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Home My WebLink About12520-zFORM NO. 4 TOWN OF SOUTHOLD' BUILDING DEPARTMENT Office of the Building InSpector Town Hall $outhold, N.Y. Certificate Of Occupancy No ...... gJ..~ ~,73 ..... Date .............. A, .~gq~...~.. ........ 19 THIS CERTIFIES that the building .... J~g~.o.~d. ~ 10.o.o, 1. ............................. Location of Property . ,300 .................. .W.5~_.o~.~..?9.i.m,~, .~.d.. . ...... Sougl~o3_cl House Ire. Street ........ County Tax Map No. 1000 Section ..... 5.~.. .... Block ...... .,~ ........Lot ...... Subdivision .......... ~ .................... Filed Map No .... ~ .... Lot No .... .~. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~T~. ~..., 19 ~3.~ pursuant to which Building Permit No ......... ~..~.2.O.~. ...... dated .... ~.~.3:.~..2.7. ...... , ........ 19 &~., 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 ......... ...... :~g~.o~4t..1~ o ~:k ........................................................... The certificate is issued to lv~'y' ~T~ of the aforesaid building. Suffolk County Department of Health Approval 608 33 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 FO~M NO. 2 TOWN OF SOUTHOLD BIJILDING DEPARTMEHT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE' KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) is hereby granted to: .~.~....~.~...~.~ ....... ~.&... ..~..~.~ ........ ~..,..~..., ........................ ..... ~~~....~ ..~ ~.&......~...~......~ .............. I'a ........................................................... : ............................... : ............. ~'"~ .......... ~ ............ ~'""'/,'"T' at premises located at .....~.~...~.~ ....... ~.~.~...~...~.~.........~...~..~ ....... ..~..~.~.~.~.~.~-~ County Tax Map No. 1000 Section ..... ,,~'~,.~ ...... Block ....... ...~. .......... Lot No....~.~.~ .............. / ~,rs,a.t to appI~ca,on ~ate~ ....... ~....~ ................... , 1~3..~,-- and a~roYe~ by the Building Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOU't'HOLD Building Department Town Hall Southold, 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. 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. C. Fees: 1. Certificate of occupancy $5.00 / Certificate of occupancy on pre-existing dwelling 9% land use $75'/ $5.00 2. 3. Copy of certificate of occupancy $1.00 Date .../~0~,~..,~. ..... /,??...~... New Building ............ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ......... .~,.1 '/J~w PoffO ....................................................... Hou,~e No, Street Ham/et Owner or Owners of Property .... ./~..1.0~..~ .....J.C~..Q.~.... ~..¢~.. 1~[ . · CountyTax Map No. 1000Section , . ..~-.-.--.~ .... Block .......................... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo./'Z,~,C)ZDateofPermit 7/.~.7/.~.Applicant' ~.0.~}~.,:~.~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ... ¥ .................. Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and perm~ regulations. Apphcant ~. ~ ~.~'¢/~//'4~ ............ Rev. 10-10-78 Sales Service Supplies A DIVISION OF DUNRITE MFG. CORP. $4-50 VETERANS HIGHWAY · BOHEM IA, NEW YORK 1'1716 Bohemia: (516) 588-1300 Hauppauge: (516) 265-0700 August 9, 1983 Tow~ of Southold Town Hall P.O. Box 728 Southold, NY 11971 Attention: Building Dept. Dear Sir: Enclosed please find check for $5.00 fer 'C,iO. for Groll, Point Road, Southold, NY. 300 Willow Yours truly, Enclosure ms ~!DATE COMMENTS ~SPECTION [ON (1st) rOM (2nd) RAME & PLUMBING . ' ..... [ON PER N. Y. rE ENEE~Z ~ODE ' rNAL · .. .,, , ADDITIONAL COMMENTS: FOUNDATION FOUNDATION 2. ROUGH 3. INSULATION STATE 4. Fib 1000 40 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy ~[~ J~y 6~ 1983 85 JOHN STREET, NEW YORK, NEV~2~/~O38' ..re A pllc..o,,No.o./i,e N 608433 THIS CERTIFIES THAT · in the following location; [] Basement [] 1st FI. [] 2,d FI. Section Block Lot was examined on J~ ~0 ~ ~3 and found to be ia compliance tvlth the r~quirements of this Board. FIXTURES RANGES OVENS EXHAUST FANS FIXTURE .'L DRYERS MULTI-OUTLET SYSTEMS NO. OF FEET E R I C E NO OF CC COHO. A W G NO OF NEUTRALS A W G PER ,~ OF Hi LEG OF NEUTRA[ ~a~mmisg Pool: Thts oe~tifie~te oove~ oc~plia~ce at ~he ~ate of i~peotiom only. ~ of u~msUal envimmm~nts it is advisable to ~ve frequen~ tesl; and/or repairs m~_de by a J.L,S, Electric Corp. 52 Vernon Ave~e N~stic~ N.Y. 11959 / · GENERAL MAN~AGER / [ · 11 Per { This certificate must not be altered in any manner return to the office of the Board~if incorrect ' nspect6rs may be r d~nt f ed by the r credent a s ~J~ COPY ~FQRtB~ILDiNG DEPARTMENT TH S CORY OF CERTIF, IOATE MUS~ BEuALTEI~ED IN ANY MANNER. .. --~- .= TOWN OF SOUTHOLD BUILDING DF_PARi'MENT TOWN HALL SOUTHOLD, N,Y. 11971 TEL.: 765-1803 ~,xamined i ~, .~r ~*~.. '~' *' . .~-~ .., 19.%.~. ~,pproved . ;~.~.., 19'~ ~. Permit No..1 .~ .~..a.a. ~. )isapproved a/c ..................................... Application No,,. }. '.bt .~7. ~ .o. ..... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building ~nspector, 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 promises or public streets )r areas, and giving a detailed descfiptiou of layout of property must be drawn on the diagram which is part of this appli- :ation. c. The work cove~d by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit ;hall be kept ou 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 ;halt 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 /~uilding Zone Ordinance of the Town of Southold, Suffolk County, Ne~v York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. l'he applicant agrees to comply with all applicable laws, ordinances, butlding code, housing code, and regulation% and to ~dmit authorized inspectors on premises and in buildings for necessary,insI~ections. , o pp nt, or n/a~e, a corporation) 300 Wi~llow Point Roa~d, Southold NY 11971 .: ,~ (5,~ailing address of applicant) grate whether applicant is owner, lessee, agent~ architect, engineer, general contractor, electrician, plumber or'builder. Owne~ qm~x¢ of owner of premises Frederick & Mary Jane Groll (as on the tax i'oll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .... .3.5.8.5..H.I ..... .1%.1 ....... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of land on which proposed work will be dtxle'5-.~ .~..~_~_~l?w..~.qS:.n.h .Rd. ............. 224 73' East o~ B //~(~ House Number Street.~;'"'-~ : ~ jlam~ County Tax Map No. 1000 Section .... _p.5.6 .......... Block .. ,5. .............. Lot...3.1. .............. Subdivision ....... ~..~../. .... .~.~.. FiledMapNo..~.& .~...-~..~.. Lot ...2.7 .......... (Nmne) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....1..f.a.m.i.ly..r.e.s.i.c.t.e.n?.e .... 'I;:;~ ~ .~7~ .": .~;')~ ,;'.l .,~??:~J!.:~? ..................... b. Intended use and occupancy .3.nqround vJ. nvt :operty linels. Give street and block nhmber terior or comer lot. Nature of work (check which aplaiicable): New Building ......... Addition .......... Alteration .......... Repair RemovM ' Demolition Other Work ~ ' (Description) Estimated' Cost g6O0'-O0 ~ (to be paid on filing this application) If dwelling, numberofdwelIingu~its ............... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................... ' ' of each type of use If business, commercial or mixed Occupancy, specify nature and extent .................... · ' ' ~ Depth Dnnensmns of existing structures if any: Front · Rear Height ~ .............. Numb,er of Stories ....................................................... · " structure with alterations or additions: Front Rear Dnnenslons of same .................................. Depth ..... . ................ i. Height ...................... Number of Stories ..................... Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Numbler of Stories ....................................................... Size of lot: Front ....... i i1,,00:!00.I ..... Rear ...... 95 ": ........... Depth ...... 1200. ........... Date of Purchase ..... ~ ........ ~ ..... Name of }~ormer Owner .......................... Zone or :use district in which premises are situated....,., .............................................. Does proposed construction violate any zoning law, ordinance or regulation: ............................... W'II I t b ~no ............... ' fill b ed fr Y No ~ o. e regraded .......... i Wdl excess e remov om premises: es Name of Owner of premises .. F~,der:Lok' ~:o{tl ' · · Address . 3aO '!~ill. ow 'I~t: · ~d' · Phone No .... 765--3070 .... Name of Architect ... ,'~. Rub~aet~n .......... Address . J.e. l~x,ek .P~h.pl,,l~'~ No .... ovl~33:l,a .... Name of Contractor ... Dunr:Lt$. Pool~ .......... Address . :i4-,$O .V~t~xans .l~w,yPhone No .... 588.,~300 .... Bohemia NY PLOT DIAGRAM' Locate clearly and distinctly all build/ngs, whether existing or proposed, and, indicate all set-back dimensions from or description according to deed, and show st'feet names and indicate whether rATE OF I~IEW YORK, S.s oubrrY OF ..... sm'n ..... ...................... 9 .J' ./' .f .~9~ .d..Ba..t .e .h~..a~. ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) oove named, .e is tl e .... '. ........ -.e. qe, 9 ,% .............................. ................................... (Contractor, agen[; corporate officer, etc.) f said owner or owners, and is duly authorized__tg.perform or. have performed the said work and to make and file this pplication; that all statements contained in flil's applidM[on are true to the best of his knowledge and belief; and that the' .,ork will be. performed in the manner set forth in the application filed therewith. worn to before me this .... . .......o~. ~. ......... day of; ~%..-,~ ............. 19... (otary Public, ....~4..~. ~jC~[ Fl;. SARU[.. ~ . . , NeTARY PUget0, State Of New York .~...~'~... ....... .~. ...... ' ' No, 52.345582.0, Suffolk , u-o , kbigna~ure oI applicanT) ' COmmission ~xp,'es ~arch 30, 19:0'0 ,, THE Y~ATER SUPPLY SUFFOLK SUFFOLK I~EALTH SERVICES FOR APP~ROVAL OF i ~_ONSTRUCTION ONLY co DATE: I N.S. REV. NO n~ ~o- ~ ' A~ROVED: DIST· SECT OWNERS ADDRESS: dEED: L. t~'/,,~ TEST