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HomeMy WebLinkAbout13757-z FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y, 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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 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 sifnilar 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 end "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 bccupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $1.00 4.Vacant, Land C.O. $5.00 ..~./. ,./.~..~, 5.Updated C.O. $15.00 Date ...... ? ........ New Bui)ding ............. Old or Pre-existing Building ............ Vacant Land ............. z, .................. Location of Property ......... . .~..~. ,~. House No. Street Hamlet _ , . . e,y. ........... Owner or Owners of Property County Tax Map No. 1000 Section .... //'-~<~ Block ~ ~ Lot .... ~../."~.~- Subdivision.., .-~'.~.'~-. ~O~;? r/,/ .~..,~,. ~ .( .~C. Filed Map No. ~..~.. ~....Lot No .... ~.~-.~. ...... Permit No. /.,~. '.~..-~z~.~-=~Date of Permit .~/,/~..J~.App cant .~.i~---7..~...~....~... ]~.~/.'.~,~?.. Health Dept. Approval . .~. ......... ~. .......... Labor Dept. Approval .... '~ .--. ................. Underwriters Approval..../{~. ~.+~..~.. ¢.~.~ ...... Planning Board Approval "~- . .............. Bequest for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..... ,~'.~ ,C~.".-~. ................. Construction on above described building and permit(~Tts/~ll/~pplicable codes and regulations. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION (pleas~ printJ)' Plumber '~6/=~-'~'7-~,~ /D/~' /~ lJJ'~'g ~/~'/7~ (please print) / I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. ~umber' s signature) ,;~worn to before me this ~ day of ~ · .~ N~tary Public ,~County ~k~A ~ Notary Public FIELD ~S~CT I ON COMMENTS FOUNDATION (1~ 'OUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION FER N. STATE ENERGY qODE FINAL ADDITIONAL COMMENT~ TOWN OF SOUTItOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TILL. 7~65-1802 Jan.29,1985 Mr. Steve Perricone Twin Fork Fence & Siding Inc. P.O. Box 41 Mattituck,N.Y. 11952 Re: Sebastian's Cove Dear Mr. Perricone: Based on a letter from Ray Dean (Highway Com- misioner) and an oral report from Jack Davis(Town Engineer,) indicating that the road meets the min- imum requirements for emergency vehicles; building permits can now be issued for this Major Sub-divis- ion known as Sebastian Cove. Let it be further understood that 280 A (Road Approval) must be met before a Certificate of Occ- upancy could be issued. Any further deterioration of the present road condition could cause Stop work Order. R~ectfu~ yours, Victor Lessard Exec. Admin. Building Dept. VL:dsm ,JOSEPH T, DEPPE ARQHITEQT P O. BOX '1 '180 EAST QUO®UE, NEW YORK ~i '1942 5'16'653'5225 765-1802 BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION :)ND [,] INS~~ON [ ] FRAMING ~']~FINAL REMAR,KS: ~ ' DATE, 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~',] FINAL DATE: ~ ~/~/ INSPE~OR THE NEW YORK BOARD OF FIRE UNDERWRITERS :L~(~0'7'7[ BUREAU OF ELECTRICITY ~]- 8.5 JOHN STREET, NEW YORK, NEW YORK 1OO,38 THIS CERTIFIES THAT only the elec trical equipment as described belotv and introduced by the app[ic~*t ~tr~ed oR the ~bo~e ~pp~tc~tt?~ ~u r~_be r t~ the~ ~re~ti~e~ of Alfred Sk~.~zypecki~ N/End ~ebastians Cove Rd,~ 1000' n/o Mill R~, -1500 ~/o Grand Ave. t ~attituck~ in the followlng location; [~ Basement [~ Ist Ft. [~ 2nd FI. Section Block Lot was examined on ,7~I~E[~.~ ~ 0 ~ ]. ~ ~ ~ and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 57 39 DRYERS SYSTEMS NO. OF FEET E E R V I C NO, OF CC COND. A, W, G. ~SR ,~ O~ CC. COND 1 2/0 DTHER APPARATUS: Future Appliance Feeders-l--.2-t4, 1~2-12e 1~3-8 Mo.to~.~ s- 1--3/4 G~F.C,I,-2~ Smoke AW, G, OF HI-LEG 2/0 R~land Elec. Co. P. O. Box 143 Mattit~ck~ N.Y,, 11952 i9.#24 E GENIEI~AL MANAGER must not be altered in an), manner; return fo the office of the Board if incorrect. Inspectors may be identified by their credentials. COPy FOI~ BUILD NG DEPARTMENT. TH S COpY OF CER?IFjCA!E I~uST NOT BE ALTERED IN ANY MANNER. I 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 8OUTHOLD, N,Y. 11971 TEL,: 765-1802 amined.. I9' ~,pproved..~f~..~4,~. !¢., 19 ~..g~. Permit No.}..~..~..~.? .~.. ,'tOWN Or='SOUT~O~-q, ~eceiYed ........... ,19... Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 ~,ts 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 r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ifion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bnilding Inspector will issued a Building Permit to the applicant. Such permit ~all 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 ~ail 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 uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or .egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to Jmit auth°rized inspect°rs °n premises and in building f°r necess .~/S.~s' ~.~/,¢<)./0~M,,ff.~_~. . ~5ignature of apptica~,,~ name, if a corporation) · .P.,.o..,.,g. ox..¢,, p..c).,..~..~.r/. ~..~..cf.~../,/. ~.. (Mailing address of applicant) tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. / .. - tme of owner of premises ~.~.. ~ t~ .... /. 2. ~.~...]~./f.~.~x~. ~... ~ ~'~.'~ /~/ ......... (as on the tax roll or latest deed) [applicant is a co,oration, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done.., k.~..~ ........................................ ....S'. ~t~.~..x..'~/.~..~..~:.. ~to..v...s-...~cl ........ r~. ~..r.r.~. 7:.~.c.-/~. ...................... House Number Street Hamlet County Tax Map No. 1000 Section .... / .O.~. ........ Block ..... 0..~ ......... Lot...././.,.,.5.- .......... , ~ ~ .~r. ~.~ ' Subdivision. ~ ~ J~.~'.'~'~j.~..v~. ~ . .~..~./~..~... 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 . b. Intended use and occupancy ./~)...~: !..~..~.- ./~)..~."J. ~.g-~... wql o 7S<o7 Nature of worl~ Estimated Cost ~Additi dch applicable): New Building .. on .......... Alteration .......... Removal .............. Demolition .............. Other Work ............... : (Description) Fee ~ :?:;~...~.' q' (to be paid on filing this application) If dwelling, number of dwellinj units ..... J ......... Number of dwelling units on each floor... !~ . ......... If garage, number of cars .... g[, ................................................................ 6. If business, commercial or mix{d occupancy, specify nature and extent of each type of use ....% .'".'". ........... 7. Dimensions of existingstructufes,i if any: Front..... ~ ...... . Rear ..............~ Depth..-;.'wt. . . ....... Height "-'~ Number of Stories ..-'T Dimensions of same structure With alterations or additions: Front .'~-7.. - . .... Rear ....~w. ........... Depth ...... · ............. .... Height ...................... Number of Stones .................. ' 8. D~mensmns qf e.n~r%new cons~ructmn. Front . . ~. ~ ~. .... Rear ... ~. ~.. ........ Depth . .-~.,.51 ........ Height .]..b..~./. ~..'. .... Ngmber of Stories../..~ .............................................. 1~9.,,. Sizeoflot Front /2,~..(~ , Rear ,:~ ~7..(,4'. D th ~'~'-~ ..... De ....... b ............................. P ''' z~ ............ at 9fPurchase .... /./~.' ~/~.'~'.' i ............ Name qfFormer Owner ..~..~/~.~..~-/.D..~.~.t. ¢ P..O/O..e~... 1 1. Zone or use district in which p~emises are situated..~.~ l .[.~r'X~).'.~/./~/-.. ~ ........................... 1 2. Does proposed construction~¥iolate any zoning law, ordinance or regulation' ./'d!~. ............ 13. Will ot be regraded ..... ~,:_/~.~. ..........., ....... Will exces~ fill be retnoYed from premises: Yes Name of Architect .Z~Q-~f-r.~.~¢i i i~-~ ;. i'bl .~.~.0 ~ . Afldressq,2q.~OtO~o~Pp~nne No~q-ZX Name of Contractor .. Q..~..,5q~.e~. t~ ............. Address ...'.%ZZ-7.. ............ Phone No .... ~ ......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from proparty lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. Pf'O p©~ ~:~o (-~cOU._~ ~ Ioo ,gl oc./d Lo' c STATE OF NEW YOR.K~ cou ¥ OF ..git I s.s · . ~ I ~.. ~.~X¢~ .~[ .............. being duly sworn, deposes and says that he is the applicant (Name of individda[ sig9ing contract) above named, j Heis,the..Q~~..~..¢~.~~ .................................................. j ~ (Co~ractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file ~is application; that all statements contained ~ this application are true to the best of his ~owledge 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 ~ . Notat~ Publi~. ~.~.~. ~. ~q~, ~ .~ ...... County . . ROBERT C. OICK / .... Commission Expires March 30, 19115 ~ -. -.,;..'FrOLK COUNTY DEP~RTUENT.OF H~LTH SERVICES L~HE 5~ DUILDING Ot"S[~[~¢,~O~ OF AT M~TTITUC~ DATE: D~C. IZ I~ I~g~l Y }~,~8q68 {.,,~y ~N ~ ~OE~OLD SCALE: = 50' ~P~OV~ SURVEY ~ 4 VI~ATION ~ SECTION 7209 ~ THE HEALTH D~PARTME~T-D TA F~-A~RO~ TO C~STRUCT ~E ~R~' ~ WHOM THE SU~EY IS PREPARED ~ ~'~.~.~;M&P ~ T'~IECTI~CK~LOT~ 'H~E~. AHD TO ~E ASSIGNEES OF THE LENDING ~E~~ J ~ ~Y~E ,EI~ WITHIN ~OO~FEE? OF T~S PROPERTY INSTITUTI~. GUARANTEES ARE ~T ?~SFER~BLE NDISTANCE~ S~Wff HEREON FROM PR~ERTY k NES WIk~ ~i ~T ~TflK ~TAN~ OF TH~ SU~K CO~TY DEPARTMEHT TqEXISTIN6' STRUC~RES ~E FOR A SPECIFIC 0F H~L~ ~l~S. '. ' ' ...... PURPOSE AND ARE NOT TO BE USED TO ESTABLISH , , ~ ¢ , P~PERTY LINES O~ FOR THE ERECTION ~ FENCES L ' YOUNG & YOUNG ,~ ~,~ , , ' RIV[R~AO, NEW YORK : :~U~/~/O~FILE~I~Tg~OE~/C~O~rg~ , ' ~OEN W. YOUNG, PRoFEssIoNAL ENGINEER. - ~y , ~ O' 9INGLE FAMILY DWELLING ONLY~ ~. '. ,.~,e.n., H.D. REF. NO,~~ ~ DATE ~J .... 5 . ~ ~q.~'~o"~' THE SEWAGE DISPOSAL A~~ FACILITIES FO~.~ O.w/ , LOCATION HAVE ~EEN i~ aY THIS D~ARTMENI AND~ Dg&.o~ FOUND TO BE SATI~FAG. TOR~. . ~ ......................... ~ ' '.' I - Chief of W~tewater Management Seotlon ./~ ~ . ~ ................. ~ ..... · ................ ' MILL SU~Y FOR ~u~ /o,~a~ AT MATTITUC~ DATE: D~C. ~WN ~ $OU~NOLD , SCALE, 1" = 50' SUFFO~ COUNTY, NEW ~RK NO. ~ ~U~IZED ALTERATION OR ADDITION ~ ~IS ~E~ ' TO: H[~ OEPARTMENT-OATA F~ APPR~ TO C~STRUCT ~ K~G FOR WHOM THE SU~EY IS PRLPAREO YOUNG S , SUBDIVISION ~P F/LED/E T~g Of F/C~ OF F~ ~DEN W, YOUNG, PROFE~IONAL ENGINEER AND ~ND SURVEYOR N.Y.S. UCENSE NO, 12845 ~ O~ ~UF~ CO. ~ ~0~ ~0, /9~ ~ ~/LE ~0. ~0~ HOWARD W. YOUNG, LAND SURVEYOR m~ Laa ~ ~L(W),~IC TA~(I~I Cg~sle) ~, ~g~ N.Y.S. LICENSE N0.45893 BRANDIS & SONS INC. 1046