HomeMy WebLinkAbout11958-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING D£PARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificnte. Of Occupnncy
No..g..1.1.~.3.5. ......... Date August 8 1983
THIS CERTIFIES that the building ..: .............................................
· 23780 Main Road Orient
Location of Property ........................................
House No. Street .................. ~r~[oi
County Tax Map No. 1000 Section . .0.1.8. ....... Block 05 .Lot .. 0.1.?.
Subdivision....X ........................... Filed Map No. X .Lot No. X
conforms substantially to the Application for Building Permit heretofore filed in this office dated
.... D. 9.c.e.m.b.e.?' .2.0, .... , 198..2. pursuant to which Building Permit No...1.?.5..8..Z. ...........
dated .... 3..a .nB.a.r, g..7 .............. 198.3.., 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. ~.?y.a?.e...o.n.e.z r..a.m.~).¥..d.~.e. ~..~.i.n.~... ........................................
The certificate is issued to EDWARD G. & CATHERINE A. LOPER
(owner, '/esEee-or 'te~arrt)
of the aforesaid building.
St~ffolk County D epartm ent of Health Approval . 1 ¢ .-.S.Q -..1.6.6. ~. ~/.2./. 8..3 .,..R .o .b .t... ~ :. ?.~ 1. ~ .a.,. ?. E.
UNDERWRITERS CERTIFICATE NO ......... N....6.0.9. 4..5 .8 ................................
t¥
Building Inspector
Rev. 1/81
' TOWN OF $OUTHO~D
BUILDING D~P~RTMEHT
SOUTHOLD, N~ y. ~
N°.
BUILDING
(THIS PERMIT MUST BE KEPT ON THE PI~E/~IS~S UNTIL TULL
COMPLETION OF THE WORK AUTHORIZED)
~s z Date....~,~.~V~.......7... ..........
Permissior~ is hereby granted to:
...... ~ ............ ~ .~.,~.~.,
....... ~..~...~'/..~......i.~ ........ ....~ .................
...... ~.~~.~..~:~.i...../.~
,o .............. ~ ~. ....~... . .~.~... .~.~. .. . ..=,~ mm~. (~ ...... ~, .....................................
...... , ......... ~ .......................................
at p~'emise, located at. ~'~.Z~........~.. ~.~.~..,. ~'~':' ~1 ........... ~' '*~"'/t/~' '~'~' · ·
County Tax Map No. 1000 'Section: 81o~k ii~ .............Lot No.
pursuant to application dated ~J.~.(--,~ ...... .~...~. ............... h-'."....., 19 and approved by the
8uildlng I~spector.
Rev. 6~30/80
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 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.
Bo
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
topograph lc 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 requ ired to prepare a certificate.
Fees:
1.
Certificate of occupancy $5.00
!
Certificate of occupancy on pre-existing dwelling ~r
:2.
3. Copy of certificate of occupancy $1.00 !
land use $/s-/$5.00
Date .. August 8~ 1983 ..
New Building . .X~.. ......... Old or Pre-existing Building(Z) ......... = ZVacant Land '
Location of Property .... 2~7~80 Mgin Road~ Orient~ New York
House No. Street Ham/et
Owner or Owners of Property Edward G, & Catherine A, Lbper
y T p N O18 05 017
Count ax Ma o. 1000 Section ............... Block ............... tot ................
Subdivision ................................. Filed Map No ........... Lot No ..............
Permit No 11958Z Date,of Permit 1/7/83 .Applicant INLAND H?I. ES, I.N.C.
Health Dept. Approval . 8/2/83 .Labor Dept. Approval .,.
N609458
Underwriters Approval ........................ Planning Board Approval .................. ~ .. ~
Request for Temporary Certificate ..................... Final Certificate ........ - .......
Fee Submitted $..5...~ .O.O. ......................
Construction on above described building and perm}~mee~s all app~ca~fe_,co_de¢ and regulations.
Applicant. ~~./-~_... ........... = .....
Robert E, Hzltz -"l~land Homes, inc.
looo174 THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
~- l"b~ 85 JOHN ,~TREET, NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
in the following location; ~ Basemer~t ~ 1st FI. ~ 2nd FI. Section Block Lot
was exarnlned on ~ ~~ ~ artd found to be in cotnpliance with the requirements of this Board,
FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS SWITCHES FLUORESCENT
19 18
DRYERS
SYSTEMS
NO, OF FEET
OTHER APPARATUS:
1-~moke Detector
S E R
C
AW, G,
OF HI-LEG
E.E.C.O. Elect. COz~, Cliff Cornell
325 Will~ Point P~.
So~thold~ NoY., 11971
LIC. ~2816
This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspecto~r
COPY FOR ~UILD[NG DEPARTMENT.
GENERAL MANAGER
their credentials.
II~~PECTI N
FIEL~ ~ 0
FOUNDATION (1st)
COMMENIS
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSHLATION PER N.
STATE ENERGY
C,ODE
FINAl,
ADDITI COMMENTS:
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] RouGH PLBG.
[ ] FOUNDATION ZND [ ] iNSULATIoN
[ ] FRAMING
[ ] FINAL
REMARKS:
DATE
INSPECTOR
FORM NO. 1
TOWN OF SOUTHOLD
BUiLDiNG DEPARTMENT
TOWN HALL
SOUTHOLD, r.l.Y. 11971
TEL.: 765-1802
APPLICATION FOR BUILDING PERMIT
INST RUCTIONS
a. This applicatioa must'be completely filled in by typewriter or in ink and submitted in triplicate to the Build
Inspector, with 3 sets of plans, accurate plot plan to scale. Fee hccording to schedule.
b. ?Itt plan showing location of lot and of buildings on premises, relationship to adjoining premises or public stre
or areas, and giwng a derailed description of layout of property must be drawn on the diagram which is part of this ap.
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon apprc.'al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pen
shall be kept on tile premises available for inspection throughout tile work.
e. No buildi;~g shall be occupied or nsed in whole or in pad: for any purpose whatever until a Certificate of Occupar
shall bare been granted by tile Building Inspector.
APPLICATION IS ItEREBY MADE to the Building Department for the issuance ora Building Permit pursuant to '
Building Zone Ordinance of the Town ~>f Soutbold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein deserib
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and
admit authorized inspectors on premises and in buildings for necessary inspections.
INL.A_ND HOMES~ INC,
(Signature of applicant, or name, if a corporation)
Box 117, Ma'~tituck, N. Y. 11952
(MaUing address of applicant)
State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build
............................. General Co~tra~tor '
Nmne of owner of premises . .. F~.d.w..~.~qt..G.... ,~..C..a.t.h..e.r.5?.e...A... ,L, 9p?.r' .................................
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly attthorized officer. :
Rober~ E. HJ. ltz~ President;
(Name and title of, corporate officer)
Builder's License No ..........................
Plu nber's License N.s... 517-P
Electrician's License No. 2148-E *
Other Tradc's License No ......................
Location of land on which proposed work will be done. . . . . . . .e/s o£.....................Rte.25 e/oTabor Rd...,~ o~:ien'l;,N.Y,
House Number Street Hamlet
~ , . e/O(lTal8)
County Tax Map No. !000 Section 18 - 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 vacant '
1 family dw¢!!.ing .......
Repair Rcli~oval Demoli~io~ Other Work
(to be paid on filing this application)
If d~9.elling, number of dwellin~ un/ts .... ] ........... Number of dwelling unRs on each floor ................
Ifgarage, numberofcars ...~ .......... 1 ..................................................
If business, commercial or mix:ed occupancy, spec~y h~ture and extent of each type of use ..............
Dimensions of existing structures, if any: Front ........ , Rear Depth
Hei ht N n b r of Storles
Dimensions of same stmcrure With allera~ons o~addifions: Fr6nt ................. Rear .............
Depth ...................... Height ................ ...... Nnmber of Stories ....................
Di ~ensions of entire ne v can't tion Front ~ ' . ' ' Rear 5~ Depth
i1 % ruc ' .' x .......................
~ ' ' ~.~ -'~ i '. ~'.:~ .....
H ght 18 .~ ~b faf Sro ' ~.~
Size oflot: Front .........150 [....'.~. ....... .. Rear.......~50.... .......... Depth ................. . . .
Date df Purchase ~ N~me of Fonuer Owner . ;.
Zone or use district in which ~remises are situated ~
Does proposed construction vi~olate any zoning law, ordinance or regulation: ..... BP ........................
Wi~ lot be regrfded ....... ;..' .................. Will excess fif[ be removed from premises: Yes Nc
Name of Owner of premises ~4~$r~..LgPgX'. .... Address~Q. [~.ng. ~Y.' ...... Phone ~T~.~ ........
Name of Architect ~ '
......................... '.. AddressQr$~P~%~..~. X* .... Phone No ........
Nme of Contractor I~[,~N~ HpM~. ~5~ . Addre~s~q~. .............. ll7,MattitUC~hone No. ~.~ ....
PLOT DIAGRAM
Locate clearly ~d distinctly ~1 buildings, whether existing or proposed, and, indicate ~1 set-back d~ens~ons fron'
roperty Hnes. Give street and bloc.k number or description according to deed, and show street names and indicate whethe:
:terior or corner lot.
TATE oF NEW YORK,
OUNTY .OF .... ..~r./F. FOLJq.....~ S.S
....... ' ........ P, ober:l:..E, !. H:L'Ltz ............... being duly sworn, deposes and says that he is tile applican
(Nanie of indMdual signing contract)
)ove honied,
is the ............... .................. ~ .............................
: (Contractor, agent, corporate officer, etc.)
said owner or owners, m~d is duly autho~zed to perform or have performed the said work and to m~e and file
)plicatioh; that all statements contained in this application are true to the best of his knowledge and belief; and that th
'ark wfli be performed in the man,er set forth in the application filed therewith.
worn to before me this
otam Public · '~ 7~'
14.o i"d A~N ' ~OAO
$.7:54 50 ~
f50,00~¢
LICENSED
GREENPORT
NEW YORK
SUFFOLK CO. HEALTH DEPT. APPROVAL
H. $. NO.
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE DISMAL
SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
SUFFOLK CO. DEPT. OF HEALTH SERVICES.
(si
APPLICANT
SUFFOLK COUNTY
SERVICES -- FOR
CONSTRUCTION ONLY
DATE:
H. S. REF. NO..
APPROVED:
DEPT. OF HEALTH
APPROVAL OF
SUFFOLK CO. TAX MAP DESIGNATION:
DIST. SECT. BLOCK PCL,
'OWNERS ADDRESS:
8.50 I(ING, ~'F~EET
DEED: L..4S~4
TEST HOLE
SEAL
"It should be noted that since this
property is located in on agricultural
~area, the possibility exists that the
w~ater supply may contain trace
amobqts o[ pestiddes and/or nitrates·
RODERJCK VAN TUYL, P.C.
G~EEN~RT 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 STAND.~DS OF/THE
ShIFiOL~G ~. D~E~DT. C~F HE/~ZSTH/SEt~ICE~.
4. /
SUFFOLK COUNTY DEPT. OV HEALTH
SERVICES -- FOR APPROVAL OF
CONSTRUCTION ONLY
DATE: I~ 12~ ~ 2
H. S. REF. NO.
APPROVED:
SUFFOLK CO. TAX MAP DESIGNATION:
DIST. SECT. BLOCK PCL
~OOO ;8 5¢'Io ~, -~ ,5,,'
OWNERS ADDRESS:
DEED: L. 45:,!
TEST HOLE
~TAMP
SEAL
ill 4"
' ' 14'; ,4-"
'ktV!H~ ~ooH
t5 ~Pg~OOH * f
D CDANCY OR
OF OCCU?ANCY
If copper tubing ~s use,
for water distributing
sys:em; piping shall be
of types K or L only
.A,QpR~.~-D AS 'NOTED
.^,~:,hI23 .,~. ,,,
NO~ B¢ILDING CPARTMENT AT
765-1802 9 A~ TO 4 P~ FOR THE
FOLLOWING
J. FOUNdATiON -
2. ROUGH - FRAMING & pLUmBING
4. FINAL - CONSTRUCTION ~UST
ALL CONSTRUCTION SHALL ~ET
'THE REQUIREMENTS OF'THE N.Y.
~ATE CONSTRUCTION & ENERGY
' '' " ~DES, NOT RESPONSIBLE FOR
' .D~iGN OR CON~RU~ION ERRORS.
-I
4L4."
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