HomeMy WebLinkAbout17410-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
7491 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 24, 1988 pursuant to which
Building Permit No. 174102 dated SEPTEMBER 13, 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 GARAGE ADDITION WITH BREEZEWAY TO EXISTING ONE FAMILY DWELLING.
The certificate is issued to CLYDE & JOYCE FRITZ
(owner,
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
UNDERWRITERS CERTIFICATE N0. N041232
PLUMBERS CERTIFICATION DATED N/A
Building Inspector
Rev. 1/81
Foaas xo. s
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
CTHIS PERMIT MU5T BE KEPT ON 7HE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N°_ 017410 Z Date ...9.-.i3.- ................................... 19.R..f~
Permission is hereb ra t d to: `~~~~
..
to .L'^"""vf..~... .....fem.. .... ..
y U / .. .. vv ..
at premises located at ...........Gl..........,~L~'i~....~'1 .....................................................
............................................... ~..~~fFlj{.K....iT.'.................................................... r...........................•
........................................................ r........................................................................................~......q......• ~
Caunty Tox Map No. 1000 Section®........'c~L.~....... Block ......... ~..~Lpot No....7r"....~/...7."~ 7•
pursuant to application doted ..CJ/./:~.T .................................... 19Q.C1.., and approved by the
Building Inspector.
Fee $..1c1 d.•. ~
.c~ . ~~.~y.~.~.. ~....~ ......................
~~"'y"'g nspector
Rev. 6/30/80
A31. ..t ar-~~
FORM NO. 6
TOWN OF SOUTHOLD ~6~ £ ° AON
Building Repartment a
Town Hall
Southold, N.Y. 11971 ~ r~ ~ r~~
765 - 1802 JJ~ c
APPLICATION FOR CERTIFICATE OF OCCUP -
Instructions
A. This application must be filled in typewriter OR ink, and submitted ~ ~~ 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 Soard 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 pxaperty 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 $'25.00, Accessory -$ ]0.00 Business $50.00
2. Certificate of occupancy on pre-existing dwelling $ 50.00
3. Copy of certificate of occupancy $ 5.00, over 5 years $ 10.00
4. Vacant Land C.O. $ 20.00 Q
S.Ubdated C.O. $ 50.00 Date !/pV °~ ~ 1 ~~
New C o cDsi'~~e.~ ~nZG~
...... Id or Pre-existing Building ............ Vacant Lan_d(~ ............ .
Location of Property ....~up.......~'!~~~.'~~~~'.~%..RC.~ v~urr~~~~
...............................
House No. ~~//~~,' Street ~ L fiam/et
Owner or Owners of Property ... ~.l yCA:er ~:. ~oy.~r... , ,7 .J~-.
.....................
County Tax Map No. 1000 Section ....~'-~..~........ Bfock ..... ~........ Lot ....,. ~. ~ .... .
Subdivision ..........................
Permit No.U~ .~~~a~~. Date of Permit . l."
Health Dept. /$pproval ................ .
Underwriters Approval !! .............. .
Request for Temporary Certif~icjate ........ .
Fee Submitted $ .. ~ ~~ ..°.~~!-~~,
......Filed Map No. ..........Lot No . ............ .
/.~; S~PPlicant.lt~.3~.1'~1~~?~S.l-~Q1?'~~.F-!~!~,fr2 t
......Labor Dept. Approval ........................
......Planning Board Approval ..................... .
............Final Certificate .. Y .................. .
C/vonstruction on above described building and permit meet all applicable codes and regulations.
Inc '~'~0 ~ ........... ..................
~,p ..~! .
~~~~ ..
Rev. 10-10-78
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1.001.071, BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK `0038
FAGF, 1
Date Of.TONA;R ?0,198$ AppficatfonNo.onfife 5R0@0088/88 N 041?.3?. ~
THIS CERTIFIES THAT
only the electrical puipnent a described 6skAm and introduced 6y tAe applicant EEamsd on the above application number in thepromiws of
X,YDF., FRl'.T'L, 1110 T,IGfIT H(?itSf,: ROAD FS/S, SOti'F'H(1/J), H.V, '
~,nx
in the folbteinR location; ^ gg~~.e S ~ /et Fl. ~ Ynd FI. ,Sertion Block Lot
OCTOHKR 14, ~~~t
revs examined m end found to 6e In rnmplianre with the reyuiremenfe of thu Board.
RXTEKI!
OUTIRf AC7lS ~~ RXTURiS
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CANDESCEM nUdESCEM v RA
AMT. NOEf
K. W. fOOlIIN
AMT. O WCKE
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AMT. ST FANS
M. P.
DRYEES
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FURNACE M10TOK FIIIVM AFlUANCE RREfERE EFlCIALpCFi
dl X. P. GAS X. r. NAT. NO. A. w. G. AA1T. AAa.
TIMEtYOCK4 RHL
AMT. NHS. TRANS.
UIRTIIEA7ERS MIINFOUTIET
AMT. H. P. ~ ~T
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AMT. WATIE
SERVICE DIECOFN#ECT NO. W S E R V I C E
AMT. NN. TYPE AEETER
RtHN-. 1 / tW 1 /TV t / 3W ~ / AW NO.OF CC. COND.
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SOii'fNOLI?, NY, '11971
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This urHficaN must not 6e oherad in any malnsr; rNUm to the ofhcs of fha Eoayd ff iTleorrM. Inspeelon Moy bn. identified their endemiah.
/~~r®
765.1802
BUILDING DEPT.
[ ]FOUNDATION i5T [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION ~ ~ ~
[ ]FRAMING [ FINAL ~ ~ ~~~E!
REMARKS: _ ~ _ _. _.._
DATE / 7 0 INSPECTO~ ~v+~
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r'1BLD I:;SPEO:iU:+ ~ ~UATc. ~ OOMMENTS ~
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± FORM N0. 1
TOWN OFSOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
Examined ..9p~`~.~........, 19 0
Approved .... f ~3• • • • • •> 1~~Permit No. ~7~/~~
Disapproved a/c .................................... .
BOARD OF HEALTH
3 SETS OF Fi.ANS .~...
SURVEY ../~
CHECK • • .~ Z"IZ8
SEPTIC FORM ,,,,,,,,,,,,,;
NOTIFY .3 •y3 ~ 3
.~ ... ........... S o~7
~~ ~ b K~,I 5 _~dM~ .gyp.
~ 2 41988
i
. .......
( 'ding Inspector)
APPLICATION FOR BUILDING PERMIT
Date ................... 19 .. .
INSTRUCTIONS
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, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for neces inspections. ^
n (Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
................................................................................................
4 ~.y d e .....,-~ O~C,.~....~'t~i ,~1',2~. .................. .......... .
Name of owner of premises ........ y
(as on the tax roll or latest deed)
If ap licant is a corporatio~n,,si/gn/~ature of] duly authorized officer.
~..~51.. ??~ ..... V.: ...
(N e and title of corporate offi er~ ~.
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 . .................... .
1. Location of land on which proposed work will be done . ................................................ .
House Number Street r.~ Hamlet ~~
County Tax Map No. 1000 Section ~~~ ~ . ...... Block ...... ~.! ......... Lot ...+•-~'/• • • : • • '•'• z.
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 • • • • • • • • • . • . -).....~...... .
3. Nature of work (check which app#icable): New Building .......... Addition . ~!¢~!¢~''~.. Alteration ...... ,
...
Repair .............. Removal ..... , ........ Demolition ... , , ......... Other Work . 8lQ~~?~itsy
(Description)
4. Estimated Cost ... ...... :.. ~'?.efy-,e5~ ,,~/~4z.u~aY... Fee ..................................... .
..~ .. ~•3~Jooo
(to be paid on filing this application)
5. If dwelling, number of dwellin u}»ts ........... g son each floor ............... .
g .... Number of dwellin unit
If garage, number of cars ... 02. i. CAS ...aFi9!?.fF6 ...................:. :.......... . .. . . ..:.......... .
6. If business, eomatlerc~~ occupancy, specify ature and extant of each type of use ..........:..... , ... .
fi,,.. , r
7. Dimensions of~8xis~iig, c vany: Front ... ...:..•;., ...Rear Depth ::~. ~ ~ ........ .
Dime lions ofsame st • • •": °IVtib of Stories .... 2 ........•..:... I ....................:............. .
d y}'
Height . ..~ ::: • • ~ :: Tit e witi Iterations or additions: Front . 1 ~~ ............. Rear .../. ~ b:.......... .
Dep ,; . i3.8.~ . , , :,Height ....3.4 ................ Number of Stories ...~.... , ............ .
8. Dim '`lions of entire new cons~ruc~ion:-Front .. ~Y,`......... Rear . , . 6,Y. ~........ Depth ..,26,E , ....... .
Heig t ..'~ .,'i,S, ......Number of Stories .: ,.:.% !!4 .............................................. .
9. Size o o'$: F'°r'on't` ::.:. d:Q :-,i......... Rear ..:...1.4$r.~'IG:.;.~.:. ~ .... Depth .. ~;'q4. G,6...... .
10. Date of Purchase .. ,b~ 3~$b„ • , , , , • , , , , , ; , , , , ,Name of Former`Owner ~'l~.!s rodNE2, , gca;c,~! g• ,C!ct7,~q i9
- 1 1. Zone or use district in which premises are situated ..../.~s~.o,~•Tl9G ..................................... ~` ~_
12. Does proposed construction violate any zoning law, ordinance or regulation : .......................... .
13. Will lot be regraded ... ~&~ ...I, .................. Will excess fill be removed from premises: Yes
14. Natne of Owner ofpremises e~YA, k9-. F?YC4. ~air2 Address~'tF:c(rN°..".i'R~ sdy:!6~®. Phone No. X65: ;ills,
Name of Architect ...........~~ .............. . .Address ...................Phone No................
Name of Contractor ~B. ~6NST.!i N°~t..r~R . ('!~~'.~, ,Address P~•. !Qe.K .?'a u soe.; Nua phone No.. $?.s .'?S ~?.. .
15. Is this property located within 300 feet of a tigidal wetland? *Yes ..... No ..i'~„
*If yes, Southold Town Trustees PermitpLO~ DIAG1tAMed.
Locate clearly and distinctly all puddings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block number or des ription according to deed, and how street names and indicate whether
interior or corner lot.
~R~h
V~~A~,
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STATE OF NEW
COtiNTY OF .................
• • • • • • • • • • • • • • • • • • • • • • • • • • . • • •', • • ................. being duly sworn, deposes and says that he is the applicant
(Name of individual signirSg contract)
above named.
Heisthe ..................... ................................... ......,,............,......
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly] authorized to perform or have performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work Will be performed in the manneniset forth in the application filed therewith.
Sworn`to before me this
Notary Public, .....1,-.. ,~, , , , ;e: • ,~Q• • , , . County ~,~(~J/// ,
NOTARY P BUCKSete of New ' • • • ~ • • • , • • • • , ~ . ~ , ; , ,f , • .. U ... .
(Signa t•e of applicant)
-~. a?oie?a, se~tmk ceurity `~`
Term Expires Marsh 30,1
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SUFFOLK CO. HEALTH DEPT. APPROVAL
H. S. NO. ~2..~ _,. l
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THE WATER SUPPLY AND SEWAGE DJSt'OSAI
SYSTEMS FOR THtS RESIDENCE WtLL
CUNFORA4 TO THE STANDARDS OF THE
SUFFOLK CO. DEPT. OF HEALTH SE'RVICE°S.
f$!
APPL1C/iM1T
SUFFOLK COUNTY DEPT. O€ !#EAttTW
SERVICES - fOR APPROWAL Q'Jt`
CONSTRUCTK?NONLY '
DATE:
H. s. R,tif . re0.: f1~5, • 50 -i t4
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aPP+eovea:
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SUFFOLK CO. TAX MAP flE `N
DiST. SECT. BLOCK " ` kGL.
OWNERS ApDRfi.96:
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