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Home My WebLink About11262-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin~ Inspector Town Hall Sou~hold, N.Y. Certificate Of Occupancy No 2~ ] J .0.8.~ Date ~. P ~-.Y. ~IS CERTIF~S ~t the b~d~g ................................................ 30 Lnnd~ng Lnne ~9~ ~Aq~P~ ~ ~99 Oreenpo~t ~tion of ~ope~ .. ...................................... '~ No. ~t H~ 0 O6 ~W T~ ~ap No. 10~ ~o~ . 0~ ........ B]~ .Q~ ............ ~t ................. c~fo~s ,ub~t~y to ~e ~ppU~tJon for B~d~g ** .;~P~..~ ~ ........... 1~ ]. p~t to wHch s~ ~t No, ~.~.~. ;. ............ dat~ .... ~..~ ................. ]9 .~ ~, w~ ~, ~d c~s to of t~c appUc;b]e pmv~io~ of ~e ~w. ~e o~up~ for w~ ~ ~fl~to b ~ b ......... of ~e a~or~d Suffo~.~ty Dep~t of H~ Appm~ . ~ ~ r.~rPA,.. ~~S ~TI~IC~ NO ............................................... Buildtn~ Impector Rev. 1/B1 FOItM NO. TOWN OF SOUTHQLD BUILDING TOWN HALL SOUTH'OLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI~S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) at premises located County Tax Map No. 1000 Section ....~../.~.. ...... Black .!..(~ pursuant to application dated .......... ~.....~..~.. ...... Building Inspector. Fee ~... ................ ........ i.~ .......... ~,ot No..~...~g ............ ,...., 19.~.~./., and approved by the ~Building i. lnspector FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions Th~s 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: I. 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 ~nspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Cerhficate 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 Date .~fx'~_.~ ~ ~..-. .. ~ew Building ....... Old or ~re-existin~ Building{X) ........ ~ rVacant kand ........ Hou~ No, ~o'S~O~' 5 Street ~O&~ ~'~, Ham/et Owner or Owners of Property . ~, ~..~ Z ~.S .~.. ~.~.~..~).~.~.~)~' ............ o~- o~,~ , ........ Health Dept. Approval ............. Labor Dept. Approval ...................... ,.. Undo~ritors ApprovaJ..~ ~2¢~ ............. Planning Board Approval .................. ~.., Request for Temporary Certificate ..................... Final Certificate ........ - ......... Fee Submitted $ ............................. Construction on above described building and perm~t~meets all app~cable~co~les and regulations. loolo?1 THE NEW YORK BOARD OF FIRE UNDERWRITERS 'f!~ BUREAU OF ELECTRIC!TY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as ~scrlbed below and introduc~ by the applicant rtamed on the able application number in the preotlses of G. ~ - J. S~, c/o ~e~ Ave. & ~ ~., ~e~, I~. Y. in the follow~tg location; ~ Basexnent ~ Ist FL ~ 2nd FL Section Block Lot ~as exart~ined on ~ ~4 ~ ~2 a~d found to ~ i~ co.~pliance wtth the requirements of this Board FIXTURE OUTLETS 2~ DRYERS ~ECEPTACLES SWITCHES 53 36 FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS FANS iNCANDESCENT FLUORESCENT 2,8 SYSTEMS NO, OF FEET S E R NO O COND OF CC COND 2/O *Fucure Ap~li~me Feeder/aL 1-2#14, 1-2#12, 1-3~8 I~G.F,I. 2-Smoke Detectors ¥ I C 2/0 G & S gleco f3ox 215 Sough)id, N.Yo 11971 11c.$78-~ Th~s certificate must not be altered in any manner, return to the office of the Board if Inspectors may be ,dent the~ir cre~enhals. COPY FOR BUII~D!NG DEPARTMENT,. THIS C0PV ~F IN ANY MANNER. COMMENTS FIELD %NSP~CTION FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~DE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 /v/ . . 7" .......... , ~v . . . , Application ~o. Disapproved~ ~ a/c ....... '.~. .......................... ~. , ............. .................. . ., ........ ........ ~c~/~o -~ ,~-~,~ d~c~ A~PLI~TION FOR BUll_DING PER~!T INSTRUCTIONS a. This application must 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 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 giwng a detailed description of layout of property must be drawn on the diagram which is part of this apF cation. c. The work covered by this application may not be commenced before issuance of Building Pemit. d. Upon apprcval of this apphcation, the Building Inspector will issue a Buil&ng Pe~nit to ~e applicant. Such peru shall be kep~ on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any purpose whatever until a Certificate of Occupan sh~l have been granted by the Building Inspecton ~PLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Pe~it pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Re~lations, for the construction of buildings, additions or alterations, or for mmov~ or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, ~d regulations, ~d admit authorized inspectors on premises and in buildings for necessa~ inspections. (Signature of applicant, or name, if a corporation) ...4... ~... 5. ...... ~...~.~,.~,~ ~ .~. ~,/~,... (Mailing address of applicant) Iii ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildt ...... ......................................................... Name of owner of premises . 0'.QFi~J..S.~iv~..O.lg.I.D..I.S..-~ ?.lJ.S..D.Q .IJ.RV~..S' .................................... (as on the tax roll or latest deed) If applicant ~s a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No. '~'~.,~.. '..~:~:..~{.~.~.~c~.~?.d.. Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ ..... .~.e~.,~¢~. .~. /.-~. /.//.~. :~.w.~. /¥ ~.~.t. . .~.~.q. . ~. . . .L. e.,V. ?. ~.~. .q. . .L.,.,.,,.,¢. :..~.,r'.~.~.~..~.,=:.'-c,. House Number Street Hamlet County Tax Map No. 1000 Section .... ~ .~..--~. ....... Block .......~. .........Lot ..... ~ ......... Subdivision../d?.~'...q.~.. ,?/27/.~.~..c.t.~.¢'.../.~.~.q (~..~. ~.. Filed Map No....~. ?..c? ~ .... Lot .... ~- ........ (Name) 2. State existing use and occupancy of premises and intended use and occnpancy of proposed construction: a. Existing use and occupancy ........ .~.~. ?..~.r.'~. 5~. .... ./:_..e,.?~. ...................................... b. Intended use and occupancy ...... ]... ~..~..t.~..t..~.¥....'~.~. t~. p. ~..~. l~.i.~t. ~ (4 ....................... Nature of work (check whict) applicable): New Building ..........i~..... Addition .......... Alteration .......... Repair .............. RemOval ............. Demolition .............. Other Work ............... ' ~ ~ (Descriptign) Estimated Cost ........ . ....................... Fee ....... " ~' (to be paid on filing this application) If dwelling, number of dwelling Units... ~ Number of dwelling units on each floor If garage, number of cars ..... i ................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structurels, if any: Front ............... Rear .............. Depth ............... Iteight ~ Nun~ber of Stories Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... i. · Height ...................... Number of Stories ........... ,' ' '.~ D,mensions of entire new constrhction Front .... .4' ~ ....... Rear ....4' .d' ........ Depth .z. ' Number of Stories Z .. , Height ...... ~..~. ............................................................. .Size of lot: Front ...... 1.~.~..~..z.~L: ...... Rear ....t. ~7'.t. .~ .... '. Depth . .~. ,~.,.4.~'..qr ............ Date df Purchase .D~l.q, . J-2.,..i21.9.7 9.. ............. Name of Former Owner . fi.LIS .$O.~P~K:ES ....... ..... Zone or use district in which premises are situated .............. : ...................................... ', Does proposed construction vi,o!ate any zoning law, ordinance or regulation: ~ &t?..'~.~.'~... ,,~ .t~' .r+¢.~ ...... Will lot be regraded ..... ~ .~ ...... ,. ........... Will excess fill be removed from premises: ~ No Name of Owner of premises ~.~Ftt.,~.,,. ,%~'q".~h'*..,<.~.~(~ Address~/7. ~.~..,fl.~. rq.~.<~., g,,?. ~. Phone No. z. iA :~y~?~..7.~..z.?. I, amc of Architect :::~.,4.~.c?~ A{.~q~,~...~.,x{q~..,r~,rffr~..Address /g~.~./.4.~.z:...~'¢~,.r-//,f~.,~.. Phone No. Z~.-¢7: .~.~'f.4~.~.. Name of Contractor ........ i ................ Address ................... Phone No .............. PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions roperty lines. Give street and block terior or corner lot. from number or description according to deed, and show street ,lames and indicate whether TATE OFINE~YORK, .. ~ .,ou r 0y. .... (Name of individual signing contract) }ore named. being duly sworn, deposes and says that he is the applicant e is the .......................................................................................... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duty authorized to perform or have performed tile said work and to mtake and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. worn to b~fore me this .......... , /_Z.. ota,¥ Public, ...(-~).$,,_- lk~..('~ ..... :_;.,,,, ..... : County ~ ~ . : v- .., ..... ........... [ Qua!~f)e.-d ~x~lre~ ~lam~ (Signature of applicant) 'SERVICE.I -- FOR ~ ___ief. Services · ~ ~ co~Y. ~w~Au~v.~, · MAP OF L~.EE Nt ' 0 AT TrG'w'N Of' Tt4OI..D ~6 b JDL'Y ~ I 1980 RODERICK VAN TUYL, P.C.. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO HEALTH DEPT APPROVAL STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK EPT. O TH SERVICES. SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION O[~LY / OWNERS ADDRESS: TEST HOLE STAMP SUFFOLK~:O. HEALTH DEPT. APPROVAL THE WATER ~LY AND SEWAGE OI~SAL ~STE~ F~ THIS' .ESIDENCE WILL CONFORM TO ,THE STANDARDS ~ THE ' ~ ~' lq " /AAH MA-%VT AVV. ~UA~~ :'~i ~ ~ L ~ ~ ~ /~: 7" 'q~,, ~P~R~VED AS~ ~NOTED { ~ 'JO/Io W3~ ~ ~l~~ 5[>U ~ ~l~ ~U /O~~ NOTIFY BUILDING DEPARTM_NT AT ~ ~ i L : i,t F I ,Tm FOUNDATION - TWO REQUIRED ~j~ ' FOR POURED CONCRETE ~ ~* GY~,~D, T~ ~ ...... A5 ~ ~. ~NVAY 4. FINAL - C~h~TRUCTION MUST ~I~TIMG ~ /~G. ~Y T~ CODES. NOT RESPONSIBLE FOR '~'-- , - -- ~ -- - ~RA~~ PA¢~UCT~ DESIGN OR CONSTRUCTION ERROR, s' ~" · ~G" ~. ~1~ -- . terafion of this Document except Architect andEngineer's'Seal.L ~nd I by an Architect or Licens~ Profes- Si~natureoNygoodfdt~ial useof ' ~0 ~~ OU~/AAO ~ d~kh sionalEngi.eer, lsilleBl,,. ' drawing, Changes, alteN~ns or rm ~ACCO~ AHLE~S& ASSOCIATE Section 7209,Subdlvlson' ' 2e visionsto orre-use o{ ~r~ings with' Architect~ & Engineers N. Y. State Education 'Law~ out Architect or Engine's ~proval ~~- ' - . ~;Y. : voids Seal and Signata?9~n:: same. 54655 Main Road, Boxs16.T6S.54551412 8outhold, New York 11971 .DOT~ C_:~-E H-E't~ A L ~T'E~: I : ~ ~ I J [ ~ACH %VAY ~= .... ~,~u ~" _ ...... , ~c~ ~ Y~"* I~'' ' ~ I "Alteratlon of this Document except A~chitect and Engineer's Seal and ~AC[O, AHLERS by an Architect or Licen~d Prof~ SJgfla/ure only ~od for ]flitial use of Architects ~ drawing, Changes, alterations or r~ ~ ~ slonal Eng neer, Is illegal . visions to or re-use of drawings with- s46ss ~ MIR Rend, Box llJ12 Southold, New York ll9?l ~AF ~'¢ Secti°n 7209' Subdivisi~ ~ out Architect or Engimr,s Approval N.Y. State Education ~w. voids ~aland Signature on ~ame. ~c--ALC ,~'= I'- 0" "Alteration of this Document except by an Architect or Licensed Profes- sional Engineer, is illegal". Section 7209, Subdivision 2, N.Y. State Education Law. Architect and Engineer's Seal and Signature only good far :[nitial use of drawing Changes, alterations or re- visions to er re-use of drawings with- out Architect ar Engineer's Approval voids Seal and Signature on same. CA%T .~C-AC-'~' 7-r": i'-o" I T__ LT__VAT ILO,, SACCO, AHLERS & ASSOCIATE Architects & Engineers 54655 Main Road, Box 1112 Sonthold, New York 11971 516-765-5455