HomeMy WebLinkAbout13509-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No. Z15424 Date November 25
.................................................. 19.86..
THIS CERTIFIES that the bnilding .,..P.o.o..1 ........................................
Location of Property ..... 5y.0.~...s.%/.z..1.w.a.~.e..r. Age... ............. .C.u.¥.c.h.o.~..u? ........ -.-.
House No. Street Hamlet
County Tax Map No. 1000 Section ..... ,1.3.7....Block .... 0. ~. .........Lot...0.0..4 .... ~ ..... '.~
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... 3.u,~t,..1.6. ........ , 1,9 .8.4. pursuant to which Building Permit No ..... .1).5. 0..9.Z ..........
dated Oct. 30 19 .8 .4 , 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 .........
Inground swimming pool and fence to code.
The certificate is issued to BERNARD R. DEMPSEY
(owner, ~gigJ~IgtKf~lFaYlll
of the aforesaid building.
Suffolk County Department of Health Approval ........ .~./..~ .............................
UNDERWRITERS CERTIFICATE NO ................ .N. 6. .7.0.4.6. 7. .........................
Rev. 1/81
FO~M NO, 0
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. ¥,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
13509 Z
Permission is hereby granted to: ~
.....
.... ~.Z~.~... ~.M~.~.~¢...~.
..... ~z~¢~¢u~ ....... ~.~....~.~
,o ..... ~~..~..~.~:~....~.~~...~~
.~X ................................................................... ' ....................................... /
................................................................................................................
C~n~ Tax Map No. lO00 Section ....L.~. ........ Bilk ~ .......... ~ No.~ .............
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
This application must be filled in typewriter OR ink, and submitted m ~ 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 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:
1. Accurate survey of p~operty showing all property 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.
Fees:
1, Certificate of occupancy $5,00
2. Certificate of occupancy on pre-existing dwelling
3. Copy of certificate of occupancy $I.00
4.Vacant Land C.O. $5.00
5. Updated C.O. $15.00
$15.00
Date ...................
....
NewConstruc%ion. .' .... Old or Pre-existing Building ............ Vacant Land .............
Location of Property .. ~*'~2 d ~' ~4:~'~..c~./,-.~..-~.~....~..~ ,~'~.,~ ~"~-c-~¢~,d ~.~C~
Owner or Owners of Property .......... : ................................
County Tax Map No. 1000 Section ............... Block ............... Lot .................
Subdivision ............................ I .... Flied Map No ........... Lot No .... '...~ ......
Permit No./~..077~.... Date of Permit/.0/?.0/.~.~...Applicant ~.~.~ ./~.~-~...~...Z"~2~ fi:~ .~..~ ....
Health Dept. Approval ........................ Labor Dept. Approval ........................
Underwriters Approval ........................ Planning Board Approval ......................
Request for Temporary Certificate ..................... Final Certificate .......................
Fee Submitted $ .............................
Construction on above described buildingz~mit ~me,~licable_codes and regulations.
Applican,~....~..~;
FIELD INSFECTI~ ~ IDATE COMMENTS
FOUNDATION (~ _
FOUNDATION (2nd) __ __
ROUGH FRAME & -
PLUMBING
INSULATION FERN. Y.
STATE ENERGY
~DE -
· 7 c-"Z'- o axe/
ADDITIONAL COMMENTS:
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
· ~.-7..~ .~, 7...~.. ~.4 c. ,~.,,~ ..~.~rx./'A~. ,~
..... ~ .... ~.~ .... : .... (~.~
PLEASE TAKE NOTICE that your application dated .... ~..~ .... ~ ~ ..... , 19 ~
Location of Property .... ~ ~ .... ~Tz. ~ ~. ~q.~, . ~ ~. ~, ~-~
noose No. b'troot ~ / / ~m/ar /
County Tax Map No. 1000 Section ...~ ~. ...... Block .... ~ ..... (Lot . ~.~..' .....
Subdivision~(~O~. . Filed Map No ................. Lot No..../~ .=. d .....
is r~t.rn~d herewith and disapproved on th~/ollow~ ~rounds..~fO~C~...~q~O
.~...~/~//~.. ,~0~.. z.5... Z~...~Z~.. ~f~. :~ ~
Building Inspector
RV 1180
YORK STATE DEPARTMENT OF E~XVIP. ON~.~NTAL CONSERVATIOit
Regulatory Affairs Unit
Bldg. 40, SUi~Y---Roo_m 219
Stony Brook,. }~f "11794
..-- -(516) 751-7900
A review has been made of your proposal to:
Locat a: a, g_ o,g: 5"/'-,7/
New York State Department of Environmental Coneervation has found the
-- parcel ~ project to be:
Greater than 300' from inventoried tidal wetlands.
~ Landward of a substantial man-made structure ~
'- greater than 100' in length constructed prior to September 20, 19~7.
Landward of 10' contour elevation above mean sea level on a gradual, nat-
ural slope,
Lamdward of topographical~crest of bluff~ cliff or dune in excess of iO
· feet in elevation above mean sea level. -...
Therefore, no pezmit under Article 25 (Tidal Wetlands of the Environmental
Conservation Law) is required at this time since the current proposal is beyond
State mandated J~risdiction pursuant to this act~ However, any additional work
or modifications to the project may require a permit. It is your responsibility
to notify this office, in writing, if such additional work of modifications are
contemplated.
Very truly yours,
loo440 THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~ 8~ JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
only the electrical equipment as described below and int~duc~ by the applicant named on the above application number in the premlses of
~, 5705 StJ. ll~ater AVe., ~e~
in ~he following toc.tlon; ~ Basement ~ lsr FI. ~ 2.d Fl. ~e Section Block Lot
DRYERS
S E R I C
NO OFECC' CONDpR~ ! A W.G. A W O NO,<DF HEU~,RA{5
~ CC CQND, OF HI-LEO
OTHER APPARATUS:
~~~s ~ft~.~ ~li~ at ~ da~ of ~ion only.
ma~ by a ~ifi~ ~.
J L S Electric
52 Vernon Aven~e
Masti¢~, N.Y~ 11950
7GS-~,802
BUILDING DEPT.
INSPECTION
[]FOUNDATION XST
[]FOUNDATION 2ND
I' ]FRAMING
REMARKS:
ROUGH PLBG.
INSULATION
FINAL
DATE ///~ ~////P~.~ INSPECTOR
rFORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
1~.. Permit No..~?.C~. ?...~
Disapproved a/c .~-~...¥..~..~.~..~-....~.../~-.: ..... z-~ ....
...... ...........
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 s~'~eets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this ap. pli-
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
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 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, b)~i~ding code, hou,~ill~/cO~te, and regulations, and to
admit authorized inspectors on premises and in building for necessary~,slSections.
.., .........
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
bs. ' ................
N~me of owner of pre~nises ./~.~.4 .rd4C~>.. ~: ~.'~/'.J:..~,~....,.. ~...,~..-:~--..~/.~". ~:..
(~(s 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 ..... ~..~./~(' ........... &~
Plumber's License No .....................
Electrician's License No....~......~'..
Other Trade's License No .......................
I. Location of land on which proposed work will be done ..................................................
.~.7..o>.~ ...... .~ .~..z~.. ~..~.... ~.
ltouse Nmnber Street Harfilet
County Tax Map No. 1000 Section .. ['~'7 .......... Block ....q)..~. .......... Lot .12)~.~ ...........
Subdivision ..................................... Filed Map No ............... Lgt ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...... .(~)../~.~.. ~.~/qT/~. (.(~...~....~.F-~. ~-///~'.~' ...........
b. Intended use and occupancy . .~..~( ,~.(~ ..... /.../~.C..7..~C{¢~..~(..,~ ~/...'5~...&d.'..~..~.../i~..~.. ·..
3. Nature of work (cheek which applicable): New Building ..... ' ..... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
(Description)
4. Estimated Cost ....... ~ ............ Fee ......................................
' '" (to be paid on filing this application)
5. If dwelling, number of dwelling pnits ............... Number of dwelling units on each floor ................
If garage, number of cars ..... i ...................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ...............
Height ............... Number of Stories ........................................................
Dimensions of same structure w~th alterations or additions: Front ................. Rear ..................
Depth .................... .. Height ...................... Number of Stories ......................
8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...............
Height ............... Number of Stories ........................................................
9. Size o~lot: Front ........... ........... Rear ...................... Depth ......................
10. Date of Purchase ........... I .................. Name of Former Owner .............................
1 I. 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 No
14. Name of Owner of premises ................... Address ................... Phone No ................
Name of Architect .......................... Address ................... Phone No ................
Name of Contractor ......... , ................. Address ................... Phone No ................
PLOT DIAGRAM
buildings, whether existing or proposed, and, indicate all set-back dimensions from
umber or description according to deed, and show street names and indicate whether
Locate clearly and distinctly all
property lines. Give street and block
interior or corner lot.
STATE OF NEW YO~K, ;.~ ,o o
COUNTY OF. Z.~CF-'Z~"f~.-~..x%'..'~7 l°'° ,-~ . ,
...... · · ·. ·
(Name of individual signing contract) _
above named. ~
being duly sworn, deposes and says that he is the applicant
He is the ........... : · · ·
(Contractor, 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; that all statements cont¢ined 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
State of New York, Qualified In