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Home My WebLink About12797-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date ................ ~.Vg.Rs.~...3 ........ 19 .8 .4. THIS CERTIFIES that the building ......... .o.n.e.~f. ~.m~.lj..~.w.e. 1..1.i.n.g ................ Location of Property ..... 2. .2.0 ............... S..h.ip.s..Ikr.. ................... S.o..u~.ho.~..cl.. House No. Street Hamlet County Tax Map No. 1000 Section ..... q 7. ~ .... Block ...... 0.3. ....... Lot ....... Q .~ .2 ....... Subdivision.. 13gy. v.i~W..~QQ~q..~$~'12,~$ .... Filed Map No.. ~ ~.2.q..Lot No ...... .8 ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated December 1 1983 pursuant to which Building Permit No. .1~79.7.~... dated........................December 13 .... 19 .8 3 , was issued, and conforms to all ofthe requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... new one-family dwelling. LARRY McCORMICK The certificate is issued to ................... (owner, lc~cc or~ of the aforesaid builc[ing. 13-SO-215 Suffolk County Department of Health Approval ......................................... UNDERWRITERS CERTIFICATE NO. N651711 Building Inspector Rev. 1/81 FOB~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 12797 Z Permission is hereby granted to: .......... ~.~..~.~....~...L..~.~c~... ............ ~..~.~.~:...~..~...~ ....... ~.~z~~...~.~ ....... ~ ~o ............. ~:Z~ ... ~.. ~/c ~ ... ~.~L~ .......... at premises I*ated at .............. *O~Z .............................................................. ............................................................................................................... ~?~ ..... ~ ~?/~ ..........~ ................... ~.....~ .......... co~.~ ~ ~o~ ~o. ~00o ~e~.o....dZ~ ........ ~ .~.~ ........... ~o~ ~o. ~.~ .......... Building Inspector. ~e .................. ' Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall ,~:,)uthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted--i~c~,Hcctc 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 disposel--(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: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 3. Copy of certificate of occupancy $1.00 use --Fre-Existing C.O. $15.00 Vacant land C,O. $ 5.00 Date.. New Building .. ~ ...... Old or Pre-existing Building ............ Vacant Land ............. D Location of Property ~..~. ,~.. I.' .............. ........... ~..s.. Y.W.~ House No. Street, Hamlet Owner or Owners of Property ./.~-.~/~ .~ .~/ ............................................. County Tax Map No. 1000 Section ... ~. '.'7..~' ..... Block .... O..~ ....... Lot....(g.. J. ~ ...... Subdivision~.~ U~.~.~J. ~. 04).~. ~.~(~(~.~. 5..Filed'MaP No..5.~. ~ (~.. Lot No..."~.. ~7'..¢ ...... Permit No. J.'~ .~..~..7. Date of Permit /.~,~./.~. T?.~Applicant. ~L,-4~t~.~y.. ~ .~.~¢-.Q ~./4~ ~/.C,~.. .... Health Dept. Approval '/?5 ~ ~ ~' ~ j ~ ......... Labor D.e?t.. Approval ........................ I~.~'*/~ l /. "': dApp Underwriters Approva ............. Planning Boar royal .................... Request for Temporary Certificate ..................... Final Certificate ...... .~.,,., ........... Fee Submitted $ , ~ .~, ~/ Construction on above described building and permit meets all applicable codes and regulations. ...... ~C;'~'~-/~0 ~ Applicant ..... Rev. 10-10-78 FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N.Y. ~-' d~ _ ~ STATE ENERGY ~ %ODE FINAL ADDITIONAL COMMENTS THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY C. 85 JOHN STREET, NEW YORK, NEW YORK 10038 ,.t~ ~a. ~o~4 ~pplic.tio. No. on/ile =5.~eO/~ N 651711 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the above application number in the premlses of Laxity UcCo~aick~ 220 8hops Drive, Sout~ld, N.Y in tae/ollowing location; [] Basement [] 1st FI. [] 2nd FI. Section 79 Block 3 rot ]2 was examined on JffLy ~, 1~)~4 and found to be in compliance with the requirements of this Board. FIXTURE OUTLETS 23 1ECEPTACLES SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FLUORESCENT DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO, OF FEET SERVICE DISCONNECT S E NO. OF CC, COHD, pER ~' OTHRR AFR~RA?US~ I~.G.F.C.I~ 1-G.F,I. 2-Smoke Detector. s. R V I C A W, G, NO OF HI-LEG A W G NO. OF NEUTRALS A, W G OF CC CON{), OF HI-LEG OF NEUTRAI. ~ Panelboards: 1-16cir. ]25~s. Larry HcCormick 95 Whale IDac Landing 8out~gm_pton, N.Y. llDO8 This certificate must not be altered in any manner; return to the office of the Board if incorrect. Per may be identified by their credenfioJs. 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~\ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION !FRAMING [ ] FINAL / DATE INSPECTOR ,, 765-1802 BUILDING DEPT. INSPECTION FOUNDATION ZST ~ ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [ ] FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ] INSULATION [ ] FRAMING [~.FINAL ~. "~ INSPECTOR FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined ....... ,19 ? Approved ........ l .'¥Pe it 7..Y Disapproved a/c ........ 27 ................. r~ ......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received .......... ,19... Date ............ 19 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 alt applicable laws, ordinances, building code, housing code, and regu~lati0p_s, and to admit authorized inspectors on premises and in building for necessary inspecti$)ns. ~ , (Signature olXaWpplicant, or name, if a corporation) ........ ¢. ....... · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... 0.cO. g ........................................................................... Name of owner of premises .... ~./2Cree/..~.~.c.~ .... /~.~/.'~.~... ¢ ~t v~.y ~e.~. 7cO... ~.4[ .~..~y.. ~..~.ff. 3..~.~. ~'~... (as ohfi the tax roll or latest deed) if applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .......................... Plumber's License No. ~a'--&/Igr /~r°~L7'//9 L'-' , 2:w_ r- . Electrician s License No ....................... Other Trade s License No ...................... 1. Location of land on which proposed work will be done .................................................. House Number Street Hamlet County Tax Map No. I000 Section ...... 7..~. ........ Block ....~. ............ Lot...1/.o'2, ............ Subdivision...~)~.bqi'.~.aA..~/oo .~.$..~7/d-'/g~'J.. Filed Map No...~..~.~. O. .... Lot .... X~ ......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ Offo:g~'z~t...~/.e~'~. ............ ~l~l~f.,lr ~ffiOt~ ................... '.. b. Intended use and occupancy "~"/~ ~''" '~'t~"<~2: ~/~4~t .............. 3. Nature of work (check which applicable): New Building .... ~ .... Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... Cost i,~2.~,~---~ .~..0. ~ / .q~..'~...~__~.. (Description) 4. Estimated (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... [ ....... Number of dwelling units on each floor: If ara e, number of cars . .: .. . ~ ...... 6. If business, commercial or mixed occupancy, specify n~ure and extent of each type of use ./~a~. ~. ~ ~.. 7. Dimensions of existing structures, if any: Front... ~ ~... Rear ..., .......... Depth ............... Height ............... Number of Stories ........................................................ D~ensions of same structure ~ith alterations or additions: Front ................. Rear .................. Deptk ................... ~... HeiSt .......... Number of Stories ......... ~>~ ~;~ 8. Dimensions of entire new const~ction: Front ~ ~ ~ ~. Rear .... ~ ~ ...... Depth .............. Height .... ,~ ~ ~ . Number of Stories ..... .~ ............... 9. Size of lot: Front ...... /.~ ....... Rear .... ~,. '/.7. ( ...... Depth ...... ~.~ ........... 10. DateofPurchase ...IZ~D/~ .......... Name of Fomer Owner ............ 11. Zone oruse district h p ~ .................. "-"" "~ in whic remises are s~tuated .............................................. 12. Does proposed construction vidlate any zoning law, ordinance or regulation: .... ~.~ ........................ 13. Will lot be regraded ~t,~m~. qre~d,f~e,/. ~... Will excess fill be removed from vremises: ~ ~SN No 14. Nme o~ of premises L ~ ~ . ~ .q ~ ,,~.gt~ Address .q~/g.. ~¢ .~o~No. ~ ~;. ~.7... Nme of Architect ......... ~ .................. Address . ~t~ ~ ~(/~Phone No ............. Nme 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 blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. If-&, STATE OF NEW/SflO13,I~,: /2/ S S .... t,~f~-~,~-~r,T,, ~. ....... being duly sworn, deposes and says that he is the applicant t (Namfe,.,/o flndividual signing contract) above named. , He is the ..: ................... i ................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ authorized to perform or have performed the said work and to make and file this pphcatmn, 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 ~ .... Notary Public .: nty ~/~.~ ~~¥~ ~ ..... ,: ' (Signature of applicant) T Z · gO'9/ T.¢. ,~.~. /4..80' /5.05' WOOD 4.0' loT- 20.4' Sos °4~'/o"~" /50.00' O/LED ~SLUE$'I'ONE PAI//A/~ 7'Old'Al M~IINTA/NED