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Home My WebLink About12405-zFORM 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~g. ;BW~LL.I.lXlG ............................... Location of Property .. ? .6.7.0...FI.a.~?.a.~..o.o.k.a...R.d.,. ............. .Fl.a.~?.i.~..u.e.k. .............. House No. Street Hamlet County Tax Map No. 1000 Section q 23 ...Block 04 .Lot p/o 003 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .~.a. 7' .9. .......... ,19.8.3. pursuant to which Building Permit No. dated ....J.u.l. 7.7 .................. 19 .8.3., 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 ......... ~or a new o~e £amil~ dwelli~ The certificate is issued to RICHARD & ~.NNA ~ AUDIOUN (owner, lessee or tenanO of the aforesaid building. Suffolk County Department of Health Approval ...q. ~-so-~08 UNDER%VR~TERS CERTIFICATE NO ................................................. Building Inspector Rev. 1/81 FOruM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12405 Z Permission is hereby granted to: .... ~.......~/.~...~ ............... :~......~.~. .... ./~.~......~ ............................................... .... ~..~.~..~...~ .......... ,,, ..... .~./e~.7./.C~..c~.......~....~.~....~.~.....~.~..~...~c~..~......~../../:....~......~....: ............... /~..z~..~....~.~z~.....~.~ .................... ...Z.. ................ at premises located at ..,,./,~..,~.,,(~. .......... ~..~./,~,~....~.~.C~.~:~. ........ ~-(~... ................. ....................................................................................................... ./..~.~.~..~.~.:.~ ~.. County Tax Map No. 1000 Section r..Z~ ......... ~'~k ''~Z ........... LOt NO' '~/~'''' '~ pursuant to application dated ....... ~..~..~........~.. ..................... , 1 .~....~, and approved by the Building Inspector. Rev. 6/30/80 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 w[th accurate location of all buiIdin§s, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposals(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. 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 certificete. C. Fees: 1. Certificate of occupancy $5.00 t //$5.00~'/ 2. Certificate of occupancy on pre-existing dwelling ~r land use 3. Copy of certificate of occupancy $1.00 New Building ............. Old or Pre-existing Building(X) ......... ~/Vacant Land ............. Location of Property . ../¢,27... ,/~_..~../~. ~.T. ~.o. ~-..,~...../r~.~,~... ..... ~'~/'~..T~. ~...J~.'./'~.~.~..~., House No. Street Hamlet Owner or Owners of Property ... ~.'.. ~/~ O)~. 2. ~ ~.-~. .................................. County Tax Map No. 1000 Section .... ~..Z:-...~ ....Block ....O./. ........ Lot...?~..o...~.~.~2. Subdivision ................................. Filed Map No ........... Lot No .............. Health Sept· Approval.../.O//..~/~.~.~. .......... Labor Dept. Approval ...................... ,.. Underwriters Approval .... /. ?/?/~.~. .......... Planning Board Approval .................. ~..~ Request for Temporary Certificate Final Certificate Fee Submitted $. ~ dP Construction on above described building and permK'meets all aPp~cable_..codeS and regulations. Applicant Rev. 10-10-78 iooo77i THE NEW YORK BOARD OF FIRE UNDERWRITERS ~- 85 JOHN ,~TREET, NEW YORK, N£W YORK 100~8 o.,e October 6, 1983 ~ppz,~.,,o. No.o./ue 224820-83 N 618996 ~d Av~o~, W/S ~r~at~ka Rd. 2000' N/O ~1~ ~ ~x.m~,~d o. $~t~ 29, 1983 a~d found to be i~ compllance with the requirernents of this Board. FIXTURES RANGES OVENS EXHAUST FANS 28 33 22 28 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEROERS iUNJl HEAIERS MULTLOUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I ' C E NO OF CC COND A W.. A W G !NO OF N~UTRACS A. W O ]. z/o :~ 2/o OTHER APPARATUS: Electr£c Ro~u Heaters:l-2o0 K.W., 3'~1.5 K.W~, 2~1.25 K.W., 2-1.0 KW, 3-.75 ~, 3-.5 K,W. 1-4. ~ K.W. Hot Water Heate~ 1-G.F.C.I. 2-Sn~[~ Detect. or~ Ruland Elect,, Co, P, O. ~ox 143 Matcituck, N.Y., 11.952 LICo #242 This certificate must rtot be altered in any monner; return to the office of the Board if incol'rect. Inspecto may be by 'their credentials. COPY FOR I ~ MAF FIELD ~NSF~CTION COMMENTS .. .~ , i~,~ FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION FER N. sTATE ENERGY q?DE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT~ INSPECTION'- [ ] FOUNDATION 1ST. [ ] ROUGH: PI, BG.. FOUNDATION ZND [ ] INsuLATiON FRAMING REMARKS: 765-1802 BUILDING DEPT, INSPECTION FOUNDATION ~,ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]INSULATION .~ FRAMING ~/] FINAL ///* / 765-180Z BUILDING DEPT, INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND ~]/INSULATION FRAMING [ ] FINAL REMARKS: DATE ,,INSPECTOR BUILDING DEPT. [ ] FOUNDATION ZND/~] INSULATION [ ] FRAMING [ ] FINAL DATE ~-:////~: ,NSPECTOR: ~ '--'~- 7G5-1802. BUILDING DE~. INSPECTION [ ] FOUNDATION IST [~] ROUGH'PLBG.' FOUNDATION ZND ['] INSULATION FRAMING [ ] FINAL~ DATE INSPECTOR ~,'i , 7&S.'1802 BUILDING DEPT. INSPECTION I: '1 FOUNDATION ZST [~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: / DATE ~'-0t_ / / / led SUFFOLK CO. HEALTH DEPI STATEMENT OF INT THE WATER SUPPLY AND SEW S'TSTEMS FOR THIS RESI CONFORM TO THE STAND.a SUFFOLK CO. DEPT. OF HEAl APPLICANT -- SUFFOLK COUNTY DEPT. SERVICES -- FOR APP ¢o? yT -i? SUFFOLK CO. TAX MAP giST. , SECT. ~LOC TEST HOLE ~ ~ ~RVEV~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.; 765-1803 Examined..)7 ./Z .......... , 19 . .d~. Approve ...Z../..Z. ...... Permit ........... i-~'. ........ ,~. ...... ~./...,... , (Building Inspector) Application NO../~.'.~..~..o. ....... APPLICATION FOR BUILDING PERMIT 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 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 g/ving 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 necessary iogpections. ..........................,~. ., Id~ /z. .G:/. ~-50 .x,. ? .... /. .~. .c. ; . . (Signature of applidant, or name, if a corporation) ....... ,~x~3. ./ (Mailing address of applicafit) State whether applicant is owner,,/essee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ~_..e. ~.. ~.. ~, .~. ~ ~zr..~ c '..z~..~ ............................. .., , c/ 2P ,~ ~'.a/'. . ,.~we { n ~. ........... / ......... ~ ......................... Name of owner of premises '~' (as on the tax roll or lates~eed) ............ If applicant is a corporation, signature o,f duly authorized officer. · ............ (Name and title of corporate office) Builder's License No ....... //. 9..~ .............. Plumber's License No .... /O..~./~..~.' .......... Electrician's License No .... ~..o?. ?...~'.~. ........ Other Trade's License No ...................... Location of land on which proposed work will be done. /4/./~...//~t~..~ .'fi .~...~.~.../~).. ................... ........ ............................................................................... -- House Number Street Hamlet County Tax Map No. 1000 Se~qction ~....[..~..~...~ ...... ,Block ...... .(D.. [ ........ Lot ..... .O..O...~... ....... Subdivision ..Z~.4.,~..d,~.. ~.,(.4~.~:/~..,~..~.-~.?(.~...~.~iledMapNo ..,~.~.~.~. Lot ~ ......... (~a~;) .......................................... State ex~st~ng use and o~ccupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .~.~. '.d%~.~.. ............................................... b. Intended use and occupancy ../.. · .,~..~../~.../.Zr/. · .~./~.. · ./~..'~...~... ff~./~..e..~,..~../fi"('~.. .............. 3. Nature of work (check which applicable): New Building ...~....... Addition .......... Alteration .......... Repair .............. Rem6vai .............. Demolition .............. Other Work ~ (to be paid on filing this application) $. If dwelling, number of dwelling hnits ............... 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. DimenSions of existing structuris, ifany: 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 .... -.~.O ....... Rear .... .,~ .cD. .......Depth . .'~...~ .. ......... Height ...... .~. ...... Number of Stories ........................................................ 9. Size of:lot: Front '~ ........ Rear ...................... Depth ...................... 10. Date of Purchase ........... i .................. Name of Former Owner ................. : ........... 11. Zone or use district in which premises are situated ..................................................... 12. Does p~oposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ......... [ ................... Will excess fill be removed from premises: Yes Name of Architect .......... ~ ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all lbuildings, whether existing or proposed, and, indicate all set-back dimensions from propet~y lines· Give street and block numbar or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE'~-'~RK, COUNTY 0~. ¢'~ · ~ .O..~.~%%d ~.~. '.. '.~i~. '~ '..~.~ ~..~..~..~.. ....... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract') above named. He is the ............. ~..~. ~...~.,rf~ e~.c.. 77'..o..,~ ....................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 mannerlset forth in the application filed therewith. Sworn to before me this ;.. ........ ' ....... day of ~ .... ,~ APPLICANT ~hief et ~eneral ~h~inee~in~ RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS , /4' G~EEN~RT NEW YORK ~ SlJF'FOLK cO. HEALTH DEPT. ARRROVAL ~"¢~7~ '>~D~ ~ ~ , '.~ H.S. ~. . . ~ N'~ THE WATER ~Y AND ~W~ DI~AL ~ ~ / ST~EMS Fffi T~S RESI~NCE ~LL ~NFORM TO THE 5TAND~O$ ~ THE ~' ~'e*."~',~,:,~_. ..... ~, q~:i~:~r~ ~"~ . ; :~ S~K' CO. DEPT, OF ~TH SERVICES. RODERtCK VAN TUYL, LICENSED LAND ~R VEYORS GREEN~RT NEW YORE APP OVED AS NOTED qOT FY BU LD NG DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR FOLLOWING INSPECTIONS; ,'I' FOUNDATION ' TWO REQUIRED / FOR POURED CONCRETE 9.. ROUGH - FRAMING & PLUMBING. ~. INSULATION 4, FINAL * CONSTRUCTION MUST I BE COMPLETE FOR C, O, ~LL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE N, Y. STATE CONSTRUCTION & ENERGY CODES. NOT RESPONSIBLE FOR !)F. SIGN OR CONSTRUCTION ERRORS.