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Home My WebLink About12301-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z.1.3.3..8.7 ......... Date April 23 19 85 THIS CERTIFIES that the building ...... .N.e.w..D..w.e.l.1. i..ng ............................ Location of Property .... 4. .8.0 ................. .G.r. 5:..s .s.o.m...L.a.n.e. ............ .S .o.u.t.h..o .1.d.... House No. Street Hamlet County Tax Map No. I000 Section 078 .Block 01 .... Lot 010.3 Subdivision...S. 1..e.epy....H.o.l.l:.o.w. .............Filed Map No. 6.3.5.1. .... Lot No... ) .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .~.p.r. ~..1 ..... .1.1 .... ,19 .8.3. pursuant to which Building Permit No .... .1.2.3. 0..1.g ........... dated ..... .~.a.y .......9 ............ 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 ......... New Private One Family Dwelling The certificate is issued to .................. .E. LSIE YOUNG ' io¥~'e;,'tC4~'4,ztCM.'~£ ..................... of the aforesaid building. Suffolk County Department of Health Approval ......... 1. 3. .-.S.C.= 2..8 ........................ UNDERWRITERS CERTIFICATE NO ................ ~..6.2.4.6.5..0..a..ff..6.2.4.6.5..2 .......... Rev. 1/81 Building Inspector BUILDING DEPARTMI~N~ TOWN HALL i .~ SOUTHOLD, N. Y.: ; N 12301 Z Permissio~ is hereby granted to: BUILDING I~ERM!T~ (THI,S PEP, MIT MUST BE KEpT ON THE PRE~IS~SUNTI'L ~ULL COMPLETION OF THE WORK AUTHORIZED) } I Date ...L.~..~....~....:; ..................... ~ , : : at premises located at ............... ./... ............... r ......... r"~4, ........ , ...... &'- ................. pu~gant to application dat~ ........ :~. ,! ~.. , 19~ and aDDr~ bv the Budding Imp~tor. Fee $ ~ .. Rev. 6/30X80 FORM NO. 6 TOWN OI= SOUTHOLD Building Department Town Hall Southold, 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--{S-9 form or equal)o 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 p~Operty 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 premis'e~s, 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 3. Copy of certificate of occupancy $1.00 4.Vacant Land CoO. $5.00 $15.00 Cate /.~. ~,JJC.~.. ~.,,./.~'~.. ..... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. ocation of Property ............... .... House No. Street Ham/et Owner or Owners of Property . ~?...?.'..,~~ ............................... County Tax Map No. 1000 Section . .~..c~ .......... Block .. ,/ ............ Lot ./, .............. ~ / Subdivision ................................. Filed Map No. (J2~ ~ .I .... Lot No .............. Permit No.J~).(~.[.Z. Date of Permit '~-/O..~'J~.Appiicant ~..~..'+.. ~,~?, ~.~ ..... l ,_ _~b-~ro-;~ , Health Dept. Approval~~ ......... Labor Dept, Approva~ ...... ,N, · · ,~.~ ........... Underwriters ApprovalS.. ~$..~?.~. ~..~.0.manning Board ApprovaL~<C. ·... × ............ Request for Temporary Certificate ..................... Final Certificate Fee Submitted $ iO.O.. ~.,. p.4:Zz~::~..~.. ~ ~)~-~('-C~ ~ Construction on above described building and permit meets all applicable codes and regulations. ...... Rev. 10-10-78 ~FiEXL~ INSPECTION ~ COMMENTS ~-: .,~ ._ FOUNDATION (1st) F'OUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS 13UREAU OF ELECTRICITY ~OV.~1~'3.3~ 30, ~385 JOHN STREET, N~W YORK, NEW YORK 10038 THIS CERTIFIES THAT only the e~c trlcat equiplRe~t ~ ~scrlbed below and introduced by t~ appl~a~t ~ed on the ah~e appllcatJon number in the premises of ~ill Yo~, ~J.ss~ t~y, off $1~9y ~)11~, Sout~ld, N.Y. was exa,ni~ed o~ ~e~ [7, 1983 and found to be in co,npliance with the require,nents of this Board. FIXTURE OUTLETS SWITCHES 33 DRYERS FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS /+1 OTHER APPARATUS: ~tors: Z-S~ok~ De~ecCors S E R AW, G. OF CC CONO C NO, OF HI-LEG OF NEUTRAt 121 Sheep Pasture Setauket, N.Y., 11733 2675 ; DEPARTMENT TUI$ cop~,OF ( MANNER. THE NEW YORK BOARD OF FIRE UNDERWRITERS TL~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equlpn~ent as described belo~v and introduced ~y the appl~t framed ow the above applleation number in the premises of ~ill Yo%uk~, Grissom La., o£f Sleepy 1{ollow off Clearview, Soul,old, ~.Y. i,t tt,e foliowing {ocutio.; ~f~ Basement [] let FI. ~] 2nd FI. Section Block Lot was examltted on Nm~aber 17, 1983 and found to be in con~pliance with the requirements of this Board. FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FIXTURE SWITCHES DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME,LOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO, OF EEET SERVICE DISC~)NNECT S E R V I C OTHER APPARATUS: NO, OF CC. COND ! A W.G. ~ 21o 2/O 121 Sheep Pasture Rd. Setauket, N.Y., 11733 L~Co ¢/2675 This certificate must not be altered in any manner; return to the off[ce of the Bootd if ~~/E ERAL AGER may be identified~-~hel~ c~edentials. MANNER. COPY F( I,G DEPARTMENT. THIS COPY OF CERTIFI( FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No ................................ To ~/./'/~.,~C:~ ./~..~c'e. '~..,52~f..~~., . ~.. ~ ~/ff~. ~ ~ ...... . . . ........... PLEASE TAKE NOTICE that your application dated ... ~l~...~ .......... 19~~. County Tax~ No. 1000 Section . .~.~. ...... Block . ~f. ......... Lot .~4~ :~ ..... ~,~,o~~4~.. ~il~p~o .... ~4 ...... ~o~.o .... ~ ............ is returned herewith and disapproved on the follow~g grounds. ~.. ~(~. ~.. ~.~ Build~g Inspector RV 1/80 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examinedx~P?...O~.~ ,19~.....~ Approved .~'-ff...~..., 1~..'<.~eermit No...~..~.~.~../'..~ Disapproved a/c/~. C:~.~.~.. ~...~.~.d~_~/.~..~ ........ ....... ..... ........ · ' APPLICATION FOR BUILDING PERMIT Date F&.... INSTRUCTIONS Application No..Z/~..~./f ......... 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. 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 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 building for necessary inspections. ...... ~ (Signature of applicant, or name, if a corpo~r~ion) ~..~.~.. .............. ..~..-.'.~..¢! .... .((.? .... ~./ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of of owner premises ....... ~~] the tax roll ;; latest deed) If applicant is a corporation, signature of duly authorized officer. Builder's License No .......................... Plumber's License No ......................... Electrician's License No .... '.?~..~ [.5.k~-.~ ...... Other Trade's License No ...................... Location of land on which proposed work will be done .................................................. ....... Y.8..O ....... . .C~...t..~., ~ ......... ~ ~ ~.~.-. ............ .~.9. ~ ~.~ .q....~.., ........ House Number Street,-~ _/ Hamlet State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. .~.~..c.~....~...~--~...c~. .................................. b. Intended use and occupancy / / ' 't~' ' .~..~. ~?.~. 3. Nature of work (check which a~plicable): New Building ..... Addition .......... Alteration .......... Repair .............. RemOval .............. Demolition .............. Other Work ............... 4. Estimated Cost ..... ~....O...: ......................... Fee ...................................... ) (to bo 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 mixe~ occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structur0s,if any: 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 construct/on: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ........... ........... Rear; ..................... Depth ...................... 10, Date of Purchase ........... ! .................. Name of Former Owner ............................. 11. Zone or use district in which promises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ............................. t~.~r 13. Will lot be regraded .......... : ................. Will excess fill be removed from premises: , Yes .,_ __~o 14. Name of Owner of premises ... ................ Address ........... Phone No. '.7..6.~..- ~.~.~.~.... Name of Architect ' 't~ ~-~ Address ................... Phone No ................ Name of Contractor ......... : ................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly alli 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, J~'ORIii,J '~ / ~ S COUNTY O~...~Q~.. ............................. .................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ...................... ! ................................................................... (Contractor, 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 flied therewith. Sworn to before me this ............... ...... ry ic,gf(:_.~.f-g4-(-:4~.~. ~. ,_.~.~~y ~r .... ~l c, ~'.a'., oti Ne ~. ~ ~. ........ ~ .......... [ ~' 5~'~°¥-, ires ~arch , ~ston, ~P j ' If copper t~Jbing Js-u)ed- for water d~str~buhng , ~stem; p~ing' shall,be Of types I(