HomeMy WebLinkAbout11938-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certi[icate O[ Occupancy
No..Z..~.3.1.1..5 ......... Date .............. J.a..n......7 ........... 19 85
THIS CERTIFIES that the building ..... .~.c.c.e.~..s.o.r~ ................................
Location of Property ...4..4p.0. ........ Old North..Rd. Southold
house Ale. Street Hamlet
County Tax Map No. 1000 Section ....0 .5.5 ...... Block .... .0 .2 .........Lo~ ... 0..0.5 ...........
Subdivision ...... X Filed Map No. .Lot No.
conforms substantially to the Application for Building Permit heretofore Filed in this office dated
.... .S.e.p .t: ......2.2. ....19 .8.2. pursuant to which Building Permit No ........ 1. .1.9.3.8. Z. .......
dated ..... .S.e.p..t:..........28 .... . .... 19 82., 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 .........
Horse Barn
.... .a.c.c..e.s.s. qr. ¥ .................................................................
The certificate is issued to ........... RECHARD G. WARD
.......... ?oYn' L¥r:tblrJn ' .....................
of the aforesaid building.
Suffolk County Department of Health Approval N/A
N627529
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev. 1/81
N°.
TOWN OF ,~,oU'rHo~D
BUILDING 'D~PARTME~NT
TOWN H~LL:
souTHOLD, N~ y,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON ~HE P~EAUSES UNTIL FULL
COMPLETION OF THE WORK AUTRoRiZ~)
Z Date ~~
Permissioh is hereby granted to:--~
..... ...............
to . ~ ~ ?.;~.~.~..~.~ .....................
at premises located ~t.
C°uh~ T~ ~op No. 1000 Section .~ ...... Block ~:~.......: Lot No...~.~.~ ....
pursuant {o application dated ........ , 19
Bull lng I~spector.
.:...~..~~~..,,~- ~~ ......
~. ,/~0~a0
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
· ~outhold, 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 Underwrlters.
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 P~anning 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"
~and uses:
1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or
topographic featu res.
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/ land use
3. Copy of certificate of occupancy $1.00
--Pre-Existing C.O. $15.00
Vacant land C.O. $ 5.00
Date ....... ~'../..~J~..-~'~. ........
/
New Building .., ,~/,. ...... Old or Pre-existing Building ............ Vacant Land .............
Location of Property ,~,V.O,O, ............... ~,~.~,../~,f. ,~,,..~J.' .............. ~ ~. ''
Owner or Owners of Property .... ~ ~ ~ ......
County Tax Map No. 1000 Section ............. Block ............ Lot .............
Subdi ision ~ Filed Map No Lot No
Health Dept. Approval ...... ]~.~. ............. Labor Dept. Approval ........................
Request for Temporary Certificate ..................... 'Final Ce~ificate .......................
Fee Submitted $ .... ~t~, .~.~. ~( ......
Construct;;~te described build,n~ and ~m,ots.II .~c.~;,.~o,ul.tion,.--
].000744 THE NEW YORK BOARD OF FIRE UNDERWRITERS
~[ BUREAU OF ELECTRICITY
~- 8,5 JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
ongy tAe e~ctr/ca[ e~ipme~t ~s ~scrlbed below and introduced by the applicant named on the able applicatio~ number i~ the premises of
Richard Ward~ 4400 01d North Rd. SouChold~N~Y."Hor~e B~rn"
in tnefollowing location; ~ Basement ~ 1st FI. ~ ~,d Ft. ga rage, bar~ s~ctio, Block rot
was examined on D~¢ , ~ ~ ~ 9~ ~ and found ~o be in co,npliance wi~k ~he require,nents of this Board.
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS FLUORESCENT VA~R
2 1 2
DRYERS FURNACE MOTORS
RE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE I S E R V t~ ~ C
OTHER APPARATUS:
NO, OF CC COND.
PER ~
AW.G,
CC. CONP*
NO OF HI (EG
OF HI-LEG
NO, OF NEU?RA[$
OF NEUTRAL
Richard Re lyea
P.O. Box 372
Laurel,N.Y. ~.1948
lic~ 2148E
This certificate must not be altered in any manner; return to the office of the Board if incorrect.
DEPARTMEN~T, THIS COPY OF CER?FI
].1
may be identified by their credentials.
FIE~D INSPECTION
1.
FOUNDATION
FOUNDATION
(1st
(2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
FINAL
DATE COMMENTS ~ k
~DDITIONAL COMMENTS: ,., ~..
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
File No ................................
To/..~/.~:~ ~q..~..~..~. ~: ......
. .~.o....~./.~..~.o..~7~.....~.~.,~.
...~.~~../~.,~-. .........
PLEASE TAKE NOTICE that your application dated . ~... ~.¢ ........ ,19 .~.
for pe~it to construct... ~:~ · · ~~ .' ................................ at
Location of Property ~ ~ ~*~ ~4 .~.~/~
County Tax Map No. 1000 Section . ~ ~7~ ..... Block .. ~ ...... Lot ~- .......
Subdivision .... ~ ......... Filed Map No ...... ~ ........ Lot No ..................
is ieturned herewith and disapproved on the follow~g grounds ~f~ ~ ff. · ~ (~(.~
........... ~. .../ ...... ~ ~ ./ _
. ~c .... ~.~.. ~.. ~.,..~.~.~,...~.~./~.. x~
RV 1/80
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
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, addifions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinanc~ilding code, housing code, an~regulations, and to
admit auth°rized inspect°rs °n premises and in building f°r neces:~ .fy~ti°n~,...~...d~........o..o...~..... ..............
(Signature of applicant, or name, if a corporati9n)
· .....
(Mailing address of applicant)
i~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
State
whether
applicant
Name of owner of premises..~...'..~r....~.~...-.."~..:...[~...~..1~..O. ............................................
(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 ....... . .-~.. ~' ./'.~.. ..........
Plumber's License No .........................
Electrician's License No...~..~..ceT..-~.../.~.~..~.J
Other Trade's License No ......................
Location of land on which proposed work will be done ..................................................
House Number Street Hamlet
County Tax Map No. 1000 Section ..... .~..~ .......... Block ..... .~. ........... Lot... ~ ..............
Subdivision ..................................... Filed Map No ............... Lot ............... (Name)
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy..~. !'.~!'.~.. h°..~.,e'./?'..'~..~....~..~ ................................
b. Intended use and occupancy ~..v'.a..~...~.~..~ .............. '.. '... (: ...... · .............................
3. Nature of work (check which applicable): New Building ....~. ..... Addition .......... Alteration ..........
Repair ..............Removal .............. Demolition .............. Other Work .........
~ Z~(~:); .~./'(~ ~ (Description)
4. Estimated Cost ............. : ......................... Fee ..................................
(to be paid on filing this application)
5. If dwelling, number of dwelli,n~ hnits .... .~.Z~?. ....... Number of dwelling units on each floor ................
If garage, number of cars . . .~t~..v~ffi .~..~ ......................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........... ~ ..........
7. Dimensionsofexjstingstructur~s, ifany Front ....¢.r.¢! ..... Rear ~.c,>! Denth zq-
Height . .~,.4..10~.. ...... Number of Stones .... .'~..~.'~..v~..~..~..~,.~./.c~OA~tp~. ....................
Dimensions of same structure with alterations or additions: Front O/k~..~.'~4~¼~..--. Rear ~ .~'~. pIq,~ ....
Depth ...................... Height ...................... Number o~ Stories ............ ~ .........
8. Dimensions of entire new constrUction Front ~ ~ Rear . .~ ~ Denth [ '~
9. Size oflot: Front ,."~O/.~;.'I.I ........... Rear .... .~.~.,.Z."~ .......... Depth ..~.l.O...'q.~.-...~,?., .
10. ~)ate of Purchase .~t~.lr~ .~ ;..[.~'1. ~ ........... Name of Fo~mer Owner .~.LX.o..~k): ~..~?,.~l...' .......
1 1. Zone or use district in which premises are situated.. ~i ~.'~ ~.~ .........
12. r)oes proposed construction v'oiate an zonin law ordinance'o'r'r;' 'iaiion"' .... '~' .......................
y~,. y g , gu .................................
13. Will lot be regraded ...... .~ .o..,. ~: .... ~ ._ ~. · .~..,.. Will excess fill be rem~d, from premises: Yes ~ No
14. Name of Owner of premises ~.~,..t/CA~..% ....U~....~.. Address~.q..O~..12g..~..N~.:..~.':... Phone No. [~.~.'..~.~..g: .t~...
Name of Architect .......... ................. Address ................... Phone No ................
Name of Contractor ......... i ................. Address ................... Phone No ................
PLOT DIAGRAM
Locate 91early and distinctly alii buildings, whether existing or proposed, and, indicate all set-back dimensions from
property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether
interior or corner lot. C:> C, t::> ~,~c~ I~.T 14 P,,G~I2>
0
STATE OF NE~
COUNTY OV._~ ,,4-~....~'~
...... ~l .~.~.~'. · . .~...~.. · :~ .'.(~..~ .~. ................ being duly
'(Name of individual signlng contract)
above named.
sworn, deposes and says that he is the applicant
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 that the
work will bo performed in the manne~ set forth in the application filed therewith.
Sworn to be.fore me this i -
........... day ofI ., 19.
Nolg~ Public, . ........ ~ ...... :. ~ County c-V"-x _
~IW~7~'~, '~i~i~ ~ ~ ¥or~, (Signature of applicant)
I NoI, §2,81258§0. Suffolk Cok~
r.[rn Ex~ires Milrch 30. 19 o..~
/
SUSAN C. WARD
4440 OLD NORTH ROAD
SOUTHOLD~ NY 11971
C MICAL a
28000 2 ,:
TOWN OF SOUTItOLD
OFFICE OF BUILDING INSPECTOR
P.O. BOX 728 '~
TOWN HALL ~
SOUTHOLD, N.Y. 11971
TEL. 765-1802
December 31,1984
Richard G. Ward
4440 Old North Rd.
Southold,N.Y. 11971
Dear Mr. Wardt
I have tried a nulmber of times to reach you
by telephone, no luck.
Your Certificate of Occupancy is ready and
waiting for you, however we need a new check. I
am returning your original check.
Please send me a new check and I will be
happy to send you your Certificate.
Thank You...
Yours Truly,
Dorothy S. Midgley
Building Dept. Sec.
Approved by John Wiekha~
C~h~airman, Planning B6ard
, ~ ~'March 12,, 1975
'765-~
B.
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