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HomeMy WebLinkAbout11067-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... ~;J.0.5.96 ...... Date .... .J'.u.i. Ir..2.2. .................... 19.8.1. THIS CERTIFIES that the building ................................................ Location of Property 1t95 Iti6hland Road Cutcho~ue~ New York - fi$~s~ ~'o: ...................... 's'~/e~i ...................... County Tax Map No. 1000 Section . .102 ....... Block ..... 8 ......... Lot .. 2. ............. Subdivision..I~$gla;1..~r~qt. ;E.~.g.g.t,.e.~. ..........Filed Map No. ~3 ....... Lot No. ,5 ........... conforms substantially to the Application for Building Permit he[etofore filed in this office dated ........ ~l.e,~.q: h..1.1 ..... 19 , .8. l>ursuant to which Building Permit No... 1. 10.6.7. . g ........... dated ... ~e.~. ch. 2.3 ............... 19 8.1., 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 ......... ....... t'r.l,~.~.e..qne. Y.~$~t¥..D.~. ,;I.;1,~.~ ......................................... The certificate is issued to ...... Jt.l, gll[alld, lt!o.a.d. ¢ox'.p., .............................. (owner, le_Ee2,or,, ten_a_n[}__ of the aforesaid building, Suffolk County Department of Health Approval ....... .1.1.-.80.-2. t. ~. ?/2.2 ZS.1..R.g...l/.t.J.l.a,~. ,P UNDERWRITERS CERTIFICATE NO... 1~5277.1.~ ..................................... Rev 1/81 FOI~M ~0, TOWN OF ~UTHOLD BUILDING TOWN HALL $OUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES COMPLETION OF THE WORK AUTHORIZED) UNTIL FULL N©. 11067 Z Permission is hereby granted to: County T~x Mop No. 1000 S,ction ..... pUrsuont to application d~t~d ....... ~.~ ................... , 19. .~ *nd opprov~ by tho BUilding Inspector. .... .... / '~ ,~uilding ~lnspector Rev, 6/30/80 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 propertv with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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, Multipte Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planmng 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- t~on 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 New Building ,....M~.. ....... Old or Pre-existing Budding ............ Vacant Land ............. Location of Property ¢~S' .z~..J~./~-~ /'~ ............................................................ House No. Street Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section .. ,/~;~ ....... Block ,..~. z~. ......... Lot, .' .(~..~. ......... Subdivision .... .~..~:~ /,2~..~.~....'~.?,',~..~-~.~. ,~. ...... Filed Map No ........... Lot No....~.. ........ Permit No. ~/.~,--.~. :7. Date of Perm.t .~. '~..~..~J~Appticant, ,~,J,'.~,...'~/,~.~'~ ............... Health Dept. Approval ../~..~ ................... Labor Dept. Approval ........................ · 5' 2 7'~'/~.i Planmn Board A r Underwriters Approval ....................... 'g pp oval ................... Request for Temporary Certificate ..................... FinalCertificate .~, .... , .........., Fee Submitted $ ............................. Construction on above described building and permit meetsCii'l~ppJ~abl~d~es and/ICegulations. ~IEL~ INSPECTION FOUNDATION ( J st ) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENTERGY CO~E FINAL ADDITIONAL COMMENTS: loaoo i THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 l-- ,.luiy lb, 19~1 ~ppt~.tlo.~o.o,,/i~ 122816 ~ ~1 THIS CERTIFIES THAT 75 ~n~:'~l~ tld~ (,~, ~ ./ ~,l.a~cl ~,, 'n/of Rt~. 25, (~tc~gu~ ~ the /otIowtn~ Iocat~o~; ~ B s nt ~ Ist FI. 34 34 FIXTURES ~ 2nd FI. See,,on10/Block ~ Lot ~ and found to be in complla~ce with the requirements of this Board. RANGES OVENS DISH WASHERS I EX~U~ FANS DRYERS SYSTEMS NO OF FEET E OTHER APPARATUS. E R V I C OF CC COND A W G NO OF HI LEG A W G NO OF NEUTRALS A W G PER ~' OF CC COND OF HI LEO O~ NEUTRAL L 3/0 L 3i0 GENEI~AL MANAGER This certificate must not be altered in any manner, return to the office of the Board if incorrect, Inspectors may be ~dentifled by their credentials. COPY FOR BUILDING DI:PART~MENT. T~IS ~OPY OF CERTIFICATE Mu~T ~OT BE ?LTERED IN ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ................... .... (Building Inspector) APPLICATION FOR BUILDING PERg~IT Application No./'.~ .O'.(.'7 ........ 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 apphcation, 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 budding 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, buildip, g,'~bd~housing code,/affid reguJ,jttions, and to admit authorized inspectors on premises and in buildings for neces~~~..~/'~' ' '~ /~'S~plic ,~?t, or.~,, if a corporation) ~._~ (M,aiJing ad~res, s of~pplicant) is,,o~'f~lessee, agent, architect, engineer, general contractor, electrician, plumber State whether applicant (as on the tax roll or latest deed) If ap~i~~, '~ature~ du~ auJJtorized officer. · ...... Builder's License No ............. ~.~) ......... Plumber's License No. ~/6~'~'.. ~...~...~.d..~.c. ~ Electrician's License No. t~ .. f .................. Other Trade's License No ...................... 1. Location ofland on which proposed work will be done. .&/.q.7~. . ?...~....&~.~../~..~...~...~)..~..~...~7'.. ........... ~c ~5~u~' ~r ............................................ Street ¢ '~~ ....................... County TaxMapmo. 1000 Section ./~¢ .......... Block.. ~ Lot~ ~ Subdivisio~ ..... ~ .~Z~ ~.~. ........ Flied Map No. ~ ..... Lot ~..~: .... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ...................... ...... . ..................................... ,, .......................... 3. Nature of work (check which applicable): New Building ,/'%-~ ..... Addition .......... Alteration .......... Repair .............. Removal ............ Demolition .............. Other Work ............... /~.~/ ~ (Description) 4. Estimated Cost .... .~.~ ~... '.~ ................... Fee .. . xf.-tc ............................ , (to be paid on filing this application) 5. If dwelhng, number of dwell~,,units . ./ .......... Number of dwelling units on each floor..../t. ........... If garage, number of cars ................................................. ; ...................... 6. If business, commercial or mixed occupancy, spe~/fy 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 ...................... Heig~ht ....................... Number of Stories ............. , ....... 8, Dimensions of e~ttire new construction: Front..~...7., ..~. ..... Rear , ,~, ,~.: (5 .... Depth .~. ~.. ~.~. .... Height . ..('. ~ .~ ....... ~J?mber of Stories..~t~..../. ............ i .... ii. i.. i. i ...... i.. i ..... Size of lot: Front ....~,../..'/.: .7.~. ........ Rear...2../.~/.'.../'..~. ........ Depth ./...~..,..~'..~..... ........ Date of Purchase ............................. Name of Former Owner ............................. Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: . .,rf~.. ......................... Will lot be regraded ....... .~,,a,, ? ................ Will excess fill be ,r,e~cnoved from premises: Yes_. , Name of Owner of pre~3ises ~A~.~/.~ e,~ .~. O~C-~.~./t,p. Address . .~..,tZj~. ~/~ .oq. Phone No..¢.7./.-,._O~._.~/.,..."Z Name of Architect . .~.~.~, ./../~./.o~c~,..r~..t .......~.. Address . ~ ~(o..,t..~.~.~../e~.~mne No.. ,d°.?(~. '.~.,l?.,('. .... Name of Contractor ~..o,~?.~,~..~..~.~...~. ......... Address .~.~ .~'/..,~o~..~..~...~. Phone No.d*.~.. ~ 7.~..~.re. ~... 10, 11. 12. 13. 14, 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK.,--, ,,~ O(N~2,~~n.i~l.g~.o~;a.c.~fi~ . . . being duly sworn, deposes and says that he is the applicant above named. "- (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfomed the said work and to m~e and file this ' application; that all statements contained ~ t~plication are true to the best offs ~owledge and belief; and that the work will be perfo~e~ in the m~t ~r~ ~ a~pli~tion filed therewith. . .... ~misston EXpireS Mar~ ~, 1~ ... ~gnature of applic~t) HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT .N NEAREST WATER IAIR MI -+ N SOURCE OF WATER PRIVATE J~PUBLIC ADDRESS TEL ~ THI: LOCATK)N OF WELL(W)~ SEPTIC TANK(ST)8* CESSPOOLS(CP) SHOWN HEREON SURVEY FOR MARC H. LEVEY 8~ BEVERLY LEVEY LOT 5, "HIGHLAND ESTATES" AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK DATE dULY 17. 1981 SCALE I" = 50' NO 81- 41Z GUARANTEED TO: SOUTHOLD SAVINGS BANK EQUITY ABSTRACT, INC MARC H. LEVEY & BEVERLY LEVEY YOUNG YOUNG ALDEN W YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N Y~S UCENSE NO 12845 H(~WARD W YOUNG, LAND SURVEYOR NYS LICENSE NO 45893 AVENUE :W YORK SUFFOLK COUN~ DEPARTMENT OF H~LTH SERVICES MOHRING ENTERPRISES LOT 5, "HIGHLAND ESTATES" ~6~. FOR APPROVAL OF CONSTRUCTION ONLY AT CUTCHOGUE O~TE dAN. 22, 1981 ~WN OF SOUTHOLD SCALE' I" = 50' SUFFOLK COUNTY, NEW YORK No. 81-11 DATE , HS REF. NO. survEY · ~ V~OL~T~O~ ~ SECtiON ~20~ OF THE APPROVED ,~ ~[w YO~K STORZ ZDUC~O. SUflVE~'S INKED SEAL OR EMBOSSED SEAL SHALL .OT SE CO~S~OEeEO TO eEa VAL;O TRUE COPY HEALTH DEPARTMENT-DATA FOR APPROVAL TO C~STRUCT ~ THE ~H FOR WHOH THE SU~E~ ~S P~EPA~EO ~ S~F CO,~X MAP ~ SECTION IOE ~CK ~ LOT ~ HERE~, AND TO ~E ASSIGNEES OF THE LENDING HTHE~ A~ ~ DWELLI~S WITHIN I00 FEET OF THIS PROPERTY INSTITUTI~, GUARANTEES ARE ~T TR~SFERABLE OTHER THAN THOSE SHOWN HEREON TO A~ITIONAL IHST~TUTI~S OR SUBSEQUENT N THE WATER SUP~Y A~ SEWAGE DIS~AL SYSTEM F~ THIS R~IDE~ OWNERS ffOI~TANCE$ SHOWN HEREON FROM PROPERTY WILL C~FORM TO THE STAN~OS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING ~TRUC~RE$ ARE FOR A SPECIFIC AODRESS I; MONUMENT SUBDIVISION MAP PILES IN THE OFFICE OF THE CLERK OF 8UFF~K ALDEN W, YOUNG? PROFESSIONAL ENGINEER COUNTY ON APRIL ~6) 197T AS PILE NGIS37 ANO LAND SURVEYOR N Y.S UCENSE NO, 12845 HOWARO W*YOUNG~ LAND SURVEYOR ~ L~T~ W~L(W))SEPT/C TANK{ST)~C[SS~OLS(CP) SH~H H~RE~ N.~S. LICENSE NO 4589~~ "It sheuld be noted thor since property is located in an agriculturo! areo, the possibility exists that t!;~ woter supply may contain trace gn~unts of pes. tic. i.d,e~,and/or ~.ates~ ~Special analyses '"nld~. be reqtm'ed._ Contract this Department SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOR APPROVAl. OF CONSTRUCTION ONLY HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT . T~ LOC47K~ OF W~.LlWh SE.nc 7ANRSST)a CESS.OOLS(OF) SHOW. HEREto4 A~ F~OM FIELD OBSERVATIONS MO OR DATA 08T~NEO FI~OM OTHERS TDY P05¥ ~0494 SURVEy FOR MOHRING ENTERPRISES LOT 5, "HIGHLAND ESTATES" AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK :fl/~. ~1 ) I~l~l DATE dAN. 22. 1981 SCALE I" = 50' NO 81-11 ~UN~UTHOI~IZED ALTERATION OR ADDITION TO SURVEY IS ~ VIOLATION O~ SECTION 7209 OF THE HEW yORK STATE EDUCATION LAW PROPERTY LINES OR FOR~THE ERECTION ~ FENCES YOUNG s YOUNG ALDEN W YOUNG~ PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S. UCENSE NO. 12845 HOWARD W. YOUNG! LAND SURVEYOR NY.~. LICENSE NO 4589~ 400 OSTRANDER AVENUE RIVERHEAD~ NEW YORK LAU ~//'b~ OD I~.M, , f 'i IZ N L SECT