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Home My WebLink About12259-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hail Southold, N.Y. Certificate Of Occupancy No..7'.1.2.3.2.4 .......... Date March 7 . . 84 ............................... 19... THIS CERTIFIES that the buildhng addition Location of Property 1885 Ackerly Pond Lane, Southold House No. Street Hamlet County Tax Map No. 1000 Section . 069 .Block .05 ..... Lot 0.0..5 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated 83 April 14 19 .. pursuant to which Building Permit No..3,2~.5.9-~ ............. · dated April 14 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 ......... addition to one family building The certificate is issued to Jo.~eph C. Cornell ........ (owner, lessee or tenant) ....... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO......~61.2~.4.2. ....................................... Building Inspector Rev. 1/81 TOWN 017, BUILDING TOWN HALI~,; ~ · SOUTH OLD,, N. 'Y.~ BUILDING FE~rr · ~ ~H S PE~IT MUST BE KEpT ON, ~HE PRE~IS~S UNTIL ~ULL C~PL~ION OF THE WORK AUThORiZED) 12259 Z at premise~ located at ¢ou~ TaLMap ~o lO00Se~ton ~£ e~i~;"~'"...':..- purSUant Building r~SPector. Fee ~..~.... ~pproved by the FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ~outhold, 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 featu res. 2, Final approval of Health Dept, of water supply and sewerage disposal--iS-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. B. 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 featu res. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of bu ildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ ~and use -- ?r e-E×~s t~±~; C.O. $1 5. O0 3. Copy of certificate of occupancy $1.00 Vacant land C.O. $ 5.00 Date '~" ' ~'-~/~ New Building ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . ./.,. ....... ; ................................ House No, Street Hamlet Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section .... .~..~..7 ..... Block ..... (;~ ~. ..... Lot ..... ~.[~..~ .~. .... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.J~../~ .... Date 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 ~plicable co/des and regulations. Applic .......................... Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ BUREAU OF ELECTRICITy ~- 85 JOHN STREET, NEW YORK, NEW YORK 1003,~ o.~e AuguSt t2. :1.9s3 ~,p,c.,o..No.o..~,. ~76~3-~3 N 612942 in the following tocatlo,~; ~ Basement ~ 1st FI. ~ 2nd FI. ~ctlo,* Block Lot wasexantinedon ~ ~ ~ ~ andfoundtobeincompliancewlththerequirernentsofthisBoard. FIXTURE OUTLETS 6 3 b FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS UNII HEATERS MULTI-OUT[ET SYSTEMS NO, OF FEET DIMMERS SERVICE DISCONNECT S E R V I C NO OF CC. COND. A W,G. h~O. OF HI-LEG A.W,G NO OF NEUTRALS A.w O. pER ,~' OF CC COND OF HI-tEG OF NEUTRAL OTHER APPARATUS: Electric Rooml~aters:l-.75KoW. 1-G.F.C.I. .E.C.O. ~lect. Corp. 325 Willow Poh~g Rd. gou~ho:Ld, MoY., ll~71 (Cliff Cornell) This certificate must not be altered in any manner; return to the office of the Board if DEPARTMENT· THIS COPY ( LiC. #2816 may be :id~ /MANNER. FIELD I~SP~TION COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION FERN. STATE ENERGY FINAL ADDITIONAL COMMENTS: ?' I1"' /~,' ?"x :?'2" ~c copper iubing is ~,~ for water distributing ~¥,sfem; piping shall be · of types K or L only FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~.f~.~..~.../.~.., 19 .Jff.ff Approved~...~../..~..., 1~.. Permit No../.~.? .~. ,~..~ · .~ :-..z~.~ ~::. :: ....... : ....... ./f.//. ..... Disapproved fl/C APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by Wpewriter 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 througJtout 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 auth°rized inspect°rs °n premises and in building f°r necessary, i.n.~d_/!~ ~__O¢.7a.e.,~/ ~i..gnfitured~f applicant, or name, if a corporation) (Mailing address of applicant) /1~' / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... .......................................................... Name of owner of premises ....~. r?.~. ~z~..,~... (~.... · ~,CdP~.~J. / .~/-/ .......................................... (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..~f../P..?.iff. & .C./~. ......... Electrician's License No. ~/5~c5.. U/d Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. · ....... ............................................. House Number Street Hamlet ~q County Tax Map No. 1000 Section ....... ct./. ........ 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 . .~..kJ(.qc'.L..~.d(.~. ...................... ~ ................... In /? ' ' ' b. tended use and occupancy 3. Nature of work (check which apPlicable): New Building .......... Addition .... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. Estimated Cost ........................... Fee .. ~ ...... i (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 ..... . ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure wi[h alterations or additions: Front ................. Rear .................. Depth .................... ,.. Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ...... ? ........ Height Number of Stories 9 Size of lot: Front" Rear Depth I 10 Date of Purchase ~ Name of Former Owner 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vioktte any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... xt~/.O. ................. Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ~: ,.q: .C.P~f~2-~- .. Address ./f~.'?'~. d~.~.-?. ..... Phone No. ~.~r..~7~. ~... Name of Architect .......... ~ ................. Address ................... Phone No ................ Name of Contractor ......... : ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all ;buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~ tumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~OR, J~/~Z ~ $ COUNTY O~--.. ~'~ ~ame~f i~vidual si~ng contract) above named. He is the .............. ~~., ...................................... [Contractor, agent, corporate officer, etc.) of said owner or ownem, ~d is duly authorized to perfom or have peffomed the said work and to m~e and file this application; that ~1 statements contained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ne'r set forth in the application filed therewith. Sworn to before me this ............ v, . .day of ..... ~I0~RY P 52.8 NO.l.~rm ExVlr0.~, March (Signature of applicm~t)