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HomeMy WebLinkAbout11264-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z. 1..1.2y.3. .......... Date Oc~,obev 21 THIS CERTIFIES that the building ................................................ Location of Property 515 Gin Lane S0ut;hold Hi~dtse hid ....................... 'S't/e;[ ....................... County Tax Map No. 1000 Section . 9.8.8. ....... Block 04 .Lot 005 Subdivision....B.a.7.. !t.ay. gn' ................ Filed Map No. 2..9.1.0....Lot No. 20 conforms substantially to the Application for Building Permit heretofore filed in this office dated ...~.91r .2.9. ........... 198..1. pursuant to which Building Permit No...1.1.2..6.4..~. ........... dated . .d.u. 1. 7...3.0. .................. 198. 1.., 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.~.;?.a.%e.. 9.n.%-.tT..a,.%~.y...a.~.o. % ;.~.n.g.: ........................................ The certificate is issued to ..... 4a. t~agp..P. :. !~e. 9' .&..w.~..r ? ................................ (owner, of the aforesaid building. Suffolk County Department of Health Approval 11-$0-53~ ?/22/82~ Rob%. !~, ~/il].a~ ..................................... P; E',' UNDERWRITERS CERTIFICATE NO. N--A 589638 Building Inspector Rev. 1/81 FOR~ NO. ~ TOWN OF S~UTHOLI~ TOWN H~LL SOUTHO~D, N. Y. BUILDING PERMIT, (THIS PERMIT MUST BE KEPT ON THE PRE/~IS~ cOMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N©. 11264 Z ,9..?./ Permission is hereby granted to: ~0 ..... : .......... T ......................... ~ .............................................. -,~..,.~ ................. ~ .............................. ~t premises located ot ............................................................. m'? ................. ~ ....................................... Coun~ Tax Map No. 3000 Section ................ Block .~.,,.~,- ............ ot ......................... Building Inspector. Fee $ ...... I / ,Building Jr~pectot FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Halt Southold, N.Y. 11971 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 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 o'r 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" ~and 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 prem/ises, 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 $5.00 New Building ..... ¢....... Old Location of Property . .~..l~.~'.... House No. Owner or Owners of Property ... Date ..... or Pre-existing Building(Z) ........ =/Vacant Land ............ Street Hamlet . . . .,,, . .... '+ . .¢. ?, . .., .................. County Ta× ~ap No. 1000 Sect,on . ..©~.~. ...... B,oek ....0..~. ....... Lot...¢...~.. ........ Subdivlsi°n"'~''(~..7~ ............ FiledMapNo..~..~/.(.~...LotNo..~..~. ........ Health Dept. Approval..1.! .~...~.0..:..~-.~. ....... Labor Dept. Approval ...N~. ................ ,.. Underwriters Approval . . ./~..'2¢ ................. Planning Board Approval ............. ~ . . ~ Request for Temporary Certificate ..................... Final Certificate ................. . Fee ubmitted ............... Construction on above described building and permit'meets all app.!~cable~co.des and regulations. Applicant .: ....~J~. .................. /. ............................... ,-.,o.,0.,a 20 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 41 STATE STREET, ALBANY, NEW! YORK 12207 THiS CE~IFIES THAT only the e~tdcal equipment ~ ~scdb~ ~ a~ i~t~uc~ by t~ applicant Mm~d on the a~ applicatio~ numar ir~ the p~mises of in the followi~$ location; ~ Basement ~ 1st FL ~ 2nd FL ~ctlon Block ~t w~ exami~d on ~f~'~ ~1, 1982 and found to be in compliance w~th the r~qatre~nts of thcs Board. FIXTURE OUTLETS SWITCHES 20 23 DRYERS FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OTHER APPARATUS: i~,.,.F. I, E n 'v ~ c COND A W G NO OF HI-LEG A W G NO OF NEUTRALS A W G PER ,~ OF CC COND OF HI-LEG OF ~EIJT~L ~ 4 1 4 lie. 578-E il COPY,,. FOR BUILDING DEPARTMENT. THIS Ga .ALTERE~ .., IN ANY MANNER. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-180:3 Examined ....... . .,~..c/..(.0, 19. Z~ Approved ...... .'~.~.'./'t...(.[?., 19.~Jl Permit No.. Disapproved a/c .. ..... ' ' · · ' '~' ~'.LLL ....... .:_:' ....... .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No./.f..~...~..c/ ...... INSTRUCTIONS a. Tins 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 be kept on the premises available for inspection throughout the work. 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 regulatmns, and to admit authorized inspectors on premises and iii buildings for nece~cti.o,~~t~ ~~ lfi~;~';t~r'e of ap"''' '~lican~, or nd'" ~'''''' ~n'e', i; ~ 'c;;~;;a't[~) .... (Marling address of applicant) //~ ~, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .................................................................. N ne of owner of premises ? .................. ('a~ 'o'n' t'~e' ~a} ;o'li ~ i~t~}t' ~c~) ......................... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... 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 Block .... Subdivision.. ~. 7 ...... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, ~i~tin~ ~ a~d acc~a~cy ..................................................................... b. Intended use and occupancy ........... q(q' [ ..... ~.t].t.~ y ...... P.~.E ~ ~ ~ ................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... pal . Re r .............. Removal ......... Demolition .............. Other Work ............... ~ . ~o ~ (_3 ,L, (Description) 4. Lstlmated Cost ................ } ..................... Fee ................................... : (to be paid on filing this application) 5. If dwelling, number of dwelling.units .t~/~..~. ......... Number of dwelling units on each floor. I~ ./~.t~. .......... If garage, number of cars . ~.~/..Z~. .................................................................. 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. I)]mensmns of ent:re new construction: Front ... ff~ .-. (2) ?... ~ear .. ~.~..-.~ ...... tJ,t,[ .,~ ............. tteigh~ ~. [O.: ......... Number' of Stones' .OA/~. . ................................................ Size of lot: Front . 1 Z.~; ..... i ........... Rear I ............... .. Depth . I ~g. ................ Date of Purchase .~. ~ ~..~. = .~'..~. ............... Name of Former Owner . .t~../q/.~./V.....~..~'.Z;..~.,~ .......... Zone or use district in which pr~mises are situated ..................................................... Does l~roposed construction violate any zoning law, ordinance or regulation: ~/~ ............................ Will lot be regraded ~..~.~'..., i ....... ..~ ............ Will excess fill be removed from premises: Yes Name of Owner of premises d, ~./ffO..~..('f~./.,f'..~... Address .~.~.-~'.../~...O,~.,~,f~.~', .~.. Phone No~,/2"].~. Name of Contractor ,~.,./l/~,~..O ............... Address ................... Phone No ................ .9. 10. 11. 12. 13. 14. PLOT DIAGRAId 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 to deed, and show street names and indicate whether interior or corner lot. Ill STATE OF ~NEW YOR.I~ , COUNTY OF i .... ~Y~.~..~,. ........ ~.~ ...... : ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .... .~'. ff~.-~?.--~ .....~..,~'f. ................................................. i (Confractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application i 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 ....... .~...~...~.~.. ........ d/aY~ ~;~..~..~..'~~. ......... , 19~..~. Notary Pub!i .... x .... WILLIAM D. mA , · · Notary Public, State of New York I " ~ .............. Qualified in Suffolk County ' ~/ (Signature of applicant) Commission Expires Mar. 30, 19831 DATUM APPRoXIMXTE ~; LOT AREA 15,625 SQ FT 'FAX MAP DISTRICT 1000 SECTION 88 BLOCK 4 LO T 5 J iT ~OR)NG others ) 7O "It ~ou.ki !~ noted that ~ is ioc~ed iR an o! ~, ~e possibility exists water supply may cento amo~ts of pesticides andl or Spetial analysis"F'gHHC re (64) fd LU pin Z o o _j ,- ice this icultural hat the o trace ~red. ~,,, 'to LOT NUMF~ER 21 VACAHT S 52"05'50"E (64) .... ~o 0 -- '0 o 12500 fd pipe 01 'W 03'N (78) ~ ¢~ ¢1 FC 04~N z (83) ~ 05 w~ (8.0) I (g 2) --, 5 oo . o..w ~grav,, J~ / LOT NUM~E~lg x~J ¢tF4 m DWELLING - WI L ~DD~ESS "EF. NO. //-_S ¢ - ~ I DE[T~F HEALTH SERVIC'ES I LINES ARE FOR A SPECIFIC pUR- · )P~ ~ SURVEYED ,FOR JAMES MEO FCO3'E O1'S GUARANTEED ONLY TO HAROLD f. TRANCHON ,IR PE~N ic, ~0 2,1115 "~c IO'N ion O9'E IAVEN MAP OF ~AY HAVEN AT SOUTHOLD SITUATED AT SOUTHOLD TOWN OF $OUTHOLD - SUFFOLK COUNTY N Y SCALE 1" = 30' DATE 9- 2- lg80 FILED MAP NO, 2910 DATE 1- 22- 1959 BOOK NO. ,L,I- PAGE BAROLD F. TRANCHON JR. P.C. LAND SURVEYOR $~CESSOR TO WILLIAM G. MEIER NORTH COUNTRY ROAD - WADING RIVER NEW YORK 11792 · (16) 9Z9~ 69§, ALT. 473-3§Z6 DATUM APPROXIMATE LOT AREA 15,625 SQ FT fax f'~AP DI,STRICT 1000 SECTION 88 BLOCK 4 LOT 5 TEST ESORIHG (by others) EL 70 gravel 5 water (64) fd p*n Z o o OJ ~ Z (8.0) bX W ~~l'%×[stence of right of ways and or easements ~,X ~* o~~ot ~he sewage disposal and wate~ suppl~ ~acilities for this looation have_bee~ ~ ~nspected by ~his department ~d C~ef o~ 'geaera~ ~nee~am LOT ~ 2~ VA C A H T S 52°05'bO"E 400 o o I STY FR DWELL 21,2 mfgn N 52°05'50"W LOT NUMBER 19 DWELLING WELL FINAL SURVEY APRIL 15,1982 Id p~p¢ Oq'W 12500 (78 03'N ~-I C 0 3't- ~0 0 1' % o F C 0 4'N :_ 0 5'V~' ,e'~'" (9 2) w O0 r, ()9'~ WIVe SUFFOLK COUNTY DEPT. OF HEALTH SERVICES FOR APPROVAL OF CONST. ONLY DATE H.S. RET. NO.. APPROVED BY GUARANTEED ONLY TO 42~992 HAROLD F. TRANCHON lCN · ~:gi . ;' . N . iis-E THE WATER SUPPLY & SEWAGE DISPOSAL FOR THIS RESIDENCE WILL CONFORM TO THE STAND- ARDS OF THE SUFFOLK COUNTY DEPT. OF HEALTH SERVICES NAME ADDRESS ! , TELEPHONE GUARANTEES INDICATED HEREOI~ JoB NO ~0- 343 FILE NO. BAY H'AV~:N FOR WHOM THE SURVEY IS PrE- SURVEYED FOR JAMES MEO TAt AGENCY AN9 LENDING IN'TI- LO T NO 20 INS31TUTtO~ m)AranteEs a~e MAP OF ~AY HAVEN AT SOU THOLO INSTITUTIONS O~ SUBSEOHENT SITUATED AT SOUTHOLD COPIES OF TiS SURWY ~AP NOT TOWN OF SOU THOLD - SUFFOLK COUNT Y CEASING THE LAND SURVEYOR'S SHALL not 8e consm[rE~ to ~ SCALE 1" = 30' DATE 9 2 FILED MAP N~. 2910 DATE q - 22 - BOOK NO. L,L PAGE LAND SURVEYOR SUCESSOR TO wILLIAM G. MEIER NORT~ COUNTRY ROAD - WADING RIVER NEW YoRK 11792 (~16) 929-~695 ALT, 473-3626 f ) · ~Z~.s 3~ OCCUPANCY OR APPROVED AS NOTE~ /ZEE' -.~3 ~ BY: NOTIFY BUILDING 'DEPARTMEN'r A:¢ 765-1802 9 AM TO 4 PM FOR TH~ ' "- - USE IS UNLAWFUL 1, FOUNDATION - TWO REQUIRED ../~.~K) .~/~ FOR POURED CONCRETE '~" ' JIF I:)CCUPANCY ,.'NSUL^T,ON ~'x ,~-ZDO~' J~/~'/-~ 4.FINAL - CONSTRUCTION MUST ,, ,, ALL CONSTRUCTION SHALL MEET ~x~ /~0X ..~/~ THE REQLBREMENTB OF THE N Y, STATE CONSTRUCTION & ENERGY CODES NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. /z --,/:° I TITLE F -1 L