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FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. .Z15.796.A. Date ..~PY..2.~z 1987 THIS CERTIFIES that the bulldog .... ~k%qB. ~.q. ~%~ .~V~.- ......... Location of Property .... 50.0. .............. ~.a.s.g..Rp.a.d. ............. .C.u.%.c..hp.g.u.e. ...... House tVo, Streot Hamlet County Tax Map No. 1000 Section ..... ~[.~.0....Block ..... .7 ......... Lot ...... }.8. ........ Subdivision ............. X ................ Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated October 5, 1983 12676Z ...................... pursuant to w~ch B~lding Permit No ...................... dated .......... .O.c.t.o..b.e.r.. 1..0.,..1. 9. .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 ......... Addition to existing one-family dwelling, as applied for. Th~ certificate is issued to NICK NEUBAUER ..................... ..................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO. N659087 5/5/87 PLUMBERS CERTIFICATION DATED: Bnil~fng Inspector Rev. 1/81 FO~tlt~ NO. 2 TO~N O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 126~6 Z Permission is hereby granted to: ....................... ,o 1 .... ......................... ~'~ .................. r~U~. ' '~ '~ ...... ~'"'~;'~ 2 ............................. ~, ~r~,, ,~ted ~....~ ....... ~.~¢~. ...... ~~..~ ......................... County Tax Map No. 1000 Section ....... I./...~ ........ Block ........ ?. ........... Lot No ........ !...~.. ........... pursuant to application dated ...(~.~.....~.. ................. , 19.~..~ and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu ilding 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: I. 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. For existing buildings (prior to April 1957). Non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of pZoperty 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. 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 C.O. $5.00 $15.00 Date ..................... New Building ..... ~. ...... Old or Pre-existing Building '~ Vacant Land Location of Property .................................................................. House No. Street Ham/et Owner or Owners of Property ..... .~).. i..~. !~....1~..` .~.~...~...~...~..-'1~... ........................... County Tax Map No. I000 Section .... I~C) ....... Block ...... .~. ...... Lot ..... J...C..~ ....... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. I..'~..I..~ .~... Date of Permit ~[.~-l ..~...Applicant ..... .~..'. ...... .~...~.=..o ............ Health Dept. Approval ...... ~. ................ Labor Dept. Approval ........................ Underwriters Approval ..... ~.. .................. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... .~. ............... Fee Submitted $ ........ .~...'~-,..~...~. I.L~.~,./ ..... Construction on above described building and permit meets all a~e codes and regulations. ~' '©'~la~b~ I ~ 7 0~ Applicant ...... ..~....: .... L..~....'"~-~.. ....................... Rev, 10-10-78 ooo77 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 Oa,e Septenl~r 10, 19&'~ ~u~,~.~.~=f,~ ~551~84 N 659087 THIS CERTIFIES THAT Nic~:l.~ Ne~auer, S/S E~t ~l, 3~' W/O ~tts S~x~t, Oat~% nthefollowinglocation; ~ Basement ~ lstrl. ~ ~nd Vt. Attic, ~ s~ot~on Block Lot wasexarninedon ~ ~ ~ andfoundtobeincon~pliancewi~htherequirementsofthisBoard. RANGES ~OOKING DECKS OVENS EXHAUST FANS TIME CLOCKS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E OTHER APPARATUS: 1-J~u~zi Timer 24]. F. C.I. 2~ Det~tox~. Elec[ric ~ H~ters: 1-7.5~. R V I C NO. Oi~ERCC,~COND.j A.W O NO. OF Hi-LEG A.W.G. NO. OF NEUTRALS A.W.G. OF CC COND. OF HI-LEG OF NEUTRAL Rul~utd Electric Co. P. O. L~x 143 J~attituck, N.Y. 11952 Lie, 242 GENERAl. MANAGE This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspecto~rs may be identified by COPY FOR B~ILD NG DEPARTMENT. THIS COPY~ OF CER1 r NQT BE ED IN ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. /~/~ Owner ~'~ c~o I~.~ ~c~ ~ (please print) ' '(please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to befor~me this day Notary Public, (plumber ' s County p. BRIsOTTI JONN ~ of New york NOTA~' No. ~732613 TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because ,of the following reasons. /Z/ An application for Certificate of Occupancy is not on file. /Z~ No Underwriters Certificate on file. ~ /~_//~ The check is (outdated/ne% /Z/ No Health Dept. Approval on file. /Z/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. ~ ~ . ***/)_// No Plumber Solder Certificate on file. (~.~,/C ( all permits involving plumbing being issued after April 1,1984 ) 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST FOUNDATION 2ND/~/] FRAMING ROUGH PLBG. INSULATION FINAL REMARKS: ~IEL~ INSPECTION COMMENTS FOUNDATION (lst) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY QODE Ye FINAL ADDITIONAL COMMENTS: Memorandum from... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, BOX ?28, SOUTHOLD, N.Y. 119? 765-1802 7. ~. ~ /~L?~ ~? ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined O~[~k~. ,~ o 19<~,,~ Approved . .~e~....../fi. 19~3 Permit No I ~ {*'7/a~.~ Application No ................ Disapproved a/c ....... ; ............................. (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildi 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 stre~ or areas, and giving a detailed description of layout of property must be drawn on the dla~am which is part of this apl7 cation. c. The work covered by this application may not be commenced before issuance of Building Pen'nit. d. Upon apprc':al of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS tlEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of thc Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or~le~olition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, ho/t~ing/e'ode, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. [ ~ ,(Signature of applicant, or name, if a corporation) . .....-%.. x..:: .... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engiueer, general contractor, electrician, plumber or bnild, Nmneofowncrofprcmises ~¢:~o~..J~,$ ~.~t~ot$&ot-~'o'-, (as on tlie tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nmne and title of corporate officer) Builder's License No ........ !~..~. .............. Plumber's License No. "~ or, 0 Electrician's License No. '/...~-'L 1~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done ................................................ House Number Street Hamlet County Tax Map No. 1000 Section ! ! o .. Block .... ~ I~ Subdivision Filed Map No ~-~ ' Lot (Nmne) 2. State existing use and occup;mcy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ! .~...?x.w. · . .'... b Intended use and occupancy ! ~,,...., ~,~e-g. t. Nature of work (check whict, applicable): New Bui/ding .......... Addition .. ~ ..... Alteration .......... Repair .....*~. ........ Remo~al ............. Demolition .............. Other Work .............. ~ (Description) Estimaied Cost ! o-o ,o~,-~ Fee " (to be paid on filing this application) ;. If dwelling, ntunbe, r of dwelling units... I Number of dwelling units on each floor If garage, number of ears .............. .-' ......................................................... i. If business, commercial or mixed occupancy, speeffy_ hatnre and extent of each type of use .... -'. ................ ~. Dimensions of existing structures, if any: Front ...~r'.,?~.~ ...... Rear . .4'. 9.'?.~ ...... Depth . .~'..%.-7.°.~- ...... Height .~.~. ~. ?.$ .... '... Nnmber of Stories ..... ~ .................................................. Dimensions of same structure with alterations or additions: Front L o ..~ '* .~ ....... .~. ........ Rear . .o. ............ Depth .,~-..'~.-?. *.-- ...... Height ~"~ ~ ?- Number of Stories 't. ..... ;. Dimensions of entire new construction: Front ...'~?..'~..~. ...... Rear ...'~....'7?.. % ..... Depth .~..~.'~..T- ........ Height, ...~.*. ~..o..*~. ..... ~..~.,~Nm~er'-~: of Stories ....... ~. .................. i ............................ Depth . ,~'.q. ~ :9.~.o ........ 1. Size of lot: Front ........... '.- .......... Rear .... .~r.'l.~..'?..~.- ....... ' ) Date 6f Purchase ............................. 2qam~of Former Owner ............................. · .a...i(.~.. ,l~ .~.~. ", ,. 1. Zone or use district in which pr~mises are situated .... : ................................. !. Does proposed constrnction violate any zoning law, ordinance or regulation: ....O..~. ........................ L Will lot be regraded ....... ~..~: .................. Will excess fil[be removed from premises: ~ No ·. Address ........................................ Nam} of Architect . .~. ......... Address ...... '..,; ......... Phone No ..... ; .......... Name of Contractor i i .~.' ( ....... ~.' '... ii ....... Address .'-~..~. !?.~..~.~.'r .~?..%~... Phone No.'~ .~5....'~'.'.'.'.'.'.'.'~..~.'~... PLOT DIAGRAM Locate clearly and distinctly all buildings, xvhether existing or proposed, and. indicate all set-back dimensions from roperty lines. Give street and block:nmhber or description according to deed, and show street names and indicate whether terior or qorner lot. rATE OF I,(E RK ?, i S S OUNTY_.. ..........(.~~ij~l,s~gl~.~....~r-~---; .... .. · .. ,..... ~ ... being duly swbrn, deposes and )ove named. says that he is the applicant e is the ....................... ~ .... ~x: ..................................................... (Contractor, agent, corporate officer, etc.) f said owner or owners, and is duly authorized~t6 perform or have per, formed the said work' and' to make and file this ~plication; that all statements contained in this application are true to fl~e best of his knowledge and belief; and that the 'ork will be performed in the manner set forth hi the application filed'therewith. worn to before me this ; ~ew York ~. (Signature of applicant)