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Home My WebLink About11701-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. UPDATED CERTIFICATE OF OCCUPANCY No Z-20769 Date JUNE 4~ 1992 THIS CERTIFIES that the buildin~ Location of Property 350 COLUMBIA ROAD House No. County Tax Map No. 1000 Section 79 Subdivision NEW DWELLING SOUTHOLD ~ N. Y. Street Hamlet Block 6 Lot 11 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 22~ 1982 pursuant to which Building Permit No. l1701-Z dated MAY 27r 1982 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 ONE FAMILY DW~TJ.ING W£T~ GARAGE ~qqDEI{ & ~I~'Ik%CM~f; DECK * The certificate is issued to PATRICK R. MALLOY ( owner ) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 12-S~-50-DEC. 23r 1983 UNDERWRITERS CERTIFICATE NO. N-628681 - JANUARY 4~ 1984 PLUMBERS CERTIFICATION DATED N/A *THIS UPDATES CO #Z12182 DAT~G3 JAN.N~ ~.5' 1984.~~"~) ~ Rev. 1/81 1:~17 I) 1 TO~N OFi' $~bUT~O BUILDING TOW~ H~'L SOUTHOLD, Hi ¥. Pei;~ nission: is hereby (THIS PERMIT MUST BE KEPT ON THEPREglS~S COMPLETION oF THE WORK AUTHORIZED) i Z UNTIL ~EL at premises located at ~.~ Coufity Tak Map No 1000 Section ....... · Block ;~ ...... ' .or No..~ ............. pu~s~*nt ~o app coton doted ...;.~.~..~ .~19 ~ ond 9pprovod b~ the FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building .-.-.n.e..w..d.w.e..1.1.i.n. ~ ............................... Location of Property 350 Columbia Road Southold House No. Street Ham/et County Tax Map No. 1000 Section . .0..7.9 ....... Block .0.6. ............ Lot . .0. ! .1 ........ ;.._~- Subdivision...X. ........................... Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore fried in this office dated May 22 11701 Z ..................... , 19 .8.2. pursuant to which Building Permit No ...................... dated . . . .YI.a.y..2. ~ .................. 19.8.2. , 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 ......... ...... a.. p r.~.v.a..~.e..qn..e.-.~.a..m.~.~.y...d.~.e.~. Z..~.n.~ .. ...................................... The certificate is issued to ...... .D.~ ~ .I.E.L.. &...Mil.~ .Y..R.E.~..~ ~ .............................. [owner, le~,e o~t~t~ of the aforesaid building. Suffolk County Department of Health Approval 12-SH-50~. 12/23/83~ Robt. A. V±lla, P.E. UNDERWRITERS CERTIFICATE NO. ? e n d i n ~ Btfilding Inspector Rev. 1/81 Form No. 6 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building 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 from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses or buildings and '.'pre-existing" land uses: ' i. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. ;, Fees ~ 1. Certificate of Occnpancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $5.00 over 5 years - $I0.00 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date ~d.~..~.~ ew Construction ........... Old Or Pre-existing Building ................. Uouse No. Street Hamlet ',wer or Owners of Property .... ./].~.?~.,~.<~./~. /g7 h~//~7. ~unty Tax Map No i000, Section .......... Block ............. Lot ..... ~bdivision ......................... ........... Filed Map .......... Lot .................... ~rmit No../ ............. Date Of Permit. · .... Applicant ......... alth Dept Approval ~ ........................... Underwriters Approval .... arming Board Approval ..... ~ quest for: Temporary Certificate ........... Finai~icate...~ .... .. z ' ....................... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 D~sapproved a/c .......... (Build(ng I~spector) APPLICATION FOR BUILDING PERMIT Application No/(~'/(.t~. ........... 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 o£ 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 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 necessaw inspections. (Signature of applicant, gr na'n~e, if a corporation) (Mailing address of applicant) / State whether applicant is~lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ... t/. rz ............................................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..... O...c~i .,~..~..~ ............ Plumber's License No Electrician's License No .... 17 f~ g .... [? ....... [. t Other Trade's License No... 1. Location of land on which proposed work will be done. z', ? . ................................... House Number Street Hamlet County Tax Map No. 1000 Section .... ~.'7.~ ......... Block .... d ............ Lot... A .( ............ Subdivision ......... ~. F~ed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing um and occup~cy ....... ~ }. ( ~.4 .W~{ .~. ~.. :.~. ~. ~ ~ .~ ...................... b. btended u~ and occup~cy 3. Nature of work (check which applicable): New Building .......... Addition ..... Alteration Repair .............. Removal .............. Demolition .......... Other Work ~Description (to be paid on filing this appncatlon) 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 [ype 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 ....... .5(..o. i... Rear .... ~. . . Depth Height ....... /.~ ~. ..... Number of Stories ...... ~ .................................... ...........................................;2~ Depth . ~ ?. ~ 9. Sizeoflot: Front . ;~ ~ t Rear z .2 ~' ' 10. Date of Purchase .... .4/..C.~ ................... Name of Fornrer Owner 11. Zone ~)r use district in which premises are situated .... ~.tS.~. ~. p.t.5.~..C .~ ./0. c... ...... 12. Does proposed construction violate any zoning law, ordinance or regulation: . .-.~:.: 13. Will lot be regraded ....... ~..~. 0-. ~ .......... O.,e~ .WJl1 excess fill be removed from premises: 14. Name of Owner of prem~ses,~/,/.~.~//.~,c. .4..,q/.~.~. ~..~. ~d~ress . .q.~.~../1. o..c.,q..,,.~.o..t._.,~.. Phone No.. ?.~. Name of Architect ............. '~ ............. Address ................... Phone No Nam e of Contractor ........ ?..c~.~. t~.,~ ..........Address . 5t~.q .~?. ~. ~ ( q ~...c.~. Phone No .... PLOT DJ.^GRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions property lines. Give street and block number or description ac, cording to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................. S.S ...... P/-2 .~.'. ·~ .~. .... ./~.~: .c ~.'T ...................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ..... : .~/?./.L!5 ....................................................................... (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 manner set forth in the application filed therewith. Sworn to before me. JJifis · ........... 19 ~y ' , .... lcd, ..... :.'..~... :...'.. '. ..... County (Signature of applin~t) FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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 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 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. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --Pre-Existing C.Oo $15.00 Vacant land C.O. $ 5.00 Date ''! ~ .~':'1~ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property -~ J'u ~'~ A~,~/~ '/~,4P. ~' ~ , 7-~ L. /~ House No. Street Hamlet Owner or Owners of Property ..... /')' '~' '/~' '/'f"~' '~: ' ' · "~'" '~'~' '~' '~' '7' //'~r~ ~ ~¢~ '[~' County Tax Map No. 1000 Section ..... .~,. ~. ..... Block ..... ,~, ........ Lot ..... /.,/ ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.././. ?.g../..~. Date of Permit . .J'/~.7./.~.~.Applicant../)..~..~./.'.~.~....'~'....'~...~.<.~... Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval .......... ~ ........... Planning Board Approval ...................... Request for Tempora~ Certificate ..................... Final Certificate ....................... ............... 0 Fee Submitted $ sos s Construction on above de,ribed building and permit me~al, applicable codes and regulations. Rev. I0-10-78 wasexamtned°n DecemoeE ~ ~-, ~- FIXTURE SWITCHES OUTLETS 13 27 1.7 ].3 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS DIMMERS S E R V I C E SERVICE DlSC..ONNECT ~ .~ I 2 APpARATUS~ 1-G.F.I. Z-Smoke Detectors 1-Post Lite. 1-4.5 K.W. Hot Wat:~~ tteater .... -, ~ Francis B. Mco~,~£er.y omEm~ I NAOE~\ ' id e Lane, Box Z~:) Lic.~ii4~ ~ Cutchogue, N.I., 119.,5 pe Thi~ cerfi~kote must mot be o~te~ed i. ~n~ mommer~ return to the o{fice o{ the Boord ~{ imcorrect tnspectors moy be ~dent* ' Y ' * IST NOT BE ALTERED IN ANY ~ANNE~. FIELD INS?E~TION' FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY CODE FINAL DATE COMMENTS ADDITIONAL COMMENTS: L.i E~E~I~TY SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO.. I ~0 ~ TH~ WATER SU~LY AND ~A~Z DIS~AL ' S~ F~ THIS R~IOENCE WILE, ~'~" ~ S~OLK CO, DE~. OF HEALTH The ~ ~wage d!~po~aI and wate~ ~uppl7 H.~;R~F.N~,: : ..... Servtoea I~ ' ~ ~ · ~ ,, J 0 U RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYOR S GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE APPLICANT ' ~u SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APRROV L OF DATE. DIST. SECT. BLOCK PCL OWNERS ADDRE~: TEST HOLE STAMP U~E IS IJNLA~WI:IJL OF OCCIJPJ&~¥ I~CEEI ~U~,~IFY BUILDING FOR poURED C :4. FINAL - au,- ~NSTRU~I CODES- D~IGN OR ~u~ ',,0