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Home My WebLink About12807-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z17406 Date OCTOBER 12, 1988 THIS CERTIFIES that the building Location of Propert~ 155 House No. County Tax Map No. 1000 Section 78 ONE FAMILY DWELLING. 8HEPARD DRIVE SOUTHOLD Street Hamlet Block 1 Lot 16 Subdivision WEST CREEK ESTS. Filed Map No. 3848 Lot No. 43 conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 21~ 1983 pursuant to which Building Permit No. 12807Z dated DECEMBER 19~ 1983 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 FAMILY DWELLING WITH COVERED PORCH. The certificate is issued to JOHN POLYWOD~ (owner, of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED I0/6/88 13-S0-219 N686758 2/20/87 K & K PLUMBING & HEATING Rev. 1/81 Building Inspector TOWN OF SOUTHOLD Building Department Town Hall $outhold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR tnk, and submitted ~ aaa==ae=~ 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. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of pL'operty 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. C, Fees: l, Certificate of occupancy New Dwelllng.$25,00, 'Acce.~sory :$10,00 ;llusJ. ne.~.~ $50.00 2, Certificate of occupancy on pre-existing dwelling ~ 50,00 3. Copy of cortificate of occupancy $ 5,'00, ove~ 5 years 4.Vacant Land C.O. $ 20,00 5.Updated C.O. $ 50.00 Date .......................... 6. ~lteration $25.00 NewConsBPuc~ton......OIdorPre-existingBuilding ...........~ Vacant Land ............. Hou~ ~o, ~ ~treet Hamlet Owner or Owners of Property .......... ~ ........... ~ · ' ...................... · · · . County Tax Map No, ~000 Section ........ Block ............. L~I ..............' Subdivision ~,~, ,~, ~5;~{5 ...... Flied Map No, ~,~,, ,Lot No .... ~,~ ....... Health D~pt. Approval ........................ L~bor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Subm;ttad ,.. ~ d):~....-:cz...~p...,eze.. .... Construction on above described building end pejmlt meets F/I epl~able codes and regulations. ~.', ~Sq 51 ~,~.t ............................ TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ILO. BOX 728 TOWN ItALL SOUTHOLD, N.Y. i 1971 TEL. 76S-1802 This is to advise you that the job under building permit no, 12807Z issued to G Van Duzer on .A2.~19/80 for New Dwellinq is completed and a final inspection bas ( ) has not (x ) been done. An Underwriters Certificate and Board of Health Final is needed [. order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enc]osed form, return same to the above office with a check for $25.00 payable to the Town of Southold. Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or rise is unlawful without a Certificate of Occupancy. l'lense help un to clear up thin, matter so that legal action does not have to be taken. Thank yot! for your prompt attention. Very truly _y~, Victor Lessard Executive Administrator VI,: g,9 r encl. l~iuua THE NEW YORK BOARD OF FIRE UNDERWRITERS oi aUREAU OF E~-ECT.IC,~ ~- 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT G~' V~ ~r, ~ ~. ~ o~ Glen ~ ~u~, N Y in thefotlowlng location; ~ B~ement ~J Ist Fl. ~ 2nd FL Sec~n Block Lot w~ exan~i~d on ~i ~, i~ and found to be in compliance with the requirements of this Board. DRYERS SWITCHES FIXTURES RANGES OVENS DISH WASHERS SYSTEMS E E R V I C AW.G. Gar~ Ooroski 42 D ~on~ell ~n¢ C~al;c,hogue~ N Y 11935 Lie 2041 E GENERAL MANAGER This certificate must not be altered in any manner; return to the office of the Board if incorrect, laspectors may be identified b~ their credentials. COPY FOR BUILDING DEPARTMENT, THIS COiI~Y OF CERTIFICAI~ MUST NOT 8E AL'I'~RED IN AIr~ MANNER, TOWN OF $OUTHOLD OFFICE OF BUILDING INSP£CTOR P.O. ~OX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERT IF ICAT I~N Date Building Permit NO. (please print) %,~ I certify that the~solder used in contains less than~ 2[J. 0 'of 1% lead. the water supply system befoz day of 19 '.r' * (plumber' s signature) 765-XSOZ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION AND [ ] INSULATION FRAMING [/FINAL REMARKS: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date ~...)~C~ ., 19 File No ................................ To .~+.-~. ~, .......... ~..¥~' .rf~., :-' .. .../~ ................. .... . ....... / County T~ U~p No. ~000 Smio... O.Z~. .... ~o~k ... ~. ...... ~ot . (dZ~ ....... is returned herewith and disapproved on th~ following grounds .,:<d~.. ~<<. ~ .... Building Inspector RV 1/80 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST I- ] ROUGH PLBG. FOUNDATION 2ND [ ] ~iSULATION / FRAMING ~r//~ FINAL FIELD i~PECTION COMMENTS FOUNDATION ( lst)~ FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ODE FIN~ ADDITIONAL COMMENTS TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN IIALL $OUTHOLD, N.Y. ! 1971 TEL. 765-1802 This is to advise you that the job under building permit no, 12807Z issued to G Van Duzer on !~!9/8~_ .... for New Dwelling is completed and a final inspection has ( ) has not (x ) been done. An Underwriters Certificate and Board of Health Final is needed [n order to complete this file, it is necessary that a Certificate of Occupancy be issued. Please fill out the enclosed form, return same to the above office with a check for $25.00 payable to the Towa of Southold. Please indicate to Whom tile Certificate of Occupancy is to be malted, and arrange w[th this office for an inspection (late Occupancy or use is unlawful without a Certificate of Occnpancy. Please heJp ns to clear up this matter so tbat legal action does oat have to be taken. Thank you for yuur prompt attention. Very truly y~, Victor Lessard Executive Administrator VL:gar encl . Metalbestos Type"B" Gas Vent for Residential, Commercial and Industrial Ventiflg RV round vent pipe 3" through 8~. Pages 4-6. QC round vent pipe 10~ through 48', Pages 7~9. WV oval vent pipe 4'~ and 5#/6~, Pages 10-12. Rugged COnstruction Assured Safety Fully Tested and Listed TOWN OF $OUTttOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because.of the following reasons. _// An application for Certificate of Occupancy / is not on file. ~/~__~/~ No Underwriters Certificate on file. /Z/The check is(outdated/~.)4~35~(~CD /_T// No Health Dept. Approval on file. /5/ No final inspection has been made. Please contact our office on this matter. Thank you for your cooperation. Build~ Dept. ***/~/ No Plumber Solder Certificate on file. ( all permits involving plumbing being issued after April 1,1984 ) FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tins application must be completely filled in by Wpewriter 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 Regu. lations, 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 c. Aode, housingqode and regulations, and to admit authorized inspectors on premises and in building for necessary/~0%spe_~tio~., ff~ _-~l "- -.. ............... · ~t (Signflture of applicant, or ~, i~4l corporation) ......... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. .... ~ .~J'~ .4~..Y~.... ;,~t ....... ~:. ..... ~., ....... ~,. ......................................... Name of owner of premises..q.(.J~.~.~.~....[¢-~, :'...~.~--~'X...~-.x*J.~..-~...~.. i .......................... ~ [ (as on the tax roll or latest deed) ff 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 w,~ [;~ci~d work will be done.. ~..~.. ~~~..~57~ .... ........ ........ House Number Hamlet co~tv r~ u~p ~o. ~oo0 s~tio~ ........ ~¢. 7 ..... mo~k ......... ~ ........ ~ot ........ 1.9 ......... Subdi,i~io,..~?.. ~.. ~~ ......... Filed ~p ~o.. ;~.3.¢5 ..... ~ot ..... ~.g ....... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................. ~.~T ~ . b. Intended use and occupancy .... ....... .. . . 3. Nature of work (check which applicable): New Building . · Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... 4. F. stimated Cost..,c.w'.q~ '"*'Q)T~-~ : .......... Fee ~ .... ~ ....................... (to be paid on filing this application) , 5. If dwelling, number of dwellinglunits .............. 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 ............... lteight .............. 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... ~.o.t~. ....... Depth ~ ~ ........... tteight ............... Number of Stories . .(~:'~q~.._ ........................................... .. 9. Size of lot: Front ....~.O.(~.~,,~: .......... Rear .... ti_cO, r~2ff: ..... Depth ...................... 10. Date of Purchase ........ '...'! ................. Name ;fFo'n &'$ vner . .... 11. Zone Or use district in which pr~mises are situated ' ~,a~.~'~,a~l..~/ . . 12.. Does proposed construction violate any zoning law, ordinance or regulation ['XJ ~ ..... 13'.. Will lot be regraded ... ~,).(~)_1 ................... Will excess fill be ren~;ved fro'm premises: Yes 14. Name of Owner of premises .~t tih~t .~,~, ~tg~_.'l~-t.~lgress .. ~O~k-~q0~... Phone No..?~.~r. [.[k~,.. Name of Architect ........ "... L ............. Address ................... Phone No. fi. 6. .~7...~ ~. ~o~.. Name of Contractor ~.~x.~ ~.~O~k/to, oO~.--Address..~O.~'~(~dt ..... Phone No.."7~.~ .--~.qo~-.~... PLOT DIAGRAM Locate .clearly and distinctly ali buildings, whether existing or proposed, and. indicate all set-back dimensions from property tines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW COUNTY/~F ~. c('Name of individual signing'rr6ntract) 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 contgined 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 ~otilmir, sion -gxp!'res Mar011 80, 19~ / . (Signature of applicant) oo~