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Home My WebLink About10936-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z..1.3.2.6.4. ......... Date March 15 , 19 85 THIS CERTIFIES that the building .... .N.e.w.. p.w.e..1.1.i.n.q ............................. Location of Property 200 Oak Wood Dr. Southold h3ds'o ~iol ....................... 's't/e3i ....................... h3Aiol County Tax Map No. 1000 Section . . .0.7.0. ...... Block .... 1.2. ......... Lot 019 X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .S.ep.t.: ..... .2 .6 ..... 19 .8.0. pursuant to which Building Permit No. 10936 Z dated Oct. 28 19 80, 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 ......... New Private One Family Dwelling The certificate is issued to FICKEISSEN, DENYSE C. ..................... ?o¥.'~;, ¥~¥~/~'~ ...................... of the aforesaid building. Suffolk County Department of Health Approval i 0- SO- 71 UNDERWRITERS CERTIFICATE NO. , N 524840 Building Inspector Rev 1/81 FOI~M ~0. 2 TOWN OF ~U H,O~ BuILDI NG ,D'~PARY~N"~ TOWN HALL SOUTHOLD, N~ Y. BUILDING P'E~iT (THIS PERMIT MUST BE KEPT ON THE PREMISIiS UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) Pormission is h,reby gra~t~d to: pBrsuant to ~pllcotion ~datod ................................................ · .. Bo[Iding Inspector, ...... · ,Buildin ¥ Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions 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: I. Accurate survey of pZOperty 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 2. Certificate of occupancy on pre-existing dwelling $15.00 3. Copy of certificate of occupancy $1.00 Date ......................... New Building /// Old or Pre-existing Building Vacant Land Location of Property .................................................................. House No. Street Hamlet .......... : .... ..... .................. Owner or Owners of Property ...... : ........ I~ ~:~,C J¢' County Tax Map No. 1000 Section 070 Block /~' Lot. ~ ~ Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo. /07'~(":;~ Date of Permit /O/P,~:/~-;~ .Applicant C~.,~,e.~', jo- 5o- 71 -- -- Health Dept. Approval ' .Labor Dept Approval Underwriters Approval ....................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..... $?.O. ? ................... Construction ,on above described building and permit meets all applicable ¢.~des and regulations. ' Rev. 10-10-78 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION []FRAMING j~lt~ FINAL / /' REMARKS. /, ,~--.__//~ ~-, ~ ~ ~ ~//~//~ , DATE //.. , . iNSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS [~ BUREAU OF ELECTRIC~ITY ~ 85 JOHN STREET, NEW YORK, NEW ~ORK 10038 THIS CERTIFIES THAT was examined on 'YqJq' ; ) * ~,~ and found to be m compliance with the requirements of this Board. FIXTURE I OUTLETS SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS NCANDESCENT FLUORESCENT 39 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME (~LOCKS MULTI-OUTLET DIMMERS SYSTEMS NO OF FEET SERVICE DISCONNECT S E R V NO OF CC COND A W G NO OF HI-LEO 3/0 OTHER APPAEATUS 1-G~F.C, l, AWG OF HI4EG NO OF NEUTRALS AWG OF NEUTRAL 3/O Peter Bogoxd. c So;~thold,, [,LL 11971 This certificate must not be altered in any to the off,ce of the Board if FOR BUILDING THIS lie. 137-.g may be ./ credentials FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Approved .... q/?~(~. ?..~.~f] 9 .~?. Permit No. /' ' 7 Disapproved a/c ....... _' ix). ~ .......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Application NO. / ~.C~.~].~. ~-.~y.: ..... Date .~.,~.~~Z-., 19d~.. 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 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 PermiL d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspectinn 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 herren 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 inspections. ~ -- . ..... (Signature o.f applicant, or name, if a corp~tion) . (Mailing address of applicant) ~r State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. >_ ............................................................................. Name of owner of premises~. ;'..-~Zii:O~.C -/~.-., .~..-./: .~ ~:. [.~..~.~..A,g .~ .~:.: ............................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. / :qz .................................... / (Name and title of corporate officer) Builder's License No .......................... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... Location of land on which proposed work will be done. &Z~ ?./.~...?.~.~.~(470~.D...: .~. ~.~../. t,//~r~./~A/. ......... House Number Street Hamlet / County Tax Map No. 1000 Section . ~ ~.~. ........... Block . ./.'.~ .............. Lot../.~ ............... Subdivision.. ~5~. iq. g .c?O.o.O. l) ...................... Filed Map No .............. Lot .............. (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... /ff.//./.~. ........................................................... b. Intended use and occupancy .............. ,-. .............................................. 3. Nature of work (check which applicable): New Building ..... Addition ......... Alteration .... ' ...... Repair .............. Removai .............. Demolition ............. Other Work ............... .O.~ ~. O 0 (Description) 4. Estimated Cost . . .~f.~..,~.~.~. Fee ................................... (to be paid on filing this application) 5. If dwel!ing, number of dwelling units... J..~.~./~../q~. Number of dwelling units on each floor.., i ........... If garage, number of cars ..... ! .................................................... ~; ............. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ../{/J~J.'. ............ 7. Dimensions of existing structure~, if any: Front..~e~.~. ........ Rear .............. Depth ............... Height ............... Num~ber of Stories ....~. ................................................. Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth .................... I.. Height ...................... Number of Stories ............. ., ........ 8. Dimensions of entire new construction: Front ....~,~..~ ........ Rear .. ~..~ ......... Depth . ~.c~. ~. ........ Height ............... NumBer of Stories . . . ~ .................................. :~ ....... '., ..... 9. Size of lot: Front ../.Q~. (... i' ........... Rear .... ~.~.~ ./. .......... Depth O~,, O~.~v, ~..~,, ~..~./.C .~'~.t.~ 10. Date of Purchase . .~J~.¢:../.71,~. ~. .............. Name of Former Owner .~.. ~/~i. ~.~:.~.~..~-}~ .4~..T'.: ..... 11 Zone or use .... ' ' ' . d~stnct m which premises are s~tuated ..................................................... 12. Does proposed construction violhte any zoning law, ordinance or regulation: . ~. O. ....................... 13. Will lot be regraded ......... ' ................... Will excess fill be removed from premises: Yes 1 4. Name of Owner of premises ~7..,..~.,..~.. ~C/~.'/.5.o~..~..~ff-d'dress .~-~L~7'~.~.x. .[~.. ~..o.:. Phone No. ~t~ ~..k/~.~Y~... Name of Architect . ..~: ~..~.c..~C~.~.~...., ,~.... Address ./Pgd.~.~..x?.~..,.~.o. ~...~Phone No. :2~. ~.-.~ .'7.~. / .... Name of Contractor ~ :,~.,i .,~.~.~.~.(~.5'.~.~.,~..~... Address ~?fi~.'.~.~d~'..~d/~: &{Phone No...~.~.-$ PLOT DIAGRAM Locate clearly and distinctly all i buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. Vh Chl?_l [ LL o STATE OF ,NEW YORK, :" ~."..."~.': ..'~.'?'.~..~-,~.',/i~,.~,~:'.,,~. .~.~.,:. . being duly sworn, deposes and says that he is the applicant (Name ...... of ~nd~v~dual s~gO~ng contract) above named. He is the .......................................................................... (Contractor, agent, corporate officer, etc.) of.said owner or owners, and is du~y authorized to perform or have performed the said work and to make and file this applicationi 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 manner set forth in the application filed therewith. Sworn to before me this .................. day o ........ , \ County ~ (Signature of applicant) I