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Home My WebLink About10948-z FORM NO.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold,N.Y. Certificate Of Occupancy No. . .Z3PA64. . . . . . . . Date . . Janu8rY. i?.9 . . . . . . . . . . . . . . . . .. 19$?. THIS CERTIFIES that the building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Location of Property .5785 . , , . , . . . . North Road to Hayviex Southold House No. Streef Ham/et County Tax Map No. 1000 Section .879. . . . . . . .Block .03. Lot 042 Subdivision . .Bayxooda, Estates . , , , . ,Filed Map No. 5520. : . .Lot No. 22 . . .. conforms substantially to the Application for Building Permit heretofore filed in this office dated October 27 1988. pursuant to which Building Permit No. 19.9.4 82 dated . . October .28. . . . . . . . . . . . . 19 $8,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 . . . . . . . . . a private ons-family dxelling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The certificate is issued to . . . G. and Ruth O'Brien . . . . . . . . . .(owner+I;m6* ►tela. . . . . . . . . . . . . . . . . . . . . . of the aforesaid building. Suffolk County Department of Health Approval 10-90-76 5/12/81 l Robert A. Villa F.E. UNDERWRITERS CERTIFICATE NO. . . . . . . N ,517.332 . Building Inspector Rw.1/81 TOWN .0~ soupcon. ~~ · ~ TOWN HAL~ SOUTHOLD, N~Y. BUILDING PE~IT~ ~ j,~(THJS PERMIT MUST BE KEPT ON THE PREMIsE, s UNT L~ULL COMPLETION OF THE WORK AuTHORJZED) : No. 1'0948 Z Rev. 6/30~80 Permission is hereby granted to: ... l~.~..0.'.. CL~-~u...XTC/,~....+.C.. ............ · ....... ....... ~o .....~.~aa~r.....~...rT~.t.C.¢.....~zgx~.....} ............. , .......................... . .............. ;...~ ...... , .~. . ....................... Co~h~ r~x ~p ~o. ~ooo s~t~o~ ..G.Z~. ....... , mo~k ~.~ .X .......... ~[ot ~o..,~:~ ....... pursuant, ~0 application dated . ~::,..,~ ~ , 19. ~ and bpprova by the BuliSIng J~spe~or. ; ~ FORM NO, 6 TOWN OF SOUTHOLD Building Department Town Hail 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 bu{[dings 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. B. 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 unusuat 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 prernises, 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-ex st ng Bud ng(:~) ....... =/Vacant Land . , Owner or Owners of Property .......... ~:~ .... : / ................................ County Tax Map No. 1000 Section ..~.~.~ ...... Block ...~.~ ........ Lot.~.[/ .......... Subdivision ..... ~ ........................... Filed Map No...~. ...... Lot No.. ~ ......... Unde~riters Approval..~ t~/..¢. ~.'~. ~ ....... Planning Board Approval ................ ~,., Request for Temporary Certificate ..................... Final Certificat~ .... ~ ......... - Fee ~ubmitted $ ............................. Con,true,ion on above d~scribed, bu,ldin~ and ~~c~n~e~)~... THE NEW YORK BOARD OF FIRE UNDERWRITERS ~ Z~, ~ , YORK, ~R8~0038 ~,~o,,~o.o,.~,~ N 517332 onty the e~et~n~ a~r{bed be~ and introduced by the appliea,~t named o. the above application number in the premises of was examined on and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS EXHAUST FANS DRYERS FURNACE MOTORS APRLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLE1 DIMMERS SYSTEMS NO. OF EEET SERVICE DISCONNECT S E R , V I : C E NO. OF HI-LEG OF HI-LEG 1 Smoke Detect:or 1-4.5K~ Rul~d Elec. P. O. Box 143 Mattit~J~k, N. Y. 11952 Li~=~242 G~NE4AL MA~,R This certificate must not be altered in any manner; return to the office of the 8oard if incorrect. Inspectors may be identified by their credentials. COPY FOR DING S COPY OF CERTI NOT IN ANY MANNER. FIEI,D~ INSI~ECTION DATE COMMENTS FOUNDATIOM ( ~ s % ) ~-' F0~ATION (2nd) PL~BING / ' / '' INS~ATION P~ N.Y. - ' STATE EN~GY / co ¢ , ~DITIONAL COUNTS: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .~..~..~.... ,~..~., .................. ,9.,.~..~... ~proved ~...~,~. ................ , 19~,, Permit No. ,~,~,~.~..b~ ...... / Disapproved .......... ;~.~ ......... ~.....~ ................................. ,~. ......................... ............................. F~;~ i~g;i ................................. Application No. ,/,~,, ,~,,¢¢/,,,,,~,, ............... APPLICATION FOR BUILDING PERMIT Dote ............................. /.~/~/..~..~...,., INSTRUCTIONS 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 lot and of buildings on premises, relationship to adjoining premises or public streets oF areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. 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 issue o 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 regulations and to admit authorized inspectors on premises and in buildings for necessary i~-~pections. . . ..... .......................... 'f~;;;;';T;G~ii;;';fi .................. 7 ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................. ~..~.~.!.P..~....~' ~ ........................................................................................................................ Name of owner of premises ..... .~.. ~- ......... ~...! ............................................................................................................... If appl cant,4~a corporate, signatu~of duly authorized officer. (Nome and title of co.orate officer) Builder's Lic~se No ..................................................... Other Trode's License No ............................................... ~ ~ / ~ ~ 1. Location of land on which proposed work,will be done. Map No.: .~.~(.~..~. Lot No....~.~ .......... s,~ ~,d ~u~b~ ....... ~..~ .... ~..~.~ ........... ~.~ ............... ...L. .............. ~b,.<~¢..~t~ ........ Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and ~cupancy ....... ~ ............................................................................................ b. Intended use and occupancy ...... ~ .......................................~....J.: ....................................................... 3. Nature of work (check which gpplicable): New Building' I,~ Addition Alteration Repair .................. Removal Demolition.., ....... ' .......... Other Work ..................................................... .................. '~ ~._~_/f (Description) 4. Estimated Cost ¢5 ~..2,~. o Fee .7.~..~/~''~ ........................................................ ..... ..... ,(to be paid on filing this application) 5.If dwelling, number of dwelHog units .....0..~..,,,L~_-~'. ........... Number of dwelling units on each floor ............................ If gaiage, number of cars ....... ~.....~.~ ................. 6. If bu, siness, 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 ............................ He ght Number of Star es ................................. Depth ............................................................ · 8. Dimensions of entire new construction: Front ...... ..~.~.'....~-../( ............ Rear ,....~....O../....~..?. ........ Depth ,.~..~.. ............... Neight /.~. ... Number~,f Stones ....~:)/.J. ............................................ ~. ............................................. ~ 'v ........ , "~" ~ '"'~' ' ~., "~ ',). J) ~ .,,. De th ~...~ ,~ J,,,,~', .... rron~ ~..~....~,.... '/' ......... ' ................... P~' ................ 9, ,~]ze Ot lOt: ................ ~,~ .,,~_, j~,-'~;4n, ............................................. 10. Date of Purchase ........... ~:/~/.I...../..I[1~.'0...? ............. Name of Former Owner 11. Zone or use district in which premises are situated ................................................. .,,~']'g ......................................... 12. Does proposed construction vipl,~e any zoning law, ordinance or regulation: .... z..-: .......................... ~-~.~ ............. 13. Will l'ot be regraded ....~..~ ............ Will exc~.ss_fill be removed from premises: ( ) Yes ( p re mises/f_~. ~r ..~.~...~.. ~..~...z.~...~....,, .~...'.,~...,~..y : / ~c~J Address"/'b//P'~]("/-'e~ )~J~) Phone No "'~ ~ ~,~.0.,%..~.~..~ ........ ome'af Owner af · ^4., .... . ........ ¢ ...... Phone No .............. ' . Name o' Architect ....,~..~ ...... Name of Contractor ..~..1~.~....~....~..~'~ ·..~..dx~.~.4t.v.~. ~' A°/~ress~'~"/'"'~' ~' "~"/' .............. Phone I~o~ ....................... : '"7 PLOT DIAGRAM Locate clearly and distinctly al:l buildings, whether existing or proposed, and indicate all set-back dimensions frqm property lines. Give street and block number or description occording to deed, and show street names and indicate whether interior or corner lot. i S'FATE OF NEW~~.~ _S.S COUNTY OF ~.~.~x'/4;.r.!,'%:... ................. '.::...~~ .~..J......~.., ~/.~/...~.:.,,~.~...~'.!, ......... be ng duly sworn, deposes and soys that he is the applicon! (Name' of individual signing contract9 above named. ~ ~, ~,,, , the ..(f,~...~., ~ ........................................... ~.i ............. ............................... " ....... He is .................... ............... , ..... (Contractor, agent, corporate officer, etc.) ' of said owner or owners and is d~ly authorized to perform or. have performed the said work and to make and file this appl cat on; that all statements contained n this application are tr~ue to the best of his knowledge and belief; and thor the work will be performed in the 'manner set forth in the applicatibn filed therewith. Sworn to be/~e me this ./~ ~/ ....... ........ Notary Public ~ .~ ounty .................. ......... ............ ........................... ,IUDITtl T. TERRY Notary Public, State of New York No. 52-0344963 Suffolki Countyr~// Commission Expires March:30~ Z~/ SUFFOLK CO: HEALTH DEPT AP PROVAL is H. S. NO. G(7. ' 1 STATEMENT OF INTENT II .. :.`G.fk` V�t�'. �' D F i.J�.:.. THE WATER SUPPLY AND SEWAGE DISPOSAL F • ti 1 C I r SYSTEMS FOR , THIS RESIDENCE WILL i CONFORM � T STA QAR S 'OF THE 7'3� SUFFOLK GO SERVICES i LiJ f 3 fis r If$' r �� b�t'vI .I• APPLICA T w E P'le . SUFFOLK COUNTY DEPT. OF HEALTH SERVICES . FOR APPROVAL OF CONSTRUCTION ONLY .. .:. a / DATE: —2�t—FfO H. S. REF. NO.:ibo r APPROVED' p � /, V SUFFOLK CO. TAX MAP DESIGNATION: 6 <} � DIST. SECT. BLOCK PCL GM 719 4` a A iV �J OWNERS ADDRESS: Y�� • 7 O'Bfd1l3FM 1, Z92 RED MAPLK DR. 86. Y wA1+ItA8tt, W .Y. 11`193 a t 'ZCJ '`tet t39,99 5Q �!2 riZf� r _ DEED: L. H P. K i j E".t%EA` ,J �t TEST HOLE AMP he' T P RTZED a 1 - 4ISSURVEYI5 OAAAVIOIF.TIION O 01 F ION O <VA C A A'T'1 I � FCT Tzcs c T,- new Yo=:STATE ,It DUCATie iy AW. .Y -,. . . x -._r. OFLC p. REA0.p113 HL it GP. •. V: I. 10:1. r a q' J .:bM ClOKA1 Lha.':C.4>rf5 ON SUbbPMAB OF,aKy .W1� ,.,0D$ Ti Y SEAL IAM. •s�5'— «E Fy✓ 1 R y. . �`,!e.Y „ • � �. Sys �g WYE &C> G r t !ER VA TU11}.,•li. ti1411VIH JU I NdW.12l wdN /�y� Q� LAt(D SURVt O*S r-. s+ `ir' 4 ,', ai ^` x } $•i „ rx �`.' , a ,"g x`,k NEWYORK, .i ON - �i. ... :•. s 'der• � f: �Ji �':.. •� 1l. ,, t .` Y .:,.. _. r �+ z¢, � h>as�. -.wA...G- •^�+z/t,�? - _ .. _ .... L. _ _ _. _� �.�,.. $;....... «. r~ o :z z <.'.) �W. P ��- OCCUPANCY OR Aspr_, riLT ? Uc> p - -- fIIs SII C"RTFICAT __. MillE Eli_y : 4T ..-_ t EkT N- 6 � .._ CLOAft SM r17,. ^.T� 7I, I TI L� 4.Art 1 ( I fx II I I V �I✓� [2NIS-@6tnn1"aa �lT wsp.c;Il0 .a,5a �iP�Rcb, V�a�rs_ Ib136'- =1rP�Su ln3en _ —. I .- . .. � -- - LVl I I �.i .- - ._ --- - - - } g(�5ri m�F w'W�'pw.St nc��e EXT.uF�NS I $ 7,n -1ti SPSu� �a R. 5f, „or+ ,N CCrI SNL , -[3 ErT Wwbts R�71 ia � ?0'r _ orbF4 N.� ST � -` ''r"'.rc� a;I l3jAT 1 0 KI ¢ar,��Y.�a� - -_-- - I ::--- 1, ---' "— '—� 7s5K?4-LEY VED AS NOTED DATE: ¢ NOTIFY BUILOWG DEPARTMENT AT 765-1862 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. FOUINUATION - TWO REQUIRED REU CONCRETEFOR 1 7- ROUGH - FRAMING & PLUMBING 44 P . (P tl -- FIIM,'�P _ CONSTRUCTION MUST, I _ BE C-3MPLETF FOR C. 0. _ p ALL CONSTRUCTION SHALC MEET THE RjEQUIREVENTS sT� ONSfRUCT ONF & ENERGY f - Com, NOT RESPONSIBLE FOR SIGN OR CONSTRUCTION ERRORS. P I r I tt r� I a ,a �'r cr noun cbl �D w rpuER h I , U . ) 3'!a' lA4LY ICtiL. 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