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HomeMy WebLinkAbout10596-z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy 29934 Apjl 25,1980 No.......,..,..,." . Date . , . . . . . . . . . . , . . . . . . . . . . . . . . , . . . ., 19 . . . THIS CERTIFIES that the building . . . . . . . . . . . , , . . , . . . . . . . , . . . . . . . . . . . . . . , . . . . . . , . . Location of Property. . ~.1.~ .'.!-'~~. .Shor:~ ,J;.~n.e~ . ~~~'t;. ~1':~~9P.,. ,r;~ r... . . . . . . . . . . . . . . . . House No. Street Hamlet County Tax Map No. 1000 SectIOn .q~99...... .Block . ,Q?9P. . . . . . . . .Lot . .QQ:;~QQ. . . . . . . . Subdivision. .~~'!>?~~ .~~.~c:h. fa~~....... .Filed Map No. €!J?99... .Lot No. ~..4... co~orll)s sUb~aritia11Y to the 1fO'lication for Building Permit heretofore filed in this office dated arch2,!. .. ~~~. ,,19.. . pursuant to which Building Permit No. ).Q'.QE?Z............. dated . .~~t.C:~. ?-!+.,. .:j.9~q. , . . . . . . 19 . . . , was issued, and conforms to all of the requirements of the applid'ble provisIOns of the law. The occupancy for which this certificate is issued is 'Private ..... .Qne:-.F:~P.y' .J;>wg... {:p,e.q~.Mc'!~t;l.p.1'!.).......,... .'. . ..................... The certificate is issued to ... .M~.c,haeJ.. .v. ~ .~. .AJ,!J.~~~ .~ ~. .~I\!V~~~E?, . . . . . . . . . . . . . . . . . . (owner, rI!~d't,7JI"f'{jIrimr1 ' of the aforesaid building, Suffolk County Department of Health Approval .. fl.!/!.. . . . . , . . . . . . . . , . . . . . . . , . . , . . . . . . . . . , UNDERWRITERS CERTIFICATE NO. . , . fl.!/!.. .. . . .. . . . . . . . , . . .. . .. , .. . . . . .. . . . . .. . . ., . .,...~-(..6~. Building Inspector Rev 4/79 ~ ',< ~ 1, , ~ l ",.r .;:."JJd1-,Ji. i 4h,,, ,&.,.> .,. . j, ..d,-,'., j:, 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) N<! 10596 Z /1A1C.C / 2 t/ Jb Date .................L ..........,........",......, ..., 19..... PermisstOn is hereby granted ta: ......l:tI..C.t.I&~?../.A.I.r..qM$..4 t/c,iA.;AS . 7:~:.Q..:.....~l{....?'1!:..7Sl. ,.. , ' I ~.h'/.9/f.I9..&!..,...H~..7~,:,.... . //.1..5'1 to ...r,!.(i:}.,.(,.<Jf7A:."d:......i)z,(:..([.;".....&O PJ(.,/..Rl.:v.., /Q.:.~~/.'?7!.N).." .. .. '- II ' ....i).~?::.. .. .4L9...::.;.........~=..............,:;. .....Z...........,........................,............,..........". . at premises located at ..$....:!C.....Ifg,.5#.affl..........'.f:.,.-k/......E...&!&.K.I..QI.Uj";(; J; ~!i;;!i::~:~:::~;;;:~;;::EJP.;;iH..~:. ~:.::~:I..i.:"i.i..::::;::::::l~:r;;;:.;?:::::,:: !d " pursuant to application dated .... .e.!!;:.~.!i.....?,Y:..,..................., l~.., and approved by the Building Inspector. /,:"- =e. I 1..- Fee $..,..~.....,......... .~ ~ . ........... .................................................................. Building Inspector :. It <~ , .' 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 filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the fallowing; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natu ral or tapograph ic featu res. 2. Final approval of Health Dept. af water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation fram Board af Fire Underwriters. 4. Cammercial buildings, Industrial buildings, Mu Itiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect ar Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957). Nan-confarming uses, or buildings and "pre-existing" land uses: 1. Accurate survey af peoperty showing all property lines, streets, buildings and unusual natural ar topograph ic featu res. 2. Sworn statement of awner or previous awner as to use, occupancy and conditian of buildings. 3. Date of any housing cade or safety inspection af buildings or premises; or other pertinent informa- tion required ta prepare a certificate. C. Fees: 1. Certificate af occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $1.00 / Date.. ('I. ~.". '.~.. ;:~~. ~ .'1.~~...... New Building. . . . . . . . . . . . . Old or Pre-existing Building .... "f. . . . . .. Vacant Land ............. ,- j l" . " . fP ..31..J 1'4..": ;..~ft-; 411/';, ft'.IVJAl"'fi.:;o.J,ll, Location 0 roperty............................... . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . House No. Street Hamlet o 0 fP 1'1:(."f'''~ V .... 1"'",,"'...... (.> t..;;V'D'VA:; wner ar wners 0 roperty........... . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C t T M N lOooS f 0300 BI k 0-..<>0 l coo";-oco ou n y ax ap O. ec Ion ............... oc ............... ot . . . . . . . . . . . . . . . . S bd'" ('.1"'f!o~~ I'1,FA<r, PA"M~ F'I dM N .~.l: ~."-. . . . . Lat No. .1........... u Ivlslan................................. leap a. Per 'tN IO.t"it- 'Z- D t fP 't 3-1."- go Art Mi....".;.. v, L ';VrH/"'} ml 0.. . . . . . . . .. a eo erml .......... pp Ican .................................. Health Dept. Approval . . ';'/.11. . . . . . . . . . . . . . . . . . . Labor Dept. Approval . ~ ~~ . . . . . . . . . . . . . . . . . . . Underwriters Approval. . '!/~. . . . . . . . . . . . . . . . . . .Planning Board Approval ...................... Request for Temporary Certificate. . . . . . . . . . . . . . . . . . . . .Final Certificate. . . . . . . . . . . . . . . . . . . . . . . {oJ" Fee Submitted $ . . . .-. . . . . . . . . . . . . . . . . . . . . . . . . Construction on above described building and permit meets all applicable cades and regulations. Applicant.. .~.':<.~ ~.<.~. Y'..~. ~.'~~.......................... Rev.10w10.78 't,6. ~ I? c... "Ff- {Oft, :?5Y (!/ tJ z. q., 3 Y I i ,;;;.t ~ ~ i~ , .~ ~ ',< FIELD INSPECTION DATE COMMENTS . . 'd'Q; .. - 1. , ~~ ~..:::-.5.:::.21. (/ .- _ e 0 t1.JJ- 7l Y A~~ ..., ~~'.............-~~ JOUNDATI<2.~ _ -11st) ~ t7 " 101 . -- -~ L b~ FOUNDATION (2nd) r ~ - 2. ROUGH FRAME & :2:~ ? CJ\\ PLUMBING ~ (f)~ 3. c+"i - ~~ INSULATION PER N.Y. ~!\ ~ STATE ENERGY ~ Ii, CODE " I.f / ~ t.j-7/1 tl' -- /)01 //- :J:'/';-J 4. /J , I):J , ~.~ - "jA'~/ I V',;' ....,""'-cU""".,,,'., 'c. , , c+. " -{/ , , ,,,,,:4," , " ", -, "oj, , FINAL ' ).' "". ,',..' ",,'eo . ,:~i ~~i~f~~N" ,,", "" ' ~ -::'{ 'e- '..: "',.. , , ~, < , ir ",,: :,:' ,',,:, H'",>"" .." ',: ,y' ~ c..' ';'hd,""'Je,Yc,'",':", ..' ~~ ' 5,;;"...0- " ...,'" <Dr.1 ADDITIONAL COMMENTS: "" ' '" ~ 'i", C\ - "t- ~ _ :~.,,' "_:~";, i:~~t, r:' "~ . _t '" , ' . -~_....._. , ,,;' '; ~i;; '~~:f~~t!;iif"~:;tf~:0,~<.,-t~-',~,-~:~ E.~;~ ")' ~ ",J '~N .~<!,+ :,' ;;, :.:L"~~~2. ,~' ~i;L;, -: ~:,:;; ,';g~::~,j;~':p4; /$& /J1&~~~ ,;~!t~ - ~'. '.< ~ . _ ~,',: ~;~~:\;:VtF?lq!i': ".-:~~~ ""~~~ , ~ . .",~~ ',,' .....~~ . ' ;{' \!:f~' I _ -,' ~Mh_;-*.~ >{~" . ~~ iI. ,,-h,,<~>1i<'YZ . ..' , ' , '. . " ~,;;;~~~~,~* 11>' cf~~ '.- ~ '-'> g~ ..:, , , '::r: CD , Il> I-' c+ :Y , t:J ~ c+ I , . ,{ .4..,,1 , "1",, "*' ,-" ...- - ~ ... .- ;i ~i ..rs Fy....,"'~ " oZ)((., " II. Dn c. ,,\(.foe w- I .;2.0 ! I ~ c.. \<' ~\.- ".,...... I -o/~ )C. " I :!! 11' I .. " . & ~"I ~'J(' dr,...., 'C.""'" _ . ,;; '(:<1..... C:"NC"&-\... \=.."+...,,,, .-. ... !' ,i.''(,,- (Ji..J..",-, ~ ~ t'I , , IS " "~~ .:l +Q:3' .......,,<-l. t . ~ (!! ~ 't) ~ek'. ':) ,I> .. j .~ ~ <i ~ 1. ? 'L~ ~ I ~ .:1./> ~ " ~<1' ..L '?~t4 WI+\.. \,....*~ ,"",;ls, Ir/J...; 3011 i" ~ "- I./.~I.f. "N <!t>N~..'te~I=..il"~.: , 9.:.+..f' S'+<\.llr S. JI7I.y)7- ~ IJI 'ot ~c:...t ~ ~ '*" ..t' ~_ k"i.) _:#-2, --P ~ I 't1 ~/I (-CloT ,'AJ<3) - ..::3 1-0 If 65/iNJ 9'/<.-o,eE UI/VINt//./..i ~ fj I " /f/ 0 c g\-~-e 1''' \)(€.. ~U. ~. 0- ~pf A .;.- - -~~ '~-- . ~g .,' .,,~~ r~ - ~~ .,iI' .~:>k"" /....~,,~~ ~9 ~-J Ii) CJ\P WY; " .~.~_.,._~ .- . o. .~- ~~- '" - , .. ~. ....--=-----C> C - --~- . " i -, ;101 }=C (J N.JZe.t..-t- ~ O!">[ "- '" - 0 0- _. I~ "- ~. c. .--- ~3 ~..u ,'<, {.. , 25"- V I'~W. -"0 ~~ ---~--; " ~ - - =------.- ~ '''0 :.... .. ~O , .. .. 11':1' z 1 <Jo~ -" I" ~'^' / <Jo,. .' f~ ---~~ I ~- .., H . '- , = i .~~---=- . ~ .. _. -'1" .' - i 1'/ , " " ~ ~----- - .-- " -~-. . -"':_""~>" .. -~-. -,-~- .- =~------ - " \" . - - --- , ..' :/0 ;,. 0 - .- - .. ~ a :!J -'-1 , .. - 1. """ ,~L~; I'"" ' , !t L,<> l , ,> ,. ",.1-( ,fu LA: iIi!!if < """,";~.I! _1ft .~;d$_~'0__M", ;,'L1.;a., ~ '"- I I I , - <<It. ..., ; t ! , 6" WATER MAl:!...?" I I ------ r-- THE EL:406 SHORT EL~.J9 [; LANE I I N 76057 oe ''E, 7500' S 760ST'OS"W 220.27' ",,' wa.+Cy /'"f, <,. ...",r.." / 'J 00. , "0 Sf ~p ~~ J~ ." B Q~~~I t,o l' I~ ~' " I~' . / ~:... \.,. Iv> ,\ Cr /./ ...ct ,.. 10'1 l- I .,.///~~ ',' r . ~ 7$1 ./ ,\1 j!! \0 - .. '" ". - UJ :z ~ I ) - <!! . IS,'" ..0. '" " <!! I\) J j $1'''1'~ f......",e -, I\) ~. -, - .. ~ h.... 4e { 'Gt"~.ge - H ~' 4 ('~ ~ ",' . ",' !!~ (.: ~ , ,;.~ CJ " I' I' ~ 1:1 1:1 .... .... I.!) "" R. , '-' ~'''. "'-"'-'-~ ._'-, -.... -.~- .. :... .~ ......-,. ......... ~ -, -- - . '~. I\) ~ -." -.iO...::. '" Lot 4 '" -~ '" " " ~,- Area =2/375 sq.ft. ", -. - " '- ~~ Y" ,~ ,,~ ~'v ~ - - -- S7605708''w 7500' Open Space "B" , i Lov~ i ,I, .1.1 iU;" .~i M , FORM NO.1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Application No. .((J.~9.; . . . . . . Examinedtltv;e.<;./f.. ?V" 19 ~- APprovecMA:'~. .4-? . ., I~. Pennit NO./CJ$2.{i!:. ---- Disapproved a/ c , . . . , . . . . . . . , . . , , . . . . . . . ....... " .---- ..... ,_.... . ,-............. ..... . APPLICATION FOR BUILDING PERMIT Date. . . . :~.: .1:":1. . .. . .. ., 19 .~~ 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 Pennit. d. Upon approval of this application, the Buildmg 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 Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildmgs, 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. . . . . ~j.c. ~ ':'.'. -f. . .v". . ~. ~.': -:-':'. . . , . . . , . . . . . . . . . . (Signature of applicant, or name, If a corporation) (J 0 13 . ~ '7..r I G. M", /f i~.J IV V /I"i j ') ....... ....,.., ,. J..,.....,.. .........,........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. () W.J':I\ . '.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... ,..... ,..,.....,.................,....... '0' N f f' M I't.- J4 ....$ t.. V.,~ /I L.. i) 1,) I >~ f'. L:J V't; ,; A " ame 0 owner 0 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. . (?iI .~'.:. ,1: . J.t ,", ': ~/!? ..'1, ~. . Plumber's License No. ,.,.... . . . . . . . . . . . . . . . . Electrician's License No. ..................... . Other Trade's License No. ...,....,.........,.. I. Location ofland on which proposed work will be done. ..,.............................................. J,,[ ... ,''.h..s..'. .~!Jf'~?.r.. .~:1.~f....,............ .~"!~~. ~A~1/;"V ,........, . ,. . .,.,...,..,.....,...,... " House Num ber Street Hamlet County Tax Map No. 1000 Section. .(;: .-! :-'.\'. . .. . . . . .. Block.. :'. ~."P. . .. . , . . .. Lot. P.~,?':D.':\'. . .. .. .. .. Subdivision, . t":,?,,,!.:,i. , P..t:.'!.".. . ,F; ~!1.A. , . . , , . . , Filed Map No. . .t.: !-: !>.~. . . . .. Lot".'!........... (Name) 2. State existing use and occupancy of premises and mtended use and occupancy of proposed construction: a. Existing use and occupancy.. .r:-!./I.,,:,.,'. f.if.~':.. !J.~~"U:'" .&.I!.I~ liaMl.47. ."];;u;Et/.;.V.~....... b. Intended use and occupancy .. p~ ."':~.<.":~. , ~. or...':. Ii .J. .~:':'..-.. .Il.>:. .I(~~,....(. . ..1f71?jQl?fl? .-::. ... .. i ; .1;,& 'k ' i- : ~~,h, .U , ~< ;~ '~'<.w.>ili hs"L ~..iZ- 3. Nature of work (check which a~plicable): New Building . . . . . . . . . . Addition. . .~. . . .. Alteration .......... Repair .............. Rem9val . . . . . , . . . . . . .. Demolition .............. Other Work. . . . . . . . . . . . . . . : #. ot:' (Description) 4. . ''r.2.lz. o~ i I~ _ Estimated Cost . . . . . . . . . . . . J . . . . . . . . . . . . . . . . . . . . . . . . . Fee . ..' . ................................ , , (to be paid on filing this application) , 5. If dwelling, number of dwelling :units . . . . . .'. . . . . . . ., Number of dwelling units on each floor. . .'. . . . . . . . . . . . . , I I If garage, number of cars .... 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. If business, commercial or mixe~ occupaney, specify nature and extent of eaeh type of use . . 7. . . . . . . . . . . . . . . . . . 7 D' ,. f'f t t "f F tJH 1...~"u-1 R D th . unenslons 0 eXls mg s ruc un/s, I any: ron ............... ear.............. ep . . . . . . . . . . . . . . . Height ............... NU11)ber of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D' . f t t "th It l' dd'f F t JJ:11 J.....~o1., R ImenSlOns 0 same s ruc ure WI a era Ions or a I IOns: ron ................. ear.................. Depth. . . . . . . . . . . . . . . . . . . i . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . 8. D' . f l' t l' F t j"" S""l ".1'1 R D th Imenslons 0 en lfe new cons ruc IOn: ron ............... ear............... ep . . . . . . . . . . . . . . . , Height . . . . . . . . . . . . . . . Number of Stories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. S' flot. Fro t .s.;,; 5~..lv.r'" Re Depth \..lze 0 . n.. . . ... . . . t. . .. . .. . .. . ar .. . ... .. . .. . ., . .. . ... . .. ... ... ... . .. .. . .. ... 10. Date of Purchase ... .'.~. ~ .<1; t. 7.". . . . . . . . . . . . . . . Name of Former Owner (<.":~ !~. ': . If!' f.". H !-.... ./."'. ~" . . . . . II. Z d' t . t' h' h ;. 't t d '~ II Joneoruse Isnc mw IC premlsesaresluae ............ . ...................................... 12. Does proposed construetion violate any zoning law, ordinance or regulation: . .I>!'!. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Will lot be regraded ..... :~~~. . . . . . . . . . . . . . . . . . . Will exeess fill be removed from premises: ~ No 14. Name of Owner of premises tl';c....~.~ ~ .!" .L.'!':"!'.' ~ . Address .~ P. ~ ~ ~ . -:r~~I".q..,! . . Phone Na. 't.".".: .'.1'.7."". . . . Name of Architect .. . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . Phone No. .. . . . . . . . . . . . . . Name of Contractor ~~ ~'!:>. .J.~o.'!<f . fj~........... (.,., 1'. . Address (,h do('. ~r~."'.'. f!."... . Phone No. 'I.?? ~ ! .8.'. ~ . :'-: . J tt~,.,. J :1. :I _ 2. Lo 3 I/o I PLOT DIAGRAM Locate clearly and distinctly aI! buildings, whether existing or proposed, and, indicate all set.baek dimensions from property lines. Give street and blockjnumber or description according to deed, and show street names and indicate whether interior or corner lot. ' \ S E-F 1/.4.6!: rt ~1Cf./ry Wz-;a;-a/,iN STATE OF NEW YORK, S.S COUNTY OF... . .~..ff...': !\.. .. . . . . .~.':~ ~I~,!."'. . .~'. . ~.~~~':"..q.~. . . . . . . . . . . . . . . . . . . .. being duly sworn, deposes and says that he is the applieant (Name of individual sig1}ing contract) above named. He is the. . . . . ()."'1 :".<>: ':'. . . . . . . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate afficer, etc.) of said owner or owners, and is dulY 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 perfarmed in the mann~r set forth in the application filed therewith. Sworn to before me this I J~ ! ~ &*i;Jjo ''f{~:'' .~!,.l............, 19 .8.l? NotalY Pubhc, ........................~, County NOTA~'NDA F. KOWALSKI \ 4, ,', ("" t. V. L........ ~""" Y PUBLIC, State of Nc.w Y k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No, 52.4524771 or (Signature of applicant) QU~!ifJed HI SuffoJk County ,QommlsslOn Expires March 30, 1980