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Home My WebLink About10037-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No .... Z97.~;! ........ Date ... l~Iovemher'. 8 .................. 19.79 THIS CERTIFIES that the building ................................................ ~'E6cation of Property ...... 1./I-80. Lands..E~nd. Road ..................... 01'l. ent;, '~e~ House No. Street County Tax Map No. 1000 Section ...0.15 ...... Block .... 09 ......... Lot ...00.1 ~.~ ........ Subdivision. · .LSrld.8..Erld. ................. Filed Map No...5909..Lot No ...... 30 ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... l~Io~retahez'. 8. .... , 19 .7.8 pursuant to which Building Permit No ..... .fl00D?Z .......... dated .... Nc~v. erabe~. 27 ........... 19 78, 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 ......... ......... P~.iva~ .One. F. am/~y..Dwelltn~ .w/A.t~a~hed. Two .Car. Oara~e ....... The certificate is issued to ............. G101:'J.& .and. JBolte~l..Mo'l;D.v..ick ................ {owne~ of the aforesaid building. Suffolk County Department of Health Approval . ~8.--.S0.-.129.....1.0/.19./7.9... UNDERWRITERS CERTIFICATE NO. ........ N.~.~889. ......... . . - . ./ ............... Building Inspector Rev 4/79 FOI~M NO. ~ TOWN O[ $OUTttOLD 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? 10037 Z Permission is hereby granted to: ...~.<~:..,.,../..2~ .~.,~e~...~.~., ....... ...... t~/ .. .__ ..: --' ,. ~ . ,o ..~,.~,~.~~....:~~:...~:~.~~....~,.~~ ......... ..... .....,.~:~....~,~......~.: ~.~...~~ .................................. at premises located at ~.~'....~~.~...-~...~.~..~...~Z~. .................... ~ .................................................. ,~:....~ ....................... ~ ................... ;~ .................. ~....~ ....... ........ .................................... pursuant to application dated ........ ~.~..~ ........................ , 19~, and approved by the Building Inspector. Pee *~...~.. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate 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 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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. Fees: 1, Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 New Building . ./': ......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property../..~,, .~.. ...... ~. ¢~./.~.~.....~../~.?..~.~..' .............. . .~. · · g.~-.~,, House No. -- Street Nam/et Owner or O~ners of Property ..... ~. ................ County Tax Map No. I000 Section .~/.~:).~. ......... Block., .(~..~. ....... Lot....~..O~. ~'.~..~.~,~.. , Subdivision.. Z~...~..~..*~..~ .~.../.~J..~....~.~.Filed Map No...'-..~.<?..~...Lot ~o....-,-~.. ~ ....... Permit No./gO. ~. 7' ~' Date of Permit/~..~.~.~..~7.'~.:~.Applicant. ~//~;i~/~../~.~)/~. ~ ....... Health Dept, Approval Z¢b.~.I.~...'~'~ ~.~....Labor Dept. Approval ...~-~./~-, .............. Underwriters Approval ~,~f~/~...~ ............ Planning Board Approval /~(./~-~' ............... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $.. ~. ~..~.. ................... Construction on above described building and peri, it meets all applicable codes and regulations. Applicant .... ~, ,~,~ .~~ ....... e.v. ,c-,a-,8 1. THE NEW YORK BOARD OF FIRE UNDERWRITERS pt11 BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK, NEW YORK 10038 ~.t. ~:o~.~, ~:~. ~?~) ~.,~.,~.~o...~,,. 0~0~ N 453889 THIS CE~IF~AT . , UO~ODe~ 97~ ~ exam~ on and found to ~ in compliance with the requi~ments of this ~ard. FIXTURE ~CEPTACLE I WIT H I FIXTURES I O~T.,SEI E C ES I.c..o,..,t..,.., I ~ I 18 29 ~1 18 .,j,, 2 P 1 2 12 RANGES PECIAL REC'P1 1 30 EXHAUST FANS DIMMERS S~RVICE DISCONNECT I NO. OF ] MLrrER I 200 ob x OTHER APPARATUS: ,,* 1-0.P.I. 1-Smoke Detector. R V I C O~E~,~ k' W.G. NO' O~ HI-LEG NO. COND. OF CC. COND. 2/0 1 Of NEUTRAL 2/O Woodollff DF. _ ~tt/tuek~ N.~, 1195~ LIQ,756 E ~ ~' ~' This cedificcte mus~ nol ~ uffered in uny monner~ relurn to the office of the ~crd if incorrect Inspectors racy be idem~d by ~i! credenfiols. ........................................... ~ .... COPY FOR BUILDIN~ DEPARTMENT. THIS COPY O~ CERTIFICAT~ ~UST NOT BE ALTERED IN ANY ~NNER. Memorandum from .... BUILDING INSPECTOR'S OFFICE TOWN OF SOUTIfOLD TOWN HALL, SOUTHOLD, N. Y. 11971 TOWN OF SOUTHOLD Building Inspector's Office Town Clerk Building Southold, N.Y. 765-2660 ¥77 ~ 0¥o o 765-1802 BUILD,lNG DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] I~SULATION / FRAMING [ ~]' FINAL ~gO~ NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMI~NT TOWN CLERK'S OFFIGE ~UTHOLD, N. Y, ..... ............. . 7 ............ ~proved ...... ~..~Z ........... ' 19'~.~,~ ,"~P~rmit No...X~,~.~.~ ...... ' APPLICATION FOR BUILDING PERMIT Date .....~¢~.~ ................. , 19.. ~....~..,. INSTRUCTIONS a. This application must be completely filled in by typewriter or' in ink and submitted in triplicate 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 ofproperty must be drawn on the diagram which Js port of this application. 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 issue 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 buildings for necessary inspections. ,,4~ignat~e of appli~;ont, or name, if (3 corporation)k,* j~j (~lcrress of al~plicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .d~..L~...G4~......i~.~'~......~.I...~..L~.y;.¢....~.: If applicant is a corporate, 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 ............................................... I. Location of land on which pro~)osed wor~, will ~ done. Mop No.: ........ ..~..~...~....~. ............... Lot No......~.~..?.~.~.. Street and Number .:;~ ....... ~.Y.) ~ ~.~/~.~.~.0..~...~.. ............................... (~/...z~.~..~/ . ........ Municipality State existing use and occupancy of ~/~4~mises and in~ended use and occupancy of proposed construction: O. Exisiting use o nd occuponcy ... ~,~..C,~.~ ...(~..4.-,.~...~ ......~.k~, ................................................................................. b. Intended use and occupancy ...~...~d~....~.~.,.~..~LM.q..~...~..%(~..~.I~'~'''' .................................................. 3. Nature o~ work (check which applicable): New Building' ....~. ......... Addition .................. Alteration ................ Repair .................. Removal .................. DemolitJo~ .................... Other Work ~1 (Description) ,O,,y .~...~ .................................. Fee 4. Estimated Cost ....... .,/'~. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ ~ .................. 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 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 ................................ 8. Dimensions of entire new construction: Front ..... ..'~.~. ...................... Rear .....~..~ ............... Depth ...~.~.~' ............. Height .................... Number of Stories ................. I .................................................................................................... Rear ...... ~...~ .......................... Depth ..~ .................... 9. Size of lot: Front .......... .~ ................................... " I0. Date of Purchase ..........~...~..'/...~. ........................ ~-~ / .~ ~Name of Eormer ?wrier ..T~...~.~.~.~..~...~. .............. 11. Zone or use district in which premises ore situated ....~...~...~.i~.q~,~.~,,,~..¢~-~ .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..... ~...o. ............................................ 13. Will lot be regraded.... ......... J~/O..... ......... . Will excess fill be removed from premises: ( ) Yes ~,~) No 14. Name of Owner of pr~s~ ............ ../rr0 ................................. Address ................................ Phone No ....................... Name of Architect .....-~-..~:~.H;d~,c~J.w~x~!,~ ..................Address ................................ Phone No ....................... Name of Contractor ......... ..~,~:~ ..................................... Address ................................ Phone No ~ PLOT DIAGRAM 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 lot, COUNTY OF .............. ~' ............. h"~-~: . ................................. '. ...................................... z;;.;-. .................. being duly sworn, deposes and soys that he is the applicom (Name of individual signing contract) above named. He is the (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 thor the work will be performed in the manner set' forth in the app~licotion filed therewith. Sworn to before me this ........................ day of ......................... : .................. , Notary Public, . ................................................... County (Signature of applicant) SUFFOLK CO HEALTH DEPT APPROVAL H.S. NO .... ~ ~AT~ENT OF INTENT ~ ~ .... ~'?~ ....... " THE WATER ~J~LY AND S~AGE DIS~L _~:-";L~ ~ ' *~ .' ~ .......... SYSTEMS FOR THIS RESIDENCE WILL ~ CONFORM TO ~E STANDARDS OF THE , ~PLICANT ~ t l SUFFOLK COUNTY DEPT. OF HEALTH SERVICES FOR APPROVAL CONSTRUCT~N ONLY DATE: ~7 APPROVED: 5c~/~:': ~ '= t" SUFFOLK CO. TAX M~DESIGNATION: JDIST, ~T. BLOCK , ECL, ~ = ~o,~ ~?.~. ~ ~ o/~~ DEED: L. N[~ P. TEST HOLE STAMP SEAL RODERIC~ VAN T~.U.P.C.. LICENSED LAND SURV~ORS GREENPORT NEW YORK SUFFOLK CO. Ht~.r. H.S, , STATEMENT OF iNTENT / , -: ', -~---' x: ~'~ ,' .- THE WATER SU~LY AND SEWAGE DIS~AL ~ v ~" [ ~ ~ "~'~-' '- ~STEMS FOR THIS RESIDENCE WILL CONF~M TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. gZ?. ~ ~ '~ ;,~ ~ SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY a DATE: . APPROVED: EnglDeer~n~ '= I" SUFFOLK CO. TAX MAP DBGNAT!~: DEED: L. N/A P. ~ ~ ~ ~NAUfHO~ZiD ALTERATION OR ADDIT~ LANE) S~V~ORS GREEN~RT NEW YORK PENNY LUMBER Mi R d Phone 477.0400 GREENPORT, N.Y. 11944 .*APPROVED AS NOTED DATE~ FEE: NOTIFY BUll, DING DEPARTMENT AT 765-26§0 9AM to 4PM FOR REQUIR- ED INSPECTIONS: 'J, BEFORE BACKFILLING FoUNDA- ~ ¥1(~N OR START FRAMING 2. FRAMING INSPECTION 3. BEFORE COVERING FIP.~S OF ANY KIND 4. FINAL WHEN JOB COMPLETED NOT RESPONSIBLE FOR DESIGN coC~t_E - L