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Home My WebLink About12623-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cerfi[icafe O[ Occupancy No...g. J:. 4. .1.6.4 ......... Date ..... J~r~!a,o~r. y .......... 1..6 ........ 198..6. THIS CERTIFIES that the building New Dwelling Location of Property .~8 §.5... .Sg.u.L.h Harbor Rd. Southold House NO. ' ..... 'S'de3i ............ h ;,ie County Tax Map No. 1000 Section ...0.7.8 ....... Block .. 0..3 ........... Lot.. 0. 9.3 ............ Subdivision ......... X. ..................... Filed Map No ......... Lot No. ' conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... S.o.p.t., .... .9 ....... 19.8.3. pursuant to which Building Permit No....1.2.6.2..3.g ............ dated ........ .S.ep.'q: ..... 2. 0. ........ 19.8.3., was issued, and conforms to all of the requirements of the applicable provisions of th6 law. The occupancy for which this certificate is issued is ......... ...... New Private One Family. Dwelling ........ The certificate is issued to PROBEr EDWARD ..................... ...................... of the aforesaid building. Suffolk County Department of Health Approval 13-S0-150 UNDERWRITERS CERTIFICATE NO. ~.63.9. 0 .4.6 Rev. 1/81 Building Inspector lrOB~g NO. ~ 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) 12623 Z Permission is hereby gronted tg~ ~ A ...... at premises located at .. .~..~..~ .............. ~. ........... County Tax Map No. 1000 Section ......~....'~1....~ ....... Block ...... .~...*~. ....... Lot No ...... ~ .............. pursuant to application dated ................ ..~.~..~:~/:~,...~....% ~ ........... , 19..~..~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1~802 APPLICATION FOR C£RTIF[CATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ,~ ~ 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 unusu~! 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, For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~2operty 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- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5,00 2. Certificate of occupancy on pre-existing dwelling $15.0 0 3. Copy of certificate of occupancy $I.00 // 4.Vacant Land C.O. $5.00 Date .~/ ............. New Building ...~.... ..... Old or Pre-existing Building ........... / Vacant Land ............ Location of Property .......... ~..¢' /TZ~ D.~ $~? .......................................... House No. Hamlet Owner or Owners of Property .. ~,...P~. ~ ,/~.. (~..' .................................... County Tax Map No. 1000 Section ...,O...~..~ ..... Block ...~...~. ...... Lot...3 ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /~. ~0..~..ZDate of Permit .~..~../~'~. ,Applicant .~.:. ,~.~../.?..c-..~.?~.; .J'..~.~/.5'...~C. Health Dept. Approval .I.~.'~.~ ~. ......... Labor Dept. Approval ...................... Unde~riters Approval .~ .~'~{~H~. ......... Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ..... ~... ................... · '~'~' · · '~' · ' ~~ulations. Construction on above described building and p.e_rmit meets all ~ ~k_~'q q Applicant . · .~.. ....................... 1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CEIl'rIFlES THAT only the eJectrical equipment as described below and introduced by the epplicant nanted on the ebo~e~ a, ppJicat~i, on number in the premises of Eda~td P~)be, E/S S. ~az~bor Z~e~ 300' S/O ~ay 'Wat~c Road, ,Sou~boia, N.~. in the following location; [] Basement [] let I,'l. [] 2nd FI. Section Block Lot was examined on ~L~v~h ~ ~ ~[~ at,d footed to be in compliance with the r~qulreorents of this Board. I FIXTURES RANGES COOKiNGOECKE OVENS DISH WASHERS EXHAUST FANS FIXTURE SW~TCHEE 29 :¢4 19 DRYERS MOTORS FUTURE APPLIANCE FEEDERS IMECLOCKS UNIT HEATERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: ~ol;ors: 1-F 1-G. F. C. I., 1-[~mok~ Detec~o~ NO OF CC COND. A W G NO OF HI-LEG A W.G. NO, OF NEUTRALS A, W. G PER ,e' OF CC COND. OF HI-LEG OF NEUTRAL 1 4 1 4 Rutlemd Electric Co. P, O. Eox 143 Mattituck~ N.Y. 1195~i GENERAL MANAGER/' Per_ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be Mentified by their I DEPARTMENT. THIS COPY'OF CERTIFICATE MUST NO~ BE ALTERED IN ANY MANNER. FIELD INSPECTION FOUNDATION (1st) COMMENTS FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: 76S-1802 BUILDING =---DEPT. INSPECTION FOUNDATION IST [ ] ROUGH, PLBG. FOUNDATION 2ND [ ] INsuLATI°N 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~!]~F~RAMING [ ] FINAL INSPECTOR% FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-18013 Approved dh.O , 19~..~ Permit No...]..~..~..~'..~.~:: Disapproved a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date ....2A ......... , 19~ 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 inslt~ctions_ .... ,~.; ~'/.~..~/....~..41~. ~ .... (~ignature of appffcant, or na .me, if a corporation) · .4 .x.. 7..s...Pl.'.../h..d.~r. ?.c.o.~, ...../.'~. ,~,,. .... (Mailing address of applicant) / State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. ................. .,~..~.~, Co. ~-,z:~...~.~-~- . ............................... Name of owner of premises ....~..: . . .'.fff.~.O. ~ .~..: ................................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. .... . (Name and title of corporate of~cer) Builder's License No .... /. '~ .. ................. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. ' Location of land on which proposed work will be done ...... ..~./-~ ..................................... ... ~.P..~. ~ ...... s.o. ?. r. ~...~.~..~..~...~ ~., ............ S.o.~..r. ~.~ .o~... ,.../v.~ ...... House Number Street Hamlet County Tax Map NO. 1000 Section ..... ~. ~.~i~ ....... Block ....... O..~.. ....... Lot.. Subdivision ..................................... 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~.....~..~..~.'.~).. ... .'-.y... , ,. :. , ~, b. Intended use and occupancy J. 17.~.~..°'?. !_ .F~/2k ,~..~. .~.1~: .'~'./~&/.~..~..~ ................... 3. Nature of work (check which applicable): New Building J Additio~ Alteration Repair .............. Removal .............. Demolition ........ [ ..... Other Work ............... 4. Estimated Cost ,t~ ,.~. o o o, o ~ ~'~ (Description) {. (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 .... 2 ................................................................... 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 .............. Depth ................ lteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear ........ ~ ......... Depth ................... ~.. Height ........... ~ .......... Number of Stories .............. ~ ..... . 8. Dimensions of entire new construction: Front ... ~.O ......... Rear .............. Depth . ~.. ~.. .... Height ............... Number of Stories ........................................................ 9. Size of lot: Front ...................... Rear ...................... Depth ...................... 10. Date of Purchase ............................. Name of Former Owner ............................. 1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed constructionyiolate any zoning law, ordinance or regulation: ............................... 13. Will lot be regraded .... .~.o. ..................... Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises .... ~'.,. · :~.~P.~.~... Address ................... Phone No ................ ~ Name of Architect ...................... } ....Address . Phone No. · Address Name of Contractor ~.,.~.~../+.~.~?.,~.5.o..~4.4'.... ~)~i¢~i~i i ~t;~r~. Phone No. ~..~.~.'4 ~i .~i i 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~/~K S. S COUNTY ..... /V.O. f~..~T>. ~'P~.... ~...f~.. 2 .t,..t..)A..' .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. : (Contractor, agent, corporate officer, etc.) i 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, 52-8125850, SIWfl~ ~h~/ ~ now or formerly "'R ' formerly Robert Kologi ', Horold Wolter$ :3: no v or formerly Norrnon Probe ~_ ! ~~ 'oo"~-. ' -- ~- ~,~ \ . ~': ~ t- formerly Robert ~zngmonn '- ~' ~~0~ O0~TY ~LTH DEPART~ y, ~:, ~e sewa~ disposal and water suppl~ G facilities for th~s Jo'.'a~ton have been c,. (,:~ inspected by this depa.rtment ~d fo~d ~ C~i~ of e~ne~l E~ineerin~ Services SG~ ~0~ v; ~WN ~ SOUTHOLD SCALE, / = 30 ' " / ~ - _ ~ O -/ ~--b SUFFOLK COUNTy, NEW ~RK NO. 8~-~0 HEALTH DEPARTMENT-DATA F~ APPRO~'TO C~STRUC T ~E ~R~ ~R WHOM THE IU~EY IS PREPARED ~E~ A~ ~ ~EKLIMI WITHIN I00 FEET OF T~S PROPERTY INSTITUTI~ GUARANTEES ARE ~T T~$FERABLE oF H~LTH ~CES. TO EX~Tm~ STRUC~SES aRE FO~ ~ ~L. r~'~ W. YOUNG, P,OFESSION~L~ ENGINEER ~ bS~NOER AVE~E YOUNG YOUNG .,~.~o.~[~ ~o.~ NOTE : I: MONUMENT ALD~N AND LAND SURVEYOR N.Y.S. UC~NS~ NO, 1~845 HOWA~O W, YOUNG~ LANO SURVEYO~ ~ L~T~ ~ ~L(W),~IC TANK(ST)8 CES~OLS(~) ~N <RE~ N.~S. LICENSE N0.45893 "It should be no~ted that since this ~dl~' ~operty is located in an agrlcultuml ,t~..I'~' area, the possibil,ity exists that the j~V ~ water supply ~ o / omounts of pesticides and/or nitrates. x -~., r formerly . NOT mE CONItOE~ED TO N~[M A~ ~ ~ELLI~I WITHIN I00 FEET OF Tffil PROPERTY INSTITUTI~, GUARANTEES: ARE ~T T~SFERABLE OTHER THAN THOSE ~HOWN HEREON. OWNERS i I/ HOW~;~ W. YOUNG, L~ND BRANDIS & SONS, INC. 1618 ___ _ _ __ __ _ _ __ _ _ I , ,`` I - i - „ ' .,",I _ q j -, - I,�- , I - I- I I I ,I I I - 11 � I I I I I , � - - - ".,1, ,4 i, - , , -"' � I.,I � ,I -1.�� , , 11 "� , �, �� " ,'� , i ,,--�� ,,-,- � " -, � ,-,---,� -,",,,---�- ,,, -� tI I � � I I - I I I I I ,I I I - I I - �� .` _ ,- , - i ` `n, ` ys ` _ - _ i. < ,,,,a A.^p„��.'nTc^,� _ sJ _ t' _ - ' _ , •t •, a , ,. _ •'4'•Ji. - , ' , • ' a - t , _11'e1r _,:w ±.,4..�r..,. r,W+,- :.iP •,pd"{-x'.m:.. — A^'-Y'"1•v. - < - , ' - , ` _ _ , _ -`.kr I , ,, , - - rv,MsA h.» ,-...r.',P,fia3,", ,...ww.:,,y,:..-.....w-_.=�..,...y.""� . - - _ xr' ., - rx,i�, , ''4,.a0. S -J» `,,, • ,,, '1 -4 w - _ , , - , I•' •` u, ',...cP"=,h.:.*-'`r- .N: ,.-aR,.F;,."�:4...at- r5,.�.._, ^.. ,rt'`#9 ''y`S„».�_. r.Y„r.< C _ _ ':a I I . 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(3 � � t._, e a , , , , � - _ -_ 1t��C 3 n � Yi b° Y0S , , - 1 , , , .1 11 r n�'e^,i.,,e,nr,xY wrAt/,.:- _ ...♦ 4M#W s. „ ` _ ,_, r r , ' 'L- ", I I I i E I DATE: C��~� B.P. + 9 " -, , ¢ ! FEE: I ® _ BY . • - ,, � - , ; : `� ., ,,t', . -„ ;,3. NOTIF`,Y BUILDING DEPARTMENT AT 'for grater di�tAuting „ - 1 765-1802 9 AM TO 4 PM FOR Tt�E ,; sir i irr �i �� i 0 �� - . - , ' —, ;f, •_r, `'.1r<'= _ i INSPECTIONS: .,l� �k _, , '..,, ,. < n a,.,. _ FOLLO,WIk�G k� 0C _ - , - , j E IRED C tl � car �. it�l i k 1 FOUNDATION - TWO REQU Y , - 1 € R P^l)RED CONCRETEl �.e .,. % _ ",_'�� „ FCSU _ Ut tUL = '`" = 1 i LUMBING 1 I , - ` , . • -. , 2 ROUG—I - FRAMING & P I ' , �A LAW , - - ' - ' - y;, , . , - ;, R ! 8. INCII aft '' I " � ` .';' _ 3'a { 4. 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