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Home My WebLink About12814-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13791 Date August 22 ................................................. 19 85 THIS CERTIFIES that the building .... .n.e..w..d.w.e..1.1.i.n.g.: ............................ Location of Property 1350 Ole Jule Lane Mattituck I~l~s'e ~o~ ...................... Street Hamlet County Tax Map No. 1000 Section 122 .Block 4 . .Lot 1 Subdivision ...... X .Filed Map No. X .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .N. qy .e.m.b.e.r...3.0..., 19 .8.3. pursuant to which Building Permit No ...... .1.2.8.1..4.Z ......... dated ..... .D.e.c.~, .e.r...2 ~ .......... 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 ......... Iq. aW ola.e, rf~lRJ, ly .d.w.~.l.l~n.g. The certificate is issued to ................ ¢ .Ag.O.L.y .N..&..R.Q.N..D.Q .B.EB.T. ................... fowner, of the aforesaid building. Suffolk County Department of Health Approval ................ 13 r S.O.n 2 ~ ~ ................ UNDERWRITERS CERTIFICATE NO ......................... I56 B~9.377 ................. Rev. 1/81 Building Inspector FOB~ NO. ~ 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) ~? 1251~ Z Permission is hereby gronted to: at premises located at .../....v.~..~..~/ County Tax Map No. 1000 Section ................. Block .......~.. ...... Lot No....~..~../. ........ pursuant to opplicotion doted .....~....~..~........~ ..................... , 19 .......and approved by the Building Inspector. Fee Rev. 6/30/80 BLDG. TOWN OF SOUYHOLD FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 TOWN OF SOUTHOLO APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted ia ~ 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 featu res. 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 p~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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 $15.00 Date .................... New Building z"/' ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ./..~..5 .....' ..... ~ ' · House No. Street Ham/er Owner or Owners of Property .~ ~'~;~- - County Tax Map No. 1000 Section ............. Block ............ Lot ...... ?. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No../.~..~'././.. DateofPermitZ~./.~..~/~,~..Applicant ...'~.~. ~----~'x~;z-- Health Dept. Approval ...z4z/..4 ?../~ .......... Labor Dept. Approval ....................... Underwriters Approval ..... ~z,/. ~..~.~/~,~:~ .......Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate .. ~ Fee Submitted $ .-~ ~ ~ .~. Construction on above described building and permitmgets all. applicable.codes and regulations. '-~..,. ',~'~'~0, ~q~ PP' · .. :~.w~ ....... ~ ................................. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK '10035 D.t. ~ril ~o. i~ ~,..~...~o.o.~,. ~7~/~ N 689377 THIS CERTIFIES THAT only the electrical equipment as described be~w and introduced by tl~ applicant framed on the abo~e application number in t~ premises of ~n ~rt~ Ole Jule ~,100' ~. of New S~fo~ A~, Mattitu~, ~ 114-12-~3-5 0~ m~ ~ i~ theyollowing location; ~ Basement ~ lzt Ft. ~ 2nd Fl. Section Block ~LotJ~.~ was exa~ninod on ~i~ ~ i~8~ and found to be in co,~pliance with the require,~ents of this Board. FIXTURE FIXTURES RANGES OVENS OUTLETS SWITCHES 49 36 DRYERS FLUORESCENT SYSTEMS NO. OF FEET S E R V I C E i~,~ A' W, G NO OF HI-LEG A.W. G NO OF NEUTRALS A W G, NO O COND, OF CC COND, OF Hi-LEG OF NEUTRAL W0 1 z/o [_T. E. Patchogue, N Y 11772 GENERAL MANA~ER~/%/~ COMMENTS FIEL~ INSPECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: BUILDING DKFT. ~ INSPECTION FOUNDATION IST [ ]' ROUGH PI.BG. [ ] FOUNDATION ZND [~J/IN,SULATION ~ [ ] FRAMING [ ] FINAL REMARKS: DATE OF NEW YORK STATE DEPARTmeNT OF E~IRO~FMNTAL CONSER~A~ AiM Building 40, SUNY--Room 219 Stony Brook, NY 11794 (516) 751-7900 P~RMI~ ~MENDMENT TO ~ '~ F~TENSION OF EXPIRATION DATE RE: Permit No. -FUr A ¢2. y - o/,.,,c q Your recemt requeet ~¢ ex~e~d the above perml~ has been reviewed purmuant to 6~fCRR, Part 621. iceham been determined that there ha~ not been a material chapge in envirommental conditions, relevant technolog~ o~ applicable law or regul- ations eince the issuamee of the e~ls~iq~ pe~it..therefore, This letter is am amemdmen~ to the original permit and as such, shall be at:aehe~ thereto, and a copy posted at ~e Job site. All other terms and ¢o~ltioos remalu -'~s written ~n the original permit. Very truly Y'9,rs~ Reg~,>nal PaX"~{t Admintstra~or OJL:¢z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Ex amineO-.4~.C. ..... , 19... '~'7 Approved~.~¢.. ?v ~. .... , 1~ Pc=it No./~.~ ~ Disapproved a/c ....................... ..~ ...... f .~ (Building Inspector) APPLIGATION FOR BUILDING PERMIT 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 plma 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 regulation_s, and to admit authorized inspectors on premises and in building for necessary in~ (Signature of ap201icant, or name, if a corporatio'N~w)-,~ .... //. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . . Name 6f owner of premises ~.'~....~'... ~. · .'~...~..~.~. ,,w..~d... ~.~q~. ............................... (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 ...................... I. Location of land on which proposed work will be clone...~.'.~ r."5 ./-.~..°.~... ~. -~- .~-~../..~..~. · · ~..~.~7.....~....~.~.~../.. House Number~/' ! :~C--O Street Hamlet d County Tax Map No. 1000 Section .... /..2-..Z.=. ........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/'~ ~'~'"' ~-- b. Intended use and occupancy ...-~..~..*'..~.~..~... · .'(7.."~..'~..".d:.°...'-~. · .'~.~.~..~'..'~.~. ........................ 3. Natur~ of work (check which applicable): New Building ......... Addition .......... Alteration .......... Repair .............. RemCval ............ Demolition .............. Other Work ............. ..~...~..,. ?.~..o. )~.:;/..~.C~' ~.. ..... (Description) 4. Estimated Cost .. ! ................... 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 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 const:ruction: Front . .. ~. ~. ........ Rear ... ~?. ......... Dept.h' .... P7.$. ......... Height ..d.~. ' ...NutnberofStories .~, ~..?~.,o,o~, .,~Zo~ ~,,..~..~..~.,.-? ..~".~...~. 9. Size of lot: Front .. -/~.~'.'~i ............ Rear .... /.~.~.,..O ........... Depth ....,~.~.~.: .~. ........... 10. Date of Purchase ff/(~.~..~'.~i ................. Name of Former Owner .,,~W~*,~.~rd':'.. ~,t~,~.$,~i' ......... 1 I. Zone or use district in which p~emises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . . .~5~.e'. ........................... 13. Will lot be regraded ........ ~ .................... Will excess fill be removed from~remises: , ,.~Yes No 14. Name of Owner of premises .' .~...,gq ..~.~.~....~-'~.. ....Address ,,~/..~.~.;z~... ~.g .°.~..~'. ff'~6~o~.~.~.g~.~. Name of Architect ~./~"&'.ff~./~?.~.~. .......... Address ................... Phone No ................ Name :of Contractor ~.. ~:~ ~d[4~..J'.'~. ........ Address . ...~.q.t~...~.~. ~..$L~...~hone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blocl~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF COUNTY OF~. ...---.. ~. ~/257L~. ,- .".Cg~Y..~...~-~.ff. ,.. ............. being duly sworn, deposes and says that he is the applicant (Name of individual sigiling contract) above named. He is the ........... ~cx~4-vcu~'~. .............................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to perform or have performed the said work and to make and file this application; that all statements cont'ained in this application are true to the best of his knowledge and belief; and that the work will be performed in the mann{r set forth in the application filed therewith. Sworn to before me this ............ q.~.~...day o! No~,tary Public, ..... ~ . ..:~.~ ...... ~~EV~ County i liOT~R PUBLIC, State of Hew York (Signature of applicanf) ~ I~O. 52-8125850, Suffolk i Term Expires March 30, 1~..7/ di~l~osal and ~ter for ~h~a location h~e R~ERICK VAN TUYL, P,e. L~CEN~O LAND Se~lbel ~ ~REEN~RT ~W Y~K SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. [~-~O-~-f~ · -' STATEMENT OF INTENT THE WAT£~ SUPPLY AND :SEWAGE DISPO$AL SYSTEMS ~FOE THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES (s) APPLICANT -'SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: ' H. $. REF. NO.: APPROVEI~: ' i~ ' RODERICK VAN~TUYL, P.C, 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 APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY DATE: H. s. REF. NO.. APPROVED: DIST. OWNERs ADDRESS: DEED: L. ~.~ ?~ TEST HOLE SEAL