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Home My WebLink About12874-z FOK~ ~qO. 2 TO~N OF $O~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Map No. 1000 Section ..... l....°....-J. ........ Block ....... ..~......~7... .... Lot No. J pursuant to application dated ..~.~...!.:~ ................. , 19.~.~'j..., and approved by the Building Inspector. ~uilding Inspector Rev. 6/30/80 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner ~c~r~ (~lease print) Plumber ~/~ (please pr'int) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. / (Plumb~' s '~gnature) Sworn to before me this /r' mda , of Notary Public, County HIll.~] K. [)[ NO[ARY PUBlIC. Sla~e of New York .'k. No 4?07878, Suffolk ~ou~ty lem~ [xp,es Morch 30, Notary Public FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,<~outhold, N.Y, 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-J~=duf~i~t~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. 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 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 / land use 3, Copy of certificate of occupancy $1.00 / --Fre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date Se~t. 18,1984 New Building ........ Old or Pre-existing Building Vacant Land Location of Property . ..~. ............................... ~ ................ House No. treat Ham/et Owner or Owners of Property. .................................. .. . . ... . ...... ,.. County Tax Map No. 1000Section /~. Z Block ...... · ..... Lot. , Subdivision ............................. Filed Map No ........... Lot No. · ~,//,~pplicant . .'..'... ' ............ · ~,~, ~,~, ,~, · Date of Permit ~.~, Permit No.'~. , ........................ Health Dept. Approval ......... Labor Dept. Approval ........................ U derw itt Approv I ~ ~..~...~. ~-~ ' n r rs a. . · ............PlanningBoardApproval ........... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .~ ./~../~ ...................... C°nstructi°n °n ab°ye described building an~;~S,~ (~ ~ ~ ~'~__ Applicant .. 7-~ .... &~~??~.. .......... Rev.~-10-78 ., · .... FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE FINAL ].oo~m THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ES JOHN STREET, NEW YORK, NEW YORK 10038 ..,~ ~..,~.,,o,, ~o. o.~.~ N 658958 THIS CERTIFIES THAT only the electrical equipment ~ de~crlbed bevy a~ i~trod~ced ~ the applicant named on the able ~p~llcation number ~n the prem~ses of ~zgelo Ac~:~a, 5 Wicid~ Avenue~ ~ttatu~, Rivc~'t~, in the/allowing Iocotlon; ~ Basemen~ ~, .~ 1st FI. ~ 2nd Fl. Section Block Lot was exa.t~ned on ~ ~ ~ ~ and found to be in compliance with the requirements of this Board, RXTURR J SWITCHES ~IXTURES RANGES OVENS DISH WASHERE EXHAUST FANS OUTLETS FLUORESCENT 14 42 J30 14 TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO, OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: 1-G,F,C,I. g-;S~ol~. Detector. 1 4 I 4 P. 0, B.)x 1366 Selden, N.Y. 11784 L~. 31~3~ GENI~EA£ ~A~ Per~ 1]. ,~.~ ~ This certificate must not be altered in any manner; return to the office of the Board if incorrect, Inspectors may be identified by t~eir ~redentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CE ~TERED IN ANY MANNER 7~54802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~']/FINAL INSPECTOR FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL,: 765-1803 Examined .G-~..~.~.., 19~ ?. Approved · .~, .~.%~.~..'W~. ~ ¥.1.., 19 .~.~. Permit No..].'.~',~..2~ .~. Disapproved a/c ..................................... Received ........... ,19... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date a. This application must be completely filled in by Wpewriter 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 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, build/~ code, hous~code, and regulations, and to admit authorized inspectors on premises and in building for necessary in,~ffect)6ns.// // // ~' ~a~.o'~plicant, or name,~/f a corporation) (Mailing address of applicant) / State whe~'~pplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......................................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duty authorized officer. ~ (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Location of land on which proposed work will be done ............................... .~.~_ ................ ............................................................... ./... House Number Street Hamlet ~ County Tax Map No. 1000 Section ~ .~.~.. Block O~. 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 and occupancy "' :55'''' .................................. b. Intended use and occupancy ................................................................... 3. Nature of work (check which a ,plicable): New Building .......... Addition .......... Alteration .......... Repair Removal Demolition Other Work i ~ (Description) 4. Estimated Cost,,/',-r.~7..~/ ~ Fee ........ ~ (to be paid on filing this application) 5. If dwelling, number of dwellingI units .............. Number of dwelling units on each floor ................ If garage, number of cars .... . .................................................................... 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 ................... i' ' ' Height ....................... Number of Stor/es ...................... 8. Dimensions of entire new constm, ction: Front ... ~....~,~ :.._ .... --Rear . _~....~. ......... Depth ............... Heigh[ ............... 'Number of Stories c~-7~' 9. Sizeoflot: Front .... ./...ff-~.. ............ / ~ Rear ...................... Depth ...................... 10. Date of Purchase ' Name of Former Owner ........... 11. Zone or use district in which p!emises are situated ............................ 3~5 .................... 12. Does proposed constructionyi_olate any zoning law, ordinance or regulation: ................. z-'-~ ...... 13. Will lot be regraded .... ~' '6~?,4" · · · v-. · ./O .......... Will excess fill be removed from p. remises. 14. Name of Owner. of premises ~.~'..'~., ./..~. · .'~..5'~'.~. QAddress .,~///.~. f'..e~..~.'/. ~..~%,.,~one No.. 7.~...~7. ~. ?~... Name of Architect . .,r~ ..... · Address .................. Phone No ................ Name of Contractor ~..ff~.~../~. Address ................ Phone No ................ ~ PLOT DIAGRAM ,'. Locate clearly and distinctly ali buildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. ! STATE OF' NEW YORK, COUNTY OF...'~ q-/..'~'~('f.~.d.]f..... S.S ..... d~F.-.mf.~..&'~ 9.. ~.~ ~.~ .................... being duly sworn, deposes and says that he is the applicant (Name ofindividual sigr mg contract) above named. He is the , : (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dui: authorized to perform or have perfo~ed the said work and to m~e ~d file ~is application; that all statements cont tined ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth in the application filed therewith. Sworn to before me this .......... t.~ ........... day of .... L~.~ '. ~. ...... 19 or formerly Groce L, SchontZ ~AreO= 14, 956 s.f. I0' wIDE ist~ t~t the on' ~ trace ~ r nitrates. IIOW or formerly Rober ! A nrig FOR APPROVAL TO CONSTRUCT THIN I00 FEET OF THIS PROPERTY SURVEY FOR AIVGEIO ACCAt~DO AT MATTITUCK TOWN OF $OUTHOLD SUFFOLK COUNTY, NEW YORK DATE: JAN. SCALE: I "= $0' "; NO. 83 ~ 945 -. ~ .... ~ L. Schonfz \ ..~,,Groce ,--' ~ ~ ~ope~ is Iocote~ men e~c~?l oreo, the possibihty exists ~t the woter ~upply moy con~ troce emouots of pesticides ond~r nit,otis. ...... ~,,, ~ ,~i, ~;,: ~T MATT/TUCK DATE: dAN. 7, 1984 OWN ~ SOUTHOLD SCALE, I'=~0' )Am~: FEB 09 ~ ~ ~ . _ ;UFFOLK COUNTY, NEW ~RK No. ~3. - 945 -:,:. ........ HEAL~ DEPARTMENT-DATA F~ APP~L TO C~STRUCT ~,~ ~"y· __ YOUNG &YOUNG ~OS~NOERAVE~E , RIVER~AD~ NEW YORK NOTE: G = STAK~ ~ ALDEN W, YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR NY.S. UCENSE NO. 12845 HOWARO W. YOUNG~ LAND SURVEYOR ~ L~T~ ~ ~L(W),~P1~C TANKISt)a CE~OLS(~) ~N ~mE~ ~ N.Y.C. LICENSE N0.4589~ BRANDIS & SONS INC, 1046 ROAD ~ su~ FOR~ ' ' AT ~M~TT/TUCK ~ . ', dU~Y ~A v~A~Off ~ SeCTiON 7209 ~ THE , H~W ~K~TAT~'~CATt~ LAW ~ 'N.CO~ E~ F'~I~.~YrY NOT K~G TH~ LAND S~yI ~1 S .iHK~O 'SEA~ :DR EMBOSSED SEAL SHALL N ~NEST ~ i, iN__Mi,,~ ~ sOuR~ WATER, ~i~TE ~p~lC ~- ' MENTAL ~ ~ENGY .A~ ~J IDM,~ ~NST/{YU TI ON LISTED ~ ~C~ ~ T ig ~TAN~ OF THE ~U~K CO~TY OEPARTMEN~L ;~ ~ S~ Tfl G~]:~ 'AREF~ A SPECIFIC flO~: G ~ ~K~ [" ~~" AEi 'EN W~NG, PROFE~IONAL ENGINEER ~E ~ ~ ~T ~S ~ O~ DATA' O~T~O F~'OTH~S: ~ N.Y~S. LICENSE N0.45893