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Home My WebLink About11794-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.y. Certificate Of Occupancy No...Z.l.6. [8..0 ......... Date ..... .S.e.p. ~. e..m.b.e.r...1.7 .... ] .9.8.7 ...... THIS CERTIFIES that the building ....Op.e...~ .a.m.i. 1. y...d.w,e. 1. .1)_.n.g ...................... Location of Property .. .... .2 .4.50. E..1.£.j a. h..s L a n e H a t t i t u c k I~ouse No. Street Hamlet County Tax Map No. 1000 Section . .1.0.8. ....... Block ...... 3. ........ Lot ,., .0.0.6.: J ........ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. 4 u.t 3'.. 7. 0..1.9. ~ ¢ ..... pursuant to which Building Permit No...z. 1. ! 7. .9.4.Z. ........... dated.................July 9, t982 :: ..... .... was issued, and conforms to alloftherbquirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... One family 'dwelllng and porches. The certificate is issued to .LOI S F. WOODHULL .................... ~o~,de',',~?d~g~k~ ~'x'~ f( ................ of the aforesaid building. Suffolk County Department of Health Approval 12 - S O- 70 1 / 26 / 83 UNDERWRITERS CERTIFICATE NO. N595319 Mar. 9, 1983 PLUMBERS CERTIFICATION DATED: Frank Meyer 2/17/87 Building Inspector Rev. 1/81 FORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPAI~TNIENT Office of the Building Inspector Town Hall Southold, N.Y. TEMPORARY CerfifJcafe Of Occupancy No..Z.1.1.4.7..8 .......... Date .... .F.e.b.r.u.?.y.J.4. .............. ,19.8..3 THIS CERTIFIES that the building ................................................ Location of Property 2190 glijahs Lane Mattituck County Tax Map No. I000 Section . .1.0..8 ....... Block . .0.3. ........... Lot ...0.96. ........... Subdivision .... X. .......................... Filed Map No..X. ...... Lot No...X ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...J .u.i.y...7 ............ 19 .8.2. pursuant to which Building Permit No.. ~. ~..7.9.4.. Z. ............ dated ... 4 .u.I.y.. 9 .................. 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 ......... ·.. ~..p?, .i .v.a.~e,. 9p.e..: f .a.m.~.l. ~/..d.~.e..1 }3.n.s: ? ........................................ The certificate is issued to LOIS F. WOODHULL ..................... Y, ,d*¥rJ ...................... of the aforesaid building. Suffolk County Department of Health Approval . J .2.-: S..0.-.7.0.,. J ./.2. ~ ./.8.3. ~. 89.b. ~,..A.....1/' .i.l.l.a., UNDERWRITERS CERTIFICATE NO .................................................. *This is a Temporary Certificate of Occupancy. Building Inspector Rev. 1/81 P,e~l BUILDING af p~em~ses located at ................ PERM, IT MUST BE KEPT oN~ ~HE~PP'E/~IS SUNTIL I~ULL (THIS COMPLETION OF THE WORK AUTHORIZED? ~ ........ ~ ..... ~.:,,. ............ .... &~:..~..~....,~:..L4....,. ..~ .................. ,. (, ~-. .................. .,. p~rSHant to applicati~n'dated ..: .......... :.......:...".:~.,:.', 19and approv~ by the Re~ FORM NO. 6 TOWN OF SOUTHOED Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions TOWN O~ 'SOUSe?- A. This application must be filled in typewriter OR ink, and submitted ~ ~ to the Building Inspec- tor with the fo~towing; 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 sew_erage disposal-(S-9 form or equal). 3.Approval of electrical installation from Board of FkFUnderwriters. 4. Commercial buildings, Industrial buildings, Multi~le 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 si~ plan requirements where applicable. B. For existing buildings (prior to April 1957), Nf~n-conforming uses, or buildings and "pre-existing" land uses: / 1. Accurate survey of property 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date .......................... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ................................................................... House No. Street Ham/et Owner or Owners of Property ............................................................ Co,,ntyTa× No. ....... B,ock ....... ...... 'or ..... ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ..... ate of Permit ........ Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters 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 · · ,~. ~ ............................. C 0 FORM NO. 6 TOWN OF SOUTHOLD Building De~ar~men'~ To'.vn Hall $oummd · ~P, ,-,C=,I ,O ~ FOR CERTIFICATE OF OCCUPANCY Instructions A. This apot(cation must be fiiled in typewriter OR ink, and sub~l,,ed in duplicate to the Building Inso~ tor ,.'rich the following; for new bui!dings or new use: ' 1. Final suttee,/ of property with accurate location of all buildings, property lines, streets, and unu% 2. Fina~ aoproval of Hea~th Dept. of water SUPply and sewerage disposal-- S-9 form or equal)· 3. Acprova~ of electrical installation from Bo~d 'of F, re Und~pwrit'ers. 4.~ommercJal.~ui]dings, Indusrriai buildings, Multiple Residences and similar t~ons, a certmcate of Code compliance from th~ Architac, n¢ c~,; ..... ~ -. , ~- T'-,'-~'~" 5. Subm~[P1anningBoard approve of completed sJ[eplan raquirements where applicable. B, For existing buildings (prior to April 1957), Non-conforming uses, or buitdin~s a~d pre-exlstm~ 1. Accurate ~¢zey of peoperW showing all prooerty lines, ~reets, buildings and unusual natural topographic features. ' 2. Sworn statement of owner or previous owner as to use, occupancy and condition of build,rigs. 3. Da~e of any housing code or safety inspection of buitdincs or premises, or o~her pertinent [nform~ tion required :o prepare a ce~ifica~. ./ 1. C~ificate of occupancy S5.00 2. Cardfica~a of occupancy on pre-existing d,,vell[ng or land use 3. Cop,/of certificate of occupancy 81.00 S5.00 NewBuild;n~ OldorPr .... Isd,,u ' '; ",' ' ............. Bullo,cg~..} ........ : /Vacant Land .......... Location of Property ............ ~--~"--' /,.Z'~)/-/ Hou~ No, ' ........................... - Owner or Owners of Property ¢/~ , . ....................................... County TaxMao No. 1000S~ct[on ¥ ~ ' , .................. B!ocx ..-/~.T, . Lot...¢.~/. Sub~iv~sioa,..~ ............................. Filed Map No ........... Lot No .............. ' Health De0t. Approval /~ ~O ~O ........................ Labo¢ Dept. Approval ....... UndeP,,zriters Approval .............. ,. ' ......... Planning Board Approval ¢ . Reqdes~ for Temporary Certificam ......... .Final Certificate s . .. ..... Constru, cdon on above described ,buildmq and pern'~it'meets all apPl?-abl%codes and regulations. 1135021 THE NEW ,YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRIC~IT~ ~- IBS JOHN STREET, NEW YORK NEW ~bRK 10038 only the electrical equipment ~ ~scribed below and intr~uc~ by t~ applicant na~ on the abo~e application number in the premises of ~.s .~.~..d o. ~'~ 3= 1983 and found to &e in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORESCENT 26 DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: ~tors ~ 1-F o 1-G.F.C.I. 1-Smoke Detector 4/O A, W. G NO, OF NEUTRALS OF HI-LEG 1 4/o "C" Elect. 4514 Sound Ave, Riverhead, N.Y., 11901 This certificate must not be altered in any manner; return to the office of the Board if COPY COPY OF C GE~ERA,,L MANAGER may be identifidd by their credentials. MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 'I~WN OF SOUTHOLD CERTIFICATION Date c~/17 /~7 Building Permit NO.,//?~gZ (please print) Plumber ~UW- ~EH~f_ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this ~G%ay of ,~4~,~ 19 Dg Notary Public,~~ (plumber's ~gnature) Notary Public }{AROLD T. CAR,R NOTARY pURLIC, St~t~ ol New No. 52-0578405- $~ft=:{× Cos~)ty Comm:ssion Ex,;has {~;z~ch 30,19 F 7 FIELD INSPECTION FOUNDATION (1 FOUNDATION ( 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY q,ODE FINAL DATE COMMENTS ,/ ADDITIONAL COMMENTS: ,j BUILDING DEPT. INSPECTION [ ] FOUNDATION ~ST [ ] ROUGH :PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ' SOUTHOLD, N.Y. 1,71971 TEL.: 765-180:3 E,amined APPLICATION FOR BUILDING PERMIT Application No.. t(/./.~. ~.. ...... Date ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted :i~-J.~=.L:._~t_~ to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according-to schedule. b. Plot plan showing location of tot 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 drown on the diagram which is part of this appli- cation. c. The work covered by this application may not be commenced be£ore 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 buildings for necessary inspections. admit author/zed inspectors on premises and in ....... .' ...... ~L..~.~ ......... (Signature of applicant, or name, if a corporation) .... (Mailing address of applic~fnt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~./..~ .... .~....(~..0.6.-~..,~.~..~f~. ............................................... (as on the tax roll or l~test 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 ....................... / / Other Trade's License No ..................... ,./// 1. Location of land on which proposed~ork will be Oon~ ............... , ................................... ' ..... ........................ · '~ 0_~ Lot...C~. (~ .......... County Tax Map No. 1000 Section .... /(~ ......... Block .................. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupanc/. 7~'f.~. ).( .~...~.... ~~ ..... }..~...: .............. 3. Nature of work (check which applicable): New Building ....... Addition .......... Alteration ...... Repair .............. Removal .............. Demolition .............. Other Work ......... ; ..... 4. Estimated Cost ........................ Fee .......................... (to be paid on filing this application) 5. If' dwelling, number of dweilin$.~ni~s.~ ..... [ ......... Number of dwelling units on each floor .... J ........... Ifgarage, number of cars .. ~.Oh}¥~- . . . 6 Il'business commercial or mixed occupancy specify nature and extent of each type of use ~ structure~ if any: Front Rear Depth 7 Dimensions of exis_~ng ........ Height Number of Stories I . .~'~. ....... Dimensions of same structure wi~h alterations or additions: Front ~ ~.,trl .~- Rear ......... - r. ..... Depth ....... ~ ........ ...., Height .... I ........... Nu Stoies .............. t ........ 8. Dimensions of entire new constrgction: Front i i i .~.' ~ ........ Rear....'3T. ......... Depth . ~.~.~ ......... Height ..... ~. ........ Number of Stories ..... ~ ....................................... 9. Size of lot: Front .~,. ~9.~l' ......... Rear ....................... Depth .................... 10. Date of Purchase . ././'/.~. ,~.~..~r~. ?i~. .......... Name of Former Owner~.)~.'f-~..7'. ~/.~.~.~.f.L.~ ........... 11. Zone 6r use district in w~ch pr6mises are situated., f/0Z2~. ............ . ....., ............................ 12. Does proposed construct~oj~ yiol~te any zoning law, ordinance or regulation.../~//J ............... 13. Will lot be regraded ....~...~..; ................... Will exg~ss fill b.~ r. em~oved from premises: 14. Name of Owner of premises ~.0/.~..~.~. 0~./'/~/J., Address/././//t(/.~./~.. (,~...~-. Phone No.~.~ Name of Architect ........... i ................ Address ................... Phone No. Iqmue of Contractor .~/../k.q--. ¢..Cig.'....°~..0..~ ........ Address.. M ~'i~. tTq .e4~, Phone Ne. ~.'c~ PLOT DIAGRAM Locate clearly and distinctly nlli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block humber or description according to deed, and show street names and'indicate whether interior or corner lot. STATEOFiN~EWQ~K' ~/- '~ S S .......... (.~ · .~m~v]~;~l~si~i;~.c.oh.t)idti .......... being duly sworn, deposes a s that he is the applicant above named. e 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 con(dined 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~lhj, s, i ~ ,.~ qX ~;' ~ It slmuld be noted that since this ~ .J ~ ~ ~ prope~y is located in an agricultural . ~ ,~ ~ area, the possk)ifiJy exisfs that the ~ ,.~0.~ "' ' water sup'ply may contain trace ~ "' ~ ~ ~ amounts of p~sticides and/or nitr~tes, ~ - ~5 X Special analysis T~ ~b~ required. , ~ "~"~ ~' -Contract this ~partment pr' cou~ g~A~T~ OF ~LTH S~iCeS ~R APgROV~ OF CONSTRU~ION ONLY AT MA((I~UCK / / ~PPROVEO .... NOT~CO,[$iDEREDTO~AVALID ~RUE COPY ~ ~, - ~ '~ ~ ~RWHOM THE SU~EY SPREPAREO HEALTHDEPARTMENT-DATAF~APPRO~TOC~STRUCT A~D ~ HiS ~LF ~ ThE ~TLE C~Y, GOVMN- MAP JT ,t~ EECTION~ ~CK O~ LOT ~, -- H~E~ AH~ TO ~J ASIIeN~S OF THE LENDIN6 ~.c~. ~.~/ .u.~,~ *NO A.~ NOt tO I I~1 V~ I~ ~O~DE~ AVENUE ~ '~ J HOWARD W. YOUNG, LAND SURVEYOR ~L~T~W~L(W),~ICTANKJSTJ~CES~OLS(~)~NHERE~ ~ ~ N.Y.S. LICENSENO. 4589~ '83 JAN The sewage disposal an~ weter suppler taetllties for th~s location ~ve bees inspected b~ this department ~d found Chief of ~eneral Engln~erl~$ HEALTH DEPARTMENT-OATA FOR APPROVAL TO CONSTRUCT + X R NEAREST WATER MAIN~MI. - # SOURCE OF WATER= PRIVATE __PUBLIC N ~UFF CO, TAX MAP DIET j0oo SECTION Io~. BLOCK o~ LOT NTHERE ARE NO DWELLII~S WITHIN IOO FEET OF THIS PROPERTY OTHER THAN THOSE SHOWN HEREON. 14 THE WATER SUPPLy AN0 SEWADE DISPOSAL SYSTEM FO~ THIS RESIDENCE WILL CONFORM TO THE STAND~,RDS OF THE SUFFOLK COUNTY DEPARTMENT OF HEALTH ~ERVlCES. APPLICANTs ADDRESS TEL. #TRE LOC, ATI(~I OF WELL(W),SEPTIC TANK(ST)e CESSPOOLS(CP) SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FR~OM OTHERS SURVEY FOR AT M~fTITUCK TOWN ~OF ~OU~L~OLD SUFFOLK COUNTY, NEW YORK 'DATE: SCALE: NO. ,,JAN. t~, I" ; ~00' "J~J~I~TH~IZEO ALTERATION OR ADDITION TO 3'HIS ~H~f I~ A VIOLATION 0F SECTION 7209 OF THE NEW YoRK~STATE EDUCATION LA~' ~COP~ES ~ THiS SURVEY HOT ~AR~6 THE LAND N6UARANTEES INDICTED HEREON ~ALL RUN ~LY ~ MENTAL ~ENCY AND L~NDIN6 IN~TI;UTIOH LISTED ~D;STANGES SHOWN H~REON FROM PROPERTY LINES TO EXiSTInG S~RUC~RES ARE FOe A SPECiFiC ' YOUNG & YOUNG ALDEN W. YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S. UCENSE NO. 12845 HOWARD W. YOUNG, LAND SURVEYOR N Y.S. LICENSE N0.4589:~ 'AVENUE , NEW YORK ' ~ ~/~/~ B~ ~ FOLLOWING INSPECT 5*-0" /2 /1/OTIC~: