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Home My WebLink About13175-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No, Z12970 Date November 8 84 .................................................. 19 ... THIS CERTIFIES that the building ..... .O.n.e...~.a.m.%]:..y..D.w.e. ~.l.i.n.q, .................... Location of Property ,....9.5: ......... Vista Place Cutchogue County Tax Map No. 1000 Section 083 .Block 0 Subdivision Birch Hills at Cutchoque Filea Man No 4908 .Lot No. 6 conforms substantially to the Application for Building Permit heretofore filed in this office dated May 29 19 8. 4. pursuant to which Building Permit No. 13175 Z dated ...... M..a.y ......... 3. .1 ........ 19.8.4., was issued, and conforms to 811 of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Private One Family .D.w.e..1.1.i.n.g The certificate is issued to ............... .F.r.e.d...&..C.a.r. 9.1y.n...L.U.B.A.N..S.K.I. ................ {owner, of the aforesaid building. Suffolk County Department of Health Approval 14- SO - 16 UNDERWRITERS CERTIFICATE NO ........... N664201 Building Inspector Rev. 1/81 I~OBM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13175 Z Date ................... I ................ , Perrnission is hereby granted ~ ~ O~~t~ ..'~...~.. q ~ ....................... , at premises located ot ......~...~. ...... .~..,~9~....c~.......~.~..!.....[-~... ......... ~.~~ .............. Co~.~ Tox Mop .o. ,ooo se¢.o. ...... ~.~..~ .... Block ........ .~ ............ Lot No ....... ~..~ .......... pursuant to application dated ........ ..~.,.~..~ ................... , 19.~..L~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 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~iccdul~Hcctc 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 peoperty 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 pert{nent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 Certificate of occupancy on pre-existing dwelling 2. 3. Copy of certificate of occupancy $1.00 land use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date . 4/)~?.-.. ~'v./.~].g.~..' ...... New Building .....V~'.. ...... Old or Pre-existing Building ............Vacant Land ............. Location of Property . .~..F. ..... ~.~..~.~.1../~....~..[..~.. ?..~. ..... ~..~.~'.~.0 .~?..~.~.~=. .....,~.-.~ .... House No. Street Hamlet Owner or Owners of Property .~..~.~-.-.~.. ~, ~. ~..0:.~..~,.~..~.,, j~.~. ~,, ~ .,-~?. ~/. .................... CounW Tax Map No. 1000 Section .... O~,~ ...... Block., ,/, ........... Lot, ~.(' ............ Subdivision .~ ! ~.~ ,~t...~.~.~.L,.~,, ~', .~. ?.~'.~,~,~.g.~.~iled Map'No./~"/~..~z~ ....Lot No. ~,.. .......... Permit No. ~,~.J.'.~v~. ~, Date of Permit .~/~,//~.¢.Applicant ~,{, .~.o. ,.~. ?, ,~-,~,-~.~.~,?,'~?,?, ,~,,; ....... Health Dept. Approval , .~l.q ~.. ~. [ .~.~l'.~-~/ .... , .... Labor Dept. Approval ~ ...................... N .. ~, ~o/ .-- Underwriters Approval .~.C.-~.; .t?~.t.~. ~.~ ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate , .~.. .................. Fee Submitted $ .... .~.'..~.~. ................... Construction on above described building and per_mjt meets all applicable codes and regulations. ~J2) -~- ~ -~c~¢) (~ Applicant. , .................. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 0~O[)~,~ ~.G~ i[~'~85 JOHN STREET, NEW YORK NEW YORK 10038 THIS CERTIFIES THAT SYSTEMS OTHER APPARATUS: $ E R V I NO, O~E ON OF CC COND. AW.G OF HI-LEG NO. NEUTRALS OF NEUTRAL Thre~ "C" Electric Inc. RT. 1 Box 4t~ Sound Avenue Riverhead; N.Y. 11901 L~#~27 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspector~ ma be dentfed ~'~~,~J~--,v~ ...... Y , by thmr credentials. FIELD I~N S~ ECT I ON FOUNi)AT ION ( 1.~ t ) FOUIlDATIOt! 2. tNOUG}I FRAbiE & PLUMBING (2nd) CO hlt~N% ~ ]USULATION PEtl N. STATE ENERGY C,ODE FINAL AI)DITIONAL COMMENTS: 7GS-:1.802 BUILDING DEI~. INSPECTION [ ] FOUNDATION '~ST [ ~ ROUGH P~G. FOUNDATION ZND [c~INSULATI4~)N /,~RAMING [ ] FINAL INSPECTOR 765-1802 BUILDING DEPT., INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ~)~ FOUNDATION 2ND [ ] INSULATI°N [ ] FRAMING REMARKS: ~~ [ ] FINAL DATE, l "~ '~ ~ INSPECTOR,, ~',G:L· ~ L ' ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ^pproved . q. Pe=it Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... ,19... 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 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 building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary igspec~ions. (Signa, ture of applicant, or name, if a corporation) ...... ~ .~..~. ~.~ ½~ ~..~.T...~.q.-.~... ~ .t.q,'.71 ........ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plmnber or builder. ............ ~ _¢..~?. ~ ,.,....c..o?..~..0.,.~ :..a-.: .................................................. Name of owner of premises .'.~..~..~..~...~..~. 77..~. (3.k~.~./..~d.....~..~...~.t&.'.4. ?. %?.' ............................ (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...~ .q. ~ :~,,~.~ .~..:. Plumber's License No .... 7, ~..~'....~ ............. Electrician's License No.. ~ ~ ~.. ,t~ .......... Other Trade's License No ...................... k'5~ 0,~>~4 ~_~l,k.$ Location of land on which ro osed work will be done C~o f~ t~,-- LtI~ ¢. ~ (g i O-ct4 House Number Street Hamlet County Tax Map No. 1000 Section ...O.. ~. ~:~ .......... Block ../. .............. Lot. ~../. .............. (Name) 2. State existing nsc and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................... b. Intended use and occupancy ...................... . ~ /,4J:: ~'~- ~ t £ ~ 1~) 6~, ff.l_£t .~. ~.~ . ....................................... property lines. Give street and block interior or corner lot. 3. Nature of work (check which a~plicable): New Building ...~... .... Addition .......... Alteration .......... Repair .............. Reinoval .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost .... ~'~'-'.~.~..~..~..a.F,).. ........................ Fee ...................................... (to be paid on filing this application) 5.If dwelling, number of dwellin~ units... ~ .......... Number of dwelling units on each floor/. $.-~?. If garage, number of cars .. ,a% ..................................-''" '" . ....... 6, If business, commercial or mixed occupancy, specify nature and extent of each type of use ' . ......... 7. Dt ensmns ofemsnng structures, finny: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure w~th alterations or additions: Front ................. Rear .................. Depth .... ~ ' ............... ~,... Height .......... · ............ Numb~er of Stories ......... ~ .......... 8. Dimensions of entire new consfruction Front...2'~....., ..... Rear ~ ........ ~epth ,,-~. ........... · ' m Height .../.~' ......... Nu ber of Stories .... ./ ................................... ;~ ............... 9. Size of lot: Front .... /.~.~.~ ............ Rear. Mt. ~..'~'.. .............. Depth .~ ................. 10. Date of Purchase .... /. ~.,Y. ..................... Name of Former Owner ............................. 11. Zone or use district in which piemises ar, e situated ....................................... 12. DOes proposed construction violate any zoning law, ordinance or regulation: ...4~.~. .......................... 13. Will lot be regraded ..../'~. 0_~. i ............. Will excess fill be removed from premises: Yes I4. Name of Owner ofpremises~.~..~.~...L..~.l~,~,i' .Ad, dressJ'..7.~.~:d..~.c.7'~'7,~$t~r~/~lahone N.o~.?.,.~o~.~'.:/.~./. Name of Architect . ~/,q.q. ~e,~t.r./.~.. ...... ii~odress Pa~ d~a3q. ........... Phone No .......... ~.3j~.... Name of Contractor .~ ~t.~.~. I. ¢.o./¥ £.-C'. ....... Address I~,.~.gc*..~?..~.~*{*?. Phone No. ~*)-i~.' .'/'i PLOT DIAGRAM Locate clearly and distinctly al buildings, whether existing or proposed, and~ indicate all set-back dimensions from number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, !S.S COUNTY OF ................. ...... L]~ .~4..~..~.. ~. c~.~....L,.i.{.O..4 .~....'i ....... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. 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 mann4r set forth in the application filed therewith. Sworn to before me this ...... .o? .~ . .'~.. , day oi..., i .~.. p4~ ...... Notary' Public ..... ~.. ~ ~)~. ...... ~ County , -, ......... NOTARY PUBLIC, State of New ¥orl~ Ne. 4707878, ~uff0f~ COunty (Signature of applicant) l~r~l E×p~res March ~,~I°O0'W. .,. 9~.:40 EXCAVATION: l] FOR APPROVAL OF CONCLUSION ONLY ' ' ' " EXCAVATIOH INSPE~!ON 1 REQUIR~ ' I I ', ~ FOR APPROVAL OF ' 17, ....................... DA~'E , ,- The ~ ...... - - faci!.~' ~ ~q .~:~ ~ ~7-1-: : ~ :'- ~ ~-' .'~' ~nspectc,] . , : ' "''a been - ' ' ' ' ,- c.::d z~ound .~-,. :'r~.. ~.~-~,~ " -- . -~ ~.- ~ " - . . ' ' .... I~ b ' ~' ~' ~'7 '~.. ~ ., : '~ ,,"~' ~ ~ C'~ ,, ,- ~ ~ ::n::::., ',,..~:;~<~ I " i