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HomeMy WebLinkAbout11508-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g.1.1.0.5..6 ......... Date ......... d..u.n.e..3..0 ................19 .8.2. THIS CERTIFIES that the building ................................................ Location of Property . .2.0.§~ .................. .H.~.t~h. ~..a.n.d.. ~p.a.d. ............ ~. ~.l.~.qh. 9t~.u.e' House No. Street Hamlet County Tax Map No. 1000 Section ...1.q2. ...... Block .: .0.8. ..........Lot...0.qT. ........... Subdivision...H.i. gh..1.a.n.d.. ~.s.t;.a. ~.e.a .......... Filed Map No..6.5.3.7....Lot No.. 1..0 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated · .~ 9 .v 9.m.b.e. ?..~.8. ...... , 19.8 .1. pursuant to which Building Permit No..1.1. 5. 9 .8..g. ............ dated . .D.a. qg.m.b.e.~..1.0. ............. 198. 1.., 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 ......... ...~.. p~.v.~.~.e.. 9.n.e.~C~. ~.~Y.. ¢.~.e.% %.x.~.~,. ......................................... The certificate is issued to ...7.5. llighland Road Cot, p. ................ ?o'.;n~k,i/~i/~'~/ahi~ ...................... of the aforesaid building. Suffolk County Department of Health Approval . .R .o.b.e.~ .~..~.....V.i.l.[q s..P.: ~... ,..1. 1. .-.S.~.-~ 1. .2.1.,.. 6/29/82 UNDERWRITERS CERTIFICATE NO. N 562615 Budding inspector Rev, 1/81 Perrhissior · TOWN ~OI TOWN HA'LI~ SOuTHOLD, N~.Y, ! ~ r · ' ~ ~ ~i~ (THIS PERMIT MUST BE KEPT ©N ~H,E:PR£MIS~S UNTIL,~,,,LL COMPLETION OF THE WORK AUTH6R[ZED 1 S [)S Z is hereby granted to: at piemise* located ,,t .................... ~..: ......,,' ........ ? ................................................................ ?.~ ....... ./,?... County T~X; Mop No. 1000 Section ........... ;. Block pursuant to opphcohon dotal ......... __-- -..,-.... Bu!l~lng I~$pector. ~ No. ........... ., and ~pproved by the 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 following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual oatu ral 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 approval of completed site plan requirements where applicable. B. 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, 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 V " (~ 'Z~' - u~ ~. .... ~.~ ....... o~ o~.~-~x~st~n~ ..~(Z) .... ~_ ~ 'W~.~t ...~ ............ Locat on of Property ~ ~:~, ~,:'~ ,:~ ~*~,~' ~~ ~2 ~ ~ ............... ,, ............... , .................. ~-. .~ . u o,· ~ ~treet ~ [ I Ham/et ow.. O er, ................... ....... Court V lax Map ~o. 1000 Section .... ~ ......... g~ock ............... [o~....~. .......... Health Dept. Approval. 1.~,--...~....". ~. ~..~ ...... Labor Dept. Approval ......................... Underwriters Approval ................ Planning Board Approval .................. ~.., Request for Temporary Gertificate ..................... Final Certificate ................. - Construction on above described buildin§ a me all a nd fagot Applican FORM NO. 3 TOWN OF SOUTIqOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTItOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ · ~.~..~.~_. ~f2 ...... PLEASE TAKE NOTICE that your application dated .... ~.... ~<~ ........ , 19 ..... for permit to construct .... 4~74_.,C.. ~.. ~ ...................... at~ ~//~/ ~ ~ ~ / /~. ~ ~.~. Location of Property ,.. ~~. --~.~ ~ _ · · ~~-~/~ /' County Tax Map No. 1000 Section .............. Blo~ .............. Lot .............. Subdivision ~¢~. ~Filed Map No ~.~ ....... Lot No...~.~ ........... is returned her~th and disapproLed on the following grounds ,~. ~- · - ..~.'.~..~..~..~~..~..~.. ~..~. ~~ .............. ....................................... .... ' ~ild~g Inspector ..... ~. C - ' - RV 1/80 FIELD INSPECTIO~ FOUNDATION FOUNDATION ROUGH FRAME & PLUMBING INSULATION PER N STATE ENERGY C~ODE FINAL 7GS-AS02 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND D~ INSULATION FRAMING [ ] FINAL REMARKS: FORIVl NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1802 -~')~Q ' ~5 ., 19~ Application No. Z~. Examine~ .... ~. ~ ...... · · ' · Approved.~... (.~ .... , 1 .~. Peri, it No..Z ...... (Building Inspector) ate 19. INSTRUCTIONS a. This application nmst be completely fiiled'~in by typewriter or in Lnk and submitted in triplicate to the Buildi 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the diagram which ispart of this apt' 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 will issue a Building Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole oF in part for any purpose whatever until a Certificate of Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or .for removal or demolition, as herein describe ;,, ..... ........ (Mailing address of applicator) State whether applicant is ~ lessee, agent, architect, engineer, general contractor, electrician, plumber , If applicao~CO;l~I'ation, signatj~e of dCy authorized officer. - '~t~fof~ c~Orad~;~') ......... Builder's License No............/--'~J~ .J'~:~m ~-~.~-. It I I Plumber's License No....~. .................... , . lC /t Electrician s License No. '-{z:, .................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ House Number ...... ~' Street ttamlet ~ ~ County Tax MaEN~. 1000 SectionX.. ~ ~ Block~...~ ...... Lot ~..?~7. ' S ;ion .. :~1~' ~'~ :~t~'~d~~ ~ .... 2 ..... Lot 4~. ;. , ...... ,......-........ubdivi Filed MapNo ............ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existineuseandoccunancv ~ ~~ b. Intended use ~d occupancy . .. . ,~. .~. 3. Nature,of work (cheek which applicable): New Building .......... Addition .......... Alteration .......... Repair Remoyal ' De,nolition Other Work ' ~ ,_,O ~_~ . (Description) . _ o0o o o ' - ~. Estimated Cost ....... Fee /,.. (to be paid on filing this application) 5. If dwelling, nu.mber of dwelling uni. i~ ............~.'. Number of dwelling units on each floor ............... If garage, numoer of cars ..... i. ~.~ ....................................................... 5. If busifiess, commercial or mixed occupancy, specify nature and extent of each type of use .................. 7. Dimenfious of existing structure~, if any: Front ............... Rear .............. Depth ............ Height Numi'ber o f Stories Dimensions of same structure wi:th alterations or additions: Front Rear . Depth .................... i.. Height ....... ~..¢ ............ N~e,g'o f Stories ......... ;. ~ .,. ..... L Dimensions of..ent~re new constrnction: Front . .'~. .......... Rear .t. ............ Depth .~. .......... Height .... ."4~'.-. ......Number of Stories ..... ~ .......................... ). Size ofilot: Front ..... . .2~O..i ........... Rear .... ~...c~ .... , ......... Depth ............ ) Date of Purchase ' ' '. Name of Former Owner 1. Zone or use district in which pr~mises are situated .................................................. L Does proposed construction violate any zoning law, ordinance or reg?ation: .~?'~. ...................... I. Will lot be regraded ........ ,(-.~..~. ~ .............. Will excess fill be removed from premises: .. Yes . [. Name of Owner of prerg, ces . .[l~.-'~.~,~t'4/'#.t...,, .....Address ./x/~-~...~T. 4~'.~t.~.¢ ./~ Phone No.. ,(-q 2. ~.~ .~..~. Name of Architect .. tt~'. ~q ./..,/~l.o~,~'~/r! ..... Address .~.q-~ . .~-~-.%~...A.~../.~ .~-r-'t~Phone No. ~2/. Nmne of Contractor . tPf~q//~/.,tl.~.. ,,fOrt.,~. ...... Address ~.~...~./.~.~..f_q~.~...~:~. Phone No. f~..2./. ~q~ PLOT DIAGRAM Locate clearly and distinctly alli buildiIlg$, ~whcther existing or proposed, mad. indicate all set-back dimensions i¥om :operty lines. Give street and block number or description according ~o deed, and show street names and indicate whether ~terior or corner lot. I'ATE OF NEW YORK, S.S OUNTY OF ............... "~"7,.'Z',;'~'~ ~/Z_/.._.,,~,,.i '-- .~ .......... ,~.~"/..~.~./..,~. ~..~-~(... ~ .~.~../.~7. ...... being duly sworn, deposes and says that he is the applicant (Name of individual signing contracO hove,named. : - 'e is the .~.. i (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized to perform or have performed the sa. id work and to make and file this 9plieation; that all statements conthined in this application are true to thh best of his knowledge and belief; and that the 'ork will be performed m the manner set forth m the apphcatmn filed therewith. worn to before me this NoW~ No. 80-461 ................ ............... , ..... , ............. i , .... ...,2/._. Z:/ ....................... · ~ ~ (Signature of applicant) % .'! Tho sewage disposal and water suppl~ fac~litio~ for t~$s location have been Snapooted by this department and found Chief of ~eneral HE~ DEPARTMEHT-D~TA F~ APPRO~ ~ C~STRUCT H~ A~ ~ ~LLI~ WITHIN I0~ FEET OF Wl~ C~FQRM m T~ ~TAH~ OF THE SU~K CO~TY DEPARTMENT OF H~LTfl I~ICES~ A~R~SS NO~: SUBDIVISIONM~PFILEDINYfI~OFFIC~OP)TfECI.~t~ICOF SUFFOU~ COUNT)' ONAPB. ~, 19YYAS PI/.~ NO. 8~? SURVEY FOR dOhl~l d. MU£CAhlY ~ MARY C. MULC,~HY LOTNO. I0," AT CUTC~GUE ~WN ~ SOUTHO~D ~FO~ CO~TY, NEW ~K NOT ~, COHSIOE~O TO ~ A VALID TRUE COPY NGUA~ANT~S INDICTED HE~QH ~k RUN ~LY ~R WHOM THE S~EY iS PREPAREO IN~TIY~TI~, GUARANT~ A~ ~T T~ERA~k~ TO ~I~0NAL ~STiT~I~I OR ow~E~s PKP~Y ~INES OR FOrt Tfl~ E~E~TION ~ YOUNG ALDEN W, YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S. UCENS£ NO. 12845 HOWARD W. YOUNG~ LAND SURVEYOR N.Y, S. LICENSE NO, 45893 AVENUE NEW YORK ~OH~I~G E~TE~P~I~ES, I~C. FO~ APPROYA~ OF CONSTRUCTION O~Y LOTTO. I0, "HIGHLA~DESTATES' ~T CU~C~ D~TE: OC~ ~, I~1 DA~E HS REF. NO. · ~-~,(j~ SUFFOLK COUNTY, NEW ~RK NO. 81 - NU~UTH~IZED ALTERATION OR ADDITION ~ APPROVED SURVEY ~ A Vt~ATtOH ~ SECTION 7~O~ ~ THE ._,.,, ..,._.,..DU.,,....,..._-,,_ .-,,.,.,.,.,-,..,.,.-.,,., , I YOUNG YOUNG ALDEN W. YOUNG~ PROFESSIONAL ENGINEER SUFF~ CO~FY ON ~. ~ , I~X~ ~S F/ZE NO, ~ ~ ~ND ~N~ SURVEYOR HY.S, UCENSE NO. I~B45 HOW~RO ~ YOU~G~ L~ND SURVEYOR