HomeMy WebLinkAbout12258-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMEN-I'
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No .... Z12.327 .......
Date ...... .M,a.r, ql3..8,,,. 1..9,8.4. ........... 19 ...
THIS CERTIFIES that the building .......................................
40 The Strand &
Location of Property . 49~.5, T~.e..!~on,Gway...
Ho~ No, ' ...... ~/e~i ' ~'~ ' ~.~90 .........
County Tax Map No. 1000 Section 021 .... Block 05 , .Lot 009.
Subdivision Pebble B~ach Farms ...Filed Map No. 6266 .Lot No. 139
conforms snbstantially to the Application for Building Permit heretofore filed in this office dated
.Ap.r.J:'.l. :l.4. ~...1.9.8. 3. ..... 19... pursuant to which Building Permit No. 122.58 g
· dated .g..p.rfi:l...1.4. .................. 19.83, 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 .........
................................. ~. ¢.w..D.v.e.~.!~.n. g .................................
The certificate is issued to Frederick g. Coffey
..................... /o~n'e~','lt~s'so'o'~r't~Ja'n't} ......................
of the aforesaid building.
Suf~lk County Department of Health Approval 13- ~O- 38
635329
UNDERWRITERS CERTIFICATE NO ..................................................
Building Inspector
Rev. 1/81
*OWN O~ SOU~O!~ ~
BUILDING DEp~RTM~N~
TOW..~LL ~
$OUTHOLD, N.Y.:
BUILDING. PEI~41T~:
¢O~PLk'TION OF T~E ~0~ ~UT~ORIZ~D)
N~ 12258 Z ....
Date ' ~ ~ ~
_._~,.~;. ~,.. .......... ~ ............ ,
to: ,
Pe~ission is hereby granted ....... /~ ~ ~.~, /~ ,: ~ /. ~.
at pfemise(~ located
...... ~,......~ ........... .~ ................................................................ ?..~, .............. ,.t. ...... ~ ................................
.... /.D~.~ ............ ~,..., ............. .-~,~. ...............
C~ !ax ~ap No. 1000 Section ~.~.....{. Bl~;~.~.;.~Lot No. ~...~ .........
pu~nUant t0 application dat~ ...... ~..~,.......:;...,... :{,...., 19
and ~pp~ by the~ r
...~..~,..,.,~ ~....~... ..
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 fo]lowing; 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 d sposa -(S-9 form or equal).
3. Approve(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.
B, For existing buildings (prior to April 1957), Non-conforming uses, br 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-
t/on required to prepare a certificate. / '
C. Fees:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling or land use
3. Copy of certificate of occupancy $1.00
$5.00
Date.
ing_, .;. ..... O~d or Pre-existing Building(~> .. .......... ,/Vacant Land ': ............
Owner or Owners of Property .~ ..
County Tax Map No. 1000 Section .,.~, ~ / Block ~.~. Lot.
,o...: ....... No. .......
Perm it No./. ~.~'~Z Date of Permit ~//~/~..Applicant . ~,. ~~
Fee Subm tted $. ~../.~ ....... :. ~ .... ~ L~(.3~ -
Construction on above described building and p~rmi~meets all app~cabl~odes and regulations.
~.ool ~l THE NEW YORK BOARD OF FIRE UNDERWRITERS
BUREAU OF ELECTRICITY
85 JOHN STREET, NEW YORK, NEW YORK 10038
THIS CERTIFIES THAT
only the e~ctrical equipment ~ described below and i~trod~ced by the applicant ~d o~ t~ ~ve app[icatio~ ~um~er i~ t~e premises of
~et ~low~, C/O ~ St~d ~ ~e ~ng W~y~ ~, ~ion, N.Y. Pebble ~
in the followlng location; ~ Basement ~ 1st FI. ~ 2nd Fl. Section Block Lot
was examined on ~b~ ~8 ~ 1~84 and found to be in compliance with the requirements of this Board.
FIXTURE
OUTLETS
B4
~ECEPTACLES SWITCHES
FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
FLUORESCENT VAi~OR
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS
UNIT HEATERS MULTI-OUTLET
SYSTEMS
NO. OF FEET
DIMMERS
SERVICE DISCONNECT S E R 'V I C
OTHER APPARATUS=
1-C~CI., 2-Smoke Dete~tor~o
11 2/o
G ~ S Eloctric
Box 215
$outho~d~
11971 IZOD. 578
11
Per_ __
This certificate must not be altered in any manner; return to the office of the Board if iocor~ect. Inspector? may be !dentified by their
COPY FO. I~IU ~D1~48 DEPARTMENT TH S COPY OF CERT F C&TE?p~T[Ng7 sE ~LTER~D N AN~ MANNER.
FIELD IN~PE~ION COMMENTS
FOUNDATION (2nd)
2.
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
C~DE
FINAL
ADDITIONAL COMMENTS:
76S.'t 802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND ~INSuLATIoN
. [ ] FRAMING
REMARKS:
DATE
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST /~[/] ROUGH
FOUNDATION 2ND [ ] INSULATION
~/~] FRAMING [ ] FINAL
REMARKS:
INSPECTOR
c-9 o
M,~p O~ P2OP~,T'Y
~U~V~Y~O tzC:~
<%
SUFFOLK CO. HEAl
H..
STATEMEN
THE WATER SUPPLY
SYSTEMS FOR TH
CONFORM TO THE
SUFFOL%C~. DFPT.
~PLIC~HT.
SUFFOLK x~OUNTY
SERVICES -- FOR
CONSTRUCTION ONL'
DATE:
H. S. REF. NO..~
APPROVED:
SUFFOLK CO. TAX
DIST. SECT.
toO0 '
OWNERS ADDRESS:
9 ~tue+op,
DEED: L. ~-,//,~ P.
TEST HOLE
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TEL.: 765-1803
-,E, xamine~. ....../~/' ., 19 .~. ·~//?~ --
(Bui~
INSTRUCTIONS
a. Tltis 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 pm~uant 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 remo,~al 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 building for necessary infl4Kec/tt'pns. ,, ~ ,Q
(Signature of applicant, or name, if a corporation)
..... 7., .: ......
(Mailit~g address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises .~.~ '3 .e..~...~. ~test~)~ (as on the tax roll or i .....................
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No...~..~.q ................
Plumber's License No....~...~. 7.~..P. :'~ ........
.~?t£
Other Trade's License No ......................
1. Location of land on which proposed work will be done.~FI/~'k~..~..~..~. · .~..~...~..~. '..~-.. ~ · ·
. .P~.....t>~,....~.~. ~ ............................. . .F.~.....~.. ~.,,. ,:. ~ :.7.'- .....
House Number ~ 7d~- Street Hamlet
County Tax Map No. 1000 Section ...O...~..[ .......... Block ...... ~ ......... Lot...~.3..~. ...........
Subdivision k~d .P~d. ~-~...~...t~'~rL~...~'. Filcd Map No. Ii./.-. S: .2..~..2. 3. Lot.. /.,-~. g .......
2. State existing use and occupancy of premises and intended u~e and occupancy of proposed construction:
a. Existing use and occupancy...~Mg:~..... ~.d..-'. ............ ....................................
b d an ca .~....t~....~. c_,,~-~ ~~
· Inten ed use doc pancy .~..
3. Nature of work (check which applicable): New Building ... ~. ..... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
~./. i ..~z~'~-~.~ (Description)
4. Estimated Cost. 2.0./..6~.. ........................ Fee ~.[1~.~. -.,~..'. .........................
(to be paid on filing this application)
5. If dwelling, number of dwelling finits.....~......'-.... Number of dwelling units on each floor·..'7'. .........
If garage, number of cars '
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
7 ..... if any: Front '~ Rear -- Depth
· Dimensions of exlstmg structure~, ............................................
Height '*"' Number of Stories
Dimensions of same structure with alterations or additions: Front ...... .~. ......... Rear ...~. ..............
Depth ....... ~ ............. Height ...........".~ .:; ~ Number ?tf Stories, .... -7. ................
8. Dimensions of entire new construction Front...~..¥._....,I. , or
/..O.. Rear ...~.~.-r.Z g}.... Depth .~ ............
~ ~ Number of Stories
Height . .. ~ ..............................................................
9. Size of lot: Front ........ .~..i ........... Rear ....... ' ............... Depth n .....................
10. Date of Purchase .. ~ .... .i/. ~?.~. { ........... Name of Former Q..kvner ?].~-~.... ~. ~.~r.
11. Zone or use district in which premises are situated.. ~~ .g-.. ~.'...~. ........................
12. Does proposed construction violate any zoning law, ordinance or regulation: .... Jq.~?..'": ....................
13. Will lot be regraded ./~... ................... Will exces, s fill bezemove.d from premises: Yes
14. Name of Owner of premises ffi~..0~. ...... Address ~.g~¢/~..7~.~i~. ~ .... z°ho3e No..T ..............
...... Address ............... ~...Tp~ne No ................
Name of Architect ....... F/~I'/Q', '.'~-~' ;" a..,--o-zz~.~,_r~, gl
Name of Contractor~~,r~-~ ....... Address . ~.(~2~...~..h.,.~,.,. Phone No. "2.3.~/:-.~
7.$..
Locate clearly and distinctly all buildings,
prope~W lines. Give street and block ~umber or
interior or corner lot.
or proposed, and, indicate all set-back dimensions from
according to deed, and show street names and indicate whether
/?
STATE
S S
·..~..~..~,~L.~ .~ ............. being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract)
above named·
He is the ...................... . ~..~:~.....~...~
( 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 be performed in the manner set forth in the application filed therewith.
Sworn to before me this
........... ....
No.~Pu, blic,,...., j...~.~ ..... !^. ~ Count~'~ ~ ./3 ~/)
ELIZAB~'rH ANN NEVILLE .........
' York ~lgnature OI applicant)
~IOTARY PUBLIC, State of New
\ IlO. 52-8125850, Suffolk Cou. J~ /
Term Expires March 30, 19.~..~7
LICENSED LAND SURV~Y~S
GREEN~T NEW Y~K
SUFFOLK CO. HEALTH D~PT. AII'~OVAL
H.S. NO. ,*~-~-1~1t~
/ ??"' t\i
STATEJMENT OF INTENT
THE WATER SL#~q.Y AND SEWAGE DISJIO~AL
SYSTEMS FO~ THIS RESIDENCE MLL
CONFORM TO THE STANDARDS OF THE
~UFFOLKAI~ OE_,.f~r. ~ I~ALTH~ .SERVICES.
API~tCANT
DEPT. OF HEALTH
APPROVAL OF
SUFFOLK COUNTY
SERVICES -- FOR
CONSTRUCTION ONLY
DATE:
H. S. REF. NO.:
AI~ROVED: :
SUFFOLK CO. TAX MAP DESIGNATION:
DIST. SECT. BLOCK PCL.
t o0~ O g t
OWNERS ADDRESS:
~-0.
DEED: L. N/~:) P.
r-~ct'd. -
SEAL
SUFFOLK CO HEALTH
. H
sE~vic['s -
DATE'.