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Home My WebLink About12688-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Cerfi[icafe O[ Occupancy No ................. Date ................................ 19. THIS CERTIFIES that the building., nP-.~ .dw~].ling ............................... .R.d. & 55 Pinewood Rd. Cutchogue Locati6nofProperty....595...,Midw°°d......... . ........ ................ House No. Street Hamlet County Tax Map No. lO00 Section 119 .Block 0..3 ...... Lot 001 ~ Subdivision ....... .X ....................... Fried Map No...X. ..... Lot No .... X. ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated October 12 .8.3 1..2.68.8. ..................... , 19 . pursuant to which Building Permit No... Z. dated ...... .O.q~ .o.b.e.r...1.3 ..........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 ......... .a. ~rivate one-family dwelling. 'The certificate is issued to ... WILLIAM .& PHYLLIS .L.O.M~B.ARD. I (owner,/~e~rtemant) of theaforesaid' braiding.' ' Suffolk County Department of Health Approval 12-80-139, 1/24/84, Robt. A. Villa, N631441 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FO~lig NO. 2 TO~'N 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) N~ 1265~ Z Permission is hereby granted tot.% ('----'), ~ '"~'T~'"'~/-f~" .......................................... ,o..~~....~..~.....~....~.~.~.~~ *- ~'~ ~' ....... ~ .............. County Tax Mop No. 1000 Section ..... ]..L.~. .......... Block ....... .~.. .......... Lot No ...... ! .................. pursuant to application dated ...~...~....~. ...................... , 19.t.~,., and approved by the Building Inspector. Fee $.. L .0...~. :. · .~....'~. · .... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Bu~dir~g Depar~men~ Town Hall Southold, N.Y. 11,971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This app(ication must be filled in typewriter OR ink, and submitted In duplicate to the Building lnspec- tor,,vi~h the following; for new buildings or new usa: 1. Final survey of property with accurate location of ali buildings, property lines, streets, and unusual natural or tooograohis features. 2. Final approval of Hea~th Dept. of water supply and seweraoe d sposa --(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Unde~rwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar building~ and installa- tions, a certificate of Code compliance from the Architect or Eng(neer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicab B. For existing buildings (prior to April 1957), Non*conforming uses, or buildines a/~d "pre-existing" land uses: 1. Accurate sunzey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2.Sworn s~atement of owner or previous owner as to use, occupancy and condition of buildings. ~. 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 occ,u, pancv $5,00 1 2. Certificate of occupancy on pre-existing dwelling q/r land use ~/-f,¢5.00 3. Copy of certificate of occupancy $1.00 , Date . New Building . .. Old or Pre-existing Bu,o ng,Z) ......... = and -i Location of Property , tOl.ll/~uOOb .4-:.?b/~.~.oo.p /7~ (.oTLHo Hous~ 270. Srree~ Ham/et Owner or Owners of Property .~/,/~ q~. ' County Tax Map No ~000 Section ............... Block ............... Lot ................ Subdivision ................................. FitedMapNo...: ....... Lot No...' ........... PermitNo./~,(~ ~¢~.Date _ ..... ....... II ....... ......... ........ IX'C;.. Health Dept. Approval ¢. / -'/ ~---:)- .~.~.' ......... Labor Dept~. Approva ...................... ,.. Undemvriters Approval · ·///- ¢/~-f ............ Planning Board Approva, .................. ~... Request for Temporary Certificate Pinal Certificate' · Fee Submitted S ~ O ' - Construction on above described, building and permit'meets all app~(cabl.~,4,o.das and ragutat OhS. ~000~71 THE NEW YORK BOARD OF FI,RE UNDERWRITERS ns BUREAU OF ELECTRICITY ~- January 25, 1~%~°HN STREET, NEW YORK NEW YORK IOO3S ..,~ ~ppliea,,on ~o. on~i,~ ~,ss~o-~3 N 631441 THIS CERTIFIES THAT only the e~ctrical equipment ~ described below and introduc~ by the applicant named on the above application number in the pretnlses of W~li~ Lombard~ E/~ ~newood ~d, C/~dwood ~d.~ gu~ch~gue~ N,Y. was examinod on g~luary 16, 1984 and found to be in compliance with the r~quirements of this Board. FIXTURE FIXTURES RANGES OVENS FANS OUTLETS SWITCHES NCAN DESCENT FLUORESCENTVAPOR 1,7 17 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNITHEATERI MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTFIER APPARATUS: Motors: 1-,F o 1-GFCI l~Smoke Detector S E I C E A.W.G NO OF HI-LEG A.W.G OF CC COND, OF HI-LEG 3 NO- OF1NEUTRALS AWG, OF NEUTRAL 5 Ru],and Elect. Co, Po O. Box 143 Mattituck, N.Y., 11952 LIC.~242 This certificate mpst not be altered in any manner;, return fo the office of the Board if i:nco~rect. 'HIS ~ Y' OF 'IFil M GENERAL MANAGER 11 ,/, ma), be identified by their ~,NNER. 765-1802 BUILDING DEPT, INSPECTION FOUNDATION 1ST ROUGH PLBG. I- ] FOUNDATION 2ND [ ] INSULATION [~ FRAMING [ ] FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING ,~? FINAL \ REMARKS: DATE ///~- ~ //~,~/~/" INSPECTOR /Iv '// I 76S-1802 ~ BUILDING INSPECTION FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION :~ND [ '1 INsULJIITION FRAMING [ ] FINAL DATE ''f"')/'~ 'NSPEcTOR:'~ ~, ~' F,IEL~INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING 3. INSULATION PER N. STATE ENERGY ~ODE Ye FINAL COMMENTS 3. Nature of work (check which applicable): New Building .....l~..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost ........... O. ~ .............. Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units on each floor ................ If garage,l number of cars ........................................................................ 6. If business, commercial or mixed qeeupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front .... , ........... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ...................... Height ........ ,~ t ......... Number of Stories ............. t ........ 8. Dimensions of entire new construction: Front .... ~..a ....... Rear ............... Depth ...~..2_. ......... Height ............... Number of Stories ........................................................ 9. Size of lo.t: Front .... ./· · ~. ............ Rear ..... ./.~.~...........q-' . Depth .................... /. '~- ~. 10. Date of Purchase ............................. Name of Former Owner ............................. 11. Zone or use district in which premises are situated ..... 4..' ............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded .... .~.o. .................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises . .~. ~'0.. ~.0..~./~.~. ~.~. f. Address . ~T .~..z-.tp.&..Al....h(.X. Phone No ................ Name of Architect ........................... Address Name of Contractor t~ , .~'.~ / ./-~. / ~J~.'~. 3.' Address ................... Phone No ................ ................... ~5)ff. ~.~.Se(/~. ~.7~..' Phone No..2~..q..~....~..~.~..~_~ 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 NF:~YO'~,~././~jd S S · ~Q ~.~. ~. f~:..~.~.~: ............ being duly sworn, deposes and says that he is the applicant (Name of individual signin~ c6ntract) above named. He is the ............................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, md is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the work will be perfo~ed in the intoner ~et forth in the application filed therewith. Sworn to before me this No~pbl~, . . · ~ .~. · ~ .... ~ .~.~ounty .. ~ZA8~U ~N n~ltLI (S~gnature of apphcant) ~R~UC, StYe of New Yor~ No, ~-812585o, Suffolk C~/ Term Expires March 30, 19~ PE~J~ · j~.,:;~ Si~-. EXCAVATIGH '~EEICK VAN Tp~YL, P.~ 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· APPLICANT SUFFOLK COUNTY DEPT· Of HEALTH SERVICES -- FOR APPrOVAl OF CONSTRUCTION ONLY DATE: i1- 0 - H. S. REF, NO. ~~ APPROVED: ( · SUFFOLK CO. TAX MAP DESIGNATION: DIST· SECT· BLOCK PCL. OWNERS ADDRESS: ~0~~ .,. DEED: L. 5~ P' I ~ ~ ~ ~ --~ TEST HOLE STAMP SEAL EST ~5.- ~F_C, T'~vo' SUFFOLK CO. HEALTH DEPT. APPROVAL STATEMENT OF iNTENT THE WATER SUPPLY AND SEWAGE DISPOSA SYSTEMS FOE THIS. RESIDENCE ~i CONFORM TO THE STANDARDS OF TH DEPT. OF HEALTH sERV'IcE! SUFFOLK CO. APPLICANT SUFFOLK, COUNTY ..DEPT. OF HEALTI SERVICES -- FOR ' APPROVA~:~ O CONSTRUCTION ONLY SUFFOLK CO. TAX MAP DEsIGNATION:~~ LICENSED LAND SURVEYORS GREEN~RT ' NEW YORK