If'. \,tJL,', 1, ; 4. !--!l',!AI_ ,. ! t.'f';):1" Plumber's License No. ....................,... rti: C)'~,\\;-'J ALL COr~r} T <J J " , I Aler!. I' Electrician's License No, 'rHC' !\LQt;1;\u',',1, J, I . .................... . If .;' STATf: CONS,:::' ' , " ~'1L:(C~,Y Other Trade's License No. .....,....,...,...... CODES. NOT :<':." ,y, ;,1'" I"'" -'. , , . ~ .1\, 1. Z;; D~N O'){Coti'II'-li;'::1()"jQR(JJl'j. Location of land on which proposed work will be done. .....91 u./. 11. " .~,.1/... .c::r. ...:2/1.:';:.."..... , ... ,~.t)3~~,.,."., ..~~~. ,1-I(17\13:J)~. .0....J ~~th ~/I..: y",....... House Number Street Hamlet . !If. tft. 1 3 'ti County Tax Map No. 1000 Section ".', .. .."..... Block .,........ ..,.... Lot.,.,..,.. .'. . , . . . . . , SubdlVlsion . . . . . . . . . . , , . . , . . , . , . . . . . , . , . , . . . . . , 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 . . . .,/L!". ~!. ':". . . J.'Y:;>-.,f/.::,. t. . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy . ,1.J..,.tt,-.,\f.~... .!..u.....:'~{fr.~!f.,...........,...,.........."....... i ., ,.,> ".jj 1.~ ",,-,, , 3. Nature of work (check which applicable): New Building. . . . . . . . . . Addition. . . . . . . . .. Alteratian ..... f:.' ./ Repair.............. Removal.....,'.. '/.... Dempition ,............ :LOtherWork .~~.j.J. '( l.<\. .r ~ C G>.!. Q........ .b/oc <)/" 'ye.I'!Oo,,<" We>", j/JI'" V'5' escription) 4. Estimated Cost . ':'. . . 9.' ?!? q /. .C?<? . .. . .. .. . .. . . . .. . . . Fee . . . .. . .. . .. . .. . .. . .. .. . . .. . .. .. .. .. . .. , (to be paid on filing this applicatian) 5. If dwelling, nU,mber of dwellingiunits . . . . . . . . . . . . . .. Number of dwelling units on each floor. . . . . . . . . . . . . . . . If garage, number of cars .... i. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mix~d oceupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . . . . . 7. Dimeijsions of existing structurfs, if any: Front. . . . . . . . . . . . . . . Rear .............. Depth.. . . . . . . . . . . . . . Height ............... NUl\! ber of Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dimedsions of same structure ~ith alterations or additions: Front ................. Rear . . . . . . . . . . . . . . . . . . Depth. . . . . . . . . . . . . . . . . . . '. . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. Dimensions of entire new construction: Front. . . . . . . . . . . . . .. Rear............... Depth .... . . . . . . . . . . .- Height ............... Nu~ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Size of lot: Front. . . . . . . . . . . . . . . . . . . . .. Rear...................... Depth ...................... 10. Date of Purchase .......... I. . . . . . . . . . . . . . . . . . ~e 2 For.t,er,ojner ............................. .11. Zone or use district in which Premises are situated. . . . . . . . / . ..,. 11 ,I ..a.. . . . . J/' . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. D?es proposed constructi~n v!9late any zoning law, ordina~ce or re~lation: ... .':. . . . . . . . '.' . . . . . '<9' . . . . . 13. Will lot be regraded ...~~. f: . . i/:dJ/. . . . . . . WIll excess fill be removed from premIses: Ye No 14. Name,of Owner of prem ses . .;. ./. . oil. . . . :. . . 'i'!.-.(. Address. . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name of Architect . . ':J' . :A l '. . . . 'f-!,; . . . . ~. . . ; Address ..,.. . . . . . . . . . . T' . . Phone No. .. . . . . . . . . . . II' Name of Contractor A.(~ .. :'fl(..... :l;1!'t'.~?,Ij.Qq'Address 0-.r: ~~.'Y'p'c;'r..... Phone Na.1(7.l.~C?7'.?. ., I PLOT DIAGRAM Locate, clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensians fram propt,rty lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. ' I/ot tl':h\ -:l if <l C /; ~ j ~ l:' xc oct v' Jr p 12 ( Wi je 5'71 j ) ';;J Cl/c>5)' /0 o <d.,*,_ ~ C /.: " C -e,. !/:J y c'h .) M )~". -<Z- Th P- c.> f f"hr- <:J <2 11 ( .,..,y , 'Zll/ I / e \/.5 rr:-J .., ! j. .--- CL"" vJI",' VI C f Ill, <: ;(/ tL/J. / /f Y (I C <2 ]..li '" 1'1 f (>(0<// II e..JA( c- 'i '( 1 3 6~/t.1( " . I r;, , I . ~ ~//:::J. V' -w 'f/I,'6- eu <.-1'/1..;...'''14 f 'lsi e'xt5 Ih'c...- fJ/= po1l /CN 8'",110 ') .\~\ ~'x:J.li- to " ~~ ill c.f~L^ . Ol~ I=Uo n"'~ b- Y /' tJl'! ?I<.R c()l-- , /oIEI/ C€J.LIt'f\. /-f" F/...fJo'R...... I I STATE OF NEW Y K S.S O\~~ COUNTY OF . .. . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . ',' . . . . . . . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applicant (Name of individual sigping contract) above named. I He is the. . . . . . . . . . . . . . . . . . . . .1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . I ! (Contractor, agent, corporate officer, etc.) of said owner or awners, and is dilly authorized to perform or have performed the said work and to make and file this application; that all statements eontained in this application are true to the best of his knowledge and belief; and that the wark will be performed in the manner set forth in the application filed therewith. Sworn to before me th~ I ..... .. '1" .., .1.. . ... ..day qf.. . . .. .!!{ ~ .., 19..h? ,~i-'~ ~ Notary Public, . ..........y:....~nty , [!f,~ ' , JUDITH T. TERR I NotalY Public, S~ate of New YOrl( . . . . . . . . . . . . . . . . . . . . (' . . . . . . . . . . . . . . . . . . . . . . . . . , c~~~~~;~,~a,4~~~;_, ~~~f~1~ ~~~Ul~~ (Signature of applicant)