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Home My WebLink About12783-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southo~d, N.Y. Certificate Of Occupancy No. Z13187 Date Feb. 4 .,19.8.5. THIS CERTIFIES that the building..Q .n.e..f.a. ~a.i.l.y.. ¢.w.e. 24.1 3D.g .~ ~-.t.h. ~1 ~.c.k. a ;1.d. fi. ~_~ Location of Property 5 1 0 Navy Street Orient House No. Street HarMer County Tax Map No. 1000 Section . 026 .Block 1 . .Lot Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated N dy. I 7 19 8..3pursuant to which Building Permit No...1.2.7.~0,Z ............. dated · D.e..c ....5. ............ 19.8. ~, 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 ......... One famil~ dwelling, with deck addition EDWARD J & CLAIRE WRIGHT .................... The certificate is issued to ................. ?o~n.o.r,.l~.~X. of the aforesaid building. Suffolk County Department of Health Approval ~ 3 - S 0- 2 0 0 UNDERWRITERS CERTIFICATE NO ............ .~ 5.7.5. 2..6.7 .............................. Building Inspector Rev. 1/81 FO~ NO. 2 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) N9 12783 Z Permission is hereby granted to: ....... ........... ~C:. ~,~.~...: ........................... ~,, /~ ...... ~.O.,:~.~.z:,r~ ~..~...........c2...~-~-'-'- ........ .~..,:~Z~./..~.%.....,z2.~ ~ /.,~.C ................. to ..................... ~ ~. . .: ;..~...' .. . :X. ...... ~'.~,.~. .~..x~...,... ~.~ z.,../. . . at premises located ot ....~,.:...>.~'.....,...'~..~...~.~'~...~.......,~?.,:.¢ ..................................................................... ............................................................................................... .~..~.~, ........... .................... County Tax Map No. 1000 Section .....~...c...¢,~. ...... Block .....~,/....,,. ..... Lot No....Off).? ........... ~ ' / 19..~..~ pursuant to application dated .~.~).~.~/~Z~...~/.~- .......... ..~. ....... , and approved by the Building Inspector. Fee $...L.......Z. ......... u~ d~ng 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 in duplicate 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. Certificate of occupancy $5.00 1. / Certificate of occupancy on pre-existing dwelling / land use 2, 3. Copy of certificate of occupancy $1.00 ~ --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date . .~ C~"~,,, . . .~. ~..~,~.' ....... New Building ...... W ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property.. ~,/.0, ............... ~. ~t~, ,,, .......... ~'~' "F' House No. Hamlet Owner or Owners of Property ~.~)'. ~, .~( .~ · · '~' · "'/'~' '(:~' ' ' ' ................... County Tax Map No. 1000 Section . .0.. ~ ~ ........ Block ... [ ........... Lot.. ~, ............ ~ Filed Map No ~ Lot No Subdivision .......................................................... Permit No./.'~, ,'~7. ~.3 Z~ Date of Permit .t. .~ .Applicant ............ Health Dept. Approval . .'~-='T'.~.~..."-~;~..-:~-~.O .... Labor Dept. Approval . .J:l:~ T. ................. Underwriters Approval .. ~ ~- .Planning Board Approval ' Raquest for Temporary Certificate ..................... Final Certificate ............ Fee Submitted $. ~,~ ,. :O.'h'1. ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .......................... Rev. 10-10-7e c'.O Z f3/ FIELC~IN~FECTION COMMENTS ~ ,. , FOUNDATION (1st) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: ~¥ ~ !:)-, oo 765-X802 BUILDING ~DEPT. INSPECTION' FOUNDATION ZST [ ] ROUGH PL~BG. FOUNDATION ZND [ ] INSULATION FRAMING REMARKS:~"~ FINAL DATE INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined .~..?...?~.. .... , 19 Approved-~.~.. --~.: ...... , 19~...~. Permit No.../~././..~..~7 Disapproved a/c ._': ........ ..-._ q-~:._~.~_ _5~_ ............. F/ / .... , (Building Inspector) Application No ............ APPLICATION FOR BUILDING PERMIT Date ~ .'.. (.7 ...... , 19~.3 INSTRUCTIONS a. Tiffs 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 regulafions, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) ...... r- (Maiting'~ddress of applicant) State wtxether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prexnises..~'~g~..~. '. · .~. ~. ~. · ~. · .~.'~ ......................... (as on the tax roll or lat~'st deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No.. ~. (a..~...~. :-.-~'..' ......... Plumber's License No...~.. ~. ~ .~.9 .............. Electrician's License No..~."~..~. ~..~. ? ........... Other Trade's License No ...................... 1. Locationoflandonwhichproposedworkwillbedone..~~g~..~.~..' .................. ·' ~'-'~' ................... ~e ~touse Number ' i~''''~ ............... ~Hamlet .................... County Tax Map No. 1000 Section . .0.. ~.&. ......... Block .../. .............. Lot...~. ............... Subdivision ............. ~ ...................... Filed Map No ...... .~. ....... Lot ....- ........... (Name) 2. 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 . __.. . .O~.. . ~.__~q ............... 3. Nature of work (check which applicable): New Building ...~N ..... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... ~..~..O. ~ ~. ~. ~../~..~. (Description) 4. Estimated Cost ......... (DC) C) ' Fee (to be paid on filing this application) 5. If dwelling, number of dwelling Units ....... /. ...... 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 ofexistingstmctures, ifany: Front ....... .-~ ....... Rear '"' Depth..- Height ~" Number of Stories Dimensions of same structure with alterations or additions: Front .... .--. ........... Rear ...."7 ............. Depth ............ . ~ ......... Height. ........... "7 .......... · Number of ~Stories, r ..... ~' ................ 8. Dimensions of entire new construction: Front ...~,...~/t.O ..... Rear ..... Ct/~.~' .... Depth .~-. ~. .......... Height ~ .-. ~2 .~,. !... Number of Stories ...~[ ~ ............................................... 9. Size of lo[:'Front . [.,~. ~?. .... ' ........... Rear .... [. ............ perth/~.2.. ~./.~.3.'r. ......... 10. Date of Purchase ......... 1.9.7.~'. ............ Name of Former Owner ....~..'...~,,~....~..- ......... 1 1. Zone or use district in which premises are situated../~~ .~..~,~/~..¥..--. ........................ 12. Does proposed construction violate any zoning law, ordinance or regulation: . ¥__..~..." ...................... 13. Will lot be regraded ..... .~ .,~.. ........ : ...... Will excess fill be removed from premises: Yes 14. Name of Owner of premises .~...(~. ~ Address 0 r',a :h ~/.' Phone No.~t~:.~-~.6~. ~¢~.'~' Name of Architect ............ ^ .............. Address . d. · ~:~.._.'."YJ. '.....'.. Phone No ................ Name of Contractor ~ ~,g0,A ...... Address .~ .~.~.~.: Phone No. ?~ .~.-. ~. g.~ .. PLOT DIAGRAM Locate clearly and distinctly ali 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¥~RK,/ ~., ~ ~ COUNT Ot (Name of individual signing contract) above named. being duly sworn, deposes and says that he is the applicant He is the ...................... ................................................................... (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 work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... d~..~. ..... : .day of .... · .'~..~.., 1~. ·~. Nota ,,u ,i , t.-- .IUDITH T. TERRY · ' (Signature of applicant) Oomml~l~lon ,& '%, ¢, "It sti4uld be noted that since this proper,,t~ is located in an agricultural area, t~e possibiJify exists that thg water, ~'suppty may contain trace amour~t,~ of pesticides and/or nitrates. Specic~l ~ anaJysis%~l/~ required. 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 SUFFOL%C~. DcLEP~.T.~O~ HEA~LT~ SERVICES. (si ~ ~ APPLICANT ~~ ¢~7 SUFFOLK' COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY . SUFFOLK CO. TAX MAP DESIGNATION: DIST. ~ SECT. BLOCK PCL. OWNERS ADE~RESS: TO~ E'A'S'r 42~ ~% I TEST HOLE I STAMP SEAL LiC,,EMSEE GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.$. NO, ['5 - SQ--~O¢ 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 SERV'ICES. (si APPLICANT SUFFOLK COUNTY DEPT· OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT, BLOCK PCL OWNERs ADDRESS: SEAL POOL Z 9.1 '%, .*.:~' H;0NUHEN] GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. i5- :~o--%JO STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSA 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: APPROVED: suFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. OWNERS ADDRESS: DEED: L:TS~8 P. ~2 {Fe'[jF} TEST HOLE T. 34, LOCATED oN 'nA~or4 PCL.[ TOP~OI L STAMP SEAL