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Home My WebLink About12689-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Sou[hold, N.Y. Certificate Of Occupancy Z12.670 Date August 6 195.4 addition THIS CERTIFIES that the bufldLug ................................................ Location of Property/~/~t~s~ ~/) 355 Deep Hole Drive Matt ituck · Street Ham/et County Tax Map No. 1000 Section ..... 1.1..5 .... Block .. 13 .Lot 11 & 12 X X ~ X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 13 198..4 ttowhi hBuildi gPermitNo 12689Z ..................... , . pursuan c n ...................... dated ........ ·.... · · · · ·.. · · · ·.. · .Oct°ber 13 198.4. ., 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 one-family dwelling. The certificate is issued to ANTHONY & ANGELA LEONE [owner, of the aforesaid building. Suffolk County Department of Health Approval ................. N./..A ...................... UNDERWRITERS CERTIFICATE NO N 5 9 9 3'7 4, R~. 1/81 Building Inspector 1~0][~ NO. ~ TOW~ OF $OUTHOLD BLiILDIJ4G DEPART/~ENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) County Tax Map No. 1000 Section ...1.1...~,~ ...... B:o~k .... J.....~. ......... Lot No..}.L..-.J...~... pursuant to application dated ...~,..~.....t..'~ .................. , 19.~..~, and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO, 6 TOWN OF $OUTHOLD 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 submitte~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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use 3. Copy of certificate of occupancy $1.00 --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~..J~. House No. Street Hamlet Owner or Owners of Property County Tax Map No. 1000 Section ./J.J..~/..~../.~... Block ..... Lot ................ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No./.~..~..~.c~ ..,~. Date of Permit ,/o././.~./~.,.~'.-- .Applicant./~ .~P.~.~/~....~..~.o..~ .~ .......... Health Dept Approval -- Labor Dept Approval " Underwriters Approval Planning Board Approval ~ Request for Temporary Certificate ..................... Final Certificate ,..~.. ................. Fee Submi~tted $ .5~,..'~.. ....................... Construction on above described building and pe~all applicable codes and regulations. Applicant .... ~,~J.../...~~ ............. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 100:38 THIS CERTIFIES THAT only the electrical equipment as ~scribed below and introduced by the appficant named on the above application number in the premises of ~ny I~, 1355 De~l.e Dr~ ~Cti~, N.Y. was examined on ~,ril 11 ~ 1983 and found to be in compliance with the requirements of this ao.rd. FIXTURE FIXTURES RANGES OVENS DISH WASHERS OUTLETS SWITCHES FLUORESCENT DRYERS 2 SYSTEMS NO. OF FEET OTHER APPARATUS: S E A. W O NO. OF HI-LEG OF CC COND. 2/O C A- W- G. NO, OF ~.mUYRALS A,W G. 21o LIC. #396 This certificate must not be altered in any manner; return ~o the office of the Board f ncorrect nspecto~s may be identifi6d by t ' /~i~'~~z~reT~.,t./~-%~./~.,,~,~,.~ ........... ~ , ' ~ . . heir credent,als. ~l' · COPY FOR BUILDING DEPARTMENT THIS COPy OF Cb~ i'FI~a~= MUST 765-180:) BUILDING DEPT, INSPECTION FOUNDATION 1ST·~/ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL REMARKS: 765-1802 BUILDING DEPT. -INSPECTION ] FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2ND ~j/INSULATION ] FRAMING [ ] FINAL DATE ~IEL~ INSFECTION FOUNDATION 1st) COMMENTS FOUNDATION 2nd) ROUGH FRAME & PLUMBING e INSULATION FERN. STATE ENERGY QODE FINAL Ye Memorandum from... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN HALL, [~OX 728, SOUTHOLD, N.Y. 11971 Examined .O'~ .~'~.., 19q~.~. Approved .0":~..[.~. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ., 19~.~.. Permit No.).~, .~.'~?t .'~ Received .......... ,19... Disapproved a/c ..................................... APPLICATION FOR BUILDING PERMIT Date ............ /.~/(J., 19~-,'7. 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 reg~ation~, and to admit authorized inspectors on premises and in building for necessary inspe o.,9~~ 4 (S~e o af~plica~Xt~Jor name, ifa corpora ion) · ' ' (Mailing address of applicant) / / 9d' 2_ State whether applicant is owner, lessee, agent, ~chitect, engineer, general contractor, electrician, plumber or builder. .co ,v. 5.-:r..L._: ........................................................................ Name of owner of premises ~...~. · .~. .' ftC./'. · .'~..~P. · ~ (V. 6..~..~./~.....F~...~Zo..(V.~.~' .............................. (as on the tax roll or latest 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 ......................... Electrician's License No ....................... 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 /la / Subdivision~ ~.~..~'. ?...h~. e.~.~, .~5.( .?~.. (~w...~. ~..7~.'~. · .~.' ·3 ..... Filed Map No..~.~..O.~.~. ...... Lot /{ ............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. /.?TS .3.t.~. .~..~.../.~..c:-..../....~../~..t.~.~.. .................. i .............. b. Intended use and occupancy .................................................................... 3. Nature of work (check which applicable): New Building .......... Addition .......... Alteration .......... Repair ............... Remo, val .............. Demolition .............. Other Work ............... -~ _~ (Description) 4. Estimated Cost...~.~.~.~ ........................ Fee..~1, .~..~ ............................. ~ (to be paid on filing this application) 5. If dwelling, number of dwelling Units ............... Number of dwelling units on each floor ................ If garage, num bar of cars . .J ................................................................... 6. If business, commercial or mixed occupancy, specifynatureandextentofeachtypeofuse~ ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height ............. 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 ......... : ..... Rear ............... Depth ............... Height ............... Nu~nber of Stories ........................................................ 9. Size of. lot: Front ........... . ........... Rear ...................... Depth ...................... 10. Date of Purchase ........... i .................. Name of Former Owner ............................. .... hp{ ' ' d 1 I. Zone or use d~stnct m wh~c r m~ses are situate ..................................................... 12. Does proposed construction violate any zoning law ordinance or regulation: ........................... ; .... 13. Will lot be regraded ......... ~ ................... Will excess fill be removed from premises: Yes No 14. Name of Owner of premises ................... Address ................... Phone No ................ Name of Architect .......................... Address ................... Phone No ................ Name of Contractor ......................... Address ................... Phone No ................ 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 NEW y/)DR~.w ~t~ ...... ~t ~ ....' .' ,... ~.~...-: .,~.': · · .................... being duly sworn, deposes and says that he is the applicant (Name oF individual sig~ing contract) above named. He is the ..................... ~ ................................................................... ~ (Codtractor, agent, corporate officer, etc.) of said owner or owners, ~d 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 ~owledge and belief; and that the work w~l be perfomed in the m~n~r set forth in the application filed therewit~ Sworn to before me this Notary'Publii~:~~; ....... County Notary Pp~c~m~ of New York I