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Home My WebLink About13642-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... ~3~4069 ....... Date ....... .D.~ ¢~t~.~:, ~l.q ............ 19 8.5. THIS CERTIFIES that tile building ........ QB.~.-.~ra,~.],y. 91.w.o. ~ ~. j.B. t2 ,. ................ Location of Prop erty .... 3. 5.0 ................ ? ~ .a.c.k...Ay.e... ............. .C.u.L.c..h 9 .cj?. o. .... House No. Street Hamlet County Tax Map No. 1000 Section .... 1.0.3. ..... Block ...... 1..2 .......Lot ...... 3. .......... Subdivision ......... .X ..................... Filed Map No .... .X....Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ·..~.ov.em~e~..3. Q ...... 19~ .4. pursuant to which Building Permit No .... 1.3..6.4.2.g. ........... dated .... I~ecember..20 ........... 19.8z3, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is isgued is ......... ...... RE iva.~.e, on~.: fam,~],7, cl~.~ ~ ~ ~ncj · ........................................ The certificate is issued to DAVID & SALI~Y B.Ld~DO$ ~owner,~ of the aforesaid building. Suffolk County Department of Health Approval ........... 1. z~ ? .S .O.-: 2. .4 .3 ..................... UNDERWRITERS CERTIFICATE NO .................... ~'71.4.451 ...................... Rev. 1/81 Building Inspector FOBM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) D ~ .~O ~3~42 z o,e ...~...~ .................................. ,,.~. Permission is hereby granted to: .... ~~.~......~:..~..,...}..~...~.~... ..... -'~'_ / /~'"-'"'"'""'"" County Tax Mop No. 1000 Section .... J,..,C~,...,,~. ....... Block ...... ~. .............. Lot No. pursuant to application dated ..... ~..~.....~.~. ......... , 19.~..~.., and approved by the Building inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions TOWN OF ~OUTHOLD This application must be filled in typewriter OR ink, and submitted l~ 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 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, 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: I. Accurate survey of p~operty showing all propertv lines, streets, buildings and unusual natural or topographic featu res. 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. Certificate of occupancy $5.00 2~ Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 Date ...................... New BuildingS../. · ......... Old or Pre-existing Building .. ' ..... Vacant Land ............. Location of Property ........................ House No. Street Hamlet Owner or Owners of Property County Tax Map No. 1000 Section . ~.Q.~ ......... Block .../..~. ......... Lot...?. ........... Subdivision ....... ~;~ ....................... Filed Map No ........... Lot No .............. Permit No./2~.~.Z.{?~.. ?7. Date of Permit .Applicant ...,~J6~..~.~.~.. ~.~../~ .~..~...~r~? ......... Health Dept. Approval i.-~. ..................... Labor Dept. Approval ...................... Underwriters Approval . .~.. ................... Planning Board Approval ..................... Request for Temporary Certificate .......... ~ ........... Final Certificate ..................... Fee Submitted .... -~ ........................ Construction on above described building and p~rmit meets all applicable codes and regulations. ................. Rev, 10-10~78 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION - (please print) Plumber (.~'o¢~°~.<L_ ~'~¢"'7 (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this 2-Mo of _dULY' Notary Public, ';" MARK 'r. GAG~N NOTARY PU[~LIC, Stale ol Now York No. 469,5550 Qualified m Sltffolk Cooety ,,..,.~. Comm~ss~o*~ £×p*rss March 30, 19':~/ County THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 8S JOHN STREET, NEW YORK, NEW YORK THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of Da,vid Ble.}x)s, q~ck Av~nu~, (~tcho~.,~w.~ t~LY in the following locatlon; [] Basement [] 1st FI. [] 2nd FI. Section Block Lot was examined on (~,t(.)bf-~ ~'~., ~ and found to be in co~nplian~e with the requirements of this Board. FIXTURE SWITCHES FIXTURES RANGES OVENS EXHAUST FANS OUTLETS DRYERS SYSTEMS OTHER APPARATUS: 4-G.F.C.I. 1-~A~3 Detec'~r E R I C OF CC. COND. A. WG OF HI.LEG NO OFNEUTRALS 1 OF NEUTRAL 2/0 FIELD I~SFECTION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & ?LUMBING INSULATION FERN. STATE ENERGY FINAL ADDITIONAL COMMENTS: MUNICIPAL TESTING LABORATORY, INC. [] 160 LAUMAN LANE - HICKSVILLE, NY 11801 [] 7520 N.W. 82ND ST. - MIAMI, FL 33166 (516) 938-7120 (305) 884-3427 RE]-':iOR]' NO.: CI_£EN F: DAV£D ADDRESS: - - COPIES: PRO~ECT: F }~ , ~A[ ~"" 3T'[ ..~A"]ER AVE ~ C .IT[:;HOGUI~, ,, b~d-.[VE. KED BY: MUNICIPAL ]"ESI'lNG SAI'PLED BY: I'tUNJC.[PAL '/'ESI"ING ~AffPLE "Y F'E: CONCRE I"1= WIND,.)OK FhO~I:: TEST I=OR COMPRESSION FYPE Tb.S'T': COMPRESSIVE STRENLiY'I"H LESS f'HAN .I.C)OC) PSI WE~:~ i WALL. .... :.7 .... EAST WALl_ 2F~5 ') SOUTH WALL. *DUE TO THE FRE[,I,:)IE,)N OF THE AI='PL I ED TO THEI ........... ~E~.~'~;[.) ]. Nb, Ii',lS]TdJl'l[:[Iq]' A FAC I'UR UF 20% + SHULJI_D BE NOTES: ]'HE WES"[' WAI...L FIAD MANY L.ARGE CRACKS MEASLIF~ING APPROXIMATELY 1/zl" THICK ]]N SOME AREAS. ONI:L L. AI~[.]E: CRACK FROM THE TOP OF I'HE WAL. L. 'F~ THE F'OUND~Yi"ION CAN BE FOUND ZN T'HE NOR]"HWE[~YT CORNER. THESE LARGE CRACI<S AND L. OW []CiNCREFE COMPRESSIVE S'TRENOTI4 MAY DEEId THIE WAL. L LJNSAF:'~'. HIS REPORT RELATES DNLY TO THE ITEN OR EXACT LOCATION TESTEDI AND CAN ONLY gE REPROBOCEB IN FULL, WITH LABORATORY PERMISSION, ............................ ~ ...... ~ ..... ~;~-- ~:~ ~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-1803 Approve .~.9.., 19~q.. Permit N ............. (Building Inspector) APPLICATION FOB BUILDING P£RMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 issued a Building Permit to the applicant. Such permit ;hall 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 ;hall 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 tuilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. l'he applicant agrees to comply with all applicable laws, ordinances, buil~t~g code, housing code, and regulations, and to ~dmit authorized inspectors on premises and in building for necessary inspelq~]4ns, fl ,, ~-, /v _ .(Signature of applicant, or name, if a corporation) .. p.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nmne of owner of premises .... ~.~../~ ..... ff. ~. J~ .................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No... ~.qo?..~¢.. ~.O.4.~. ....... Plumber's License No. '..~.e.*.rS¢...~..¢ cl.7 ....... 1' Electrician's License No... ~o.~.x?...% ........... Other Trade's License No ...................... Location of land on which proposed work will be done ............................................ House Nmnber Street County Tax Map No. lO00Section ../.0.~. ......... Block ..../.6~ .......... Lot....~. ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use ailS occupancy ......... 0 ~ ~_~rO 7' //]~qj lJ~ b. Intended USe and occupancy .. -. ......... ..... -.,... . t 3. Nature of work (check which applicable): New Building ..... ' ..... 'Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... . .~.[.~?. ~ (Description) 4. Estimated Cost .......................... Fee ...................................... i .x (to be paid on filing this application) 5. If dwelling, number of dwelling uhits ............... Number of dwelling units on each floor ................ If garage number of cars 6. If business, commercial or mixed 9ccupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures,iif any: Front ............... Rear .............. Depth ............... Height ! .............. Number of Stories ....................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................. Depth ..................... i. Height ...................... Number of Stories ..................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth .............. Height ............... Numbler of Stories ......... z...: ... ....................... 'd ',~' ;~ .......... 9. Size of lot: Front .... ~, .~..- .i ....... ....Rear ... ~..~.~. ............ DepOt .... J..7.~. .......... 10. Date of Purchase ~.~.~ J./..~..~'J~'..z./ ........... Name of Former Owner ... ~f,~..O'7~ ................... 11. Zone or use district in whi~ premises are situated ..... ~..~..~. o:..~ .~ ....... ,~ ........................ 12. Does proposed construction viola!e any zoning law, ordinance or regulation: .... :,e/.,¢"'~ .................. 13. Will lot be regraded ........ /,~_&.-(-~ ...............Will excess fill be removed from premises: Yes 14. Name of Owner of pr~mises . :.¢~Pt ~./J.~.~..~ ..... Address . .~ .~.O/xc'3O.q- ....... Phone No.. '2.¢~/:ff.?'?.~.. Name of Architect ./~.~ ~'~...c¢'.~ .~'~M,.-~..~. ~ .... Address & I/.°~O..~.?.C4~..~.,q Phone No..'?,2,'~ :'2.~,~/./. .... Name of Contractor ~ .l.,~l~i~l~..... ..... Address ~ ...... Phone No..2,3.¥. ~27~.* .... Locate clearly and distinctly all property lines. Give street and block interior or corner lot. PLOT DIAGRAM buildings, whether existing or proposed, and. indicate all set-back dimensions from ~mber or description according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNTY OF'. ................ ~.S . ..... being duly sworn, deposes and says t he is the applicant (Name of individual signing contract) above named. He is the .... .~....c~. ~ ........................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui authorized to perform or have performed the said work and to make and file this application;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 ' Notary Public, . ............ -g~. County Iq[IEN IL DE V0I~ . . . ~0[^P,Y P[IB[IC, SI;N~ 0f Clew Y0dl (Signature of applicant) /%, 4707878, Sullo!l~ Count~ ~ V / /, $UFFOLK COU~qTY DFP/ZT)Jri.~T OF HEALTH SERVtC~S FOR .'?FqOV,;,L C2 C~.-':"~ UCTiOFI ONLY ............ ,-, ~. . -- ',. .... : ............... ~..-. ,:L~.:.._ ~ SUFFOL~ COUNTY, NEW ~ AP OV 1 /'%x SURVEY FOR SCALE ~ ~0~ NO ~4- lIB8 i [] J HOW~RO W YOUNG, L~ND SURVEYOR ~ IJ N Y $ LICENSE NO 4§89] ~ OSTRA~DE R AVENUE RIVERHEAD~ NEW YORK > -'~J~?' ~ ~' :ii' ~ :."': ---/ T[ST ~LE .' ,, I ~ ~'Y mJ~ D~P~T~ ' SU~Y FOR . ~F~._O~.. MAY ~ 1985 AT COTCHOeOB DAVE: Mmgl ~I'1,1~.~9~ for ia'is locatiom lm~e tn~.ootea by this; ~lep~'c~eat &~t~ SUFFO~ COUNTY, NEW ~RK NO. ~'11~ ~ . ~ ~" SURVEYNEw YORK ~ STATEA VI~ATIONEwcATi~ ~ SECTIONLAw TZOG ~ THE S~THOLD SA~~ HE~"DEPARTMENT-DAT~ F~ APPRO~ TO C~STRUCT ~[ ~ Fort WllOM THE SU~EY IS OTHER THAN THOSE SHOWH HEREON, TO A~ITIONA[ INSTITUTI~S OR SUBSEQUENT M THE WATEN SU~Y ~ SE~O[ OI~AL SYST~ ~ ~{S R~IOE~ OWNERS j/ NDISTANCES S~WN HEREON PROM PR~ER~Y ~NES WiLL C~FORM ~ THE STAN~ OF T~ S~K CO~TY OEPAnTMENT TO EXISTING STRUC~RES ARE FOR A SPE~IFI~ OF H~LTH 8~IC[S. PURPOSE ANO AR~ HOT TO BE USEO TO ESTABLISH ~[. ~~- mc. ~~ ~ ~ OS~NDER AVE~E YOUNG YOUNG I - ~ONUMe~T ~-~T~ ALDEH W. YOUNG, PROFESS OHAL ENGINEER AND ~ND SURVEYOR N.Y.S. UCENSE NO, 12845 HOWARD W. YOUNG, LAND SURVEYOR ~ ~ c~T~ ~ ~L(W),~KSC TANK(ST)I CE~(~) ~N ~g~ N.~ S, LICENSE NO. 45893 ME ~ FIE~ ~TI~I ~ OR DATA OBTN~O F~ OTHERS