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Home My WebLink About11058-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date ........ ~ pi~,J-.], .6 ................ ,19,5..1. THIS CERTIFIES that the building ................................................ 1435 Pelf'way ~vive, Cutci~ogu~, ~I.¥. Location of Property h~ds~ ~Jo[ ....................... 'S't/e~i ....................... h$d*/el County Tax Map No. 1000 Section .... 1.~.9 .....Block ....... 9.5 ......Lot .... 0.1. t): ~.8. ...... · ' 28 Subdivision. ~'?.~.z~¥."?}t..F..o. r?..~? ............... Filed Map No.6 .0.6.6 ..... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated J'~iar'cl't 10 ~. 11058 Z ...................... 19 1. pursuant to which Building Permit No. dated.. .........,,,=z"cn.................17 19,g.?.,wasissued, and conforms to all ofthe requirements of the applicable pro¥isions of the law. The occupancy for which this certificate is issued is ......... D~cl~. 3ddition %~ One~F~mily Dwelling The certificate is issued to ....... ~.r .r'~.r~ Q .~ .~..S.a.r., 0.e.r: ................................... (owner, ~Ol.t.,~)_ _ _ of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. lq/~ Building Inspector Rev. 1/81 BUILDING p, ER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S COMPLETION OF THE WORK AUTHORIZED) UNTIL FbLL N? 11058 Z ~" '~'/ Permission is hereby granted to: d~.~~r~-/~ ~-r'. /~¢,~.~ ~.~.~Z~.~..~......~.~...~.x~.~.~.~.~.,..~.....~.~x.~..-..~ .......... : ~,c~ ~Zx~ .., .;~ ................................. ....... , ........................................... , ~ ~~ ¢ '* ;'?7 ,~ , _ ................. ~ ;. ~ i 4 ; · -.~ ....................................... t Co~ ,o~ ~p ~o. ~ooo s,~,o~ ...~..~ ......... ~o,[ :;D,.~. ........ :~[ t uo..~.Z~.Z.F parsuont to op lication doted ~ : , i9and opprov~ by the p .................. ~ ....... ~ ........... ~ ...... : ......... ~ ng Ir~spector. ,'~e ~.../.~ .......... Rev ~4/30L80 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 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. 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 3. Copy of certificate of occupancy $1.00 $5.00 Date ...... .~..~. · .~. · .~./. ........ /-- New Bt~ . ~. ~-..C-..~. .... Old or Pre*existing Building ............ Vacant Land ............. Location of Property . ./.~..~..~'...../~.~./..~..¢~..~..~.....~..~. ........ ~ ~..'F~-.. ~. ~. ~ ~ ........... House No, Street Hamlet Owner or Owners of Property .../?~..~..~..~..~..~ ........ .~.d~..~y~..~..~'.~ .......................... County Tax Map No. 1000 Section /~'.~~/~ "~'~ Block Lot... Subdivision....~/~--../~.Z~.'./(* .... .~.~../~.~. ....... Filed Map No..~..~..~.~....Lot No...7_..? ........ Permit No//.O...J~..?.'. Date of Permit . .~.f.o./~. ?./..Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ PI B I Underwriters Approval ........................ anning card Approva ...................... Request for Temporary Certificate ..................... Final Certificate ..../~.~2./? ....'~'?~' ' ' FeeSubmitted$...~. ......................... Construction on above described building and permit meets all applica le codes and regulations. ' Rev. 10-10-78 ~PECTION FIEBD COMMENTS FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENTERGY CODE % FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Disapproved a/c ................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No../f.C~-.~...~. ........ 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 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) · "'' ( mhng address of ap t) State whether applicant i(owne.r.,~flessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... ~..ff~f-.&r..% .............................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corpora~t_e, office. ~ Builder's License No..'../C..~...~::~:t(.~.cZ~.~:~. -- Plumber's .License No ......................... Electrician's License No ~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. / . ....... House Number / Street Hamlet ' County Tax Map No. 1000 Section f.o.~.:.,~..~: f.~.~.?.~... Block .................. Lot ................... Subdivision.· f'Atl~..~.O?/.....~?..&~..,7 ............. Filed Map No....~.~..~..~. ..... Lot. ~ ........... (Name) 2. State existing use and~~ccupancy ~f premises and intended use and ~ccupancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy .. ' . ~ .................... ~ .............. b Intende ~ ' '-- / / /// / /' ~- · d use and occupancy ~...-2d~.-:~. z~f~e..~. ~.. ~ ..................... 10. 11~ 12. 13. 14~ Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal .... ' .......... Demolition .............. Other Work..-~.'?~ ..... (Description) Estimated Cost /.'.~-~.. '~ ! Fee .~'..~. f. (th be paid on filing this application) If dwelling number of dwelling' units Number of dwelling units on each floor If garage, number of cars ........................................................................ If business, commercial or mixe:d occupancy, specify nature 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 ~ Height ' Number of Stories Dimensions of entire new construction: Front ............... Rear ............... Depth ............... lteight ............... Number of Stories ........................................................ Size of lot: Front Rear Depth . ' Date of Purchase ............................. Name of Former Owner ............................. Zone br use district in winch pr~m~ses are situated ................................................ Does proposed construction violate any zoning law, ordinance or regulation: ./Y~. ........................... Will lot be regraded .... Will fill b d fro emi Y No .... ~ ................... excess e remove m pr scs'. es Name of Owner of premises ' Address Phone No Name of Architect ......... ; ................. Address ................... Phone No ................ Name of Contractor ........ ~ ................. Address ................... Phone No ................ 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 scription according to deed, and show street names and indicate whether interior or Corner lot. STATE QF NEW Y. ORK, cou~cr~ OF ...~...u..~..~.~..a../(.. S.S ........ .F. .4. 1.c 5 ..... . . . ~ (Name of individual signling contract) above named. ..... being duly sworn, deposes and says thane is the applicant (Contractor, agent, corporate officer, etc.) oil: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 performed in the manner set forth in the application filed therewith. Sworn to before me this : Notary Public, .. . ? · County M DOLLY DIE FENB NOTARY PdB;I-, Stero o~ New york ................................... No. ' Quqh[,ed in,)~k.~l~ounty J4 (Signature of applicant) Commission Expires ]~rch 30~ 19~'.J~ j ?/TL£ /VO. 7808-0/G52 Lot o~ A~ 88°59'20 "~. Lot YYO O D 2Gg. GI ' HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT ~ NEAREST WATER MAIN.~.MI.-+ ~SOUREE OF WATER~ PRIVATEk~PUBLIC ~ ~ BUFF. CO. TAX MAP DIST. SECTION BLOCK LOT 4(-THERE ARE NO DWELLINGS WITHIN tO0 FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON. ]4' THE WATER SUPPLY AND SEWAGE DISPOSAL S YS TEM FOR THiS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH EERVICES, APPLICANT~ · -- MON. SE~' '. '#THE LOCAT~Ofl O~ WELL(W),~ R OBTAINED FROM OTHERS. SURVEY FOR FRANCES SAIVIVER LOT NO. 28 , "FAIRWAY FARMS" AT CUTCHOGUE TOWN OF SOUTHOID SUFFOLK COUNTY, NEW YORK 'X'UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. ~ COPIES OF THIS SURVEY NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAl. SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY ~GUARANTE~S INDICATED HEREON SHALL RUN ONLYTO THE PERSON FOR WHOM THE SURVEY IS PREPARED. AND ON HiS SEHALF TO THE TITLE COMPANY, GOVERN- MENTAL AGENCYAND LENDING INSTITUTION LISTED HEREON. AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL iNSTITUTIONS OR SUBSEQUENT OWNERS. . ~DISTANCE$ SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USEO TO ESTABLISH PROPERTY LINES OR FOR THE ERECTION OF FENCES. DEC I1~ 1978 DATE · SCALE NO. . 78 - 357 CHICAGO YOUNG s YOUNG 400 OSTRANDER AVENUE RIVERHEAD, NEW YORK ALDEN W. YOUNG, PROFESSIONAL ENGINEER AND CANDSURVEYORN~S. LICENSENOI2845 HOWARD ~ YOUNG, LAND SURVEYOR N,~S.~ICENSE N0.4589~