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HomeMy WebLinkAbout11020-z FO RM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building I~pector Town Hall Ir Southold, N.Y.: Certificate Of OcCupancy No .................. Date "'Ii ............................ 19 81 THIS CERTIFIES that the building ............. ; .................................. 485 Boisseau Ave., ~I Southolfl, New York Location of Property ': /Y~$'e ~oi ..................... ~1! .................................. Street Hamlet 062 " 01 P/0 023 County Tax Map No. 1000 Section .Block i ........... !~ .............. Lot ................. Subdivision ............................... Filed M~p No ......... Lot No .............. conforms substantially to the Application for Building P~rmit heretofore filed in this office dated January · 19...8~ursuant to which Building Permit No. 1 1020 Z dated January 2 ~ 19..8. ~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 ......... Private One-Family Dwelling Frederick P. Rich The certificate is issued to ..................... io~,~'r.'l~r;t~'t~t~ ~ ;' ................... of the aforesaid building. SuffolkCountyDepartmentofHealthApproval ?/2/~'t, 11-$0-02 R. ~,. Villa, P.E. N522456 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 No. FOEH NO~ Town o~ soUT.0,t~ BUILDING DEPARTML~I TOWN HALL SOUTHOLD, N~:Y. BUILDING ~ERMIT ~ (THIS PERMIT MUST BE KEPT ON' THE COMPLETION OF THE WORK AUTHORIZED) 110 2 0 Z UNTIL F~ULL Permission is hereby granted to: ......... i~..~,¢~. ~..~.,..../..;~c_ . , 2 ................................. F~'''' ....... ,o ......~z~.~. ....... ~.~.~......~ ~~~.4~ ........................ ~..., ............. ~~z~.:~... .~..~C~. ....... ,......~ ............................ ' ~ ~ BI k ~ ~ Lot No,~ co~n~ ~x M~p No. ~00o s.~t,o....~..... ........... o~ .~?~.... ....... ~ · .......... t~ applicoHon datod ~..L...b....~ 19 ., ~nd ~pprowd by tho purs0ont Building inspector. ;. : inSPector Rev. 6/30/80 ' ~ FORM NO. 6 TOWN OF SO~ITHOLD' 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 natura~ 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 .... ~./-.~...Z...~.~... New Building .... /~ ....... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ............ ,~.O./,-,¢~:~.., ./~. ~. ........... · .-~. · .~-~. ~¢,~...- ....... House No, Street Hamlet . . . . Owner or Owners of Property ........ ~J~,-~z~-f~/~ ......................... County Tax Map No. 1000 Section ...... ~(~¢ ;:2~... Block ....... ./ ....... Lot./2/~¢..¢,~. ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No...,/./..~-P..~.~.. Date of Permit ~.¢v¢..2-.'/¢',/.Applicant Health Dept, Approval ...//..-..~..O. %. ,~..-Zr ...... Labor Dept. Approval ....... .~/~ ............. Underwriters Approval . . .-~.~.. 2 ................. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... .~..L,'~~. ............ Fee Submitted $ .... · .~7~.c?,~. .................. Construction on above described building and permit meets all applicable codes and regulations. Applicant..~. &. ~¢~¢~¢~.~f~ ....... ,/,*&2~_~ ............ Rev. 10-10-78 iOOl07i THE NEW YORK BOARD OF FIRE UNDERWRITERS Lb BUREAU OF ELECTR C Ty ~- 86 JOHN STREET, NEW YORK, NEW yORK 10038 ~'~.'..'fi', Rich, ~io~ea~ Av~.,, w/szd~, ih Colonial Vl£1age, $outhotd~ in the following location; [] Basement [] 1st FI. [~ 2nd FI. Section Block Lot ~md found to he it~ compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS SERVICE DISCONNECT S E R V I C OTHER APPARATUS: .,L -G. Fo L. 3 .) gl~ctric~Ll, 11971 li¢.578-E This certificate must not be altered in any manner; return to the office of the Board if'incq~rrect. Inspectors may be COPY FOR~ BUILDING DEPARTMENT. THIS ~COPT OF CERTIFICATE,~ 'NO~· B~'ALTERE~· IN ANY MANNER. ..FIELD, INSPECTION FOUNDATION COMMENTS FOUNDATION 2. ROUGH FRAME& PLUMBING INSULATION PER N.Y. STATE ENERGY FINAL ADDITIONAL COMMENT-S: j(5~6) 28'/'c~cr~.~'j '1 M P O R T A N T N O T E S LOADIN~ DATA P~OFILE DATA HENRY E. RAYNOR, Jr.,Chaffman FREDERICK E, GORDON JAMES WALL BENNETT ORLOWSKI, ~. GEORGE RITCHIE LATHAM, Jr, Southold, N.Y. 11971 November 26, 1980 TELEPHONE 765-1938 Mr. Albert W. Albertson, Colonial Corners Main Road Southold, New York 11971 Jr. Dear Mr. Albertson: The Planning Board reviewed your request for Mr. Rich that he be allowed to build a home for himself on the property in the area whic~ was designated as Unit G on the site plan of Colonial Village. The Board sees no problem with this as long as the building is no larger than what was in the approved plan. They also saw no problem with the garage proposed. The Board would like an amendment to that portion of the plan when it is available. Yours truly, HENRY Eo RAYNOR, JRo,CHAIRMAN SOUTHOLD TOWN PLANNING BOARD By Mdriel Tolman, Secretary 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST ~ ~ ROUGH PLBG, [ ] FOUNDATION ZND [ ]INSULATION [ ] FRAMING [ ] FINAL REMARKS: '*'~.~ ~?~/~*--~'/~ ~)-~//~ * DATE / I NSPECTOR~~------' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL,: 765-1803 ApprovedJ~...~. ..... 19~. Permit No.. ~.t(.(~}.~O Disapproved a/c ..... ~ .......... · · · .~. ~',/~. · .~-.iZ .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No..'/./.~..~...~d. ....... Date ........... ¢.~., 19 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 drown 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 Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. 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. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit 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. . ........ (Signature of applicant, or name, if a corporation) .~.o..~.,q.:,.-.4..~0, .... S~¢/~.o~ .... /!?.'z/ .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ ~.~:~ .~..~.~. ..................................................................... Name of owner of premises . . ~.~.,,"~g9~-~/.c.. ~, . ./~../.~..Kf.. .......................... (as on the tax roll or latest deed) If applican~ is a corporation, signature of duly authorized officer· (Name and title of corporate officer) Builder's License No. ~/~'/'"'~ :~.')~t52 Plumber's License No.' . [12... t..,z~. Electrician's License No. /t tt ~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done.. A)~.77....~¢~.~-. .... . .2~../..~..~.~..g2y~.....'~. C~ ........ ................................. ~,~.~-.~...~...~ ............ . .,~.~.~ .................. House Number Street Hamlet County Tax Map No. 1000 Section ...... .~)..(o.~ ..... Block ..... ~ ............ Lot../.~/~ . .~.~. ....... Subdivision ..................................... 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 ..... /.x/~.,~./.~.. ................................................... b. Intended use and occupancy .... / 3. Nature ofw )rk (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Rem6val .............. D~molition .............. Other Work ............... 7..~. ~ .~..~ (Description) 4. Estima!edC~st ...~4. d~2).., ......................... Fee ............................. (to be paid on filing this application) 5. If dwelling, lumber of dwelling ~nits ............... Number of dwelling units on each floor ................ If garage, number of cars ..... i ................................................................... 6. If business,, :ommercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions )f existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Num. ber of Stories ........................................................ Dimensions )f same structure with alterations or additions: Front ................. Rear .................. Depth .. ' Height Number of Stories 8. Dimensions ,f entire new construction: Front .... ~:~ ....... Rear .'.~.~. :'. ....... Depth .. ~.~. ......... ./f~. ....... Numj:~r of Stones ...... /. .................................... i ........... *rent ..... ~.~9r/~5'. .......... Rear ..~<.~'4</ ..... Depth . .,f/~..d~..~.. . hase ........... ! .................. Name of Former Owner ............................. district in which pr~mises are situated ..................................................... ed construction violate any zoning law, ordinance or regulation: ................................ ~graded .... ~ ¢>. ................. Will excess fill be removed from premises: -9~;-Yes,, '_ .N~o ncr of premises ~ .~./..~P/ ........... Address ~.~..~q~/~.. · . r~. ..... Phone No. 7~.-~...'-.~.©. ~/.~. · Chitect I Address ~ ~ Phone No ntractor ~//n<~r-,,~4..~t~Address . .. Phone No...~..,C. :-fO.~... PLOT DIAGRAM .y and distinctly all buildings, whether existing or proposed, and, indicate ail set-back dimensions from .ire street and blocklnumber or description according to deed, and show street names and indicate whether r lot. STATE OF NEW Y_ORK COUNTY OF....-~.' · .~. · · S.S ....... .~"~z/~.... ~.~_.~. .................... being duly sworn, deposes and says that he is the applicant (Name of individual sigping contract) above named. : He is the ' ~-d>/~....~..'~ i (Contractor, agent per ffi ) , , cot ate o cer, etc. of said owner or owners, and is daly authorized to perform or have performed the said work and to make and file this applicatiori; that all statements con:tained in this application are true to the best of his knowledge and belief; and that the work: will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ /..~. ..... day of... Notary Public,. .............. ~/ · /I',IOTARY PUBLIC, stat0 of New York .......... ~ N0. 52-8125850, Suffolk C~o~ (Signature of applicant) Term Expires March 30, 1._,,.,.. Height 9. Size of lot: i 10. Date of Pur~ 11. Zone or use '12. Doespropo~ 13. Will lot be r 14. Name cfC, Name of A~ Name bf c( Locate cleax property lines. ( interior or ~orne SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. , STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DtS~SAL ~ ~ ~O~f i SYSTEMS FOR THIS RESIDENCE WILL ~~ ~ CONFORM TO THE STANDARDS OF THE '--~ ~"~ / , , SUFFOLK CO. DEPT. OF HEALTH SERVICES, ~O~W~{O~ SUFFOLK COUNTY ~PT.. OF HEALTH ~/J~FO~ CO~N~ ~/,Y, SERVICES -- FOR APPROVAL OF APPROVED: SUFFOLK CO. ~AX D~ST. SECT. ~, ,, ................... ~,~ ~0~ O0~ ~TB DE~A~T~~''- ~uxz~>~s The sewage disposal ~d watsr supply ro tacilitte~ for this locatkou ksve b~$~ "o ~ef of General k&ineerl=i Se~lces R~ERICK VAN TU'YL, GREEN~T NEW,,,Y~K , ,, SUFFOLK CO. HEALTH DEPT. APPROVAL 1 t '81 JA.t~ lq A~I '~ H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE .%UFF'OLK Ce, DEPT, OF HEALTH SERVICES, A%LICANT SUFFOLK COUNTY DEPT, OF HEALTH SERVICES -- FOR APPROVAL OF APPROVED: ~ . ~{" ~- SUFFOLK CO. TAX MAP DESIGNATION: DIST, SECT. BLOCK PCL. ~ 0~2 ~,' plo ~ SEAL ROOERICK VAN TUYL. P.C. LICENSED LA.D GR~N~RT NEW YORK