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Home My WebLink About12166-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall 5outhold, N,Y. Certificate Of Occupancy No, 211687 Date . .N..a. ¥..2.3. ... 19 83 THIS CERTIFIES that the building . ~ew. D~ell~.~g ................................ 4322 Westphalia Rd. Ha~ituck Location of Property ............................................................... House No. Street Ham/et County Tax Map No. 1000 Section . .! .fl .~ ....... Block ..... ? ......... Lot 9. d Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~ .e.b?.~.a, .~r...fl. 7., 19 .~.~ pursuant to which Building Permit No.. q 2.q6G7, ............. dated ....FI.a.~.o..h..'1 ................. 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 ......... ............ ~.97..~.. 9.~.e. .~..<m.:q.z.~, .d~e..z.z~.q~ ...................................... The certificate is issued to Rober~ Johnsen (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval d ~-s 0-23 U~DERWmTE~S CErTiFiCATE NO...~.~.q .2.¢.9.5 ....................................... Building Inspector Rev, 1/81 BUILDING BUILDIN~ (THIS PERMIT MUST BE KEPT ON THE ~ AUTHORizED) COMPLETION OF THE WORK :12166 Z Pen nissioh is hereby granted tc~ tQ ..~ ......... ~ ............................. ~:~ IW T~X M~p No. lO00'~$ection ..,.....*.....¢ ....... lant ~0 application 'darL'cl and Opproved by the FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewr]ter 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-(Sg 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 Pianning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conformh~9 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. Ddte of any housing code or safety inspection of buildings or premises, or other pertinent inforrr.]m tion required to prepare a certificate. ~ C. Fees: I. Certificate of occupancy $5.00 o~ 2. Certificate of occupancy on pre-existing dwelling land use~l~'' 5.00 3. Copy of certificate of occupancy $1.00 New Building . .~.~/.,4/ Old or Pre-existing Building(X) ......... ~ ZVacant Land House No. ~,~ Street ~ 'Ham/et Owner Or Owners of Property ~: ,~ i~ ~ c~ ,? County Tax Map I'Jo. 1000 Section ..............//?) Block ........................ O ~ Lot Subdivision ................................. Filed Map No ........... Lot No .............. Hea th D.pt. Approval 'ff. Labor De Approval C.. Underwriters Approval...~.. ~ ~ ~-...~/. ~.5. .... Planning Board Approval . .-'7. ............... ~.., Request for Temporary Certificate Final Certificate .. .' .... and regulations. Rev. FI~L~ '~NS?ECTION COMMENTS FOUNDATION (~st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: [oo~o71 THE NEW YORK BOARD OF FIiRE UNDERWRITERS I-IS BUREAU OF ELECTRIC~!TY~ ~-- 8~5 JOHN ~TREET, NEW YORK NE~ ~RK 10038 THIS CERTIFIES THAT was examined on ~y 9, 1983 and found to be in comella~ce with the requiremeats of this Board. -- FIX;Oaa RXTUg~5 EANGES =o~klNO oaCKS OVENS DISH WASHERS ~XHAUST FANS 21 28 23 21 1 ~1.7 1 1.2 2 F DrY,rS FURNACE motors ~utu.~ APPLIANCE FEEDERSPECIALREC'PT time LOC.S ~m UNItHEAtl. S 3 F [ 30 SERVICE DISCONNECT NO. OF S E ~ :~V I C E 1 150 CB x 1 1 1 1 ~ __ ~b~rs: t~F. 1-G.F.C.I. : 1-~m~ ~eetor G & ~ P. O. B~ 215 ~ ' This certificate must not be altered in any manner return to the office of the Board 4f 4nc~trect. Inspectors may be~ idenhfl~B by/their credentials. COPY F~J8~ U LDiNG DEPARTMENT FORM NO. 1 TOWN OF SOUTH~Lp BUILDING DEPART~I~[~JT TOWN HALL; $OUTHOLD, N.Y. '[1971 TEL.: 765-1802 ( uilding Inspector): ..... i APPLICATION FOR BUILDING PERMIT Application No. f~ / .~ ~ INSTRUCTIONS a. This application must be completely filled in by typewriter.or in ink and submitted in triplicate to the Buildi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee accord!ng:to schedule. b. Plot plan showing location of lot and of buildings on premise~, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must fde drawn ou the dia~am which is part of this ap[ cation. c. The work covered by this application may not be commenced befbre issuance of Building Permit. d. Upon apprcval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern shall be kept on the prenlises ava[lable for inspection throughout the Wot;k. e. No buildiug shall be occupied or nsed in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department fo} the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town 'of Southold, Suffolk County,.. N6w York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, buildi~de, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary ii~s. ..,,. (/-~¢'¢~. ~.~~./Z~/____~ ............. (S~nature of appfii~cant, or name, if a corporation) · ......... · . (Mailing address of.applicant) '- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrici/ln, plumber or bnitd~ ....... .~.~..t~...~..~..~ ................................. ;.. ..................................... Nmne of owner of premises .../~O. [e.,~.~.... ¢~..~. l~..~ $ ~4. ................................... (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.. o~.~h. .~ ................. Plmnber's License No, ./4~ t'~./¢~.. .............. Electrician's License No.' ~..o. ¢. ~.ed~.e9.& ....... Other Trade's License No ...................... l. Location of land on which proposed work will be done ................................................ ...'¢-. A .¢.;L,... ,:--. .0. ,,7:.,' ............... House Nmnber Street Hamlet County Tax/vlap No. i000 Section ........ //~. ..... Block . .O. ~. ........... Lot..(~..~.,/. ....... Subdivision ..................................... Filed ~la~ No ............... Lot .............. (Name) 2. State existing use and ~ccupancy ~f pr.emises and intended use and, ~c~upancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy . . ..&/CZ %¢g..~..~. ............. ....................................... b. Intended use and occupancy .'/ ~ ' ' L Nature of work (check which applicable): New Building . ./ff..,5:... Addition .......... Alteration .......... Repair ......... Removal .............. Demolition .............. Other Work ............... , (~.?~ (Description) ' Estimated Cost ............................. ee ................. -~ ........... (to be paid on filing this application) ;. If dwelling, nmnber of dwellingiunits .... / .......... Number of dwelling units on each floor ................ If garage number of cars ~ h If business, commercial or mixe'd occupancy, specify nature and extent of each type of use ..................... Di si f itl ~s, ifany F .... Re D pth / men onso exs ngstmctur : rent.* ........ ar ........... e .......... Height ............... Nun~ber of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ~ Rear Depth ' Height Number of Stories t. Dimensions of entire new consth~ction: Front ... ,~.~ ........ Rea[ .. ,J"7~'~ ......... Depth .~,,~ ~ .......... Height ..... ~.O. ....... Number of Stories ..... ~./~,e ~..~.q,4....~... ' .................. h Size of lot: Front ..... ~. ?.7,~ .¢g' ......... .Rear. ....'/'Y'7'" '~'~ ........ Depth .. ~. ,.~ ............... ). Date 6f Purchase .../¢.~ ;Z- .............. Nra'ac of Fenner Owner . ~ .]-ff.q ,~ o ............. I. Zone or use district in which pr~mises are situated.., i/~...~ ........................... ". ................. 2. Does proposed construction vie'late any zoning law, ordinance or regulation: .~.o ............................ 3. WilJ lot be regraded .... .A ..o. i .' .................. 'Will excess fill be removed from premises: ~ No L Name of Owner of premises .~,~ ~.e~/."*-. ~T~.b #.a~Address .~.~OO. S~.~4t~'¢~/~'6ne No..~7~..5~..]].~.-,-~..... Name of Architect ......... ~ ............... '.. Address ................... Phone No ................ Name of Contractor ! ! Address ! ~ Phone No ~ ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from roperty hnes. Give street and block! number or description according to deed, and show st eel names and indicate whether ~tcrior or corner lot. Ir, s.s ..... ~. ~O.b.~ ~..~ .h,b~%~D ................ being duly sworn, deposes and says that he is tile applicant (NaMe of individual signing contract) ~ove named. is the . . ........................................ (Contractor, agent, corporate officer, etc.) said owner or owners, m~d is dtfly anthorized to perform or have performed the said work and to m~e and file ~is )plication; Omt all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork w~l be performed in the rammer set forth h~ the application filed therewith. woru to before me this ............ .ty / O~I O/ ~ -~ '~ ~'~ ~~///'~1~'o~b ~. ~rm~r'~ / , or ~- o.~.~;o.~ ~~.,o ~o~ o%,,o / ~BE~T JOHNSEN SUFFOLK COUNTY DEPART~NT O~ ~LTH SERVICES DATE_~~ ~ ~bTH~IZED ALTERATION O~ ADOITION ~ SU~V Y ~ A VI~.*TION ~ SECTIO~ T~09 ~ TH~ HEALTH DEPARTMENT-DATA F~ APPRO~L TO C~ AND ~ Ht~ BEHALF ~ THE TITLE C~P~Y, GOV~N- "~E~ A~ ~ ~LL'~: WITHI" I00 FEET OF T~ PROPE"TY INSTITUT' . GUARANTEES ARE ~T T~SFERABLE TO A~ITI~AL INSTITUTI~S OR SUBSEQUENT ~..i. oA.i ~Y '" ~'//~- j~j YOUNG & YOUNG ~O~.O~.*V~RiVER~AD, NEW YORK ~0~ .' ~ : ~O~N~ ALDEN W. YOUNG~PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S. UCENSE NO. 12845 HOWARD W. YOUNG~ LAND SURVEYOR ~ ~ L~Ta ~ ~L(WI,~IC TANKJSTJ& CE~OLS(~) ~N ~E~ N.~ S. LICENSE N0.45893 ~E ~ FIE~ ~TI~S K OR DATA OIT~O F~ ~H~RS ' , ~ , , Lot 3 ~ Lot 6 Lot 7' 6olgOr~° forr~erW 17 /~reO; ~oP:~9 s. f' /o ~. ooW ~ formerl~ of 4- peOO~ The sewage dc spo~al ~-,a ~,,tev supply facilities for th' . ' ,~,ttoD h&v~ been Inspected by this dopnrt.m~t ~d fO~d to be sattsfacto~,.,- ~' Se~ioes HEAL~ DEPARTMeNT-DATA F~ APPRO~L TO C~STRUCT AOORE~ FOR ROB£R? JOHNSEN AT .M~TTITucN suFFOlK COUNTY, NEW YORK APTS. ~9, /983 DATE: FEB. SCALE: I : 50' NO. 83 -GG OWNERS i'i N OIST~NC~S SHOWN HE~EO~ FROM PROPERTY LINES YOUNG a YOUNG ALDEN W. YOUNG, I ROF ESSIONAL EN(~ AND LAND SURVE~ )R I~ .Y.S LICENSE /~ HOWARD W. YOUNG,~ LAND SURVEYOR N,Y.S. LICENSE N0.4§893 ALDEN W. YOUNG~ PROFESSIONAL ENGINEER AND LAND SURVEYOR N.Y.S, UCENSE NO. 12845 400 OSTRANDE R AVENUE RIVERHEAD, NEW YORK J