The URL can be used to link to this page

Home My WebLink About11525-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No .... 74'1.~ 662 ...... Date .............. MaX..~.6 ............ 19 85 THIS CERTIFIES that the building .. ~e.~ .~.2].±z~ ............................... Location of Property .... '1030..Gour~tr7. .O. lub. ~e±¥~ ............ .Qu~;eb, ogue ......... House No. Street Hamlet County Tax Map No. 1000 Section .... '109 ..... Block .. 0.5 .......... Lot .. 2.: .13 ........... Subdivision...c.o.u.n.t?. ¥..c.~. u..b..~.s..t.a.~?. ..... Filed Map No. 6. 7.3.6 .... Lot No. 22 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... I)ee.ember..23 .... ,198.q. pursuant to which Building Permit No...q.q52.~g ............ dated.. .... December. ....... ..............29 198.?., 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 ......... ~or a One ~amily Dwelling The certificate is issued to Jolm~ G. & Mariozl H, Smith ..................... i g ~.'e;, '~;i~ ~r'~b;d~) ...................... of the aforesaid building. Suffolk County Department of Health Approval .! q..".s.°.'7 '/..}.6.,...9 ./.~.6./..83 . ~ ? ,b.t. :..A....V.i..1.1.a., UNDERWRITERS CERTIFICATE NO... NSSq 544 Building Inspector Rev. 1/81 FORM NO. ~ TOWN ~OF~ SjO~UGL~ BUILDING TOWN ~HAU. SOUTHOLD} N~ Y,~ .U,LmNG, (THIS PERMIT MUST BE KEPT ON THE PRE/~IISES UNTIL.~ULL cOMPLETION OF THE woRK AUTRORIZEDi ' N? 11525 Z Perr~issior is hereby granted to:~-- .... '~-;-i ~ ~ ....... ....... ....... : ............ ;.~, .~ ................. ~ ........ ~ ~ ~ /~'"~ /~ ~ ~ ,o.. C.~.~.~Tc~....~.....~m~z~..,...~m~Z/~ ...................... ~ ~o~,~ ,o~o~ ~ .~.~.....~:~.-~ ~.....~ ............................... ...... , ......... ~ ............................................................. ~ ............. ,., ....... ~.~a~._..,..~.-~.. / ~ :... ~~_ - .. ~~..C~. ~~...m.~7~... ?..?...~ ~ ....... .~.~ ....................... c~h~ r~ ~op ~o ~ooo s~t~o~ ..... ~.~..~...: ~ ~....,....,.~ ~Cot ~o.~..z.~ .......... Bb~il~lng I~spector. -~/ Fee ~$ ./-~.. './- .~'... FORM NO. 6 TO~N OF SOUTHOLD ,Buiiding Department Town Hall $o~thold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and ubm~t~ed m duphcate to the Budding Insp~,~ tot ,,wth [he following; for new buiMings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or to0ograohic 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. Submi[ Planning Board approval of completed site plan requirements where applicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings ahd ...... land uses: pre-ex~sting 1. Accurate survey of peoperty showing all property lines, ~reets, 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. / - Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3. Copy of certificate of occupancy $~.00 ~/Z Date ..... New Building .... ,~ ...... Old or Pre-existing Building(%) .. ........ :/Vacant Land -. ........... Owner or Owners of Propert · - - ¢ .... V~.~ c ~ ...................... . Health Dept. Approval . ; .......... Labor Dept. Approval Unde~riters Approval ............ arming Board Approval ............ Request for Temporary Certificate ..................... Final Certificate ~ - Fee ~ubmitted Construction on above described, building and per"it ~ets all apP~cabl~odes and regulations. 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: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic featu res. 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. Commemia[ 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 $5.00 / ~_/$ 2. Certificate of occupancy on pre-existing dwelling er land use $/ 5.00 3. Copy of certificate of occupancy $1.00 New Building ..... .~. ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Propertv L~)--~ ~) ..... C~?,~,/,~/..7. (/~, ,~.... ,~.~. '..D,.~. ~.~ Owner or Owners of Property ...... .~ ~..~..~.~ .~..¢~.~.~.. :~.~../. ?.'~./?~.....'~.'. ~.~.o.."?....~.[ .... . County Tax Map No. 1000 Section ......... Block ...... Subdivision .C¢~..~...~..~.~'.. ~.~.'?..~.. ~.~.'¢.~.~-~...Filed Map No. ~'. ~..~...~....Lot No....~....~. ..... Permit No. ~./.,.~..~-~.~.--Date of Permit~.~'/. ,Applicant...~...../~. ,'. ~... Health Dept. Approval ............ Labor Dept, roval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and ~ermit meets all ap!iicable codes and regulations. ,,v. ,o.,o.,a C, O . ( ? ........ 1OOuT~l ~t THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTI~ICIT¥ 0.,~ ~,,,~.,o. ~o. o.~,~ N 581544 THIS CERTIFIES THAT t only the electr~m~.~esc~ ~.~.q~e~ t~R~~~ ~ /i~er ~ ~e retakes o FIXTURE OUTLETS 25 DRYERS IECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST F NCANDE$CE NT FLUORESCENT 38 2O 25 SYSTEMS E OTHER APPARATUS: ~L-G. ~'.G.~L. 1-~a~ Dec ~c~or W. G, NO, OF HI-LEG j NO. ERCC,~COND OF '~C CONO ~/o C AW, G OF HI-LEG ~ul~d ~lec. Co. P.O. Box 143 Mattitu~k, N.Y. 11952 Lic,242 E MANNER. FIELD INSPECTION 1. FOUNDATION (1st) FOUNDATION 2, (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY ~ODE FINAL COMMENTS ADDITIONAL COMMENTS: FORM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Exam,ne;Z -C., I Approved ~.¢.~.....~. ~. .... 1 . Permit No ........... Disapproved a/c ....... - ............... .... APPLICATION FOR BUILDING PERMIT Al¥lication No..~./'.?~..~..~.7:... 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 according to schedule. b. Pict plan showing location of lot and of buildings on promises, relationship to kdjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn ell tile diagram which is part of this apF cation. c. The work covered by this application may not be conmrenced before issuance of Building Permit. d. Upon apprc.'al of this application, tho Building Inspector will issue a Building Permit to the applicant. Such porn shall be kept on the premises available for inspection throughout the work. c. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS IIEREBY MADE to the Building Department for tho issuance of a Building Permit pursuant to t Building Zone Ordinance of the 7'own bf Sonthold, Suffolk County, New 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, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary,i~spections. . ; .... ' .......... ¢ ¢/7 ~~. ' ' ' i'i~,;;tire (;f';¢;licant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build .... .b'..~.' ._~?~/..~ ......................................... - ...................................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly attthorized officer. (Name and title of co~t)orate officer) Builder's License No .......................... Plumber's License No .... El;~ctrician's License No.., ..................... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .... .~ ~ u, XJT/~ ~ ~o/.~{_2.~ _~.. ~¢.e~.~/.. C.4.e~....&&/.;?'. ...... C ¢:~2//¢.~. <4..- ..... House Number Street Hamlet O0 O~ .~ County Tax,bp No. ~0~0 Section .... [.0.¢ .........Block .................. Lot. '- ~ ........ Subdivision ~ [AlY~'-(/~ ~. (~' ~ .~ .~d~7~TFiled Map No. .~. Z ~3. ~' .. Lot .... (~'a;n~) ......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Repair .............. Rcmbval .............. Daniolidoa .............. Other Work ............... (to be paid on filing this application) ;. If dwe!ling, number of dwellingl units..~../Y...~..../~.~./.V/./z./VNtnnber of dwelnng nnits on each floor ................ If garage, number of cars .... ' .... e~. .~. ~"P,/~. ...................................................... ;, If business, commercial or mix(d occupancy, specify h,2ture and extent of each type of use ..................... ~. Dimensions of existing structuros, if any: Front .......... ' ..... Rear .............. Depth ............... Height Nmhber of Stories I)ime~sions of same structure With alterations or additions: Front ................. Rear .................. Depth .......... , , He'ght ..................... Numl:ar,~of,,Stories ..................... /. Dimensions of, e, nIire new const:ructmn: Front...~.' d'.~-.,¢,_: ..~, R.~e,~r,d .,.~J'~.~. ..... Depth .......... tteight ./6 Number of Stories . c-'¥v.~. ,~/..°7.~ ~,,g. ..................... ). S~z~ oflot. Front ....... /..,. ~..' .......... Rear .... ~z/.4..T~ ........ Depth ...... ~ . ..,~. ......... ). Date pfl urcbase ..... '~.~,,..'ff,~./ff. ............ Name of Former Owner ............................. 1. Zone or use district in which premises are situated ................................... · .................. !. Does proposed construction violate any zoning law, ordinance or regulation: ...................... ,,-m-,,_ ....... 1. Will lot be regraded ........ ! ./~..~ ................ Will excess fill be removed from premises: ~ No L Na ne of Owner of premises ..n/. ,fl./~, .,~. ~.: ff.z~,zT',,Pf..., Address fi./¢~ r/~.~l~.? /W,ff Phone No. ,~,.d.Z-- P'.,q ./ff.. 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 lines. Give street and block nmnber or description according to deed, and show street names and indicate whether ter/or or corner lot. rATE OF NEI~)RI,(~ , · '! S S ' ' ~_,.~ (Nanie o~ inuix idua~ sigping contract) ~ove nanled. is the ' (Contractor, agent, corporate officer, etc.) f said owner or owners, al~d is dt,ily authorized to perform or have performed tile said work and to make and file this )plication; that all statements con:rained in this application are true to the best of his knowledge and belief; and that thc 'ork will be performed in the manner set forth in the application filed therewith. worn to before me this · ; }1o. 52-8125850, Suffolk Coun.,~.y.. ] ~erm Expires March 30, 19,,,~ Lot LOTN~ ~2, . COUNTRY CLUB ESTATES ' HEALTH DEPARTMENT-DATA FOR APPROVAL TO C~STRUCT AND ~ HI~ ~HALF ~ ~HE TITLE C~Y, GOV~N- : '"' 'YOUNG YOUNG . RIVER~AD~ NEW YORK AL~EN W.Y~NG, PROFESSIONAL ENGINEER SU~I~ISION M4P F/LED IN ~E OFF/CE OF ~HE C~K SUP~ COUNTY~N OC~ I?, 19~ 4S FI~NO.~7~ ' 'Bt should be noted that since th~s property Js located in an agricultural area, the possibility exists that th~ water supply may contain trace amounts of pesticides and/or nffmtes. Special analysis '~/~required. ~,UFFOLK COUNTY DEPARTMENT OF HEALTH SERV~CFS JOHN FOk .APPROVAl O~ CONSTRUCTION ONLY ~T ~U~C~O~U~ DATE: ~OV. /~, oA~e..fi_~,% .HS R~L NO. Z SUFFO~ COUNTY, NEW ~RK NO. ~UTH~IZEO ALTERATION OR ADDITIO~ m ~IS H[AL~ OEPARTM[NT-DATA ~ APPROV~ TO C~STRUCT ~ ~ ~R WHOM THE SU~EY IS PREPAREO RIVER~AD~ NEW YORK SM~IVISION MaP F/LED IN ~K OFF/GE OF ?H~ ~RK OF~ ALDEN W. YOUNG, PROFESSIONAL ENGINE ER S~F~ COO~V ON OG~/?,/~ AS F/~NO. 6F36 AND LAND SURVEYOR N.Y.S. UCENSE NO. 12845 HOWARD W. YOUNG, LAND SURVEYOR L~T~W~L(W)~IC TANK(ST)aCES~OLS(~) ~H HERE~ N.~S. LICENSE N0.4589~