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HomeMy WebLinkAbout13185-zFORM NO. 4 TOWN OF 5OUTHOLD BUILDING D£PARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy &ddition THIS CERTIFIES that the building ................................................ Location of Property ....~.2..5:5. ..... pvt:Rcll Goose Creek Lane Southold Mouse tvo. ' ................. 'S't/e~i ....................... County Tax Map No. 1000 Section ...0 .7.8 ....... Block 0 8 ..... Lot 0 09 Subdivision X ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .~Rril 27 19 8.4. pursuant to which Building Permit No. 13185Z dated ....J.u.n.e. .... 4. ............... 19.8.4., was issued, and conforms to all of the xequirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...... .~.d.a.%~. $9.n. .~.9..an, .z.x.~.s.~. $.n.g..Q.n.e. ?.a..ra!.!7' , p.w.e.l ~. ~.n.q. ...................... The certificate is issued to ............. gI~V....4Q .H.lq..D.$ .I>l.lq.Y. ............................ (owner, I~. of the aforesaid building. Suffolk County Department of Health Approval ...lq../.~. ................................... UNDERWRITERS CERTIFICATE NO .... ........................tq667558 ...................... Building Inspector Rev. 1/81 TOWN O~ $OUTHOLD BUILDING DEPARTMENT TOWH HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL CON~PLETION OF THE WORK AUTHORIZED) N? 13185 Permission is hereby granted to: .~..~?.~~..~......~ .............~ ~ ~? , ........ ................ F ........................... ~----'~-')2~ rA~--'"'~p, ~d ~'.'~'"~ ..... ;~: ........... ~r'/~ ............ · o-/4 ? o ~ ... County Tox N~a~JNo. 1000 Sechon ........................ Block ...................... Lot N ..................... ...~,~'. ........ ~. ................... , ~...~. pursuont to application dated ~ . ~ .... 19. , and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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: 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 inspectionof buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: Certificate of occupancy $5.00 1. Certificate of occupancy on pre-existing dwelling 2. 3. Copy of certificate of occupancy $1.00 landuse--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date ..07 New Building ............. Old or Pre-existing Building ... ~X. ....... Vacant Land ............. ~ l' ,~ Sou. tho-Id NY ...... Location of Property 12~q Goqse..u.w.a~k., ~.r.~ .................................. House No. Street Hamlet Owner or Owners of Property John De~nY County Tax Map No, 1000 Section 078 Block 08 Lot. 009 Subdivision ................................. Filed Map No ........... Lot No .............. ...... ~nvir onraent East., Permit No. of ermite/. ./.8! ....App,cant fo' ......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate .... X. .................. Fee Submitted $ ..... .~.-,~. ~ .(~. · .............. ~ Construction on above described building anC/~erml~t~~ ~gulations. CO ~ ~ ~ Applicant/~~/~~.. J ................ ~ ~ ~ ~ "~~n~ as a~;en~ for n~. 10-10-78 John Denny NE;~ YORK STATE DEPART~T~(T OF EF)VIRO~fI!E~!TAL CO?!S~RVATIO~ Regulatory Affairs Unit Building 40, SUNY Stony Brook, NY 11794 Henry G. Utlltams Con~ntsstoner ~]0 PERi, IT ~,!ECESSARY - TIDAL ~ETLA;(DS ACT Environment East, Inc. Peter R. Stoutenburgh, President 30?5 Indian Neck Lane Peconic, NY 119~8 M~y 25, 198z~ qe: TW Permit No. t0-S~-062~ Father Denny Dear Mr. Stoutenburgh: A review has been made of .your proposal to: Construct ~n ~Cdition to the rear of ~n existing than ?~ feet from tidal wetlands. ~ocatton: 1255 Pvt. Rd ,~1 Goose ~r_,ek'~ a L~ne dwelling ~reater It has been determined that no permit is necessary under Article 25 (Tidal ~(etlands). However, any additional ~ork or modifications to the project may require a permit. It is youP responsibility to notify this office in ~ritinu if such additional work or modifications are contemplated. Assumtnq you have obtained any other a~nlicahle permits, you may ~roceed with your project. Very truly yours, / . naniel O. Larkin Reqinal Permit Administrator 9JL: RNT: l 1 Environment East, Inc. R. R. No. 3 - 3075Indian Neck Lane Peconic, New York 11958 516-734-7474 October ]_6, 3.984 Buildinm Dept. $outho] d, NY Town of Southold 11971 Attn Bui~di~-.g Oept; Please accept these revised pis. ns for B2dg. t-'ermit ~r 1318,3 for Father Jovan Denny. L~.e cham~es you wi2] note show the change in the wood burnin~ stove location amd its related haarth au~ fire w~!l. We have s]so ~Oded a slop sink im the down stairs utility room. ~'/e will be re~dxr for the f~na_ inspection by the end of tho week of 10/~2/84o We will nee.d to get the key to the Building: Dept. or~ buzldin~ open on whs~t- If there are any~ please contact me. ~ours truly, Env~ ro~;k~ s t, ~c. -)3a-:~, b-5, c-5,d-5 t'RS; jm THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Oat~ ,~ov~;~'~.~ ~, ~ ~.~,,~.o~o.o.~.~ ~'z/~ N 667558 THIS CERTIFIES THAT only the electrical equlprnent as ~scribed bel~ and introduced by t~ applicant named on the able application nuntber in the premises of Ray..Jo~ D~y, 1215 ~a in the/ollowing location; ~ Basement ~ lst Fl. ~ 2nd FI. Section Block Lo~ was examined on ~OV~K~X* 5 ~ ~: and found to be in compliance with the requirements o~ this Board. FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES 16 17 DRYERS FLUORESCENT DISH WASHERS EXHAUST FANS SYSTEMS NO. OF FEET OTHER APPARATUS: E R PER ~' OF CC, COND. ]. 2/o V I C OF HI-LEG NO OFNEUTRALS A, W. G. OF NEUTRAL 2/0 J~5~s~ 1-13cir. 125amps. , // Sourly, Id. N.Y. 1.1.971 Lie. ~ ~/ /'~ ' ce iticate must not be altered Jn any manner; return to fhe office oJ the Board JJ Jocorrecf. Inspectors may be identified ~y t~eir credentiaJs. COPK FOR BUILDING DEPARTMENT. THIS COPy OF C,RTIFICA!E MUST NOTBE ~:LTERED~ ANY MANNER FIELD INS?ECTION COMMENTS FOUNDATION (?st) FOUNDATION (gnd) ROUGH FRAME & PLUMBING 3. INSULATION FERN. STATE ENERGY qODE Ye FINAL ADDITIONAL COMMENTS: FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .... ~.....~ ........... , 19.'~..![.. Permit No../....~....)....~...~.~.......~.. ......... Disapproved a/c ............................................................................................ Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Oa,e ............. ................... , ....... INSTRUCTIONS a. This application must be completely filled in by typewriter o¢ 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 ]of and of buildings on premises, relationship to adjoining premises or public streets oF areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. 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 Occupa~cy 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 buildings for necessary inspections, (S'gnature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, g~ene~al, controctob electrician, plumber or builder. Name of owner of premises ............ ..~...~..~....:........~......~ ....... ..~....~.....~x___~%j .............................. ~/o_[ duly authorized officer. J ................................................ / ......... ....  (NamFe and tif'le of c~e~6fficer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... $ u b d ± v ± s ± o ~ Location of land on which proposed work will be done. Map No.: ........................................ Lot No ......................... Street and Number ....~,h.'~..~...{ ...... ...~....~..]b. ....... .'~..j.,-~...[ ......... ~...z~......~...~,..j'..~.....~, ....... .~....0....~.., .o..L. 4 ................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occ~ancy I '-~ ~.~ b. Intended use and occupancy ................. ...~...~ ............................................................................................ County Tax Map NO. Dist. ~000 Section__ ~ g Block 0 ~ Lot 00~ 3. Nature of work (check which applicable): New Building.. ................. Addition ........... Alteration ................. Repair .................. Removal .................. Demolition .................... Other Work .....................................................  ~ (Description) ©i 4, Estimated Cost .......... ;,f..~.~..,~. ........................... Fee , (to be paid on filing this application) / 5. If dwelling, number of dwelJing units ........ J. .................. Number of dwelling units on each floor ............................ If garage, number af cars ...L ...................................................................... ~ .................................................................. If business, commercial orj mixed occupancy, specify nature and extent of each type of use ............................ ' O' ....~.....~.'. .................. Depth ....... · .......... "~imensions of existing struct'ures, if any: Front ...... ~ ................... Rear ~. I He ght ....... ..~-....~. ......... Number of Stories ......... ~ .................... ~ ............................ ; tDimensions of same structure with alterations or addition,s: Front ........... ~..~. ................... Rear ..... .~.~ ................ L I~epth .....~:~;~%....:4T. ll. ........ iHe.ght ........ ....... ju:.Number of Storms ....... .................. , Dimensions of entire new c~nstruction: Fro, nt ..... '..~J~.....~ ........... Rear ......~)). ............. Dept, h ..,.r.~.,...~- ......... ~Height .....'~:.,~ .....Number of Stories .........~Z~'. ....................................................................................................... Size of lot: Front ............... ,i..~.....~... ........................... Rear ........... ..~..~.. .................... Depth ..'~...~. ..................... Date of Purchase ............... i ........................................ Nome of Former~ -". ~Owner" ....................................................... Zone or use district in whicl~ premises are situated .......... .,~.'~..~...~(....~. .................................................... Does proposed construction ,iolate any zoning Iow, ordinance or regulation: ........ .~,L.~.. ...................................... 13. Will lot be regraded ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises ... ................................................. Address ................................ Phone No ....................... Nome of Architect .............................................................. Address ............................. ;.. Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimens OhS from property lines. Give street and block number or description ~ccording to deed, and show street names and indicate whether interior or corner lot. 10. 12. SLATE OF NEV~Y~I(~ _, .v,~ /¢ c ,,..~..~:~..~..:..~.X.~..~..I...Aw.~..I ......................................... being duly sworn~ deposes end soys that he is the oppliconl (Name of individual "' s~nlng contracf) above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this appl cation; that ali statements contained in this app ication are true to the best of h s knowledge and belief; and thor the work will be performed m ithe manner set forth n the opphcat~on filed therewith ~worn,4'o before me this