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Home My WebLink About12754-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z12966 Date NOV. 7 19 ~.4. THIS CERTIFIES that the building ...bJ. 9.w...D..w.o.l.l.J:..rig .............................. Location of Property ....2.3.8..5 .......... a..e.n.rX '..s..~.a.n..e ............. .P.e.c. 9.n.5:.c' ......... House No. Street Hamlet County Tax Map No. 1000 Section .... .0.7.4. .... Block .. 0..~ ........... Lot ....0.4.4.: 3. ........ Subdivision...?.e.c.o.n..i.c..K.n. 9.1.[.s' ........... Filed Map No..6..6.0.7...Lot No..2 ............ conforms substantially to the Application for Building Permit heretofore fried in this office dated ...N. qv.: ...... .7 ....... ,19.8.3. pursuant to which Building Permit No....1.2.7..5.4.Z ............ dated ...... N..oy.. .......2.0. ......... 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 ......... · ?.r.%v..a.~.e. ,9.n.e. ?.a..m.~.lX..D.w.e.% X..~.n.~. .............................................. The certificate is issued to .............. .K.E.N.N.E.T..H..~.. %9.U..A?..~..R.u, T.a.~o..s.~.z. ........... (owner,-i~see. er-teoe~t) of the aforesaid building. Suffolk County Department of Health Approval ........... .1.3.'759:-.1.8..8 .................... UNDERWRITERS CERTIFICATE NO ................... ~.6.§ ~ .1.1.4. ...................... Building Inspector Rev. 1/81 FOU'M' NO. ~ TOW'N OF SOUTHOLD 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) l~ z ~o,.....~.~~ ........................ ~ ,,.~..~ Permission is hereby grantp~ to: ,~ /~) ~ · ' .~...=.~...~--.?.~ ................................................... L kk ~ .~..~.~.....~.:..~ ...... .Lm...L.t. ........... ,o ..~b.~.~..~ ....... ~..~...~.~.~.....~.~...~s~.~.....j..~..~.~..~.~.......~. ....... ~ ....... ~~....~: ............ ~. ........................ ~ ~ .... o"~, ,"i;""~ at premises located at ..................... .~.-~d~.~...~....~...../....~..~ ............... -~. ........ County Tax Map No. 1000 Section ..... ..O.....-)...~ ....... Block ....... 1 .............. 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 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=ia=duff4~,~*~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 owne~ 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: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwel ng / land 3. Copy of certificate of occupancy $1.00 / use--?re-Existing C.O. $15.00 Vacant land C.O. $ 5.00 New Building .~J.. .... ; Old or Pre existing Building ...... · ......... · · Vacant Land ......... ... . Location of Property .'Z,~.~..~..~.q¢.~/~.5... /-~.~e House No. Street Ham/et Owner or Owners of Property ~ .~,x r, . ....... :.~... y... ~.*.'?..~.. ~ ~ ....................... County Tax Map No. 1000 Section ..(~.~. ......... Block .../ .......... . Lot.H.~.;~ ...... ..... Subdivision .~.~co,~'~c ~(r~ol]~ .... Filed Map No..~.~0.? ..... Lot NO. Permit No..J ?..q. ~.H. ~ Date of Permit il./..1~../.~?..Applicant ./~.~-./.~..~1..,. ?.. LO.~..~,..~ Health Dept. Approval ............. Labor Dept. Approval .................... .. . . Underwriters Approval ~. ~. ~.~. ~./..~/ ' .......... Planning Board Approval .................. ... . Request for Tempora_ry Certificate ....... · - ............ Final Certificate ....................... Fee Submitted $..~.. ......... · · Construction on above described building and permit meets all applicable codes and regulations. Apphcant .~.~...'.~ .... Lot 1000174 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 Datelqovember t~ i984 Ap~tlcatlonNo. o,~ylte 256844-84 N 666114 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the dbove application number in the premises of Kenme~h Ruthinoski~ Henry Lane, Peconic, N.Y. ~ 074 ! in the fotlowi~g Ioc~tio~; Bas t ~ 1st FI. [] 2nd FI. U~.. ~ ~.~?~ Section Block was examined on and found to be in compliance with the requlremet~ts of this Board. 24 51 39 24 I ! f ! 30 I SERVICE DISCONNECT NO'OF X si E 4/~. EQUIP. ,~e'2W '~3W 3~3W 3~4W h~O'O~E~¢~COND' O~C~ND NO*OF H'*~G O~'~L~O NO. OFNEUT.A~ Motors= t frac.hp. I GFCI, t smoke detector~-- Elec. room heaters: 5~t.5~ 2-1.25, EXHAUSTI DIMMERS OF NEUTRAL 4/0 geco Elec.Corp, Cliff Cornell 325 Willow Point Rd. Southold, N,Y.11971 !ic, 2816E Ii This ceHifico~ must not be alfred in any manner; return to the office of the Board if incorrect. Inspectors moM be identified COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNI=n FrELD TNS?ECTION FOUNDATION (1st) COMMENTS FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ODE FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [~] [ ] FOUNDATION 2ND [ ] FRAMING ROUGH PLBG. 2/,/ INSULATION [ ] FINAL REMARKS:~,/ ,~ INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ~...0-~....~-~....~.0..., 19 ~..~ Permit No. } .~.--].~.t{..~. Received .......... ,19... 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 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 regulatioj~l to admit authorized inspectors on premises and in building for necessary inspections..~.~1~..~ ~.~.~.(2;SFIC4~/g.~ AP~-~r~.r~f~ ~~ (Signature of applicant, 6r name, if a corpoXmtlon) . 5.o.q., .6. ,??!.0.q.uq ............ (Mailing address of applicant) State whether applicant is o_wner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .K.%.~p.~J..~..~.: .~..~. o..~..~.~ .~..~..~.~.; .~o.3.~.( ..................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly author/zed 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 0~1 Block I Lot..~ .~.,.~ ............ Subdivision .~.cp.~;?...~.~. 97! .~ ..................... Filed Map No. g.~.l).-]. .......... Lot .~ ............ (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy $,~ .c~. ~. 3. Nature of work (check which applicable): New Building ...v~. ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~ (Description) 4. Estimated Cost~. 6¢~ ~,.~.~. .............................. -1~...~.{ .cl.'.~..'~. .................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ....I ........... Number of dwelling units on each floor ................ If garage, number of cars .......... ~ ........................................................... 6. If business, commercial or mixed occupancy, 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 ...................... Number of Stories. · ......... , ........... 8. Dimensions of entire new construction: Front · {o (> ......... Rear . .6/~. .......... Depth . .(o. l~Cx.~.~.~ Height ... 18 ~.~*:) ...... Number of stories ii ' 9. Size of lot: Front . .k cd.o ,.~ ............ Rear ..... ) ~.K ~ :33. ......... Depth &.~. ~.,.~./~4.g ........ 10. Date of Purchase .6 :-~.?/.~. .................. Name of Former Owner $.'~,~ 1~¥..~.~.a~r~.~ ............ 11. Zone or use district in which premises are situated ..................................................... 12. Do~s proposed construction violate any zoning law, ordinance or regulation: .~.a ............................ 13. Will lot be regraded .~3. ~ ........................ Will excess fill be removed from premises: Yes Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot.(-~ STATE OF NEW y~l~ ,~/ e e COUNTY OF .K.~ .~.~."r.b ..~. ~.k.~?..b,p.~. ~ .~.K~.~.~.k.~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the .Q v'?.r~[c' (Contractor, a~,~0rp0tate officer, etc.) · -' ~ ' of said owner or owners, and is duly authorized to perform or have performed the said work and to make and t'de this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,~ ............. 7..' .'~...~ .... day of....x~.~, 19 ~ ..~ No. 52-0344963 ty~ t~//tw '~ -- ' ,'/"'" "~ ~ighature of applicant) Commissk)n Expires March 30, 19~._~ ( - ,5¢o/~ .' ~C, '= I" LICENSED LAND ~,,,I~VEYOR$ GRE£.PO.T NEw YORK SUIrPOI. K CO. HEALTH DEPT. Ar'~'~OVAL 0EPA?~£HT 0~H~-'AL~IR ' p+V~ ~HF P,g. N.Y. '83 OCT ~THE STATEMENT OF INTENT WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOt~ THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (si APPLICANT SUFFOLK COUNTY DEPT OF HEALTH sE.v,cEs - FO. AP,=,~OV~.L O,~ CONSTRUCTION IpNLY D^TE:~ o I-co Iq ~ A~OVED~/~~--- ~ · · / SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT BLOCK PCL OWNERS ADDRESS: DEED: L. TEST HOLE STAMP 0,9 .~ -LS' "/o N. 4~"Z~'I*,I. - 158.$$ lvq P P, OPEgTY RODERICK VAN T~IYL, LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL aS'~s~FN~o~y TO THE STANDARDS OF THE CO DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY DATE: H.S. REF. NO. l~ '$0'~1~ APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT BLOCK PCL. /ooo 074 OWNERS ADDRESS: 7'~-'£..'f77 --./$,44- DEED: L. TEST HOLE STAMP SEAL ./ NOTIFY BtHLDING DEPARTMENT AT FOLLOWING IP~SPECT~ONS' FOR PmURcD CONCRETE 4. FINal _ CONSTRUCTION MUST ALL CONqTRUCTION SHALL MEET ~ODES. NOT RESPONSIBLE FOR ~ A~ CONSTRUCTION ERRORS. If copper lubing is used for water distributing ~ys~em; piping shall be bf types K or L only ),O,/· ~L_O0'~ 41Lio'' r-- -'1 L .4 L. J ~to" I k '1 r -I vh.I