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Home My WebLink About12466-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13018 Date November 23 19 .84. THIS CERTIFIES that the building ...N.e.w..D..w.e.l. 1. $.n~ ................................ .............................. Location of Property ..... .1.7.0. ........... Eraory Rd. House No. Street Hamlet County Tax Map No. J000 Section ., .].0..3 ...... Block ..... 0..4 ........ Lot 032 Subdivision .... ~.~..ri.ny..~..h.o.~.~.s. ............. Filed Map No. 3231 .Lot No. 5 conforms substantially to the Application for Building Pemait heretofore filed in this office dated ............. 12466Z · ...J.u.l~. 21 , 19 .8.4. pursuant to which Building Permit No. ..................... dated ............ .3:.u. g: ..... .8 ..... 19 .8.4., 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 ......... NeW One Family Dwellinq The certificate is issued to ~L.B.~TA. JACOBS (owner, I~ of the aforesaid building. Suffolk County Department of Health Approval 13- SO- 125 UNDERWRITERS CERTIFICATE NO. N635593 Rev. 1/81 Building Inspector ]gOJl~ NO. Il 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) . ~ ,.~ ~9..~..~ N.° 12466 Z Date · .~4'..~ ..... , Permission is hereby granted to: ........... ...... ..~.~..~.....Td~..~....~ ............................. C', ..... ~.~..~....,~...:,.....~..:¼., ..................... ,o ...... ~t premise, located at ................................. ~ ............ Count-/ Tax Map No. 1000 Section .......]....C~...~ ...... Block ........ ~ .......... Lot No....~-....'~... .......... B~ pursuant to application doted ...... ~.~C~....~-~.J ..................... , 19.~.~.., and approved by the vJ Building inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY TOWN OF Instructions This application must be filled in Wpewriter 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 Heatth 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. 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 safeW inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1' Certificate °f °ccupancy n ~5-e~mt~i' elhn' q/r, land use$/~-/$5,00 2. Certificate of occupancy o pre-~e~isl'ng dw g _ 3, Copy of certificate of occupancy $1.00 Date ............ New Building . .~. ........ Old or Pre-exi~ing Building ............ Vacant Land ............. Location of Property... [ ~O...~G~... ~d, .............. O~ ~=...'~. Z Owner or Owners of Property ... ~..~/~.-'~ ........................... County Tax MapNo. 1000 Section ...~...~. ..... ~Block ...... l. ....... Lot.~ .............. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. '.~.~,',~.~.. Dateof Permit ~_~_~.~.~...Applicant ./~'~Z~¢~,~-~.~.~.~'~: ...... Health Dept. Approval ........................ Labor Dept. ApprovaJ ..................... Unde~riters Approval..~ ................ Plannin oard royal ................... Request for Temporary Certificate ..................... Final Certificate .................... Fee Submitted $.. ~ .. ~ .................... d regulations. Construction on above described building and ;7~?/~ eets a App,cant./ . "¢7 " Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS SUREAU OF ELECTRICITY ~2t~ 02~, [4 85 JOHN STREET, NEW YORK, NEW YORK 10038 Wil~mn J~bs, 170 ~ Ro~, C~ N.Y, FIXTURE OUTLETS SWITCHES DRYERS FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS 1-4.5~v,, trot water 1-Smoke detector E R AW.G. OF CC. COND. C NO, OF Hb[EG~ NO, OFNEUTRALS 4 Th."ee '~" El(~trlo, I~. ~f. 1 aox 4[~ Souad Avenue 1~iverhe~d, N.Y. 11901 This certificate must not be altered in any manner; return to the office of the Board if i~ncocrect. Ipspector~ COPY FOR !~UILDII}IG DE '¢l/;ide~ ~yy t~ireir ~rre~enfi~ls. ~J~ FIELD~I~N~FECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL COMMENTS · 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION ,,~/ ,[/~FRAMING ~-~..[ ].FINAL REMARKS: FORM NO. 1 TOWN OF SOUTHOLD - BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1803 Examined(~..x.~.e~t.~?~.-.?...., 19~..~. .~.x~. ~ . .~..., 19~.3. Permit No./. '.&.~..(o. (.o.~.. Approved Disapproved a/c ........ ~ .......................... ............................... .... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 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 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~. - '~: ' '~t~' ' ' ' 'F~' ' ' )'~'~/~'inspgt~[ig'ns' __ (Signature of applic~4t, orfi~ne, if a corporation) (Mailing address of applicant) / ( State whether applicant is owner, tessee,~ent, architect, engineer, general contractor, electrician, plumber or builder. (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... ~ .~..,~..~.. ........ Other Trade's License No ...................... 1. Lcication ofland on which proposed work witl be done. ~ .... ..~...o..~.~....~..~.: ............ ...... ?..,. ........ ~~Z'zz~-' ~' ......... Street Hamlet r ' C~)hnty Tax Map No. t000 Section .. i.'/. O ..~. ....... Block ... ~.e ............ Lot .... .~i~ ........ Subdivision ..... ~...~r~/..~.~.. ~..~ ........... Filed Map No...~. ~ ~ ..... Lot ..... ~ ...... / (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... .~...t~../~.,. ~ ~ .................................... b. Intended use and occupancy ......... ~.' ....' .~'..~4.. ¢..~......~.. ~/.~. .................... : 3. Nature of work (check which applicable): New Building .. ~.. ..... Addition .......... Alteration .......... Repair .............. Remqval .............. Demolition ......... Other Work ............... i d a o. 0 :. o o (Description) 4 Estima e Fee ..................... (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 ... ~. ................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... /. Height · ........... Number of Stories ... ,.~.'/.~ ............................................. Dimensions of same structure with alterations or addition's: Front ................. Rear ................. Depth .................... .. Height ...................... Number of Stories ........... ,,,. ~ ....... Dimensions of entire new construction: Front .... ..~..~ ...... Rear . .:[-~(~ ..... Depth ... Date of Purchase ........... .................. Name o~ Fenner, Ow.l~.~. ~ ............................ Zone 6r use district in which premises are situated ......... ~/'...~f~....~.O~.. ......... ~ ............ Does proposed construction violate any zoning law, ordinance or regulation: ................. .'~. ~. ......... Will lot be regraded ........ ~; ~/~...~.,.d~.. p~ ;...~.. Will exc?~s fill be removed from premises: Name of Owner of premises . ~--/'~ .~Address . ~..~. P?'...~. ,~,-% .... Phone No.~.,,~..' .~.~ Name of Architect .... .,~. ~,,, ........ t:~C/^. ~,~ .... Address ....... c ........... Phone No .... ( ........... Name of Contractor..~. 4~f..~.,~,,~..../.~ r.~l~.~ dress ........ .( .......... Phone No .... .t.~ .......... 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly ail~ buildings, whether existing or proposed, and, indicate ail set-back dimensions from property lines. Give street and block 'number or description according to deed, and show street names and indicate whether interior or corner lot. : STATE OF ,NEW (f'6-RK .... S ~" /~ ...... ~....~. ·. · ~~. .......... b~uly sworn, deposes ~d says th~he is ~ applicant (Name of indivi~al si~ng contract) above named. ~ ~ ~ ~ / e is the ................................................................ ~ .......... (Contractor, agent, corporate officer, otc.) of said owner or owners, ~d is duly authorized to perform or have peffomed the said work and to m~e and file ~is application;, that ail statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfomed in the m~ner set forth ~ the application filed therewith. Sworn to before me th~s ........... .... ....... ,, ,, ........... SUFFOLK CO. hEALTH DEPT. APPROVAL C~e~; o~ ~ene~! ~gineeri~ ~ Services ~ODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS GREENPOrT NEW YORK STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE W~LL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES APPLICANT SUFFOLK' COUNTY DEPT. OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE: H.S, REF. NO.. '5- ~-. "?~ APPROVED: SUFFOLK CO TAX MAP DESIGNATION: DtST, SECT. BLOCK PCL OWNERS ADDRESS: DEED: L. ,~/'A P. TEST HOLE [TAMP SEAL , / LICENSED