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Home My WebLink About13199-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate No .... ~1.5505 ....... of Occupancy Date..D.~c em.h~e. 35.~ ................. 19. ¢.6 THIS CERTIFIES that the building One ~i....ly Awe.. ~ ~ . Location of Property .3.2.~.~...~.~.~ $9.h..L.~..~.e ................ ~.~.u.q q ~..i~¥..g.q~. 1~ ........ House No. Street Harnle¢ County Tax Map No. 1000 Section 1.2 5 Block 2 .... Lot I . 8 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated M.o.y.. g 3., .............. 1986. pursuant to which Building Permit No .... 1.2[ l 99 g ............ dated ..... eun.e 8., 19 ~.6. i dc fo llofth ...................... ,was ssued, an on rms to a e requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... One family dwel.ling W~LTER GgNKO The certificate is issued to ......................................................... (owner,~Ys~( ~r~(tX X X of the aforesaid building. ~3-S0-59 Suffolk County Department of Health Approval ......................................... Pending UNDERWRITERS CERTIFICATE NO .................................................. Plumbers Certification dated 1986 Building Inspector FORB~ NO. B TOWN OF SOUTHOLD 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? 13199 Z Permission Is hereby grant dq~. , .......... 1~,~ ' . . .. at premises located at ............................. ~ ........... County Tax Map No. 1000 Section ..... ,~..~.~. ........ Block ....... .~. ......... Lot No ......~..:.~ ........... pursuant to application dated .............. ...~.1~..~] .................. , 19.?..LJ..., and approved by the Building Inspector. Building Insl~ector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property I?-'O~- L'~JcJ?i~' ./,,.~.. ~,~ ..~..d~x~...l,~.~..~. Owner or Owners of Property .......... ~.y)....O ................................ County Tax Map No. 1000 Section .. J?...~. ....... Block ..... c~ ....... Lot... ~ .? ......... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo,]'.~]~Q' Date of Permit ..~.'.~.'.~.~.Applicant.,,~..J~..{~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ~-' ~ Construction on above described building and permit meets all applicable codes and regulations. Applicant...~..~ ........................... Rev. 10-10-70 A. This application must be filled in typewriter OR ink, and submitted ~ 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 natura~ 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 p(an 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 p~operty 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 $15.00 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 .~. .~. 5.Updated C.O. $15.00 Date .. THE NEW YORK BOARD OF FIRE UNDERWRITERS Dece~er 10,, 19be~ JOHN STREET, NEW YORK, NEW N 783350 THIS CERTIFIES THAT X X X in the following Ioca~ B~F,~86 ~ I,~t FI. ~ 2nd FI, Section Bl~k Lot OUTLETS SWITCHES DRYERS FURNACE MOTORS SERVICE DISGONNEC! . RANGES APPLIANCE FEEDERS iPECIA[ REC'PT [COOKING DECKS I OVENS I DISH WASHERS AMT K. W A~T K W ~J.AT K W 1 1.2 TIME CLOCKS BELL UNIT HEAFERS MUlTI.OUTLET A~T, AMps, TRAN$ ~ SYSTEMS NO. OF FEET EXHAUST FANS DIMMERS 1~'2W ,.~3W 3.~3W 3~'4W NO'Oi~ECRC~.COND ~,jU , ',.L 3/0° NEUTRAL S~ -'. w, '-2o ' .~W, 2~l,0~W, 2-.75kw, i .5k~ ' Electric Water }leaters: 1-4.5kw i-G.F.C.I. 1 Smoke Detector Track LightJ3zg 16,-.0-, 8 lites Waiter Ganko Box 444 .~. Aldrich La. , ~=. ~ , GENERAL MANAGER ~ ,,au=el, N. ¥i1948 lhi ·. Per ]~ s certff,cate must not be altered in any manner return to the off ce of the Board if.incqrrect. ~nspectGrs ma be identif' ~OPY ~OR BUILDING DEPARTMENT. THIS COPY OF CERT EICA~r .n'~f~ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~/~ Owner ~-/~m ~ $ /q~ FFC_ ~- ~ L.C. (please print) Plumber ~-~4~% y~ ccc~tL_ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Swor.n.~to before me thi~ ~ay of ~.~; ~ , Notary _ . _ County ~er's signature) RUDOLPH H BBUER NOTARy PUBLIC, S~ate of N ~ No. 52*0465.530 ew York · "-~- ~arch 30, 1987 [ELD I J,,?ECTION ?LUMBING 3. '][ i'l S U [, A'~ [i 0['] FEI{ STAT[:: ENEt~GY C.Oi) E ox.( ADDITIOI~AL COMMENTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT APP~.IGATION FOR RUI/DING PERMIT 1. Application must be filled in by typewriter OR in ink and submitted-~h'r--~.~pl;c6[e to Building Inspector, with: a. Health Department approval to construct private well and sewerage disposal system, OR approval to hook up to pablic water and sewer system if available, i C~e~-~/ b. Accurate plot plan TO SCALE showing all lot lines, buildings, unusual natural streets, features, exact size of lot and proposed buildings, and existing buildings, elevations and other topographical information, Subdivision name, lot and block number etc. Plot plan or survey must be signed by person or engineer or surveyor preparing same. v/C. The plot plan must show the actual shape, dimensions, radii, angles and area of the lot on which it is proposed to build, or add to an existing building. The dimensions of all yards, setbacks, distance between proposed building and existing buildings or structures on same lot must be shown. Plans for proposed building OR addition to existing building must be clear and legible, submitted ih triplicate. One copy of each filed application, plan or document will be returned to applicant for their records. Where required, copy of approved special exception from Board of Appeals and/or site plan approval from the Planning Board must be submitted with application for such building permits. Application for sign permits will use same forms and procedure as for buildings, however separate "plan sheets" giving outlines, dimensions, exact locations and other detailed pertinent information may be submitted. h. Permits expire in twelve (12) months from date of issue with exceptions as noted in building zone ordinance. As soon as a foundation for a building OR for an addition tea building is completed and before any first story framing is started, an accurate "foundation survey" showing accurate distance from foundation to all property and street lines shall be submitted to the Building'Inspector and approved before further construction is permitted. PERMIT FEES: New dwellings--S25.00 plus 5~ per sq. ft. for oil buildings over 1,000 sq. ft. floor area; Additions and alterations to dwellings--S15.00; residential acce~s~, $10.00 . . .~s~.~g~. ft. floor area; Additions ~o such a~ces- sory buildings--S10.00. Hotels, Motels~h~s~;~--,m~ol buildings--New Construction-- $50.00 plus 10~ sq. ft. for over 10~oo~ons and alterations to such buildings--S25.00 plus 5~ sq~iness and in~ccessory buildings and additions to same~l other structures~----"$15.00: Signs--- 25~ per sq. ft., ' ' .?0. Permits may be revoked for cause as outlined in the building zone ordinance. Stop orders will be issued under conditions outlined in the zoning ordinance. 2. Certificate of occupancy must be applied for, and are required for all new and existing buildings, land use, etc., FEE $5.00. Inspection of existing building and issuance of certificate--Fee $5.00. 3. Regrading of building lot or premises, removal of excess fill from such grading, cellar or basement excavation, cesspool excavation, driveway construction, etc., must be applied for at time of building permit and permit issued by Building Inspector (sand, gravel & excavation ordinance). ]'65-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION REMARKS DATE 765-1~02 BUILDING DEPT, INSPECTION [ ] FRAMING REMARKS: ,,, [ ] FOUNDATION 1ST []ROUGH PLBG. [ ] FOUNDATION 2ND []INSULATION []FINAL 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined..~.~,.~.~..~..., l~ .~.~ Approved ...~2,.[.,'~ . . .'~.., 19~.~. Permit No. I..~..~ .~ .~..~.. ',3 Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received ........... 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~,~tmilding code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necess~ inspeX~ti~ns. ~ _ /(Sigpdture of applicant, or name, if a o porati ) ....~.. ~. ~ ~..~~ .,..~: ?.,. t .,.q..~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... ('a} ~' 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..'~i~--. ~. ~tZlqci.~.'?iF~'~'~F~'- , Other Trade's License No ...................... l. Location of land on which proposed work will be done .................................................. · ./. ...... ............................... House Number Street Hamlet County Tax Map No. 1000 Section ..... ].c.~..,.~-~ ........ Block c~ Lot. /.~ 8 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 ....................................................... b. Intended use and occupancy ..... ~--~..q,~J) ......................................... . 3. Nature of work (check which ap. hcable): New Building ....... Addition .......... Alteration ......... Repair ' Remo.'vai Demolition Other Work 4. Estimated Cost ........ O.O.~I~.~ .irC..o. .............. Fee ..................................... '~' (to be paid on filing this application) I 5 If' dwelling number of dwelling Onits 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 ofexistingstmcturei if any: Front ............... Rear .............. Depth ............... Height ~ ............... NumBer of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... !.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new constmction: Front ...... .~.O.t ..... Rear .... .~.O ........ Depth .... /~Ot. ....... Height .... ~ ¢1.O ! ...... Number of Stories ..... .02 ................................................. Size of lot: Front ..... o~.qC,t. L .......... Rear ...... r-~.~/q9. .......... Depth ... 5.@0 ............... Date of Purchase ...~B..o,4-¢J~,,.... {qg.3 ....... Name of Former Owner . .['. {~.0 .O..~...'¢.o. t~ ~¢. ~.~, ..... Zone or use district in which premises are situated ..................................................... Does proposed construction violate any zoning law, ordinance or regulation: ..... JS~.O ........ Will lot be regraded ........ g~t'O ............. ' .... Will excess fill be removed from premises: Yes No Name of Owner of premises .~'~P~.~.% . ~ :T%~.~c.%. Address~. ~..~.q~. l..t~..~_~..~... Phone No..*{~.4.~..~o.~. .... Name of Contractor ~ .r~.¢5. ~,.x.~.~¢~_~. ........ Address .-~.?. ~-~-4.qelo.~.~.q.... Phone No. 25.q.n ~7~5 ...... 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly all ibufldings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block interior or corner lot. '"O i ST - STATE OF NEW YORK, COUNTY OF ................. ~umber or description accordin (Name of individual sign lng contract) above named. and show street names and indicate whether being duly sworn, deposes and says that he is the applicant Ue is the ......... (/X_O. .......................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is dul authorized to perform or have perfomed the said work and to m~e ~d file this application;that all statements cont(ined ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ne: set for~ ~ the application filed therewith. Sworn to before me this .............. IA ...... daf°[~ .... ~ ...... , 19r~ erlV ~ .......................... GUFFOLK GOUNT¢ HEALTH DEpA~MENT' ,,, ~ F.M,LY ONtY ~AV~> , , ~as~ewat~r Managem~t Se~n ' SURLY FOR AT LAUREL DATE, dULY /a, ~WN ~ SOUTHO~D SCULl, /" = /00' SUFFO~ COUNTY, NEW YORK ,o. M~UTH~IZED ALTE~TION OR ADOITION ~ ~$ GUARANTEED TO~ surVEy · · VI~AT~O, ~ SECTION ~0~ ~ ;.E FIRST AMERICAN TITLE INSURANCE CO. MC~IES ~ ~1S ~VEY NOT ~AR~G THE LAND OF NEW YORK NO. I~1S2675 su~vg~ws toKIO ~AL O~ [NBOSSEO SgA~ NOTBE CONSIOEREOTOKAVALIO TRUE COPY~/~ OF ~ HEAL~ DEPARTMENT-OAT~ F~ APPRO~ TO C~STRUCT ~ ~ ~oR WHOM THE SU~gY ~S NEAREST W~ IAIN~lb~ NSOU~C[~ WATER,~ ~TE~U~IC__ MENTAL A~NCY AND LENDING I~STITUTION LISTED ~. V~ I I k I ~ ~~NDER AVENUE BB YOUNG ~ IUUI~O RI~R~AD, NEWYORK NO~: ~ = ~ONU~N~ ~ = S~ --~ ALDEN W. YOUNG~PROFE~IONAL ENGII4EER ANO ~ND SURVEYOR N.Y.S. UCENSE NO. 12845 HOWARD W, YOUNG~ LAND SURVEYOR N~ L~T~ ~ W~(WI,~PTIC T~NK(ST}aCES~OLS(~)~N H~E~ N.~S. LICENSE N0.45893 ~,r(nefly y~o'., ~ C;;°l D°Iy O0v/ or formerly ' forr~erlY 0r L,Q~M SUFFOLK 'qi' should be need that since this ...... ' )()coted in F'. ,),e ,y Is .:..... ,..~.t~ thot the . . required, Contact this Department prior to sampling". COUNTY DEPARTMENT OF HEALTH CZ. / F£ORD HEALTH' DepARTMENT-DATA FOR APPRoVJ~ TO CONSTRUe Z H NL4n[sT ~Arl~ ~#--.UL -+ H souscE ~ WA.H, mt~l ~P~lc ._ H~JFI~CO, TAX MAP ~DI~T//J~ SECTION/Z~ BLOCK ~ LOT./.~-~ HTHEM ~1~ HO DI~ELLHNI$ WITHIII tOO, FEET ,O/F It THE ~TER S(J/~Ly AND SEVMOE DISPOIAL SYSTEM I,Gq THiS NOTE ** I : MONUMENt' D -' D. i POL ACEK 400 OSTRANDER AVENUE RIVERH~AD, NEW YORK DATE' ~IUG 27, /9,~/ SCALE: /" NO. 81 - 472 SflO~itH H~O# FHOM PNGffEHTY UNE$ OUNG YOUNG ALDEN W. ~NG, P~OFE~IONAL ENGINEER AN~ LANO sURvEYOR N Y.S UC[NSE NO 12845 HOMARO W. YOUNG, LAND SURVEYOR N ~S. LICENSE N0.4589~ ~lS ~v Y NOT ~A~WG THE CAMO