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HomeMy WebLinkAbout11066-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No ....... Z. 1. 97.7A .... Date ....... ~.qVo~.b.~'. J.3. ............ 19. B. 1 THIS CERTIFIES that the building ................................................ · 2490 Highland Road Cutcho ues New .Y.q~..k... Locatton of Property ............................................ .~ ........ House No. Street Hamlet County Tax Map No. 1000 Section ..... 1. 0..2 .... Block ...... q~ ....... Lot .......... .~ .... Subdivision... ~I;i,ghla;a.d. ga.t.a~;ea ......... Filed Map No. 653.7 .... Lot No ..... 29 ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..I~.a..~9.h..h0 .......... 19.8 Spursuant to which Building Permit No.110.6.fi .7. .............. dated ........ H.g e. 9 ia..23 .......... 19... Oxl, as 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 ......... ................ e. 9.n. 9 ................................ The certificate is issued to ...... ?.5. Hl.gh 1 arid. R o~td. C oJe. p ............................ (o~mer, of the aforesaid building. Suffolk County Department of Health Approval . . 1. .1 .- .~. q -. .2 .0 j . . 8. ./ .3 J./.8. 1. ,. ?. ·..&o..7..5..]..3..a...P~ .~, UNDERWRITERS.CERTIFICATE NO ....... }1.53152.Q .................................. Rev 1/81 Building Inspector FORM~ NO. 2 TOWN OF ~OUTHOhD TOWN -HALL SOUTHOLD, N. ¥. BUILDING ~ PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL EULL COMPLETION OF THE WORK AUTHORIZED) N©. 11066 Z Permission is hereby grarited to:~ ........ ~.,:-..,;'.e/.~.,~. ~.....~z.z.~'./.~ ........... ......... .......... ~ ...... ~z~.....~z~...~.~....~Zz~...~.;..::=: ........ ................................... 7~..~.~.~*~ ~ ~~'""~'~ ........ ~.., ........................ ~ ~,~ ,o~ ~ ..~r..~.....~.~....<s.~...~ ........................................ ~t ~ - .................................................................................................... ~ ................. ........ ~ ......................... cou.~ w~ ~, ,o. ~ooo s~,io, ...5~.~...... s,~ ....~ ........ ~o, ,o...z..~..: ........... Building Inspector, ~o *..~.~....~:~ ........ : / / Bu~ldlno I~ctor Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD 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 lnspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of al/ 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- t~ons, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed s~te plan requirements where applicable. For existing I~uildmgs (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 naturat 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 ....,x ................ New Building ............ Old or Pre-existing Building ............ Vacant Land ............. ............ ........ Owner or O ners Property ............................. County Tax Map No. 1000 Section .. [.~...~.'3('/ ....... Block... ~ ......... Lot.. ~..c~..... Subdivision Permit No ........... Date of Permit .......... Apphcant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate Y'- . .Final Certificate Fee Submitted $ ............................. Construction on above described bu.lding and ~~~, ,~.~Z,~e~ns. Rev. 10-10-78 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 buddings, 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 buddings (prior to April 1957), Non*conforming uses, or buildings and "pre-existing" land uses: I. 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 .............. New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........ ~-~ I'~'~ \~.wt~ .~.~,, ,... House No. ' ...................... 'S'treet .................. ~,~r~/'e~ Owner or Owners of Property ........................................... County Tax Map No, t000 Sect,on ~.R..~. ........ Block., .O..~. ........ Lot..~-..~. ........ Subdivision....~...//~.~_~..~'~...~'.-~.,./'~.,~. ........ Filed Map No. ,~.~.,~..7..Lot. NoI ,.~......, Permit No ........... Date of Permit .......... Applicant ......................... Hea,th Dept. Approval., .//.~....~.~...:. ,~..~....Labor Dept. Approval ................... U nOerwriters Approval . . .~... ,~...~..~,, .~., ,~, ....... Planning Board Approva,' ' 'l~/' ': ' '~"" i: '\' ' ~'/~'~'V Request for Temporary Certificate ..................... Final Certificate ........... Fee Submitted $.. ~.. ....................... Construction on above described building and pe~ m~t~l~l app~abIe c/q~des and regu lations. Rev. 10-10-78 looo68l THE NEW YORK' BOARD OF FIRE UNDERWRITERS -,' - ' ' BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ., o.te ' AuguSt 13, 1981 Avplic.t,o. No.o.$il. 122a14-81 N 531520 THIS CERTIFIES THAT o~ly the glec~rical equipment ~ described below and introduced by the oppllca~t ~amed on ~he able application ~umber i~ t~ premises of ~tcho~ N.Y. ~q' ~,, L~ ~ in the fotlowlng locatlon; ~ Basetnent ~ l,~ Fl. ~ 2ndr,.- °kA~& ~ ~..a,,~a o. Au~ k0, ~98~ ..d ~o.~d to be in compllanee wltb the requirements of this Board. ~ ~ ~ RX~Ua~ FIXTURES RANGES COOKINGDECKS OVENS DISH WASHERS EXHAUS? FANS 19 17 SYSTEMS NO. OF FEET E OTHER APPARATUS. 1 Sr~ke Detector E R 1 3/0 V I C NO OF HI-LEG A W G OF NEUTRAL 3/0 Paramo%mt Elec. Co. 2041 Shelley Pl. , East ~a~, N. Y. 11554 Lic.f/533 11 F~ELD INSPECTION FOUNDATION FOUNDATZON (2nd) ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CO E FINAL DATE COMMENTS ~DITIONAL CO~TS: FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined F~?..~5~..~... ~...~., 1 .~. Approved ~.~. · . .~. · . · .~..~..., 19°~. Permit No. Disapproved ale ...... ".~. ..... .~ ................... ............ :...-... t.!~. ..................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application No. ~/./..C~:. 4 ......... Date//.//~.~. ?./ ................ ,19... 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 ~nspection 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,.forJemov~l or demolitio~,~,as he_re~.n described. The applicant agrees to comply with all applicable laws, ordinances, bkvit'di~odj)~hoj ~i~,g~Dde,~d reg~tions, and to admit authorized inspectors on premises and in buildings for nece~ ~..~...~..~.. (Signature of appl~ tnt, or/ga'me, if a corporation) ,, ............... pplicant) State whether applicant is~ssee, agent, architect, engineer~_~ral contra~electrician, plumber or builder. Name of owner of premises ?..~. · .~../'.~.~ .l~.At. ~...~?.~.. dQ .P2.~. ................................. (as on the tax ro~or latest deed) If appH/~r~a~f d~o~d officer. Builder's License No ................. D .... ~. · Plumber's License No.. ~. ~.. ~¢~ Other Trade's License No ...................... 1. Location of land on which proposed work will be don~ .................................................. . . ....... . . . . .2.:L. .......... /. ........................ House Number (,/ Street (jrt tamlet / County Tax Map No. 1000 Section ../~...~..... Block , ~ Lot '~'~:P ... /~t' 7~'J,~ 7~..,~.'?.~. ..... .~?.?./ ....... Lot ..'~.~. .......... Subdw~s~on ...... ~' ~' ~?"' (~q'a~)' ~ ' Filed Map No. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................. .~ ........................ b. Intended use and occupancy .............. 1~. .............. .~ ...... ',~ ~'~.t.~': i' ~.:.~:'..,. ~. ................ 3. Nature of work (check which applicable): New Building¥~ ....... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition ............ Other Work ............... gt/,,~, .~¢~ ~O e~. 7~? ~-- (Description) 4. Estimated Cost.. ' Fe r. ............ (to be paid on riling this application) 5. If dwelling, number of dwelling units ....... l ...... Number of dwelling units on each floor./. ............. If garage, number of cars ...... 2-~ ....................................................... ' ........ 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 oLStories ........ ,-,,.~ ......... 8. Dimenslon~._~f~ntire new construction: Front...~..(~ ....... Rear .~.. *- .~- . Depth . .~'~t~: ........ Height ..~.~. ......... ~,un~b,e~ofStories...~. .... ~ ....... ii.iii.iiiiiii ...... ..i ..... i ....... Size of lot: Front .../.~. ~.: ..~.[ ......... Rear.. ~.(~..~. ,.././. ......... Depth . '.M.C?.~p.o..O..~,, .......... Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated .................... :~t~ .............................. Does proposed construction violate any zoning law, ordinance or regulation:'.~ .......................... ~ Will lot be regraded .. J~ff~.. i .................. Will excess fillhexemoved from premises: _ Yes ~ Name of Owner of pre_~/~ses . .~.t~ .~4...ct. ~ .... Address, ,~,-~;~;~,-.~. ~: ...... Cg~gne No..~.7(~.~,~. 4 ..... Name of Architect ./,'~, .f'f..]..~..~.o~.~ .~..~. 1] ....... Address .~.°-r., ..~,. ~°~.~ .g~. ?.t. ~gone No...~. 2. 5~'~* .2:.. ~... N e of Con r c or . ./ff.°.~4~/ ~ L~o~,~g /-~ ~4./g/q-Ot~ Phone ~ln ~, ~/. dt/~-/' am t a t ..... .~ ................. Address ...................................... 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from properly lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF.. ............. · ~g.~.~. '~' · .~.. · .~..~.~..~.~.#.~.. ........ being duly sworn, deposes and says that he is the applicant (Name o' f individuM M~ing contrait) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly author~ed to perform or have peffomed the said work and to m~e and file this application; that all statementh contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in th~ner~) f~ i~ the a~plication filed therewith. Swo~ before me this ~~~ ~ Not~yPub!ic, ..... ~ ...... x ....... County ~/f~ ~ / ~ ~ ~ ~ ~ ._~ / / ~ ~gnature oiappficant) SURVEY FOR FOR APPROVAL OF CONSTRUCTtOH OHLY ~WN ~ ~O~OC~ sc~cg* / ' ~ ~0' SUFFOLK COUNTY, NEW YORK ~o 8/-93 N U~UTHOR~ZED ALTERATION OR AOOiTION ~ mis SURVEY ~ VIOLATIO~ ~SECTION 7209 OF THE ~PROVED ~gw YORK ~TATE EOUCAT!ON LAW THE ~RSON FOR WHOM THE SUWEY IS PREPARED HEALTH DEPARTMENT-DATA FOR APPROVAL TO C~STRUC T ANO ~ HIS BEHALF ~ THE TITLE C~P~Y, GOV~N- ,~ ~ '~ ~: , ~ ~UF~K COUN~ ON A~ ~6, 19X~ AS ~E NO.~ ALDEN W. YOUNG, PROFESSIONAL ENGINE ER ~ AND~%AND SURVEYOR N Y.S UCENSE NO. IZ845 ~ ~ HOWARD W. YOUNG, LAND SURVEYOR ~L~L(W),~PTICTANK(ST)aCESS~OLS{CP)~NHE~E~ ~ ~ ~ N.Ys LICENSE N0.45895 * ~ ~ FI~ ~SE~ATIONS ~D OR DATA OeTAtNED ~0M OTHERS TDY POST ~0494 $~8VEY ~0~ LOT NO. 2~, "HIGH. ND ESTATES" M~ ~, ~N OF ~OU~OLD SCALE /' - ~O' SUFFOLK COUNTY, NEW YORK No. NE~ YORK STATE EDUCATION L~W HEALTH DEPARTMENT-DATA FOR APPROVAL TO C~$TRUC T A~o ffi HIS BEH*LF m THE TITLE C~P~Y, eOV~.- ~ NEAREST WAT~ aAIN~MI ~ N SOURCE OF WATER ~I~TE ~PUBLIC ~ MENTAL A~ENCY AND LENDING INSTITUTION LISTED ~S~FCO TAXHAPmSTIOO~SECTION;O~ B~CK ~ LOT~ fl~E~,ANOTO mE ASSteNEESOF THELEaDIN6 TO ADOITIONAL INSTITUTI~S OR SUBSEQUENT PROPE"TY LINES OR FOR THE E"ECTION ~ FENCES ,g, I m 1 V~l I~1~ ~ V~l IAI~ ~OS~ANDERAVENUE I ~ / /~UI~ ~ /~Ul~ RIVER~AD, NEWYORK ~SUFFOL~ COVN~ ON ~P~ ~, 197~SFI~ENO.~3Z ALDEN W YOUNG~ PROFESSIONAL ENGINEER ":ET~[ ~ J AND LAND SURVEYOR N Y.S UCENSE NO 12845 ~ ~ ~ HOWARD W. YOUNG, LAND SURVEYOR ~ L~T~W~L(W},SE~ICTANK(ST)aC[SS~OLS(Cp)SH~HH[R[~ ~ ~) NYS LICENSE NO 45893 ARE FR~ FIELD OBSE~ATIONS ~O OR DATA OBTAINED F~OM OTHERS "It should be not~ that since this pro~rty is located in an agricultural ar~, fhe possibility e~sts that the water supply may contain trace amounts of pesticid~.and / ~ nitrates. S~cial a~lysis ~ be re~ired. ContrgU this ~ffment pri~ to sampling". ~URVE~ MOHRING ENTERPRISES SUFFOLK COUN~ D~PARTMENT OF ~LT~ S~RVICES LOT NO. 29, "HIGH. ND ESTATES" FOR APPROVAL OF CONSTRUCTION ONLY AT CUTCHOGUE OATE MAR DATE '~ . .~ ~ ~ O. ~ ~UFFOLK COUNTY, NE~ YORK NO. El- 9~ ~PROVED su~vz~ ~ ~ V~o~T~o~ ~ SECTtO~ ~2o~ O~ TU[ NE~ YOR~ StaTE EDUCATION L~ ' ~COPIES ~ YHIS SURVEY NOT KAR~G THE LAND SURVE~R'S INKED SEAL OR EMDOSSED SEAL SHACC ~ NOT BE CONSIDERED TO BE ~ VALID TRUE COPY XGUAeANTEE~ INOICATED HEREON ~ALL RUN ~LY ~ HEALTH DEPARTMENT-0ATA FOR APPROVAL TO C~STRUC T ~E ~R~N FOR WHOM THE SU~EY IS PaEPAeEO I ~/~ /¢~ '' ~ ~/ ~// ~1YOUNG sYOUNG ~OS~ANOERAVENUE NOt~: SUSMVI~ION MAP P/LED IN ~ O~FICE OP~E ~Nff - RIVER~AD, NEW YORK ~u~F~ff COUNTY ON AP~ ~E, 1977AS FILENO.~37 ALDEN W. YOUNG~ PROFESSIONAL ENGINE ER AND LAND SURVEYOR N Y.S UCENSE NO. 12845 HOWARD W. YOUNG~ LAND SURVEYOR ., N ~ L~T~ ~ W~L(W),SEPTIC TANK(ST)a CESS~OLS(CP) IH~N HERE~ N,Y S. LICENSE NO 45893 ARE FR~ FIELD OBVIATIONS ~D O~ DATA OBTAINEO FROM OTHERS --, I I' ,C~L. AppRQV~-D AS 'NOTE~,~ r ~.~ I DING 765-1B0~ 9 AM TO 4 PM bu~ tn~ iNSpECTIONS: FOLLOWING - 1. ~OUNm~TION - ~0~ Pmt)~O cONCRETE ~, ~Otl~l ' FRAMING & pLUMBIN~ ~, INSH~ N DESIGN OR CONSTRUCTION ERRORS. r ......... ±!-? LL~q' 6 DL. -F ~o L,) T T.L..~."//~-t' I' 0 M