HomeMy WebLinkAbout17367-zFORM NO. 4
TOWN OF SOUTHOLD
' BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No 217490 Date NOVEMBER 4, 1988
THIS CERTIFIES that the building ADDITION
Location of Property 1110 LIGHTHOUSE ROAD SOUTHOLD
House No. Street Hamlet
County Tax Map No. 1000 Section 50 Block 5 Lot 9.2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 23, 1988 pursuant to which
Building Permit No. 173672 dated AUGUST 26, 1988
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 DECK ADDITION.
The certificate is issued to CLYDE & JOYCE FRITZ
(owner, X7LXliI:2DCL;KXXXXXXX)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ,
CERTIFICATE NO. N/A
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
FORD! NO.
TOWN OF SOUTHOLD
EUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N o 017 3 6 7 Z Date ...... ~ (/ .:...°.'1.fir ............................ 19 ~~
Permission is hereby granted to: ~ !`F^~ ~ 1T°"`~ .~,
..~Q... ... sa..~.d...`°~...... .. ~
................ ~9.~.1...................................... ~'
ta .....~ti'~.......Gt....,~G.F,aGr~,,... .k~S..+~.~t/~!Rt.r........ a:d:•'.~~~r~e!~-~..~......
. ... .... . .. . . .. . . . .. . .. . . .. . . .. . ... . .... ... . . ... .. .. .... .. / . / . . / ./ . ~ ... . .. .. .. .. ...... . ... ... . .. ...... . .. . ... .~. . . ? .. ../. . . .. . . . . .. . . .. . . . . ... . . . . .. . ... . . .. ... .. ... .
of premises located of .........~.L//1.l/..G.~?:i.~caa~......"~'{ ..:...........................................
.................................-.P.'~n..................~ .. ..
Cvunty Tox Map No. 1000 Section `r0 .......... Block S Lot No..~~!'~...~..
pursuant to application dated ............... ..... .R.`.:3.................., 19..~Q., and approved by the
Building Inspector.
Fee $... ~~:. ~.....
yd~~
.............fir ,~-~............................
....ding Inspector
Rev. 6/30/80
~.ei1y _ ___._
~~ 3_ 3~. aioa+inos ao NMOI
Anj~f ~m ~~~~- ,)~ ] FORMN0.6 ~09g
~'~"`~ h^'"v TOWN OF SOUTHOL
Building Department
Town Hall ~86~ E ~ ~~
Southold, N.Y. 11971
765 - 1802 ~ry
APPLICATION FOR CERTIFICATE O 2J
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~e~sr to the Building Inspec-
torwith 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, acertificate 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 property 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: Additions $25.00 POOLS $25.00 ALTERATION $25.00
1. Certificate of occupancy New Dwelling $25.00, Accessory -$ 10.00 Business $50.00
2. Certificate of occupancy onpre-existing dwelling $100.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $10.00
A.Vacant Land C.0, $ 20.00 ~
5.Uodated L~C.0. $ 50.00 Date ~~~...J..i..).~~,,......
New C ons tr~c''~1 on , , , , , ,Old or Pre-existing Building ............ Vacant Land
1 / ~, ............
Location of Property ............ ~. ~ l~U .....!~.~ .~s. ~f'r!!C~l~ ~:~ . ~G~ ~(.{ :-YJ.S~.G,
...
House Na. Street Ham/et
Owner or Owners of Property .... ~ ~, ~ ~. ~, . ~~?~ .~, , , , , ~~ ~~;-; , , , , ,
~r~• q ..........
County Tax Map No. 1000 Section ............... Block ....~.. , ...... Lot .... /.~.~:..... .
Subdivision .............................N....Filed Map No./~.~~.........ILot N/o. ............ .
Permit No.v.'..7-~. ,7. Date of Permit ~.~ :~°..Applicant ..!~-; )?, ~.~;j"~S ;5 ~f~,Y,» ,Z,a,~`,~'1xJU'~'
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
~,~/`p.c3(0(~0 APPlicant.~G~2-Ei~Le.~..~.-..~~~.,~...............`~`-`Y:~"
neg. to-tons .. ,ll/ ~~
~oa~FFlkk
~'~/°+•q ~g~;,~$~~~~ ;<.~ OPI 1Cf3 01' [3UlL,UiNG 1iJS1'C:CTOR
U ~ r ~.. .' -,-
~~. c~;,~w;lt~''~ "~= TOWN HALL
4 ,~/~1K`~~ ~~ ~ SOLI"T1IO1,U, N. Y. 1~1797n1 ~) P ~p p~~y
i 110 ~ " .t.~.9~2~ ~~
To Whom This May Concern,
Pie are u:rable to complete your Certificate
of Occupancy bccau;n of the following reasons.
~ A
/
n
/ application for Certifica te of occupancy
is not on file. C~iriT~e~..Q~~
/ / `lo
~ Underwriters Certificate on file.
/1
'1'he check .is (~~~~,,Fnot on file. } ~~„tS,//~
/_/ [ao ttealt}x Dept. Approval on tile.
/__/ P:o final. in;;pec t:ion has bcera made.
Plenr,e contact our office on this matter.
Thank yoi.r for your. cooperation.
~luildinr; Permit 11 1. ~ ~ ~ ~ Z _ C~~~
TSuil<i.ir.rl UepL•.
'`**/~/ rlo T'.lumbcr Solder Certificate on file.
( all permits involving plumbing being
TEL. 7GS-180?.
.issued after April 2,.19fl4 )
I73(~~
rss-isoz
BUILDING DEPT.
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING [ FINAL ,~.¢~~Cz¢,~~
REMARKS:
DATE `~ /~ ~O INSPECTOR
'"-~iL`Llj if:5P2C: iU;J I IJni" ~ ~(;o`1i`1E;NT° _ \ I
1 m\
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FOUt]DATION (1st)
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FOUNDATIOtd (2nd) __- -- `~
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OUGH FRAME & .~
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PLUMBING
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3. "
INSULATION PER N. Y. ~ ~ y
STATE ENERGY
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ADDITIOP]AL COMMENTS:
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FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
' TEL.: 765.1802
Examined .... .~(o, .., 19 .GG~~
Approved ......~ i?l/, ., 19 v.~Permit No..~7~(f.1 . .
Disapproved a/c .....................................
BOAKD OF HEALTH
3 SETS OF PLANS
SURVEY.........,
CHECK ~-~~~~ ... .
SEPTIC FORM
NOTIFY
CALL ...L.............
MAIL T$d"s'aa ~p .
P-p .
......................................
(B ilding Inspector)
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
yw
Date . t~.°2.G'.........., 19 ~~
~ 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. ~U' '~7J
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 Depaztment 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 inspections.
'/ i
~~ .. 0%~ /C ~L`~l!.. 'S .../~a~h.£.../MOl2.o u2.w,cvTl /NC,. .
(Signature of applicant, or name, if a corporation)
$,..
;, ..~Q•:..Po,X Sao S'eatHccO /vy //9
....................~..:.•.....7/...
%~ (Mailing address of applicant)
State Whether applicant is owner, lessee, agent, azchitect, engineer general contracto electrician, plumber or builder.
''r
Name of owner of premises .....~:~ y'~~ .. ¢. , , U o yCE ~'.2/ T2
(as on the tax roll or latest deed)
1f applicant is a corporation, signature of duly authorized officer.
..............................................
(Name and title of corporate officer)
ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED
Builder's License No . ........................ .
Plumber's License No . ....................... .
Electrician's License No . ..................... .
Other Trade's License No. ...~.3 0. 7. 7, /~.Z
1. Location of land on which proposed work will be done . ....................... .
c / .........................
a Q /~.l ~f~ T ~f d Ct .frL ~Qr ,~U Ct % ~f 0 (-
House Number Street Hamlet p n
County Tax Map No. 1000 Section .... ~.'so Bloc,l. ,~'" ... Lot ......./. ~.~, ,
Subdivision ..................................... Fi]ed 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 ........~ L'/.Ec c i N
........................................................
b. Intended use and occupancy ......0~'!`~~.~ (:`~.~... ~, O~C'eK
............................................
3. Repaic of work (check whiRemovl~icable): New Building .......... Addition .......... Alteration ......... .
• • • • • • al ..... . ........ Demolition ..............Other 1Vork ...IP!4A.~f..0.~~~
4. Estimated Cost ....~9.'a,Zs (DescripSio;~)
... ~ ...................... Fee .................................. ..
5. If dwetlin number of dwelling un ~ (to be paid on filing this application)
g, ,its .......:: : ::::: Number of dwelling units on each floor ............... .
If garage, number of cars . , ..... , , .. ,
6. If business, commercial or mixed gccupancy, specify nature and extent of each type of use :... , , ~,~; `'; , , , , , , , , , , .
7 Heigl Ysions3cf existing stru Numbe f any: Front ... S'`f ~......... ,Rear ....YO........ Depth .', .,$ e','• , ...... .
r r of Stories ....~.......'..... ...... ..
,....... ......i ..................
imensions of same structure with
alterations or additions: Front . , s.Y ~........... Rear ...y4 ~, . , , , .. , ... .
8. Dimensions of entire new construct Height .... 39. ~ .............. Number of Stories .. ?-...... , , , .. , ..... .
tion: Front ....~?-.'........ Rear ...°'r! ~......... Depth . YB.~ ......... .
Height .. f......... Number of Stories ..... ¢•;~.¢ .................... .
..........................
d
9, Size of lot: Front ...:.. , • .
.. Rear...~a 8;,86
.. ~/9~-/ 88~ ....... .......... Depth ... s.'o,l,,CC...........
10. Date of Purchase Name of Former Owner .S:N R;sra PNtR• acse:uvec.vko,~ /b[r~r
1 1. Zone or use district in which premises are situated ... ~P~sr,nK!~;t.yc ~ ' ' ' ' '
1 ~, Does proposed construction vtolate any zoning law, ordinance or regulation: No ~ • ~ ~ ~ ~ ~ ~ • ~ ~ ~ ~ ~ ' ~ ' ' ' '
13, Witl lot be regraded ...., ,!1!p, , ; , , , , , , , , , , , , , , , , ,Will excess fill be removed from premises: Yes !~
14. Name of Owner of premises 4r4Y. ~, $:7:°,Y.r~, F?! ?? . ,Address 6!fNrN°f•r~ .~4, s~;~;r~~~ophone No.. 76 5': %ts'ss
Name of Architect ~ ~ ~ ~ ~ ' '
.a..Kt/c ~ ................Address...................Phone No. ...............
Name of Contractor .B. d. , . /. ,'. , ,
* P P y HcMQ rn/, iNe 0,. ak S}o Soniikcd
15. Is this ro ert located w '~ ~ • • ~ ' ' ' ''' • • Address .P...~...... Phone No..~?.3, , ; 35~,> . ,
i;thin 300 feet of a tidal wetland? *Yes ..... No h'...
If yes, Southold Town Trustees Permit ma be reqgu~ired.
PLOXI' DIAGKAM
Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner la`
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iTATE OF NEW YOxtc,
'OliNTY OF ................. S.S
' ' • • • • • • • • • • • • • • • • • • • • • • • • .g • • ~II';• • .... • • ......... , being duly sworn, deposes and says that he is the applicant
kY~xr~
(Name of individual si nin contract)
bove named..
ieisthe ........................:.. ...................... .. .......
(Contractor, agent, corporate officer, etc.)
f said owner or owners, and is duly authorized to perform or have performed the said work and to make and
PPlication; that all statements contained in this application are true to the best of his knowledge and belief; and
•ork will be performed in the manner set forth in the application filed therewith.
worn to before mge~this ', D
............aV'`.~~.~: ....day of.. ~..........., 19!p,0
file this
that the
otaryPublic . .... .........`x.•.~,C•............ County ~~ V
BEIEN K. DE VOE ~ J~-!"!' (. .
~m Ezpu alMi ch 30'1~h.1L~ ...... ........ ... .. .... ~~ .... .
(Signature of applicant)
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RODERI K YAN TUYL, P.C.
LICENSED LAND SUR EYORS
aREENPORT NEW YORK
SUFFOLK CO. HEALTH DEPT. AP*WOYAL
H. S. NO. ~'
STATEMENT dF INTENT
THE WATER SUPPLY AND SEWAGE DISPOSAL
SYSTEMS FOR TWiS RESIDENCE WItL
CONFORM TO THE STANDARDS OF THE
SUFFOLK CO. DEPT. OF HEALTH SERVICES.
(S)
APPLICANT
SUFFOLK COUNTY DEPT. OF HEALTH
SERVICES FOR APPROVAL OF
CONSTRUCTION ONLY
DATE.
H. S. REF. NO. 85 a0-1E4
APPROVED:
SUFFOLK CO. TAX MAP DESl4NAT1t7N: I
DIST. SECT. BLOCK RCL. I
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