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Home My WebLink About10494-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Date June 17 19 31 THIS CERTIFIES that the building ................................................ Location of Property ..... ~:5.1.5.. '.d.e. 1. ! .~..R.o. ~. qs ...... .P.e.c..o.n.t.~ ~.. ?.e.w...Y?.~.X. ............ House No. Street Hamlet County Tax Map No. ]000 Section . .Q86 ....... Block ..... 8 ......... Lot . .P./.Q..1 .,.e02 ..... Minor I;169 Subdivision. Geo. Wells Em %. .Filed Map No. .Lot Nlo conforms substantially to the Application for Building Permit heretofore ~ed in this office dated · .N..oy.~m.l?. ??, .~0. ...... , 19 .7.9. pursuant to which Building Permit No. 10494 Z dated . .N..o y ?.~ b. ? .r..2.6. .............1 ~ .9.., was issued, and conforms to all o f the requirements of the applicable provisions of the law. The occupancy ~r which this certificate is issued is ......... ~rivat~ One-~amil7 Dwelling The certificate is issued to ..... .H.~.n.r.y..P.t.~. r.,.c? ........................................ [owner,/e~ae ~teaa~ . . ~ of the aforesaid building. 6 / 1 '? / 8 l Suffolk County Department of Health Approval ......... 9.-..~ p..-. t. 0. '.d..i~.q b. ~.t~.%..~ :............V'[ 1 ~ a ?, :~, UNDERWRITERS CERTIFICATE NO ...... i~ $ .0.1.8.! .3 .................................... ',. :,. : : '-. {-.'t?. . . . :: Building Inspector Rev. 1/81 lrO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10~t9~1 Z Permission is hereby granted to: ..;~.~.!,v..~.~ ............. .~.!..,~:....E.c...~ ..................... ........ ?.L.....~.~..~., ....... ??..!!..o..~......~.: ,. 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 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 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 safew 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 or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date .~../?~../:.~../' New Building ............. Old or Pre-existing BuildiF(g ..... ~, ...... Vacant Land ...; ......... Location of Property ................................... ~..~.. .............. /~ ..... House No. / / ~ Str~t , / Hamlet . Owner or Owners of Property ......... .~.. · ·/.7. · - · · ............................. ~ ........ ............ n (~/-~~/ -'ock .~'~..~'.... Lot .~.~.~..~.../,6~.~ ~ounty lax ~wap ~o. luuu ~ec~lo ............... u~ ............. ~.~. ........ Subdivision ................................. Filed Map No. ,~/~ .... . ./L-jot N,o ............. Permit No ........... Date of Permit'~.~../'?. ~ :?:Applicant...~..~'.~. . Health Dept. Approval ........................ Labor Dept. Approval ....................... J Underwriters Approval ........................ Planning Board Approval ..................... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $..~.~...". ................... 9' ~ ~ /~ Construction on above described building and p~'J)~ mee. ts all.appJ~able codes and regulations. ~ ! Applicant......~...~.~:~..'~.: .............. i...~:.Y Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRIC-Ty ~-~ ~ ~. 1~0 85 JOHN STREET, NEW YORK, ~RK 10038 THIS CHRTIFIE~ THaT only the electrlcal equipment as described below and ~ntroduced by tl~ applicant na~ on the eb~ ~p/tcation namer in the premises t~ Piece, E/$ ~l~a ~d, 2,200 $/O ~ 25, P~c, N. Y. FIXTURE FIXTURES RANGES 27 20 DRYERS DISHWASHERS EXHAUST FANS SYSTEMS NO OF FEET E R V I C E PER ~' OF CC COND ~ OF HI LEG 1 ' 210 AWG OF NEUTRAL P. O. t~. 143 ~k%tci~, N. Y. 11952 L~, ~242 Th~s certificate must not be altered in any ~anner; return to the office of the Board if i. co~;rect. COPy FOR BUILDING DEPARTMENT, THIS may be ~dentifled by credentiqls Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD Town HALL, SOVT~OLD, N. Y. 11971 765-1802 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 E×amined ...... ?¢19 Approved .... Permit No, ./?,?, Disapproved a/c.. :~""~~~.%;.f..:Z' ': ....... ;2';":'; ............. j [- .~~ ~ APPLICATION FOR BUILDING PERMIT Application No. / .~.?.~..c.~. ....... a. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of tot and of buildings on premises, relationship to adjoining premises or public streets or areas, and g~ving 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. Upo~ approval of this applic~ation, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspechon 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 issuanc6 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 regulations, and to admit authorized inspectors on premises and in buildings for necessaryy?Tcuominsp ctions. (~9 (Signatur<4 applicant, or name, if a corporation) .~..o.~...~ .2., .~o. ?.~.~p.~. ~ .................... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ,/h,,./~. f.... ...'~ ............ J£,v,v-/~ d ,. . .~./~.~..c.~... ........................................ (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 ...................... 1. Location of land on which proposed work will be done ............ ...................................... .................. ,. House Number Street Hamlet County Tax Map No. 1000 Section .... .~..8.~ ......... Block ... ~ ............. Lot...~...o~.'...¢ I Subdivision ........... ~ {.~.//~,_ ff~F~ Filed Map No. Lot . '~f~-~ '~ ~ (~ ~l~ ................................................. (Name) 2. State existing use and occupanoy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................... ...................................... b. Intended use and occupancy ...~.~.5./?f..~.~.~ ...................................................... 3. Natureofwork(checkwhichapplicable):NewBuilding ~ Addition.. Alteration Repair .............. Removal .............. Demolition ............ Other Work ............... ~ ~ (Description) ..~..~ O. o o Fee 4. Estimated Cost ......................................................................... (to be paid on filing this application) ' ; / Number of dwelling u its on each floor 5. If dwelling, number of dwelling ¢nits ............... n ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... ...... f ny pth 7. D~mens~ons of existing structure~, x a : Front ............... Rear .............. De ............... Height ............... 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 . ...q.o. ...... Rear ...c/..° .......... Depth ...~.q..--, ....... / 7'Z ' / Height ............... Number of Stories ........................................ ~ ............... 9. S~ze' of lot.' Front .... ~.e. 9' . .i ........... Rear .... ~ ................. oo-* Dap. th . ./.~:f..~ 4V' ............. 10. Date of Purchase ........... i .................. Name of Fenner Owner ...//.~f¢.~.z?..~.. (4/./.44.~. ........ 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction,viol~te any zoning law, ordinance or regulation: ..A(.~. ............................ 13. Will lot be regraded .... .~Z'.4.~.I ...... t .....,~ ..... Will excess fill be removed from premises:_ ~, ~ _,_., No 14. Name Of Owner of premises ~..~.-i.~.~._~j .//.~.~../. ?.'7.zCe.c.~-Address ~/.~.-.,f4~.,~. Name of Architect .......... Name of Contractor.. ~.o.~.r~.I. i .~;c~;~.i. i ..... Address/~.¢~ .t~g~.~..~.p...~??.~.°.~?hone No2~.~. p.Z.O. ~. ..... PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block number or descrip tion according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK_ 'S S .......... ~7'-'~.~-,-Jq~.~ ...... [..~q.~.c,~,,~ ............ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. (Contractor, agent, corporate officer, etc.) of sai.d owfier or owners, and is duly authorized to perform or have performed the said work and to make and file this application; 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 manna? set forth in the application filed therewith. Sworn to before me this qlOrARY PUBLIC State of New Yor~ No 52-8125851), Su~lo[k Term [xDlres MarCh ~10, l§J.~6~ (Signature of apphcant) ,? ~he sewage dtsposaI and ~a~e~ s~p~ tns~ct~ b~ this d~artmen~ ~d fou~ '~ Se~i~eB o RODERtCKyAN TU~. P.C. ~ LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO HEALTH DEPT. APPROVAL h S. NO. 9-.<O- ~g STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS Of THE SUFFOLK CO. DI~PT OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES - fOR APPROVAL OF CONSTRUCTION ONLY DATE: APPROVED: SUFTOLK '(~0 TAx, MAP ~$1GhATtC)~: .... DIST. ' ~CT. ~ ' ~. DEED: L. TEST HOLE SEAL .. % ,.e, SUFFOLK CO. HEALTH DEPT. APPROVAL 'O ,.. .-~l H.S. NO. . · STATEMENT OF INTENT ~4~/ ~ trig waTgr su~uY aND s~wa~g ~' ~ SYSTEMS FOR THIS RESIDENCE ~ILL ~FFOLK 'COUNTY DE~. OF HEALTH CON.RUCTION ONLY /' . SUFFOLK CO: TAX MaP DESIGNATION: ~o~ o~ _ . '= .. ~t~: ~0 TEST HOLE ,, ~TAMP · ' RODERICKyAN TUY~ P.C , LICENSED LAND ~RVEYORS GREEN~RT NEW YORK LAWRENCI~ Id, TLITHILL Mr. Henry Feirae p~sidence l~ellS Road, ?econfC Design tsmperature Insids 70°F Outside I0°F Loss ~esign degree days 67000 Area BTU./H.~R Insula t .io_~u "U" -L1 .05 1,g75 Floor R-19 .03 2,160 3'880 l. mlls R-38 330 13, ?00 Ceiling .69 %~ndo~s (Dbl glasS, therma ) I~0 39 1,320 Doors oer code lvireolace (air leakage 20cfm% infiltration (VolUme) .018 17,2~0 52,260 Gl~ss 20% of wall area %~eatheratripping all ~indo~S aud doors ~ur~ce to be 75% min. efficiency F~te~ior duct and non.combustible docrS to be orovided for EireplaCe Heating a~d Service lines to be insulated as per code DoorS, Thermostat, Hot ~at~r Heater and Caulking as per code