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HomeMy WebLinkAbout11087-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g J.1.~5~ ...... Date ...... p.o.qe.~a.b.e.r...1.~ .............. 19~. THIS CERTIFIES that the building ................................................ Location of Property . .~ ~3.~5 .............. ~l.5.gb~.~. ~p.~c) ............. ~.u.'~q~.oEu. 9' .. House No. S~reet Ham/et County Tax Map No. 1000 Section ...1.0.2[ ...... Block ...0.8 ........... Lot . ...0.0.6. .......... Subdivision.. ~t Sg:lll~la.d..E e .t~li~}e .......... Filed Map No. ~ 5 ~.7 .... Lot No...9. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~lar. c h. 2.4 ....... ,198 ]. pursuant to which Building Permit No...1 .I.Q ~37..Z~ ........... dated .... Apr 5.1 .~ ................ 19 .~3 ~, 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 private one-family dwelling. The certificate is issued to 75 Highland Road Corpora~l.on .................... ..................... of the aforesaid buil,ding. ~, Suffolk County Department of Health Approval .! ~ r.g.q':2.7.,. ?l/..2.7./.8.2..~. ?.gb..t....~.... y.~. 1.1.~.1' P.E. UNDERWRITERS CERTIFICATE NO 1~ ~.5~6~9 Rev. 1/81 FOEM NO. ~ TO~N OF ~uTHOL BUILDING DEPAP, TMEN~ TOWN HALL SOUTH'OLD, N. Y. BUILDING PERMI'~'* (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) : N? 11087 Z Date ...... r:. .~ ..................... , 19. Permission is hereby granted to: ...... .............. .... ................. t ........ .U~.z!...~z../..~.~. ~ .... ~ ...... ~ · ~..~... · · ...,~,~.. . / ___ .~ - ,'~z -~ z . . .......~ ........... ............... ....~. ../~.~.~./~.~....z~Z.~.~.~......~'~?...:...?..~ .............. ~..; ..................... '"'-'~'-~-~f:/. ~.. ~.. ~_x.~....~~ ......................................... ~ ................ ,;....~...~...~ ........ ,/ County Tax Map No. 1000 Section ,../..F_~.~j~. ........ Block .~.., '~. ......iLar No...~1~. ......... pursuant to application dated ~..~.~'.~j. ~....~.. 19 .~./.., and approved by the Building Inspector. Fee $.. ~t~..':~q.: ..... Rev. 6130/80 FORM NO. 6 TOWN OF SOUTHOLD Buiidlng Department Town Hall Southold, N.Y. 17971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th:s apphcation must be filled in typewriter OR ink, and subn~itted in duplicate to the Building Inspec- tor w~tn the following; for new buildings or new use: 1. Final sunzey of property with accurate location of all buildings, property lines, streets, and unusual natural or toDograohic features 2. Final approval of Health Dep~:. of water supply and sewerage disposal--(S-9 form or equal), 3. Approval of electrical ~nstailat~on 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 topograph ~c 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. / Health Dept. Approval [ ~ -- ~(:~) c~."7 . .Labor Dept. Approval Underwriters Approval ~'1 5,-.~.~¢ ~:~_,~(-'¢ .Planning Board Approval Request for Temp~ry Certificate ................ ; .... Final Certificate ........ - .... - Construction on above described budding and Jlations. ~ % C. Fees: 1. Certificate 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 ! Dar ...... ~ . . v' New Building............./~ Old or Pre-existing Building(X} ........ =/Vacant Land ............ Lo a,,ono, p roperty.. * [ Owner or Owners of Propertv. .~..~.~..~.. _~'~ county Tax Mao No..~O00 Section ...~0~ ........ B~oe~ .~©?.. ....... Cot...0~'...~. ...... Applicant FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ ....... PLEASE TAKE NOTICE that your application dated..~~ .d~ ........ 19~. for pe~it to construct .... ~. · ~ (. ~7. · ~/~. · -: ............ at ~Ss~ ~o~ ......... '~ ..... St~et ~ H~mlet / County Tax Map No. 1000 Section .../~ ...... Block ...~ ....... Lot . .~ ...... Building Inspector . ~'- -' ! i,'THE,NEW YORK BOARD OF FIRE UNDERWRITERS = -1000681~ ,,:/.~ ~D:-~ :: '~'"O"tel~y 7, 1982 A..~icat~o,~No.o.41m 145116-81 NOOOo3'~'~ =r,~ ~ o~ t~e,e~ct~al equ~p~nt ~ ~scrlbed ~elo~ a~ i.t~duced by t~ applicant ~med on the able applic~tlo~ .u~r in the premises of i~ the followgng location; ~ Basement ~ ~ 1st FL ~ and r~. ~ S~t~o. ara& ~ 9 ' '~xamined,~n/l.~ril 29, 1982 and found to be in compliance with the r~ulrements of this Board. FIXTURE tECEPTACLES j SWITCHES OUTLETS , "'25 7 22 ~ FIXTURES RANGES OVENS EXHAUST FANS FLUORESCENT OTHER APPARATUS. 1-Smoke D, et~ector AWG 3/0 3/0 :ii=, - Paranount Elec. Co., ~ =,~// ,' 2041 Shelley Place, k,~,~(~'~ ~./G~ :,~/~1 Tbls certificate must not be altered in any manner, return to the office of the Board if incorrect. Inspectors may be ident~J~] the:: cr~j FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION FERN. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180~ ., 19. ~. Approved (,~. O.//24~../..~:.' .... 1¢?. Permit No.. Disapproved a/c . APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Application No. lt??. ....... Date ................ 19... 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 desc~ption 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 Pemfit to the applicant. Such pem~it 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 pnrsuant 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, buildi~de~ous~g cp. de, 3~ regulations, and to ad,nit authorized inspectors on premises and in buildings for necess~~~ t~S'~~~t ~or~ne, if a corporation) ... c'~/~ (M~ing ad.j~ve~,,~of,.applicant) State whether applicant is (owner,)lessee, agent, architect, engineer, general contractor, eledtrician, plumber (Nam~ anC'titn2gtiffe o~rpmarporate officeQ Builder's License No .......................... Plmnber's License No ........... Electrician's License No ............... ? .~ ...... Other Trade's License No ...................... 1. Location ofland on which proposed workwillbedone...~../Q./.(~..~ ................................ liouse ~q~l}ir' ' ~// ............. ~tr;;i ..................................... County Tax Map No. 1000 Sectio. n ...:.~...~. ........ Block ...~: .......... Lot..~~ ..... Subdivision ~~....~...~.'4~..~..~.~. · Filed Map No ~>~ ~ V Lo t../~. ........... .... ......... (i4aifi;) ............................... 2. State existing use and occupancy of pr%raises and intended use an~ occupancy of proposed construction: a. Existing use and occupancy /'~'-'~' '~'/' '~":' ~' '~' '~" '~'~'~57: ~ ................. } ............... b. intended use and occupancy .......... . .... . ...... ..... 7-~.. .... ': ¥.,,: .~;~}':'~:}~:, ;~:~;:~..~;'. ............. 3. Nature of work (check which applicable): New Building . ~ ...... Aura, ...... Alteration ........ Repair .............. Removal .............. Demolition ........... Other Work ............. 4 Estimated Cost .~.c~ ~.~.O: Fee L..~..~..~?. · (Description) (to be paid on firing this application) ! 5. If dwelling, number of dwelling un~s ..... ] ........ Number of dwelling units on each floor ............... If garage, number of cars ...... ~ .............................................................. 6. If business, commercial or mixed ioccupancy, specify nature and extent of each type of use .................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth .............. Height ............... Nmnber of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ...................... Height ........ ./..//. ......... Number of S.t~ries ..................... Dimension.s ~ej~tire new construction: Front. ~.~...~..' ...... Rear..~'fft~../..~./.(. .... Depth ...~..o. ........ 8. Hei~!ht . '5' .-7 .........)q,,ml~er of Stories 9. Si:,x, oflot:--Front../f'.ffX.~(.~.' .......... 't~;'a; '. i i i '.Z/~.~,?'~2. i i i i i i i i i '~);~i~' i i .~..7~.'i 10. Date of Purchase ............................. Name of Former Owner ............................ 11. Zone or. use district in which premises are situated .................................................... 12. Does proposed construction violate any zoning law/ordinance or regulation: ............................... 13. Will lot be regraded . .~.~..~..., ,.., .~ ....... .~ ......Will excess fill be_removed from premises: - ~ Yes 14. Name of Owner of pref~i~es ~?ra~.~.~t&~. ?~c~/. .... Address~_/-~-~ .,~..,~.. ,//~..~.. ..... Phone No. ~.¥?~.~.,~.: Nmne of Architect .. ...... Address .~.e....?~..~,~..~. Phone No. Nmne of Contractor ...~./e2~'+/~..~7. ¢7On_q ..... Address . .~..~'~.~q~..~q~... Phone No...(~. ?/2 .~:;.~..~.ff... PLO"I' DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions rrm, property lines. Give street and block number or description according to deed, and show street names and indicate whethe interior or corner lot. STATE OF NEW YORK, . /. · .~. being duly sworn, deposes and says that he is the applican above named. ~~ He is the ......~ ..................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d is duly authorized to perform or have performed the said work and to m~e ~d file application; that all statements contaiued ~ this application are true to the best of his ~owledge and belief; and that th~ work will be perfomed in the manner set forth in the application filed therewith. Sworn to before me this MOHRING ENTERPRIS[S LOT ~) "HIGHLAND ESTATES" MAY 4 AT CUTCHOGUE DATE. MAR. 17, 19~1 ~WN ~ SOUT~LD SCALE: SUFFO~ COUNTY, NEW YORK ~o. NEW YORK STATE EDUCATION LAW H~TH D~PARTMENT-DATA FOR APPROVAL TO C~STRUCT ~ ~ FOR WHOM THE SU~EY IS PREPARED ~E~ ARg ~ ~ELLI~ WITHIN )00 FEET OF THIS PROPERTY I~STITUTI~, GUARANTEE~ ARE ~T T~SFERA~E OTHER THAN THOSE SHOWN H~REON TO ADO)TidAL iN~TITUTi~S OR ~LIC~T,, P~P~RTY LINES OR FOR THE ERECTION ~ FENCES ~~~. ' - ~BmV S ON MAP FILED IN THE OFFICE OFTHE CLERK OF SUFFOLK C~NTY ALDEN W, YOUNG, PROFESSIONAL ENGINE ER ~ ~RIL ~, 19~7 AS FILE NO,~?. AND LAND SURVEYOR N.Y.S UCEHSE NO, 12645 HOWARD W, YOUNG~ LAND SURVEYOR "It should be noted that since this property is located in on agricultural area, the possibility exists that the water supply may contain trace amounts of pesticides and/or nitrates. Special analysis required. Contact this Department prior to sampling". $~JFFC.~L~ ~_ObN1Y DEPARTMENT OF HEALTH SERVICE: FOR APPROVAL OF CONSTRUCTION ONLY APPROVED~- HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT # NEAREST W III I MI. -+ N SOURCE OF WATER, PRIVATE /_PUDLIC N RU~F CO. T~AI~p ~t-~00 SECTION IO2 nlOCK a LOT I~ MTNEI~ AI~ NO DV/ELLImB WITHIN lO0 FEET OF THIS IIROl~lt~tl?Y OTHER THAN THOSE ENOWN NENEON, WILL CONFONM TO TRE/S~NIM~ OF Tile SUFFOLK COUNTY OI~.PAR?M~NT OF H~LtN imvmE~.~/ · /(.-, M · MONUMENT Q · STAKE SURDIVI$ION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON APRIL EGt IB77 AD FILE #0,65B7. 'lETHE LOCATION OF WELL(W),SEPTIC TANK(ST)8, CESSFOOLS(CP) ~HOV/N HEREON ,~qE, FRO# ,~!ELD, ~BE.VA.,ONS *aD ON DATA OST^mEO ~OM OTHERS SURVEY FOR MOHRING ENTERPRISES LOT 9, "HIGHLAND ESTATES" AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK DATE. SCALE. NO. MAR. 17, 1981 I" :40' el-lO§ NUHAUTHQflIZEO ALTERATION OR ADOITIOH 10 THIS SURVEY IS A VIOLATION Of SECTION 7E09 OF THE NEW YORK STATE EDUCATION LAW NCOPIES ~ THIS SURVEY NOT BEARING THE LANO SURVEYOI~'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED 1'0 BE A VALID THUE COPY XGUAI~ANT, EES INDICATED HEREON ~HALL RUN ONLY 10 I~H~FE~SON FOR WHOM THE SUI~VEY IS PREPAREO AND ON N)~ BEHALF TO THE TITLE COMPANY~ GOVERN* MENTAL K~GENCY AND LENDING INSTITUTION LISTED H~EON~ AND TO THE ASEIGNEES OF THE LENDING NSYIt'UTI_~, OUARANTEES ARE NOT TRANSFENADLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS MDISTANCES SHOWN HEREON FROM PROPERTY LINES TOEX STiNO STRUCTURES ARE FOR A SPECIFIC PURFQSE ANO ARE NOT TO DE USED TO ESTABLISH PROPERTY LINES OFt FOR THE ERECTION OF FENCES jj V/'~.I IKI/"' = Ve%l ILl/'~ 400 0STRANDER AVENUE /k./I./l~l~3 ~ I k../IJl~l~,.~ RIVERHEAD, NEW YORK ALDEN W YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N Y.S UCENSE NO. IZ845 HOWARD W. YOUNG~ LAND SURVEYOR NYS LICENSE NO 4589~ SURVEY FOR MOHRIN6 ENTERPRISES SUFFOLK COUNTf DEPARTMENT OF HEALTH SERVICES LOT g, "HI6HLAND ESTATES" AT CUTCHOSUE DATE: MAR. 17, 1981 FOR APPROVAL OF CONSTRUCTION ONLY TOWN OF SOUTHOLD SCALE: 1"=40' DATE ............... HS RIFF, NO.~ SUFFOLK COUNTY, NEW YORK NO. el~lo5 ~PPROVED~, HEW YORK ST&TE EDUCATION LAW A~' O~: NE.~V~ ~' ....... ~ ff COPIES ~ THIS SURVEY NOT B~AR~N~I THE LAND H~NTEEJ INDI~TEO HEREON ~ALL RUN ~LY ~ AN~ ~ ~1~ ~HALF ~ THE TITLE C~P~Y, 6OVEN- -- ~f~ ,~ ~ , OTHER THAN THOSE ~HOWH H~REON, YO A~ITi~AL ~STIT~i~S OR ~U~SEQUEHT ~ ~ ~ ~ ~NOER AVE~E ...... YOUNG YOUNG · · MONUMENT ~ Q · ~T~KE aUB~IS~N MAP FILED IN THE OFFI~ OF THE CLERK OF ~FFOLK O~NTY ALDEN W. YOUNG, PROFESSIONAL ENGINE ON AFRIL ~, 1~7~ AS FiLE ~. ~7. AND LAND SURVEYOR N.Y.S UCENSE NO. 12845 HOWARD W. YOUNG~ LAND SURVEYOR ~ ~ L~T~ ~ ~L{W), ~}C MNK(ST)& CES~OLS(~) ~N HERE~ N Y S. LICENSE NO 4S895 ~E ~ FIE~ ~TI~S ~D OR D~TA OBTNNEO FR~ I F l I Vihli~'[ CERtifiCATE OF OCCUPANCY J ~/~FFRCtVED AS ~OTIFY .UILDING DEPARTMIE~lr AT FOR POUP O CONCR~E ROUGH F~MIN t ? I I 1~- .3'4 = I o"