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Home My WebLink About12065-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.. ~.i.~.~.Q ,3 ......... Date ..... .N. qv.e..m.b.e.r....3.0. .............. 19 .8.3. THIS CERTIFIES that the building .... .N.E..W..D.W.E..L.L.I.N.G. ............................. Location of Property .... 2. ~ 5.0.. PlumP.. H. 9LJ~..D~.:r.E~. :'. ....... .M.A. T.T.I.TU .c~(. .............. House No. Street Ham/et County Tax Map No. ] 000 Section ...]~2~ ~ ..... :Block ..... 4. ......... Lot ..... ~..3 ......:.. :-- Subdivision ............................... FiJed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated .... NO.V..EMBE~ .30 .... ,1~$3. pursuant to Which Building Permit No...~2. .0.6.5.Z. ............ -- datedDE. CEMBF_,R. 9 ................. 198g., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... .... Frxc. a. ~.ew. or~e. family, dwelling ......................................... The certificate is issued to . EJ~WARD..&. CHItI ST.T~IA. ¥-T~LA ......... ' ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .. ~--2--$o.~1,12 ...... ~ ...................... UNDERWRITERS CERTIFICATE NO.. N. ~g09817, ...................................... Building Inspector Rev. 1/81 BUILDING ,DiPARTM~N~ TOWN HALL SOUTHOkD, N. Y. BUILDING PERMITI ' fi'HIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) N? 1~065 Z UNTIL ~ULL ?C¢ x'7~~ Date ............................ ....... ........ ...... .................. ~0 .............................................................................. ~ ............. ~t '.~ ................ ~ ......................... .............................................................................................. ~..?...,. ................ ~ .......... ~ ..... / ...... ...................................................................... ~.~ ....... ..... .......... ~....~; .............. ;~ ............. ........... ~ ............ Coun~ Tox Mop N~. 1000 S~a,on ...................... ? Bilk .,..,~. .............. ~.~ No ......................... ~u~ant to aDD caton dat~ ....................................... ,...:....., ly....,~..~ ano apDr~ ~y me Building I~spector. Fee $ ........ ; ............... ........ ; ........ L..~..;...' ......... ~ ............. . ......................... Building nspecto~ 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-(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. 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 t --Fre-Existing C,O. $15.00 Vacant land C.0. $ 5,00 Date ................... / ...... New Building -- - ............. Otd orPre existing Building ............ Vacant Land ............. House No. Street . Ham/et Owner or Owners of Property .......................................................... County Tax Map No. ,000 Section..~.za.. ...... .... Block...............~ Lot.... /~. ..... .. Subdivision Filed Map No .... Lot No ~ Permit ,o/.~...~.~..~.. ...... Date of Permit/..~l.~./~.~..Applicant...~.'~..~..../~..~.~..~. ................. . . Health Dept. Approval ................ Labor Dept. Approval ................. Unde~r[ters 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. Applicant .............................. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 1003e THIS CERTIFIES THAT only the electrical equipment as described below and introduced by t~ applicant ~med on tl~ above application number in t~ premises of was examined on ~%~' 1~, 1~ andfo,nd to be in compliance with the reguire,nents of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT V^POR DRYERS FURblACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO, OF FEET AWG. OF NEUTRAt 1./0 Viola 430 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspecto(s may COPY FOR I~U LoI~IG DEPARTMENT. THIS COPy OF CERTIFI credentials. FIELD INSPEC'{~ON ' FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & COMMEN'iS .~- ~ INSULATION PER N. STATE ENERGY C,ODE Ye FINAL ADDITIONAL COMMENTS: ' STATEi THE WATER SUPP SYSTEMS FOR CO NFOr M/T~/ suffoLK {s~ APPLIOA SUFFOLK COUA SERVICES - CONSTRUCTION DATE: .. s..EF. APPROVED: SUFFOLK CO. ], DIST. SEC J OWNERS ADDRE~: DEED: L.?4cJD TEST HOLI~" i FORM NO. 10 . APPLICATION FOR DEVELOPMENT PERMIT ~n the To,,n of Southoldf~ 1. ~of Development Propose~d~ New Structure (including storage tanks~ am~z~ion and/or AlterationS[ Flood Proof Below Base Flood Ele~ation~ ~.- ~ ~on ~a~a ~n ~e~a~on n? aoove mean sea l~v~ o~: (b) ~n a V Zone, bo~on of loW~s~ s~ru~ural ~e~'~{ . . 5. Looa$ion of P~ope~y: DEC , =- ~ W~LANDS (Town Board) 0~ ~~, . '~,~.~/~- / . N0 52-8]2~850, Sufio~k address ~d phone ~ _ ,, ' if not given above: 4~80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined ~.~,~-~...~...., 19 ~ Approved .... .5..., l , mermit No. Disapproved a/c .......... (~ ........ 27 ....... / (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 Inspecto~ will issued a Building Pexmit 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 necessary ins/~ions. / · " .... (Mailing address of applicant') State whether applicant ~lessee, agent~ engineer, g~r,Gtri~plumber or~ Name of owner of premises ..... . .~..~)../~.~..~..~/.~././../.ff.~-....~../.ff...d~. ............................ (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 ..... .5...~ ............ Plumber's License No...~..~....~4.~.~..-~...~..ff~../-Tr...~_~ Electrician's License No. Other Trade's License No. ~ ~.~ - ~;~'//~',4'/~ Z~),4>,~/~ 1.Locahon of land on which proposed work will be done .......................................... House Number Street Hamlet ~ ~ County Tax Map No. 1000 Section.../~ .......... Block .... ~ ............ ~.' .... 4. ............ " ~ pN ~ ~ Subdivision ..................................... Filed Ma o. Lot (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ b. Intended use and occupancy ................................................................... 3. Nature of work (check winch aPphcable): New Building .... : ..... Addition .......... Alteration ...... , .~,. - Repair .... ~ ..... Rem6val .............. Demohtion ............. Other Work.. , ~i, ~ , ~ ~,/~/~/~/~'g,~ 4~//~ffY~ _, ~(Description) 4. rzstimated ~ost../:¥:v. ..... ~/ ................ r ....... P'ee ..................................... . (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. r)i.mensionsofexistingstructuris, ifany: Fr. ont...~.~./ .......... Rear .~...~/ ......... Depth...~<~./.O.f ...... 8. Dimensions of entire new construction: Front .... ~..,~. ....... Rear ...~..~-. ........ Depth ?. !.~.~.qg.c.~..,?~. Height .'<~O ..... ~ ~...; Number of Stones ......................................... r ............... 9. Size of lot: Front ././/.g~.~.~. ?. ?. ......... Rear .... ./'~.~..'?. ............ Devth ..~?.. ~ .... .~.~.~. 10. [)ate of Purchase ..../../~.'../~i/~.o~.?.. ............ Na~ne of Former Owner .../~.: .~.'/f.z..~.~ ..... 11. Zone or use district in which premises are situated ..... .//-.."7 .~?.,~..z~.z..-. .................................... 12. r)oes proposed construction, v, iol'ate any zoning law, ordinance or regulation: .... .~.~. ........................ 13. Will lot be regraded ..... ~f..~'. ..................... Will excess fill b.e removed from premises: - ~z No 14. Name of Owner of premises . ~..~/../'/~....k'/?.~..g.... Address .Z~...)(. ??.o.../~.~..7~..,.. Phone No. ?..~..~,,.~r.r.~/.~.~'./~. Name of Architect ' h .......... . ................. 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 pumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NETWORK; , ,C/ ' · · · ~.~~ .......... being duly sworn, deposes and says that he is the applicant (Name of indiv~[d~'l sigr ing contract) above named. He is the ..................... ~ ................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dut 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 &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 this ~ Nota_D, Public, .... ~ .... ,_:~r'a..~kf_,z,g~A~(-/,<~.... County ~'~ / /~ /'~ )Z~ [ ~O'['A~Y PUBUC, State of Now YoHI (S~gnature of applicant) ~o. 52.8125850, S0[f01k Co~,'~ Term Ex,)ires March 30. 19~.~7~ / ~I' HEALTH DEPT APPROVAL SUFFOLK CO. . ~A~MENT OF INTENT THE WATER SU~LY AND SEWAGE DI~AL C~F~M ~ THE ST~DAR~,~THE : DERVICES -- FOR APPROVAL OF YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S, NO, (C-~-50-[I~ STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL ~YSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCT ION ONLY DATE: , H. S, REF. NO.: [~- ?~O T ll~ APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. OWNERS ADDR~:SS: LICENSED LAND SURVEYORS GREEN~RT NEW Y~K SEAL 1 1 1 / I i NOTIFY BUILDI~IG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C. O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N, Y. STATE CONSTRUCTION & ENERGY QODES. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. A ,,0 y,% IJ~ copper lubing is Used fo£ water ¢listributing system; piping shall be o{~ types K or L only J 1111(1111 ~A _i 1