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Home My WebLink About8228-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... Z. 1. 6. .7 .5.7 ........ Date .... .A.p.r. ! .1.. I. ,...1.9.8. 8. ............. THIS CERTIFIES that the building ...... Qp.e.. f..a.m.i.1.]~..d.w.e. 1. ~t .i.n.g ................... L~cnfi~n ~ Dr~n~rrxr 1060 Nor thview Drive Orient County Tax Map No. 1000 Section 13 .Block I .Lot 2 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated Sept. 16, 1975 pursuant to which Buitding Permit No. 8228Z dated .. O. 9 .t.... 7. ~.. I. 9. 7. .5 ............ was issued, and conform~ to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... O..n.e family dwelling, split level, porches and garage under. The certificate is issued to EDNA E. DOLL {owner, i'~,~e~& of the aforesaid building. Suffolk County Department of Health Approval . .5. S. 0.7.1.3. 9...Np.v.:. 23, I 977 UNDERWRITERS CERTIFICATE NO. N310492 Nov. 4, !976 PLUMBERS CERTIFICATION DATED: N/A Building Inspector Rev. 1/81 FOP~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 8228 Z Permission is hereby granted to: pursuant to applico~tion dated ............................. ~,~,1~.........( ....... lc~..~.j., and appro~;ed by the Building Inspector. Fee PERMIT INCLUDES APPROVAL TO REMOVE EXCESS FILL FROM ABOVE PREMISES BY REgRADING LOT DRIVEWAY ,~ONSTR UCTIQN ~ CESSPOOL t30NSTRUCTION ~/ ]OELLAR CONSTRUCTIO~,~.~ 7 OTHER Building Inspector FORM NO, 6 TOWN OF SOUTHOLD 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 i ~ to the Building Inspec- tor with the following; for new buildings or new use: I. 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-iS-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. B. For existing buildings {prior to April 19§7), 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 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 $]0.00 4.Vacant Land C.O. $ 20.00 5 .Updated C.O.' $ 50.00 Date ,. ~O,C....~.~..b lq.~'.~J' ..... NewtOns tvucti on ...... Old or Pre-existing Building ............ Vacant Land ............. Loc~tbn of Property ... ~ ~0. .... ~. a r::'t:6..V,'~... D. c,'.v..~. ........ .o...~.~.~n .~...._... House No. Street Ham/et Owner or Owners of Property . .~.fdl~¢:~. . .~,.. . . , .Z~. .~. (/ ................................. County Tax Map No, 1000 Section ............... Block ............... Lot .............. Subdivision ................................. Filed Map No ........... Lot No ............... Permit N o.~..~'.Z'. .~, ~... Date of Permit /.O,/2/J7b.--'.Applicant .... .~,al~, ,~., .T~,4~.~ .......... App ' ~ ,~ Health Dept. royal ........................ Labor Dept. Approval .,. · : ................ Onde~vvdters Approva~ , ~. ~ ............... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and permit meets all applicable codes and regulations. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS · ak bUREAU OF ELECTRIGITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 O~le~, %.Z. ,~.s.~.,.i.~do. October 28, 1976 andfoundtobeincompliancewiththerequiretnentsofthisBoard. DRYERS OVENS OISH WASHERS EXHAUST FANS SYSTEMS NO. OF FEET OTHER APPARATUS: Elec.room heaters: 5-!.Skw~ Motor/s: 1-1/2bp !G.F.C.I. 1 Smoke Detector I-~.5kw Hot water heater E 'R ..... V ........ ! C 4/0 17-1.0kw, 1-.625kw, 1-.Skw E Junior's Elec.Inc. ~arter L~ne GENERAL MANA~R RI East Quogue, L.t. 11942 Lic.305E P,r D _~[[~'~ ~ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES Health Services . Reference Number~'-~'~ -/ '' APPLICATION FOR APPROVAL TO CONSTRUCT f~/~.~ ~ /~ A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1..-Applicant MISS EDNA DOLL Phone 201-276~4365 5. Subdiv. Open Development Address ~-[aSal]e Ave,, Cranford, New J6~ey 07016 6. Section N.A. 2. Property Location ~v~w J._. nrive 7. Let Number N. Brow~'_~t~_~ 8. Private Well A~o ~age ur~n~ Township SouthoId~ 9. Public Water'--T6-~ 3, Public Water Company ~ Brown's Hills Water Co. Distance to main 2~ 4., Lot size: Width 250 feet Length 425 feet 10. Sewage Disposal System: A. 900-gallon septic tank: Precast X Squivalent Block B. Leaching pools: Number of pools Precast X Block ~pecial ll. If private well, fill in the fol- lowing blanks: A. Ta~k 'capacity , gallons B. Pump G.P.M. C. Total well depth D. Depth to ground water E. Amount of water in well (For Health Services De~t~. Use) The undersigned CERTIFIES:. "Construction of authorized installations will be in accordance with the Suffolk County Department of Health Services' current standards thereto." This application will be valid for one year from the date of approval indicated below and may be renewed if a current local Buil~ihg Department Permit is in effect. FOR THE DEPARTMENT OF HEALTH SERVICES~ USE ONLY. Based on the ini~ormation presented here- with, it is the opinion of the Department of Health SeEvices that an adequate and satis- factory Sewage Disposal System and Water Supply can be~~~ APPROVAL DATE / ~ J SIGNED S-15 Rev. 4/1/73 EXCAVATION INSPECTION REQUIRED TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 December 3, 1987 'FEI,, 765-1802 Edna Doll , This is to advise you that the job under building permit no, 8228Z issued to Edna Doll on 10/14/75 for new dwell_in~_ is completed a final inspection has (xxx) has not ( ) been done. and In order' to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out tho enclosed form, return same to the above office with a check for $25.00 payable to the Town of Southold. Please indicate to Whom the Certiflcate of Occupancy is to be mailed, and arrange with this offic.e for an inspection date Occupancy or uae is ~ without a Certificate of Occupancy. Please help us to clear up this matter so that legal action does not have to be taken. Thank you for your prompt attention. Very truly y~, Victor Lessard ~ Executive Admlnistrator VL:gar Health Department final approval is also needed stamped in green Not a copy TOWN OF $OUTHOI~D ~,~ i/~ .,~,,,~Z ~ ~ ~- ~ BUILDING DEFARTMEHT ~/~ ~ ~ ~ ~ ~ ~ TOWN CLERKS OFFICE~ .~ ~ ~ ~o~ ~ .......... , ....... ................................. , .~~/~( ~ APPLIGATION FOR BUILDING P~RMIT f~~-~ %~.~,~_~ o~ ......................... ~ ....... , ~..~.~ ...... INSTRUCTIONS a. This application must b~ completel~ fill~d in by ~pewri~er o~ ~n ink ~nd submitted in triplicate to the Inspector, ~it~ 3 s~ts o~ plans, accurate plot plan to ~ale. ~ee according to schedule. b. Piot plan sho~ing }ocotion o~ lot and o~ buildings on premises r~lationship to adjoining premises or public s~r~ts or,as, and giving a detailed description o~ layout o~property must be drawn on the diagram which is pa~ o{ this ~pplication.~ c. The ~o~k covered by this ~pplication may not be commenced be~ore issuance o~ Building P~rmi~. d. Upon ~pproval o~ this application, the Building inspector ~11 i~ue ~ Building P~rmit to the ~pplicant. Such permi ~11 b~ k~pt on th~ pr~mis~s ~v~il~bl~ {o~ inspection t~roughout the work. Mo building sh~ll be occupied or used in ~hole or in part ~or any purpose whatever until a Ce~ificate o~ 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 construmion of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ali applicable laws, ordinances, building c~e, housing code, and regulations, and to ~,3dmit authorized inspectors on premises and in, buildings for n~essaw in~ections. ..~ .............................. ~.,~...~ ................. ~ ................. (Signature of ~pplic~nt, or ~ame, if a corpo~n) (~ddre~s of appficant) .. Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. --· ......................................................................... .0.~.n..e..r. ........................................................................................................... Name of owner of premises ................................ ~[dfi~..,[~g].] ....................................................................................... : .......... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Other Trode's License No ............................................... Location of land on which proposed work will be done. Mop No.: ........................................ Lot No ......................... Street and Number .................................................. NQ~.~IY.J.I~/..D~.J..~ ...................... ~l~..~.~.,..J~.et~...¥fl~.~ ............. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy Fiotle b. Intended use and occupancy .............................. ~.'[~g].~..[~..~..~..~.~.s.~.d..~.~.q.e. .................................................... 3. Nature of work (check which applicable): New Building., ,.....X. ........... Addition .................. AJteraticm, ...~...~ ...... P, epai r ..................Removal .................. Demolition .................... Other Work .................................................... (Description) 4. Fstimated Cost ...$..6..5..~..0..0..0..:.0..0. ...................................... Fee ............. ,~..~ ......................................................,~ cd,, -~-~,, (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... .1. ................ Number of dwelling units on each floor ..N..,,A..: ................... If garage, number of cars .............................. ]. ............................................................................................................ 6, If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................Height ............................ Number of Stories ................................ 46' - 0" 46' - 0" 46' - 0" 8. Dimensions of entire new construction: Front .~ ................. , ................ Rear Depth Height ...].~..~...r....0.".. Number of Stories ........ .Z,w,.,o...(..2~ ............................................................................................... 9, Size of lot: Front 124.42' Rear250' + (high water- De,,th 425' 10. Date of Purchase .......... .1..9..5..9. ...................................... Name of Former]~)~n~r ...D..0..u.~.]..a..s.....R..0..b..e.~.~,.s.9.,rl. ................... 11. Zone or use district in which premises are situated ................. .A...,..R..e..s..i..d..e..n..t..i.,a.,l. ........................................................ 12. Does proposed construction violate any zoning Iow, ordinance or regulation: .... .~1.o. ................................................ 13. Will lot be regraded' . ...... .Y.~.$ ............... Will excess fill be removed from premises: (X) Yes ( ) No 14. Name of Owner of premises .,..[d,.i!.~...E..:..~.o..!.]. ........................ Address ~...k..a..S.(.].]..e....A..v..e...,..., Phone No. ~].z~Z.6.~,3..6.,5 Name of Architect Todd W, Schmidt z4~,... 13111 Shaker Sq. pk~.~ k~ 216-491-8822 Name of Contractor DeVoe Builders -,, 3630 Orchard St. No. 5.]..6.7..3..2..3.~-..2..7..8..3 ............................................................ Aoaress ................................ Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck dimensions from property lines. Give street and block number or description according to deed, and show street nQmes and indicate whether interior or corner lot. STATE OF NEW YORK, [¢ ¢ COUNTY OF ................................ f "'" Edna E. Do11 ................................................................................................. being duly sworn, deposes and says that he is the applican~ (Name of individual signing contract) :' above named. Fie is the Owner (Contractor, agent, corporate officer, afc.) 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 alt statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to ~,~'fore me this ............ ~.~.. ...... day of ...~....~..~..'..~...~...../22...~..~..;~. ........ ' 19"~":'~' C ~ /'~ ~ ,~ ,~/'} ~ Notary Public, .....~tk:~¢..,~..~...~..¢'~. County ...~. .......................... :.~..~,~4M,'...... ,~..;..~,~ ....... (~ ~, ............ ~ (Signature of applicant) .utnrlr CUULJC OF NEtN JERSE'Y)~, My Commission Expires June 12, 1980 ESSEX C QU NTy~ N for this location have lnspee~ed b~_y thl~ department Md ~hief of General Setwtcea I