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Home My WebLink About13180-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date September ~6 ]9 85 THIS CERTIFIES that the building .... - 3~e'~..~.~ ~-~&~.~ ~ ............................ 500 East Rd. Cut chogue Location of Property ............................................................... House IVo. Street * Hamlet County Tax Map No. 1000 Section ~0 .Block 7.. .... Lot p/o ~1~~ Subdivision.. X ,Filed Map No, X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ......~.~. 7..2.5. ...... .., 19 ...Sg- pursuant to which Building Permit No ....... ...............q 3~1807, dated .......... .~.~.~e.. ~. .......... 19 ~., 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 ......... New one-family, dwelling. The certificate is issued to ....... GERTRUDE & ~'Rg2xlK ALI .............. ..................... of the aforesaid building. Suffolk County Department of Health Approval ~Z4-S0-86 ~675075 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1;81 FORM NO. 6 TOWN OF $OUTHOLD 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 submitte~'~Ncctc 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. Commemial 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 featu ms. 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 1 2. Certificate of occupancy on pre-existing dwelling/ land use --?re-Exls ting C, 0, 3. Copy of certificate of occupancy $1.00 Vacan6 la~d C.O, New Building ............. Old or Pre-existing Building Location of Property .'-..~.~...~./~)~. ~..../~ ./~. ........ House NO. $15.00 $ 5.00 Date../, ,X~/.~,¥. ,'~. .............. ............ Vacant Land ............. Street Hamlet Owner or Owners of Property ~...~./~..Z-.~:~.~,Z)..~r~.. ?.,...'~.../'~../~. ~. .... ~ ~ / ........ ~.~.: ~. Y~ (' County Tax Map No. 1000 Section ..... ~9 ....... Block .O.~ .......... Lot...~.. ~.~. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./~/.~..~.. Date of Permit ~./~/~.Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary C~icate.., ................... Final Certificate ...... . .~... ............ Construction on above described building and pp~mit meets all applicable.codes and regulations. ~ ~_ ~__,~ ~ppllcan~ ..~..-.; .................................. ¢ ..... R~. 10-10-78 / ~ ....... ~ ~ ~ 100138J~)iII THE NEW YORK BOARD OF FIRE UNDERWRITERS BURl=AU OF ELECTRICITY 85 JOHN STREI=T, NEW YORK, NEW YORK 10038 pplica,ionNo. o,fi, N 673075 Date THIS CERTIF~ THAT only the electrical equipment as described below and i~troduced by the applicant Mined on the above application au tuber in the premises of in the/oliow[ng [ocation; ~ Basement ~ Ist b~. ~ 2nd Fl. Section Block Lot was examined on ~ ~ s ~ and found to be in compliance with the requirements of ~hls Board. FIXTURE OUTLEFS DRYERS FIXTURES RANGES OVENS :DISH WASHERS EXHAUST FANS 40 MULTI-OUTLET NO. OF FEET OTHER APPARATUS: E R V I C E 2/O ~. ~l/O Per_ This certificate must not be altered in any manners, return to ,he office of She 5oard if incorrect. Inspectors may be identified by thelr~ed~nfi~ls~ TOWN OF SOUT~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~/~ ~ Owner ~E~T'//'D~ ~ f~ ~ /'~L I (please print) Plumber~-D~/~ ~ ...~CL ~,~._ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber ' s!/~igna~ure) Sworn to before me this ~ day of , ~u~/~ , Notary Public, ~ ..... County Ngtar~ gPubl~c INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY C DE FINAL ADDITIONAL COMMENTS Rcgelat. ory Affairs Unit .. .. Bldg. ~O, ~U~--Room 21D Stony B~.. ~ 'I%794 .~ -"~516) 751-7900 A review has been made of your proposal to: C~C~A%, ~'0~7~ ~ New York State Department of Environmental Conse~ation has found the ~ parcel__. _ project to be: Greater than 300' from inventoried tidal wetlands. greater than i00' in length constructed prior to September 20, 1937. · Landward of 10' contour elevation above mean sea level on a gradual, nat- ural slope. Landward of topographical crest of bluff, cliff or dune in ex,ass of 10 feet in elevation above mean sea level. Therefore, no permit under Article 25 (Tidal Wetlands of the Environmental Conservation Law) is required at this time since the current proposal is beyond State mandated Jurisdiction 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, [ Daniel J. Larkin Regional Supervisor of Regulatory Affairs DJL:RNT: cz Meeting,Date. ~'~'~'1 ' Members Absent, any. Relief requested and I~ocation: Charles Grigonis Resolution made by: Seconded by: ( ) ( ) Appeal No, ~-~;7 c3~5'" Applicants: ~ ~_-~-~' Serge Robert Gerard Joseph Doyen Douglass Coehringer Sawicki ACTION'. ) Approve as applied ( } Deny as applied ) Deny without prejudice ( ) Deny A ~pithdrawn ~'ithout Prejudice as ~equested prove w|th the fqllowing Conditions: [2] {,~ Subject to County Planning Referral ) Subject to Planning Board approval ) Subject to D.E.C. ( ) Special Exception criteria applicable ( X ) Prior application conditions applicable, If any NOTES: VOTE OF THE BOARD: Ayes~ ( ) CG ( ) SD (C~J~D (~ ( 4-T~JS Nays: ( ) CG ( ) SD ( ) RD ( ) GG ( ) JS Abstain: ( ) CG { ) SD ( ) RD ( ) GG ( } JS Absent: ( 4~)~CG ( ~ ( ) RD ( ) GG ( ) JS Resolution was passed: ( ,~3 unanimously Resolution was not passed: ( ). This application was'recessed until ( ) by majority vote 765-t802 BUILDING DEPT. INSPECTION FOUNDATION 2ND [ ] INSULATION D~T[ IN&P£GTOR 11~ ' ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 , · TEL.: 765-1802 . Examined ........ 19 Disapproved ~/c ... ' ...... ................................ (Building Inspector) APPLICATION FOR BUI LDING PERM IT Application No .................. INSTRUCTIONS 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 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 issue 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 Occupahcy 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, buildi~.g. ~c~de, housing code, and regulations, and to admit authorized inspectors on premises and in buildings for necessary insff~s ,CT~ i/i hi ; ;ddress of apt~icant) State whether applicant is owner, lesse~ ~chitect, engineer, general contractor, electrician, plumber or builder. / (as on the tax roll or latest deea) 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 ....................... ~ ~.,~ r'~.~.'~ , Other Trade's License No ...................... 1. Location of land on which proposed work will be done. .~ · - [~dt[n; ~ i ; -' '~ " Street Hamlet .. Cohnty Tax Map No. 1000 Section ... ~(~.' .......... Block .... ~.~ .......... Lot .... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... r ...................................................... b. Intended use and occupancy .......... -:.~ · ~-.~ "; ........ ~ ................................. 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Removal Demolition Other Work ............... Repair .......................................... --- ' (Description) ....... 4. Estimated Cost ........... ~ ............................ Fee ............................... i /~,') (to be paid on filing this application) 5. If dweiling, number of dweiling uhits ................k~.... Number of dwelling units on each floor ................ If garage, number of cars ...... 1 .................................................................. 6. If business, commercial or mixed]occupancy, specify nature and extent of each type of use ..................... structures! if any: Front ~ Rear Depth 7. Dimensions of existing , · ........................................... Number of Stories ' Height ............... · ....................................................... Dimensions of same structure with alterations or additions: Front.~.... . .......... Rear. .................. D ,, '. Hei-ht ~ Number of Stories ...... , ,.... ·; .... cpm .................... i' r~ ...... ~'?>~ ...... ~,~ - .- ~ -~- 8. Dimensions of entire new constrUction: Front .... ?p..~ ...... Rear ....? .......... tpepm .............. Height .~.g:q .~ ......... Number of Stories ..... ~ .... ;.v's; ,,',z .................... ~':- ............... 9. Size of lot: Front....~.~.o .... :~., .......... Rear ..... ./..~(~: ?..~77...~ .....D~p~t~ 2;;~ .//.,~_;: .. ...... n~t* of Purchase -,/e~,~ ~.ff- ...... N.~me et cermet uwner .. ',,:...~. ¥ .-' .... '.: ............. 10 ..... : ........ , . ~-, . ........ 11. Zone or use d~stnct m which prermses are s~tuated ~.i ........ ' ordinance or regulation: 12. Does proposed construction violate, any zoning law, · ............................... 13. Will lot be regraded ....... .~ · i ..... L ... Will excess fill be remov.ed from premises: Yes No 14. Name o f Owner of premises ~F-~Po.~- ·. Z-2.4 f. ..... Address ........ 7. .................................... Name of Architect .......... ,' ................. Address ................... Phone No. Y~s~ Name of Contractor ....O.4~.~ .~..~-. ........... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~i:'~KK. z [ COUNI~Y OF. ~.zw'.. ~/~ c-O ...7~ /7 ~ /~-~ ,~/8 n < dy' being duly sworn, deposes and says that he is the applicant / (Name of individual signing contract) above named. He is the ...................................................................· .. .. " (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d'uly 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 manher set forth in the application filed therewith. Sworn to before me this tefra £xptres M~rch T['Y I)F, PA]ITM~' ~' T OF }IEALTH SERVICES v,' £ '; <'[,' CONS'i'IIUCTION AT CU~'HOGU~ 'WO~N O~~ SOI. i~tOLD SURVEY FOR r~sr ~o~ - ~ , ~, ~ ~o~r ~ . ~. , ~ ~.1~ ,,o, CAVATION II{SP[CTIOH RE ED ~ . ~ .- [ GE~T~U~ ~ ~1 dAN. ~ ....... TH~ TITLE ~ ' ~ ~COPIES ~ mis S~VEY NOT ~A~G THE CANO F ~E ~. N~EM ,~ ~ ~[LLI~I WITHIN IOO FEET OF T~S PROPERTY TO A~ITIONAL ,NSTITUTI~S OR SUBSEGUENT ~ ~ ~ ~ ~ / V~l I~1~ ~ V~I IM~ ~NDERAVE~E ~,~ ALOEN W. YOUNG, PROFESSIONAL ENCINEER ql I J AND LAND SURVEYOR NY.S UCENSE NO 12845 i ~J HOWAROW. YOUNC, LANOSURVEYOR ~ L~f~ ~L(W),~PTIC TANK(ST)! CES~OL$(~) ~N ~RE~ ~ ) N.Y S. LICENSE NO. 45893 ~E ~ FIE~ ~Tl~S ~ Oa DATA OeT~D FR~ OTHERS - dAN. E8,1984 ~ JAN ~c I~ .. ~. ~. ~~~ amr~u~ ~ ~/ ~,~ _ . JA~ I~ 1984 ~ ~ ~t~esal a~d ~at.e~ supp!? /,, ~e~ by this d-ep~t~en% ~d fo~- SUFFOLK COUNTY, NEW ~RK NO. 83' ~9 * SURVEY ~ A VI~ATION~ I~CTION 7zog ~ THE HEAL~ DEPARTMENT-DATA F~ APPRO~L TO C~STRUC T ~' ' "' ANO ~ ~lS BEHALF ~rTH[ TITLE C~P~Y, GOV~N- )}~ ~/%~ , ~, ~E~ A~ ~ ~ELLI~S WITfllH I00 FEET OF T~S PROPERTY . .YOUNG YOUNG ~T~' ~ = ~g~ : ST~KE AL~DEN W. YOUNG, PROFESSIONAL ENGINEER AN~ EAND.SURVEYOR N Y.S UCENSE NO. 12845 HOWARD W. YOUNG, .L~NO SURVEYOR ~ L~T~L(W),~IcTANK{sT)ac[~OLs(~)~N ~E~ N.~S LICENSE N0.45893