HomeMy WebLinkAbout11443-zFORM NO. 4
TOWN OF SOUTHOLD
: BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Zl1548 Date March 14 1983
THIS CERTIFIES that the building ................................................
Location of Property 300 Willow Point Road Southold
County Tax Map No. 1000 Section . . .0 ~.6 ....... Block . ...0 .5 .......... Lot .. 0..3 .1 ............
Subdivision .... .W~_.~.~.9.w' .P.o..i.n.~ ............. Filed Map No..4..6.5.2...Lot No...2.7. .........
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... O.q ~ p.b.e.~...~ 9 ...... , 19.8. 1 pursuant to which Building Permit No.. ! .1.4.4.3...g ............
dated ... p.e. g..o .b.e.~.. 3. .0 ............. 19.8.1., was issued, and conforms to all o f the requirements
of the applicable provisions of the law. The occupancy for which this certificate is issued is .........
a private one-family dwelling.
The certificate is issued to ....... F..R..E p.E?. X..O.K. .~.~.~..q~. 9. .h ................
(owner, le:&~.~cer~an~d-
of the aforesaid building.
Suffolk County Department of Health Approval .ltl..-.8P.~9~. ~..9./.2..8/.8.2.,..~.qb.t.....~.: . y.i.:l: 3:.a..,. P.E.
UNDERWRITERS CERTIFICATE NO ......... ~. 5.8.1.8.3. 1. ................................
Rev. 1/81
Building Inspectqr
(THIS PERMIT MUST BE KEPT ON THE P'REMIS~S UNTIL ULL
COMPLETION OF THE WORK AUTHORIZED)
Rermission is hereby granted to:
puw~ant to application dated ......... ~. .,;,....., 19 , and opproved by the
Bu!l~ing 1~3spector.
FORM NO, 6
)WN OF SOUTHOLD
%ilding Department
Town Halt
$outhold, N,Y. 11~71
APPLICATION FOR CERTIFICATE OF OCCUPANCY
Instructions
A. This application must be filled in typewriter OR ink, and subr~itted 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 topoeraohic features.
2.Final approval of Health Dep~, of water supply and sewerage disposaI--(S-9 form or equal).
3.Approval of electrical installation from Board of Fire Underwriters.
4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ 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 dnusual 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 85.00
3. Copy of certificate of occupancy $1.00
New Building ..../.. ....... Old or Pre-existing Building(X)., ....... =/Vacant Land - . ..........
Location of Property ........ .. i. v¢ i d
Hou~ No. Srree~ Hamlet
County Tax Map No..1000 Section .O...~ .......... Block ...0..-'? ......... Lot....O..~..j ........
..................... Filed Map No. ~ .~':? .~. .... Lot No.. ~ ~ ........
Health Dept. Approval . J J .-. ........ - ......... Labor Oep . Approval ................... ,..
Underwriters Approval ........................ Planning Board Approval ..................
Req tfo T rope C tiff Fi alC tiff
ues r e rary er cate ..................... n er cate ................
Fee Submitted S ....................
d
~000~78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
I~' I='UREAU OF ELECTRiCiTY
THIS CERTIFIES THAT
only the electrical equipment as ~scribed bel~ and introduced by tlw applicant ~med on t~ ab~ application number in the premises of
i,~ rhe fotlowing Iocat~q,~; ~ Ba~etnextk~, ~ Ist FL ~ 2nd Fl. Section Block Lot
was exarnined on ~ ~ ~ ~ and found to be in Compliance with the rOqulrernents of this Board.
FIXTURE FIXTURES RANGES , OVENS
DRYERS
DISH WASHERS EXHAUST FANS
SYSTEMS
NO. OF FEET
E
OTHER APPARATUS:
3-G.F.C.I.
1-~Dke
1-4.5 K.W. Hog Water tteater
E R V I C
Ne. OF CC. COND A W,G, ~
PER ~ OF CC. COND
1 3/0
A W, G, qO, OF NEUTRALS A, W G
OF HI-tEa OF NEUTRAL
1 t/0
O~u'les ~. Hall ~;lec.
760 l~g ~ Dr.
to must not be altered in any manner~ return to the office of the Board ~f incorrect. Inspectors may be 'identified by their credent a s
FIELD INSPECTION ~
FOUNDATION (1st)
COMMENTS
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
C,ODE
FINAL
COMMENTS:
Memorandum from....
BUILDING INSPECTORS OFFICE
TOWN OF $OUTHOLD
TOV~ HALL, SOUTHOLD, N. Y. 11971
765-1802
MARANTZ
BUILDERS. INC.
RIDG HOITI $
4960 SUNRISE HIGHWAY
SAYVILLE~ NEW YORK 11782
Phone 589-1230 (Area 516)
October 28, 1981
Mr. Hindermann, Building Inspector
Southold Building Department
Main Road
Southold, New York 11971
Dear Mr. Hindermann,
RE: Frederick Groll's
Building Permit Application
As per your instructions, enclosed is a booklet containing
the heat loss information you requested on %he Weathershield
windows.
The clear opening size for the casement windows in F. Groll's
bedrooms is 20 inches.
Thank you for your assistance in this matter.
~-~Be~ Pfarant~~ /
MARANTZ B~L~RS,
INC.
NEW YORK STATE DEP~RT~NT OF EMVIR01~NTAL CONSERVATION
Regulatory Affairs ...........
Building 40, SUNY
Stony Brook, NY 11794
(518) 751-7900
Robert F. Flacke
Commissioner
A COPY OP T__}II..S A~JTHORIZATION I~JST BE AVAILABLE ON PROJECT SITE
TIDAL NEl~24DS ~.{OTIFICATION LETTER APPROVAL
Dear P%6~ -~¢S. {~RO~.L;
This is to inform you that we have reviewed the notification letter (or
permit application) filed on ~'~- ~ 19Y/ and have determined that
it will not be necessary to file a permit application (or secure a tidal
wetlands perzit) to
Asst~ng you hav~ obtafned all other necessa~ pe~ts, you my proceed
with your project adhering to the special conditions (if any) found on this
Regional Pem~t A~fnistrat°r
s~ued
E~n Date ' ....
cc: U.S. Army Corps of Engineers
ITYSDEC Law Enforcement - Region I
FORM NO, 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N,Y. 11971
TEL,: 7(35-1802
app rove c~t3Z{'7.O -/~e'~..~.~., 19 & permit No. ,,//..~..q~..ff...~-'~
Disapproved a/c ' -" ' /
....... :.:55_5 .........
................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT '
Al~plication No. ~./..SZ.g-. ·~. .......
INSTRUCTIONS
a. This application nmst be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accordin,¢ 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 is part of this apl
cation.
c. The work covered by this application may not be commenced before issuance of Building Pe~it.
d. Upon apprc':al 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 throughont the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan
sh~l have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pe~it pursuant to t
Building Zone Ordinance of the Town bf 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
The applicant agrees to comply with ail applicable laws, ordinances, building code, housing code, and regulations, ~d
admit authorized inspectors on premises and in buildings for necessa~ inspections. ~
...,.. ......
(Signatnre o~ applicant, or flaNe, if a corporation)
(Mailing address of appticant)~;~,
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bnild
.............. ....................................................................
Name of owner of premises..~~.t.C~x ~,. ~.~: .... ~. ,~' 7~ ~ ~Gk.k-
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly anthorized officer.
(Name and title of corporate officer)
Builder's License No ..........................
Plumber's Licens, N.o.'~.~'..~...-~T..~..~...~....
Electrician's License No .......................
Other Trade's License No ......................
1. Location of land on which proposed work will be done ................. , ..............................
House Number Street Hamlet
(Name)
2. State existing use and occupancy of premises and intended use and occnpancy of proposed construction:
a. d occnpancy .4.3 . =-..- ...................................
).
3.
' Demoli[ion Other Work
Repair Removal
........ ~:~ ....... : ...................... ~'~ ...................
(to be paid on filing this application)
'
If dwelling, mnnber of dwelling units ..... Number of dwelling unRs on each floor
If garage, number of cars .... ~...~ ..................
I f busi.ness, commercial ~r mixed occupancy, specify ~ature and extent of each type of use .....................
Dimensions of existing structures, if any: Front .......... ' ..... Rear .............. Depth ...............
Height Number of Stories
Dimensions of same structure With alterations or additions: Front ................. Rear .................
Depth ...................... He~t ...................... Number of Storms ................
D hens OhS of=nt r= new constrt chon Front.. ~ ......... Rear..~ .......... Dgpt i~ g,.~, ....
Height ............... Number of StoNes ......... } ............................................
Size of lot: Front ..... {~... '.. :.~ .......... Rear . . ................ ~ep~h .&%~ ~ ............
Date o'f Purchase . ~.,. ~ ~.J~7 .............. - Name '~ of Former Owner .~ N~ ..................
Zone 0r uso district in xvhich p~emises are situated ................................... ' ..................
I),oes proposed eonstru~/~n vio:iate any zoning law, ordinance or regulation: . Nq ........................
%kill lo~t be regraded . ,~...; .................... Will excess fill b~ r~moved from premises: -- Yes
Name of Owner of premises ~.,g.~k ......... Addr~~.t~k ~f,. Phon~ No.W~ ~ 0.~1.~ ....
Nam~ of Architeot ......... : ................ '.. address,,',~~' ~'. Phon~ No ................
or Cont =cto ............. No ................
PLOT DIAGRAM
Locate clearly and distinctly ali bniklings, whether existing or proposed, and. indicate ,'all set-back dimensions from
roperty lines. Give street and block, number or description according to deed, and show street names and indicate whether
.tcrior or corner lot.
rATIi OF NEW~?I~)RK, ~ ,~ _
OUNTY..O.OF ~.. ?:i.~ ~
: -~'~ duly sworn, deposes and says thaS-he is tile applicant
...... "" (N~~i:~ contract) ..... being
)ore nanled.
is the . .~ ....... ~o.--.,.~...rv~..~.! ..................................... . ...............................
i (Contractor, agent, corporate officer, etc.)
said owner or owners, m~d is duly authorized to perform or have performed the said work and to m~e and file Otis
)plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the
· ork w~l be performed in the manner set forth in the application filed therewith.
worn to before me this
o~Public, . ..~. , - ~i ~~ Count,,
T~m Expires March au, ~..~
TH~ WATER S~Y AND ~WAO~
CONFORM T~ TH~ ~T~
for ~ts location ~ve bees ~FFOLK ~OU~Y ~PT. ~F HEALTH
~? this ~r~men~ ~ ~O~ '... '~RVICES -- FOR APPROVAL OF
'~ : DEED: L, ~/~ P. '
~. ~' , , ~" , - . ,~ ' ,,,.
,
RODERICK VAN TULL. ".C.
'~ x SUFFOLK CO. HEALTH DEPT. APPROVAL
, '~ ~ , . ....... ~ LICENSED LAND SURV~'YORS
4
D~:~B/~p~VED AS~NOTED
G DEPARTMENT AT
765J802 9 A~ TO 4 PM FOR THE
FOR pe~jp'-q CONCRETE
3. INqlII-AT~n~,,CTDU~ION MU~
4, FIN~l-- ' '
ALL CONSTRIICTION SHALL
OF THE N,Y.
THE REQUIREMENTS
CODES- NOT ~ESPONSIBLE FOR
j
;
PLOT PLA~
~Y ~' vA~ TUlL ~ p,~. ~ L.L,5.
',FINAL
./..0..O/.T ,.... 5ou..o..
-
~ [ It T O ~2 3. (,) 2'--0' x 2'--0" X 1'--0" CONCR~E FOOTINGS.
" ~ APPROVED DATE
:', ~g. ~ N~% ~gE~/c~ ~NOL~ DRAWN BY SHE~ NO.
/ ' . W/~w ~T ~0~ ~ ~ ~
~F~oz4 T ~L_E VFt T~ o h4
_¸12
,LEFT
I~ I
'~ -T: ........... 7_-:::-:: :~-~: ,~ - ~-~
J
zq~FIYRLT WI~T~.
FINAL PLANS
REVISIONS
RIDGE HOtllE'S
(~ sv~ns P~ODUCTS ~
A RESIDENCE FOR
~OL L
APPROVED DATE
DRAWN BY SHEET NO.
O~ rlOl~A k
OP I'IONAL
.:? ;.._.'
FLOORS
' '15'.
. w,,,, ',s
BASEMENT & BI-LEVEL EXTERIOR WALLS ?' '~' - ·
HAVE AN ~VALUE -MUST HAVE AN ~VALUE ~AS8 A~S
AT L~ST 7. OF AT LEAST 8 ~ ~ ~LAS~ Wl~:
~, ~T ~ USED WHEN~ ~TE, MUST ~ USED WHEN BASE~NT ~ DATA
F~.IS AT GRA~ ~ ' rLO~ IS AT~ADE "