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Home My WebLink About12630-zPORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ...n..e.~..fl.w..e.1.~.'[339 ............................... Location of Property AT~O ....... St3illwate.r Avenue ~utchogue ,. h~se No. ' ............ ~r'e;i ...................... h~t;~let County Tax Map No. 1000 Section ... ,1..3.7. ..... Block . . 2 ........ Lot... 18&19 Subdivision ......... ~: ..................... Filed Map No. '....x....Lot No ...... x conforms substantially to the Application for Building Permit heretofore trdcd in this office dated ·, .Seplze. mbe r..7. ...... 19 . 83pm'suant to which Building Permit No .... ~.2. 6. .3.0.g. ........... · dated .. £eptember. 22 ........... 19.83, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... new dwelling. The certificate is issued to ....... RICHARD. 240$ER .................................... (owner,/ot~ea:~aea~J of the aforesaid building· Suffolk County Department of Health Approval ........... Z 3'r $13.-,7. 7 ...................... N638182 UNDERWRITERS CERTIFICATE NO .................................................. nuilding ~nspecror Rev. 1/81 ~OEl~ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CTHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12630 Z Date ...... (~ .................... Permission is hereby granted,to: ~ ...... ...... .~.~.:~ ............................................................. .............. at premises located at ..~..-].~.~.......~..i~ ......... ~~.,,...,L~.,.,,.L~.; ..... County Tax Mop No. 1000 Section ..... ]...'~...~ ......... Block ....... .,,b=. .......... Lot No. ~....~..~...l..cJ ....... pursuant to application dated ...~..~.~:~...~......~. .................. , 19.~;~., and approved by the Building Inspector. B~ilding Insp~tor Rev. 6/30/80 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 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 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: Certificate of occupancy $5.00 21 Certificate of occupancy on pre-existing dwelling land use · --~re-Existing C,O, $15 00 3. Copy of certificate of occupancy $1.00/~ Vacant land C.O. ~ 5.00 Date . .~ .~. ~..\(~.).~.~"~/ ...... New Buildin§ ...~... ....... Old or Pre-existing Building ............Vacant Land ............. Location of Property . .~ .~. %.0. ~ ?..~.~..~. ,~.. ......................... ' ' House No/ Street )' ' Owner or Owners of Property...~.~C.~(~.-~\_z,,..~ .... ~x~.~q, ............................. Block' ~ Lot . .~..~. j.OJ County Tax Map No. 1000 Section .; .~,.., .......................... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.'\.'¥.~.~.~.~ Date of Permit .~..~-.~([~ .Applicant..--~ ~...~...~, ~'~ ~ .~ .~ .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Cer~(l~ ~ ..... IIII~ Fee Submitted $ ............................. III I Construction on above described building and permit meet~Dal~J~abl~ ~ L= ........ Rev 10 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ ~ah 26, 19~ THIS CERTIFI~S THAT ~ ~oser, 47~ ~illwa~r Ave., ~t~, N.Y. in the following locatlon; ~ Base,~t ~ 1st FI. ~ 2nd Fi. ~ectio,t Block Lot was examined on ~ ~ ~ ~)~ and found to be irt co,~p[iance with the requlremer~ts of this Board. FIXTURE Ob~LETS 17 17 FIXTURES RANGES OVENS DiSH WASHERS EXHAUST FANS FLUORESCENT SYSTEMS S E R NO 0 COND OF CC COND. OT~ APPARATUS: ~Cure ~ppli~uce feeders: 1-2#14, 1-2#12, l~.F. I · 4-~es. I C E G.O. Electric Corp. 6 Poplar Ave. ~edford; N.Y~ 11763 Lic#2677 GENERAL MANAGER Per_ 11 / This certificate must not be altered in any manner; return to the office of the Board if incorrect Inspector? may be identified by their cr~den~:ials. COPY FOR BUILDING DEPARTMENT. THIS COPY ;OF CERTIFICATE K J IN ANY MANNER. Memorandum from.., '~ ' ' ~' BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, BOX 728, SOUT[IOLD, N.Y. 11971 765-1802 '~IE~ INSPECTION COMMENTS FOUNDATION ( ls t) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. / STATE ENERGY qODE 7~.'~02 BUILDING. DEPT. INSPECTION ~OUNDATION ~ST ~ ~OU~N ~L~. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING FINAL BUILDING DEPT. '~',,,~ .~-'E'.D ~'O0~Z)~e/y [¢] FOUNDATION 1ST'[ ] ROUGH PLBG. ['~] FRAMING '?" [ ]FINAL 765-t802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [~/i FRAMING ~ ] FINAL REMARKS: DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL,: 765-1803 Examined ........ .~.¥.., 19 ~.~.. ..~....~..~.., 19~..~. Permit No. ]..~.~..9...5~.. Approved Disapproved ~a/c ..................................... Application No .................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS 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 ap~;dScant, or flame, if a corporation) State whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builder. Name of owner of premises . .~.5.c. .~.~.~..~...C~......~ .~.<.~.~..~. .......................................... (as on the tax roll or latest deed) If applicant i~t&~oration, sigCture of duly authorized officer. ~~nd title~bf corpora~te ctfficer) Builder's License No... ~ ...................... Plumber's License No. ~.0,,.~..c.t_...~',xO,9,.~X~.~..~. Electrician's License No. 9.'-~..'...~.~.¢.c.~..~.x.c....(~..~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. .... ............................ House Number Street Hamlet County Tax Map No. 1000 Section . .~. ............. Block ~ Lot .~/O. 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 ...X].(.KQh, x.~)..~.....~.~Y4 .'~ ............... / b. Intended use and occupancy ...~..~.e.,....~.~.l~x.x.~, K~....~4q,~,\4.9..' ''~: '~':~ .: ....................... 4. Estimated Cost .......... ............ 5. If dwelling, number of dwelling units... ~. .... Nature of work (check which applicable): New Building ...... Addition .......... Alteration .......... Repair ' .............. Removal ............ Demolition .............. Other Work ............... (Description) (to be paid on filing this application) ....... Number of dwelling units on each floor... I ............ If garage, number of cars .~.O .~, ................................................................ 6, If business, commercial or mixe4 occupancy, speci[y nature and extent of each type of use . ~ '.c~.' ............... 7. Dimensions of existing structures, if any: Front, ~q.Mzw. .......... Rear .............. Depth .............. Height . .............. Number of Stories ......................................................... Dimensions of same structure with alterations or additions: Front lk~. ............ Rear .................. ...... Number of Stories ...................... Depth ...................... Height ....... 8. Dimensions of, entire new construction:, Front . D.%. ..... Rear . OB ........... Depth . .)~ ........... Height . .\{O ........... Number of Stories ..... ~i.. iiiii ...................................... . ..... 9. Size of lot: Front ...G.~ .~ .... ,. i ........... Rear .... .~ ~ .............. Dept. h . 0.)¥.' ................ 10. Date of Purchase ~..~..'&...G./. g.~ ................ Nazae of Former Owner . Y'~.*-.~.$ ...................... 11. Zone or use district in which prem/ses are situated. ~gS.~{~W:LN.~.\..~ ........... ./. ....................... 12. Does proposed construction violate any zoning law ordina,n..ce or regulation: I4.O. ................ ' .......... 13. Will lot be r~graded . .kO. .... .................. Will excess fill be removed from premises ' ' ~'2~es No 14. Name of Owner of premises ~,.tq~.~. (-:..WS..Oc, q .O--... Address ~.~.oF,.~ ~,. ). ~.,~..-) ..... Phone No. ~,~..~.q.~ ..$ ~'1~, .... Name of Architect .......... : ................. Address Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all Ibuildings, whether existing or proposed, and~ indicate all set-back dimensions from property lines. G~ve street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N~__K, //ad COUNTY OF.~. ~'~ .. . , . ..~ ~.~..x~..~.....'~. :...~ ~..~_L-~..~..~...~ ................ being duly sworn, deposes and says that he is the applicant (Name of iffdividual ~igning 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 f~e this application; that all statements contained in this application are true to the best of his knowledge and belief; and t~at the work will be.performed in the manner set forth in the application filed therewith, Sworn to before me this 19~. N?9,ta6gtq~ubli,c, . . . . j . .,,~, .... - . " , ~11~'~ '-'~ ,.~,o~ e~ ( .. :-%~-- ~mgnaru~ o~ appncano SUFFOLK CO. HEALTH DEPT. APPROVAL ', , ~ ' , ,, ' STATEMENT OF INTENT ~; ~'"', :: N" {: -' ' ' ~'- %; THE WATER SUPPLY AND SEWAGE DIS~SAL CONFORM TO tHE STANDARDS OF THE SUFFOLK CO. DEPt. Of HEALTH SERVICES. .... t~ ~ APPLICANT .~, . ................. SUFFOLK COUNTY DEPT, OF HEALTH CONSTRUCTION ONLY ~ ~ ~ SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT, BL~K facilities for this location h~e been ; ,'-- tnspected by this department ~d fo~d SEAL LICENSED LAND ~JRVEYORS GREENPORT NEW YORK JEZE'~ -;'67.0t RODERICK VAN TUYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO, STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO, DEPT. OF HEALTH SERVICES, (si APPLICANT SUFFOLK COUNTY SERVICES -- FOR CONSTRUCTION ONLY DATE: DEPT. OF ' HEALTH APPROVAL OF H. S. REF. NO.. APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK P/O PCLS. OWNERS ADDRESS: DEED: L. TEST 14OLE SEAL