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Home My WebLink About12641-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z.1.3.1.8..9 ......... Date Feb. 5 19 85 THIS CERTIFIES that the building ......... .N.e..w..D.w.e..1.1.i.n.g ........................ Location of Pro err 445 Smith Rd. p y .................................................. Peconic House No. Street ........ County Tax Map No. 1000 Section ..... 9.9.8. ...Block ...... 9.4 ....... Lot ..... 99.5. ........ Subdivision ............ .X .................. Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .S.ep.~.: ....... .2.2.., 19 .8.3. pursuant to which Building Permit No .... .1.2.6.4.1..Z ........... dated ......... S..ep?.......2.9. ....... 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 ......... .... .~.e.w., .~.r./.v.a, .~.e..qn..e. ?.a.m..~.zy..p.w.e.!~..i,n3. ...................................... The certificate is issued to W. KENNETH & NANCY B. SMITH ..................... ?o¥,;o;, " '-~4~'~ ...................... of the aforesaid building. Suffolk County Department of Health Approval .... ~.} r$,Q-z Z..5.7 ............................ UNDERWRITERS CERTIFICATE NO. N6 5 8 0 6 5 Rev. 1/81 Building Inspector FOB~ 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) 12641 Z Date ......... .~. ........................................ , ...... Permission is hereby granted to: ........ .... /..~..~....~.....~ ............. at premises located at ,....~,,~..,~.. ...... ~......,.-..~- ..'- .............. ]~.~,~.,.c~... ........................ County Tax Map No. 1000 Section ...... .(~.~..~. ...... Block ........ ..d/L. .......... Lot No. pursuant to application dated .... ~..~.....:.~.....~=. ....... , 19..?....~. and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 BUilding Department Town Hall 5;=uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted-,i~=dupllc=t~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 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: --~I. Certificate of occupancy ~ d el 2. Certificate of occupancy on pre-exmti g w ling / land 3. Copy of certificate of occupancy $1.00 use .-Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date .......................... New Building ...~. .... ~.~. Old or Pre-existing Building_ ............ Vacant Land ............. Location of Property q/~ . ~#} i~']q ~O/'~) ............................ ................................... House No. ~ ~ I . Street ./ Hamlet Owner or Owners of Property ~. ~e.,¥ .~ ................... ~ ......... ~.. .~-,4, ...... C tyT MapNo. 1000S tie....~..9(~ BI ck .... ~/ ............... oun ax ec ....... o .. . Lot '~ ...... Subdivision ............................... Filed Map No ........... Lot No .............. Permit No .... Date of Permit ~.:~. ~;.~?/..Applicant .... 0. ................... Health Dept. Approval . abor Dept. Approval ........................ Underwriters Approval ~J .~.~.~ .~.~.~.. · ......... Planning Board Approval ...................... Request for Temporary Certificate .................. ~:erti~ ..................... Fee Submitted $..'~ .~.. ....................... C°nstructi°n °n ab°ye described bu lid lng a/~/f/er~/--, i.tom~l_d~_~z~and regu lati° ns'..' . _ ~ ~"~'?)~D\'~-, ~ Applicant //~. ,~.'.z r. ~..- .............. Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY e~1'~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the prernises of in the follo~vlng location; ~] Basement ~ ls~ FI. [] 2nd Fi. Section Block Lot was examined on and found to be in co.tpliattce wi£h the requirernents of this Board. ~, 198~ FIXTURE FIXTURES RANGES OVENS EXHAUST OUTLETS FLUORESCENT DRYERS MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: Mu~or~: 1-F i~G. F.C,, I ~ ~t~tors E R V I C NO, OF CC COND. PER ~( OF CC COND, NO. OF HI-tEG AWG OF HI-LEG NO OFNEUTRAt$ 1 A. WG OF NEUTRAL z/o 16~ Pine ~tl,~m~ ,~~~, ~e~.J~~~tbe~mdinany manner; return to the office of the Board if incorrect. ,n~pecto,s may be identified by their cre~'~'s. COPY FO~ BplLDING DEPARTMENT. THIS COPY OF CErTIficATE ~ U' T NOT BE ~LTERED IN ANY MANNER TOWN OF SOLIT~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date //~"~/~/ Building Permit No. ~ ~bql ~please print) Plu~er ~J][~ ~~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Sworn to before me this day , Notary Public, ~Z~<-- County Notary Public FIE~D INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~[/~] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION /~ FRAMING [ ] FINAL REMARKS: FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exa nined Approved,= .. Disapproved a/c ..................................... ~ (Buil~ INSTRUCTIONS Received .... .~/~.,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 shail 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 he_rein described. aTdhme i~ paPulti~ ~ rnitz e.' ~ ~en;; etcOt oCr~ n~Pnl yp r eW~ihs etl la na~ pi~ Cbaubilled .lma~V ~ ro rndeic~.~t ~.;il~...//~.' regulations, and .... to State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (as on the tax roll or latesf 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..~..47..~..'~..~.'.-...~. t'D:.~,~ Electrician's License No .... .~.~. [i .~...' ........ Other Trade's License No ...................... Location of land on which proposed work will be done ....... .............. ...... ......... .............................. House Number Street Hamlet County Ta~ M~p No. ,000 Section ..... ~.2 8 ........ Block..q....~ ........... ~ot.. ?.. ............. Subdivision ' Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy OK}~ ?~-i/BiL~. /~o_..~ }).¢ 3. Nature of work (check which alpplicable):' New Building. .........~ Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... '~.(OC2t /~/. ~. {~. . (Description) 4. Estimated Cost ............................. Fee ...................................... (to be paid on filing this application) $. If dwelling, number of dwellin~ units ....... [ . Number of dwelling,~n~ts on each floo~ ...... If garage, number of c~s .... ~ ............................. ~ .u ......... * ...... ~ ............... 6. If business, commercml or m~xed occupancy specff~natur~ and,extent of each ~v.~e of u~ ~... ,.?. y~ ........... 7. D~mens~ons of ex~st~ng structures, ~f any: Front...-..: ....,~. 55. Rear .... [ T~h~t[&,txg~.: ~ Height . Number of Stories D~ensions of same structure With alterations or ad~tions: Front ................. Rear .................. Depth ....................... HeiSt ....... ~..,.., ........... Number of Stories .................. 8. Dimensions of entire new construction.: Front .... ~ ........ Re~ .~¢ ........ De~*h .~ ~ ' neignt ............... ~umber of.~s t ,. ~.. ~,..~,~'.~ ...... ~ ............................. 9. Sizeoflot Front .,. ~QO~t '~ ~ear ')~J~'~q De~th ~/~/t~,~7 1 0. Date of Purchase M~:.. 7. ~ .................. Name ~f Fo~er Owner ¢.~t0¢..¢..~d~: ........... 1 I. Zone or use district in which piemises are situated..~$~t~{ q~l$&. . .... 12. D6es proposed construction vi~late any zoning law, ordinance or regulation: .~.. .......................... 13. Will lot be regraded ... ~.'.i. ' ' '" '~' ',% ......... Will excessfill bex0mgved fr~m premises: _ Yes 14. Nme of Owner of~remises ~q~g~ ~)~h- Address lb2 ~e ~. &~ot,~h~ ~ m~e of Architect ~O.~e. ~. g~.~ ~ .... Address . -- Phnne ~n Nme~of Contractor~ .fi~'~. ~)~.~q ~'.q~/ .... Address ~-~{of~'~'''' ~'' Ph;~e ~;' ¢~2~Q~ .'"' 5 ..... ......... PLOT DIAGRAM ~/~ Locate cle~ly ~d distinctly ~I bufld~gs, whether existing or proposed, an&indicate ~1 set-back d~ensions from property ~nes. Give street ~d bloct number or desc~ption according to deed, ~d show street nines and indicate whether inte~or or corner lot. OF N] · ' ................ being duly sworn, deposes and says that he is the applicant (Name of individual contract) named. He is the. ~;r....,.~r..v.,.,. ....: ....: ................................................................... I (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the h work will be performed in t e manner set for. th in'the application filed therewith. Sworn to before me this ....... ~ .... day of ..... 19 N°~~°unty . .fyi.ua .... · ..... I/V. r ?,/:h ·/, .......... ~lw.~etle, s~ ~ ~_~w ~o~ ,. t ' - ( iS a/natu~ of a'-"lican*~ No. 5~.61~58§0, t$~'~folk It property is I~at~ ~n an agricultural area, the possiNlitY exists ~t the r supPlY may contai~ trace ~te .... * .estic~es a~/or mtrat~s. 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 ~FFOLW¢¢~ ~EPWOr~~.V, CES. u'~l(PFLICAN~F - SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTIONDATE: ONlY H. S. REF. NO. /3-.~/) APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. ow.,'RS A=:,RESS: tO J* DEED: L. ~l ~c~ TEST HOLE P.I~ STAMP SEAL SUFFOLK CO. HEALTH D~WF. API~OVAL STATEMENT ~ INTENT SY~ FOR THIS RESIDENCE WILL C~FORM TO THE STANDARD~ OF THE SUFFOLK ~.}~P~~H SERVICES. A~LtCANT SUFFOEK COUNTY DEPT. OF HEALTH SERVICES -- FOR. APPROVAL OF DATE: .... '= J" MAP DESIGNATION:* DIST. ~CT. BL~K ~L. Se~icea RODERICK LAND ~Y~S GREE~RT ~W YORK