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Home My WebLink About12275-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy No..z. J .29.q 1. ......... Date ...... 9~.~.9 .b.e?.. ! ? .......... ' .... ,19 .8.4. THIS CERTIFIES that tbe building N.%w. one family, dwelling. of Property l Ty0 Sta.rs Road East Marion Location ................................................ I~$e HO. ' ....... Street Hamlet County Tax Map No. 1000 Section . . .22 ..... Block h 37 Subdivision .S. 9.u.n.d.c. rP.s.%. ~,o.qd.s. ...........Filed Map No.5.31.5. .Lot No. 12 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... bP ¥.~,%. 6 ......... ,198.$. pursuant to which Building Permit No .... %2..27~.Z. ........... dated ..... g P?.~,J,. ¢5 .............. 198.3.., 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 ......... 0n.c. r~ln~l. 7 ~.w.e.~.n.g v.it.h att. ached dp.c.k: ............................. The certificate is issued to ....... .W.i.l,~. $ .a.m..~,..a.n.d.../t.m.y...S....H.u..k.i.l.1. .................. town,r, ~ ~x of the aforesaid building. Suffolk C6unty Department of Health Approval ..... 1.3.. S 0 .4. 7 .. UNDERWRITERS CERTIFICATE NO ........... ...~t~ .63.1. .q2.8.. ........................ ... Building Inspector Rev. 1/81 N? BUILDING D~FARTM~HTi, ~ TOWN HALL ~ . ~ ~ SOUTHOLD, H. Y. ~ BUILDING PE~IT~ ~HI5 PE~IT MUST BE KEPT ON~H~ P~IS~S uNTIL ULL C~PL~ION OF THE WORK AUTHORIZED) L2275 Z TO REMovE EXCESS FILL FROM ABOVE PREMISES BY REGRA~DING LoT / DRIVEWAY CONSTRUCTION ~/' CESS?C~OL C~NSTRUC'TION ./ CELLAP, CONSTRUCTION ,,/ OTHER~ nspecto~ permission is hereby granted to: ........ ....... ~'T,:~.7....,Z~.-~.;..:.. to. , .... ~'~'..4.~ ...... ~. ....c::~,~,~.e, ...;.....-...-., ........ ~ ....................................... ...... ~ ................................................... .., ........ ~ ......................... ~...,, ............ ~...~ ............ ~ ................... at p~mise~ I~ated ot ................ ..~.~.~~..~ ......... ;~~...: .......... ~..: ....... ~.... Building Inspector. FORM NO. 6 TOWN OF SOUTHoLD Building Department Town Hall ,~,outhold, 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 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 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survev 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 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/ land 3. Copy of certificate of occupancy $I,00 use--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date...~/~.~.. ~.~. Z.~..z~. ·~. ' / New Building ......../~ ~. .... Old or Pre-existing Building ............ Vacant Land ............. House No. S]:reet . , Ham/et Owner or Owners of Property . · .~..~.~ ~./. ~. · ./'~.. ~.~..q.~t..~. ¢'/-~./'~/· ·-~.'.. ~- .f-K/- ./'.~. '/'~' · '/~- ....... County Tax Map No. 1000 Section ...o~...~.. ....... Block ...~..~.. ...... Lot..../t ......... Permit No./(..~...~.Z~Date of Permit ' .Applicant .['[~.(~.c.~.~.,.~....~;...~..LJ.I.~../..~.~ .... Health Dept. Approval. ~ .': ..~. 227. ~..~ ..... Labor Oept, Approval .... ~-,..,..-~, ............. Underwriters Approval//~/. ,~. ~,.~ ~ ...... Planning Board Approval. ,~, ............ Request for Temporary Certificate ..................... Final Certificate ~ Fee Submitted $. I.~.. ¢- ....................... Construction on above described building and per~, it~-Z~::~/,~, ~ ~ ,meal applicable.~c0de,~ and regulations. ;Z: l $oo~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRI~ITy j~j, lgL[~, ~.~! 19848~ JOHN STREET, NEW yORK, NEW~8 THIS CERTIFIE~ THAT onl~ the electrical eeui~ment ~ describe ~ b~[ow and ~trodu~d ~ ~he a~l~nt named on the able application number in the prorates of t~,~oilo,~in~lo~a.o.; [] Ba~e.ne.t ~ ~t ri. ~ Znd ri. S~otio. BIo¢~ ~ot examined on t~PAlO~2 ~ 10 F 1~ and fouttd to be in compliance with the requirements of this Board. FIXTURE OUTLETS SWITCHES FIXTURES RANGES OVENS DISH WASHERS FANS INCANDESCENT FLUORESCENT 13 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TiMEqLOCKS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT $ E R V I NO, Oi~ERCC~COND.] OF ACCW'COND(~ NO OF HI.LEG OTHER APPARATUS; 1-..j,~,C,I,~ 2~F~ Detectorr~,, Trac~k IAgiai;ing 8'0", 6 lite~. C E OF HI-LEG OF NEU?RA[ · 2 Denni~ D. Cl-alre~ Jr. P. O. Box 284 Laurel, N.Y, 11948 This certificate must not be altered in any manneo return to the office of the Board if incorrect. Inspectors may be !dentifJed COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFI( MANNER. BLDG ,"J'OWN OF SOOT~OLD ~i~ROYED AS ~OTED 765-1802 9 AM 'FO 4 PM FOP. THE FOLL~,,N~ ~ ' FOR POURED CONCRETE 2. ROUGH - F~iNG & pLUMBiNG 4. FINAL - BE COk'PL~TE FCR C. O. ALL CCNSTRZCT~ON SHALL MEET THE REQUIREMENTS OF THE N.Y, ~ATE CONSTRUCTION & ~NERGY 6ODES. NOT RESPONSibLE FOR D~GN OR CONSTRUCTION ERRORS. IF copper tubing is used for water distributing sys'emi pLaing shall be of types K or L only C£ LL,~R z4'/~' o_os- o~ 2o, ?.% \o F'r~ Z .... 7'~'" /" J..IVI~6 'i I I Roo~' ?}~.o ~00~" FIELD INSPECTION COMMENTS FOUNDATION ( 1 st) FOUNDATION 2. ROUGH FRAME & FLUMBING (2nd) INSULATION PER N. STATE ENERGY FINAL 'IONAL MENTS: · AS NOTED BUILDING~P~RTME~T 765-]802 9 AM TO ~ PM FOR TH LOWING IN~ECTIONS: 1. FOUNDATION - ~O REQUIRE1 FOR POURED C~CRETE 2. ROUGH - FRAMING & PLUMBIN( 3. INSULA7[ON 4. FINAL - CONSTRUCTION MUS: BE C~MPLFTE FOR C. O. ALL CONSTRUCTION SHALL MEE THE REO~'~REMENTS OF T~ N. STATE CONSTRUCTION & EN~RG' CODES· NOT RESPONSIBLE FOI ..... ' R-CONSTRUCTION ~RROR. / / FORM NO. 3 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL TFile o ,~.~<~......'.. No .............. ~.~. ............. ...~.¢:~.. ~...Z~..~... ..... .&_.. X..~.,...~..~.,.. PLEASE TAKE NOTICE that your application da~, ] ~ ~. · .~. ........ ,19~. for pe~it to construct .... ~..~.. ~~ .......... ~ ........... at Location of Property ~:~. ~~.f.~,~, ...1. ....... d ~~i~ ~y ~o~ ~ ~ ~o, ~ ~,~o~ .... ~& , ~o,~ , , ~ ~ ........ ~o~ .~ ~,~ ........ Subdivisi~~.~ Filed Map No. ~/ff' .. .~.~ .......... Lot No. ~.~ ........... is returned herewith and disapproved on the following grounds. ~ ~~.. ~.~. · ...... ............. ~ld~g Inspector RV 1/80 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL DATE INSPECTOR 765-1802 BUILDING DEPT. · INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND '[ ] INSULATION FRAMING ~ FINAL REMARKS: DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION I* ] FOUNDATION XST [ ] ROUGH PrBG. [] FOUNDATION ZND ~ INSULATION [ ] FRAMING [ ] FINAL ~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ SU,.,~TIO~ FRAMING FINAL FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined~.~. f/.~,7../..., 19 .~..~'~ Application No.../~7~.~..~. ·~- ...... Approvea/~.~'/~. ~ , l~Pemit No /~ APPLICATION FOR BUILDING PERMIT Date .. ~.~.~/~.. &.,., 19 X~ INSTRUCTIONS 'J a. This 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. d 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 issuefa 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 an~/. 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 buildhigs, 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 in building for necessary inspec ' admit authorized inspectors on premises and (Signature of applic~t,-ydr name, if a corporation) (Mailing address of applicant) ') State whether applicant is' owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises..~, t. 4 g/,~,,9~/, f.~./~.~./~.~... ~.//~.,~..,~/~..~.,..~../~. ~[' ./.L'..~. ............... (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. ~o~_L°cati°nj~f[~9./77dland on.~..~.'~/..~which proposed/~x~7~work will be ~/) J'2"~. .~.'~. .&? .'~?.d'°'-ne' .. ~..~...X.~.../..~.: .................................../~'" '~' ' . House ................................ Number Street Hamlet County Tax Map No. 1000 Section :~.'. Z~. Block . ...~. ............. Lot../.~. ............. Subdivision .S0.~/./~J/2~.~.~'~e~-.. ~/~4~.~. ,~'...~.~.~..c,. ........... Filed Map No. ~.~. l~.'~ ...... Lot. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... . .~.~.~.x/~./~.'~ 7~. .................................................. b. Intended use and occupancy ......................................... 3. Nature of work (check which a~plicable): 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 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 structures, if any: Front ~" .. . Rear ....-77 ......... Depth..~ .... Height .....~w. Number of Stories . ~ . Dimensions of same structure wlth alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ......... -,i ........... Number of Stories ............. , ......... 8. Dimensions of entire new construction: Front .. ~.,q. ........ Rear . ..~..~..' ........ Depth .~. ~o .......... Height . .g.~. .......... Nu~mber of Stories ................ 0 ................................. ,.~. ~... 9. Sizeoflot Front ~.~. ~. : Rear .... /.¢~.&e. ..... Denth 10. Date of Purchase ../0tg~ :. ~, ~., ~.~ ,~..,.~ ..... Name of Fo'r~er 1 1. Zone or use district in which premises are situated.../~../~.~.=7.~/..~..,~-s~...~./..,~.. 12. Does proposed constructio/a violate any zoning law, ordinance or regulation: . .~.~. ........................... 13. Will lot be regraded ~.~O. $~&.~i----. ..... Will excess fill be removed from premises: ~'"'Yes No "'!_'__lb~ : ~' &.' .~-'~t~'$ 14. Name of Owner of premises' · .' · · .~;~'t ~-,,e- .... Address ................... Phone No ................ Name of Architect .......... ' ................. Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block Inumber or description aceording~, and show street names and indicate whether interior or corner lot. I '~. // STATE OF NEW YORK, S.S COUNTY OF ,~br~-._~-~:~/,/.~. ..... .......~ ' '" W. ,i ' .~. -~'7'. ~ t~; .y.../.~./,~. ~/.~, .~,. ............ being duly sworn, deposes (Name of individual'" signing contract) above named. ~ and says that he is the applicant He is the .... ,Z~.~./..7--7/5f...7-'. .... : ................................................................... , (Contractor, ~..agen_.t' 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 manner set forth in the application filed therewith. ' ' Sworn to before ~ ......... ~..'..~ ..... day of: .... _~ .~..~/..~. ...... ,19 '~'~ · Nota.~.~ ,u~blic, . .... ..,~¢~ .... .e~c'h.~... County ' ' ....... ~' [ ~ am~vt'z~u~ i~ c~. ~t~}lT~ ,t ,il- )/ (Signature of applicant) NO, 52-8125850, Suf[01k r~rm £x~ires March SO, 19~ SUFFOLK CO: HEAL. TH DEPT. ~OYAL ..s..o ....... STATEmeNT OF iNTENT THE WATER SU~LY AND ~WAGE SYSTEMS FOR THIS ~ESIDENCE Wt~L ~,,, :,, .... ( ' ~~: ~ ~.~ .UKi~L ' ' ' ~ SUFFOLK CO. HEALTH DEPT. AI~q~OVAL '~ ! ~ f .., Ho."-'~,'','~ , M, ,~ ~' ~'~, /~, ~ ~ ' : ~AT~NT~mT~T ~ ~ ~ ....... ]] T~ ~ATER ~Y AND ~ D~AL ~ ~ ~ ~ ~ ~ ~.~ F~ THIS ' ~ , WfL ~ I,~..~ ~,~,~ ./~ ~. t~L ~:~. ~. ,. ._.,o~Y~ ,~.r4 Woo,',:, ...~.,-'~7~-,',, d2n~. , o~ L~E~ ~K M~ ,,-- ~ ~T ~ ~K co. )~^~.T. o~r. SUFFOLK CO. HEALTH DEPT. A~OVAL THE WATER ~Y AND SEWAGE DI~AL SYSTE~ FOR THIS RESIDENCE WILL CONF~M TO THE STANDAR~ ~ THE ~FFOLK CO. DEPT. OF HEALTH ~RVICES. SUFFOLK COUNTY DEPT. ~ HEALTH A~ROVED: SUFFOLK CO. TAX MAP DESIGNATION: DEED: L. P. RODERJCKyAN TUYL, P.C. LICENSED LAND ~R~Y~ GREEN~RT NEW YORK