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Home My WebLink About11375-zFORM NO~ 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Nog.l.(~gT~. Date ........... l~ay. 5.. ;. ............. 1982. THIS CERTIFIES that the building ................................................ Location of Property .. 8.7.5 .............. Aclce~l y..P. ond..bane ............ ,~,u l;la.o.].d.. House No. Street Hamlet County Tax Map No. 1000 Section .. 069 ....... Block . .05 ........... Lot . .'~.,.P,O 3~...j.3..?3 Subdivision...X ........................... Filed Map No... X ..... Lot No. X ............ conforms substantially to the/.Applica[ion for Building Permit heretofore filed in,this office dated ·. ILugu s.t..28 ........ ,19 .B 1 pursuant to which Building Permit No...1 .~ ~7..5. g ............ dated ... B.epgember..1.5 .......... 19.81, 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. p~,J. val;~..one.-.l~am:t.l.y, d~.ell, tn~g .................................. The certificate is issued to .... B.~,rl~¥..~. ~. &. lqt~py..~[O .ur~ ............................. (owner,.l~see,~r. tenete, t~. of the aforesaid building. Suffolk County Department of Health Approval .t I .-~.0.-.5 ~ .~..5/.3/B.21 ~. B.o.h g 0.3, ~. I/j.J,J~t ,..P UNDERWRITERS CERTIFICATE NO .... hi. 55.~728 ..................................... Rev. 1/81 FOI~ NO. ~ TOWN OF S~OUTHOLD TOWN HALL SOUTHOLD, N~Y. BUILDING P~ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISi=S UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) N°. 1:1375 Z Date ...'~~"~".Z~..~....../..~.., Permission is hereby granted~ ~ ......... ........ ~~ ........ ~o ...... .~.~ ....... ~.~. ~ ,~. ....... ~ ~7/,~? .......... ~..~.~ ....................................... .................................................~ . ~/~.~---.~--~~ '' .~; at premises located at .. .~ -. ~ ......... ; .......................... ......... ~,~.~.~..~, Coun~ T~x Mop No 1000 Section' ~ ......... Block ,~ ......... ~Lot pursuant 'o applic,tion dated ../.~.~.:...~'~..:....:-...., 19~:, and ~pproved by the Bulldlng Ihspe~or. Feo$ ~..~ .............. ' 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 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 certificate. 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.. New Building .... x. ........ Old or Pre-existing Building(X) ........ ~/Vacant Land 875 Ackerly Pond Lane Sou~thold Location of Property ................................................ ~ ................... House No. Street Hamlet Owner or Owners of Property ...... ~a.n~l¥ J . .a~.c!...~..a.r;y'. you.~, ................................ County Tax Map No. 1000 Section .... 0,~9. ........ Block .... ,0,5 ......... Lot, . . .0~.3.-.0.0~ ...... Subdivision ..... .D.e.s. qr.i.b.e.q .p.~.o.~.e.~.tj. ......... Filed Map No ........... Lot No .............. for Randy and MaryYoung Health Dept. Approval . ...1.1...S.q .5.1. ........... Labor Dept. Approval ... i .................. Underwriters Approval . .X J. ~.~{¥~'./.~,~ .......... Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificat~ .... d: ......... Fee ~ubmitted $..~.,.qq... Z .................. Construction on above described building an¢~mee~s all app~cable~codeS and regulations. Memorandum from . . . . BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD Tow~ l--I~.rL .~ou"rnoro. lq'_ 'ir_ 11071 765-1802 Riverside Homes, Inc. P. O. BOX 274 1159 West Mein Street Riverheed, N. Y. 11901 Phone: 516 - 727-3395 1000805 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK. NEW YORK 10038 THIS CERTIFIES THAT . /,,~- only the elec~r.i~al eq,ipmer~t, as de$crillce]~elp~v, and jntrq~uce~ ~y~ ap~.~c~ tV~lltev~ on_ the a~o~e applica~ipn ~{~? ~ the~or~rF~i~x~s.of was examinod on ~l]l~T"~ [] 2nd FI. Section Block and/ound to be in compliance with the requirements of this Board. Lot FIXTURE FIXTURES RANGES COOKING DECKS OVENS EXHAUST FANS OUTLETS"jO SWITCHES "JO FLUORESCENT SYSTEMS NO, OF FEET DRYERS OTHER APPARATUS: 1-G.F.L 1-Smoke Detector E R NO, Oi~ERCCfCOND.A W.G. NO OF HI-LEG A W G NO, OF N~UTRAL A. W G OF CC. COND, OF HI.LEG OF NEUTRAL 2/0 1 2/0 Elec. l~xx~m Heatere,l-2.5,1--2.0,2-1.5,1-1.0,1-.75~ 907, La~e Ronko~aoma, N.Y. 11779 Lic, 498E GENE"AL Per ll ~... , · This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspector~ may be identified by thei THIS COPY ANY MANNER. FIELD INSPECTION FOUNDATION (]st) FOUNDATION (2nd) 2. COMMENT%. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ADDITIONAL cOMMENTS: FORUM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .., _~,~-,. ,~,..,.. ,~....,~.~.~, ....... '~.,~,~,,~,,. ^ppHcatien No,. ,~,~,,'--~,l~,-~,,, ............ proved ......... , Per ,t ./., ....... ................... · ~ x (Building Ir{spector) APPLICATION FOR BUILDING PERMIT ..... ~ .... - Date ................. , 19- . INSTRUCTIONS a. This application must be completely filled in by typewriter o~ Jn ink and submitted in triplicate to the Building Inspec_tor,~with 3 sets of plans~ ~cu~rat;e plot plan to scale. Fee .acccordiog to schedule. b. PIo~ plan showing location of~iet and'o~f buildings on premmes, relationship to adjoining premises or public streets or areds;~3n~J giving a detailed description at-layout ofproperty must be drQ~nCOr~the diagram which is part of this application. .c. _ The work covered by this application may not be commence?l before issuance of Building Permit. d. Upon approva of th s appl cat on, the Bu Id ng Inspector wdt ~s%ue o Buddmg 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. APPLICAT ON S HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Bu ding 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 inspectiqns. ...... or nme, if o corporation ' ' PO Box 274~ Riverhead, New York 11901 . (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. buitder Randy and Mary Young Nome of owner o~ premises .................................................................................................................................................... f- r If applicant is a cprl~drate, s~lnature of duly authorized office . ~j3Xme and title of corporate officer) Builder's License No ..................................................... Plumber's License No .......... ..2.0..4.,.0,P. ............................ Electrician's License No ..... ~..6.~.~ .............................. Other Trade's License No ............................................... 1. Location of land on which proposed wo~k will be done. Map No.: ...,,D.~.~.b..e.~,.,~.~, ...p..e.?,,~?. Lot No ......................... Street and Number ..~/..$..A.g~.e;.~'..lY,..]?.O.g.,d,..~.~....4,~.:.,.W,/-~i~..R~ ........................................ ;~gp.¢.h..q.~.~. ............... Municipality State existing use and occupancy o~ premises and in~,ended u~e qn~d occqpan_cY~of pr9P~?ed con~struction: a. Exisiting use and occupancy ......... .¥.~,g.~,~,~.J,~,~,~ ................................................................................................ b. Intended use and occupancy ...~e..~e~,[y..d~e~,~.~8 ...................................................................................... 3. Nature of work (check which applicable):' New Building' · ................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitior ..................... Other Work .................................................... 4. Estimated Cost ............ ..,.-..=7~.~.~..~).....-.-...-.-~..Fee ..................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .3.. ............... 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 structures, 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 ........ .~.0. ....................... Rear ...... ~g .................. Depth ....... ')~ ............. Height ....... ]-.6 ......... Number of Stories ...Z ................................................................................................................ 9. Size of lot: Front ............ .[..6..0.....8..8. ................................ Rear .......... ~.5...0. :..4. .0. .................... Depth ....... $.0.8.,..g.7 .............. 10. Date of Purchase ...... ~Y..7.~...],,~.8.], ............................ Name of Former Owner ....~T~.c!jJ-h..T....~:et-t-~ ..................... 11. Zone or use district in which premises are situated ..... .A...~.e.?..J:.d..e.~.];..~.~..d...~?.}?..?.?...t.?..z'.?..].. ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ...... .~..e. .............................................. 13. Will lot be regraded . ........ ~y.e~ .......... Will excess fill be removed from premises: ( ) Yes (x~ No 14. Name of Owner of premises ......~...n..d.y...~.n..d....~..n.~)z'....~..o...u..a~ ........ Address .~l~.o.~.e...~ Phone No ...... .3..6..g.7..7..0..6.~. Name of Architect .....~..p..tLn...~.c]...~.o.~.o.~ ...................... Address ....~..~.~.~.~.T.~. ............ Phone No....'L~,?..-.~.~.c~.~.... Name of Contractor ...... .R~.v..e.~.~..d..e...~...o~...e.~...][.~..c..~ ............ Address ..~j_..ve.~..h..e..n..cl. ............ Phone No....?.~?....~.~.c~.~.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according ta deed, and show street names and indicate whether interior or corner lot. SEE ATTA(~ED SI~RVEY STATE OF NEW,/,,~,[~-~ ~ c ¢ COUNTY OF ..°..u.~.u.~F. .......... ~-.....[~:~ . ........................ ~..fl~.~.~ .................................... bei~ dqly sworn, deposes and soys t~t he is the opplicam (~ameCof individual signing contract} above named. He is the ........... ~e~..~o~..bu[$de~l~pD&.~ .............................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that olt statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed~the manner set fo~h in the applicatibn ~ile~ therewith. Swor~fore me this /~,~ ......... ..... ............. , , · Not~li~ ...... ~..~.....~..~ ......... Coun~ ...... ~..~ ................................................................................... / ~ //~ ~ ) ///~ ~~ ~D // (Signature of applicant) / / ~ N~AR~UBLIC, State of New Yor~ ~ "o. 52-460 [884 ~mmission Expires March ~, ]9__ SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. THE WATER SUP~Y AND SEWAGE DI~AL ~~ CONFORM TO THE STANDARDS OF THE 5~V~ ~ SUFFOLK CO. DEPT, OF HEALTH SERVICES. ~T SUFFOLK COUNTY DEPT. OF HEALTH C~STRUCT ION ONLY o~a~ "' ~' as~' ~~/ """~" m.w~X ~m~:"'' ' ;' '" "" disposal and ~ater ...... t~7' +o hou~ ~ / [ : ?o O. Box 2.74 "It should be noted that since this property is located in an agricultural area, the possibility exists that the water supply may contain trace amounts of pestJddes and/or nitrates. Special analysis 7-E-~//£ required. Contact this Department prior to sampling". RODERICK VAN TUY~., P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM ~ STANDARDS OF THE ../~PPLICA NT SUFFOLK COUNTY DE~OFJ HEALTH APPROVED: '' SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. OWNERS ADDRESS: DEED: L. 4~t ~ravel STAMP SEAL N75564 ~' DATE: ' FEE: BY: NOTIFY BUILDING DEPARTMENT ,AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS'. ~1. FOUNDATION - TWO REQUIRED FOp POURED CONCRETE ~2, ROUGH - FRAMING ~ PLUMBING 5. INSULATION .4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C. O~ 'ALL CONSTRUCTION SHALL M{~ET THE, REQUIREMENTS OF THE STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE EO~ DESIGN OR CONSTRUCTION ERROR,~, L r¸ L -- SMITH