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Home My WebLink About11362-zFORM NO. d, TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildln§ Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...Z. 1.0U3.1 ......... Date ..... qe.,c. ?.m)4qp...2.3. ............... 19 ?}? THIS CERTIFIES that the, building ................................................ Location of Property .5. ? ,5 ......... ~, 9..?{:. 9~'.1:i..~9.u3~.g.s. ./t.v.o..n.u.e ......... .O.p.5:e.~:~ .~ ...... House No. Street Hamlet County Tax Map No. 1000 Section . .0. ~ .8 ....... Block . .0. 1, ........... Lot . .0.1. .(2 ............ Subdivision..X ....................... .................. , ....... Filed .Map No. X - .Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... J.t~ .1 y..~.5 ........ , 19 ?~.1. pursuant to which Building Permit No.. ! .1.3.6.2.. ¢ ............ dated .$~p.h~p~.t 9.r: .P~ .............. 19 .Sfi., 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 ......... -, private one-fam~lM dwelling--seasonal use only. The certificate is issued to Marianne Wail ..................... ?oh;,'o;. ..................... of the aforesaid building. Suffolk County Department of Health Approval .1.1, -. ~ 9.-.'li '( ~..1.2./..1 ).4<3. 1. ~..R.o..b ?.p.t;...A ....g. ~; 1..l~, ?. UNDERWRITERS CERTIFICATE NO. ~ 5 33 6 35 *Private well with high nitrates--water not to be used for preparation of' baby formula or consumption by infants under 6 mos. of age. Building Inspector Rev. 1/81 BUILDING PEPJ~IT ': · (THIS PERMIT MUST BE KEPT ON THE PREM~SI~S UNTIL ~ULL · COMPLETION OF THE WORK AUTHORIZED) ~ N? 1~1362 Z BU!ldllng fispector. Fee $,,~,/~,,~ .............. Permission is hereby gronted to: ....~.~:../.~.~.~:..:~./..~..:....~ ..,.,~.~....~..,~.~.d.i....;i .............. ~.~...~...~o.m..?~;~.~:a~..: &~..~~~' ~,~ o~o~.~z~...:~:~.~.....~:.~.~.....~ ............. ~.. ...:..:.....,...: .......... : ........................ ................ ....... ........ Co~ ro~ ~p ~o ~000 s~o~ ..... 0.~..~ ...... ~oe~ ~ ............ ~[ot ~o. :.:...~.~ ...... p~SUO~T ~ u~ ~u lu ....... ~ .. ..~-.. , ~..,~ ......... ;,..?...~ '" ~ Building :!nSPecto~' Rev. i6/30~80 ..... ' ' ~ FORM NO. 6 TOWN OF SOUTHOLD Bu ilding 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. Bo For existing buildings (prior to April 1957), Nomconforming uses, or buildings and "pre-existing" tand 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 safety inspection of buildings or premises, or other perti,nent informa- tion requ ired to prepare a certificate. C. 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 .~.~..'.~.., .[ .~..~.. J /-- New Building ............. Old or Pre-existing Building ~.. ......... Vacant Land ............. Location of Property ....... ! ............................................. Hou~;e No. [J Street Hamlet Owner or Owners of Property ........................................................... County Tax Map No. 1000 Section ... I~ Block t Lot...j .~. Subdivision ................................. Filed Map No ........... Lot No .............. Permit No ........... Date of Permit .......... Applicant .................................. Health Dept. Approval ........................ Labor Dept. Approval ........................ · Underwriters Approval ........................ Planning Board Approval ..... ~,~-~/.1~-.~.~, .¢~... Request for Temporary Certificate ..................... Final Certificate ...................... Fee Submitted $...~....O? ..................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ........................ COUNTY OF SUFFOLK DEPARTMENT OF HEALTH SERVICES DAVID HARRIS, M.O.M.P.H. The attached approval was issued subject to the notation contained below our approval st~p. Would you please type the follo~cag eondit:Lon of approval 'on the f~al C of 0 as tkis will ensure that ,~ny ~,~ture owner ~,rill be made . aware of the nitrate problem. · ......... '~rivate well ~ith high nitrates - see He~th Departr. mnt note on f~al sarvey. Thank Robert lo ~illa, P. E. iooo77:~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the able application nu~nber in the premises of Ymrl~a~ We~, Priw~te Road~ Y~gs R~I, ~ieat~ NoY. in the/allowing location; ~ Basement ~ Ist Ft. ~ 2,~d FI. Section Block Lot was examined on ~:~C 27~ ~ and found to be in compliance witb the requirements of this Board. FIXTURE OUTLETS SWITCHES FIXTURES RANGES OVENS EXHAUST FANS DRYERS SYSTEMS NO. OF FEET ~THER APPARATUS: E R V I C NO. O~ CC COi'4D ,~,.~/ O. NO OF HI-LEG A NV, O. qO OF NEUTRALS 1 3/0 L Ru~oede N.Y. 11957 lie. 2334-~ GENEI~AL MANAGER 11 ~ This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their cred~ntlals~ COPY ~OR BUILDING DEPARTMENT. THIS COPY OF CERTIFIC~?IE ~M $1'~NOT B" ALTERE ANY MANNER. FIELD INSP~CTI~N FOUNDATION (lst) FOUNDATION (2nd) 2. COMMENTS ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY ~ODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Disapproved a/c . (Buil~ling Inspector) APPLICATION FOR BUILDING PERMIT Application No...~./d~..~.'. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or ih ink' and submitted in triplicate to the Buildi 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 adioining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn on the dia~am which is part of this cation. c. The work covered by this application may not be commenced before issuance of Building Pe~it. d. Upon apprc'.'M of this application, the Building Inspector will issue a Building Pe~it to the applicant. Such peru shall be kept on the premises ava~able 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 Occupan shall have been granted by the Budding Inspector. ~PLICATION 1S HEREBY MADE to the Building Depa~ment for the issuance of a Building Pe~it pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of bnildings, 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, ~d regulations, ~d admit authorized inspectors on premises and in buildings for necessa~ inspections, (Signature of applicant, or~n3m~if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, .... .......... ....... ..................... ........ I' ',*J;' Z;'" (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Nazne and title of corporate officer) Builder's License No ..................... Plnmber's License No ......................... Electrician's License No ....................... Other Tradc's License No ...................... 1. Location of land on which proposed work will be done. .~.}'. .~.1~fl. ~.~. . . . .~. ?.~. '~' . . . .~/ . . .~. .~.4',~'. ~ . .~. .4~. . . ......................... .~..... f. :~ .................. .~.,~ .~.. ................. House Number r Hamlet ~ount~ Ta~ ~ap No. ,000 Seotion ...... I ~' " ....... ,~Iock . . I ............... ~ot . .t Subdivision ............................. Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use an~t occupancy of proposed construction: ..... .... ................................ 4'.7. ' - b 'ntendeduseandoccu anc ,'~.Oda~Lt ~ ~ ~, .............. ~ ........ ~.d.~ ............. Nature of work (check which applicable): New Building .......... Addition ....... "... Alteration ....... Repair ....~ ........ Removal .............. Demolition .............. Other Work ............... -- ./~.. ~. 0..~. O _vx.'.... ~./.,.:.~: (Description) Estimated Cost ..................... Z .................... ~. ........... (to be paid on filing this application) If dwelling, nuxnber of dwelling units.. ./ ......... Number of dwelling units on each floor ................ If garage, number of cars ..... : .................. q .................................................. If business, commercial or mixed occupa ,, specify ngture and extent of each type of use ................... Dimensions of existing structures, if any: Front ..... i'~. (__) ..... Rear .... ~. O ...... Depth . ~..O .......... Height ............... Number ors )ties ........................................................ Dimensions of sarape,structure w/th altera Depth ......... /.ti .......... Heigl Dimensions of entire new construction Height ............ size orlot: Front.....~'..$~/. Date o?Purchase ...~'..-~.,~. Zone or use district in ~vhich premises ar, Does proposed constrnction_~_____violate any Wil! lot be regraded ..... ]'1~."~.. .... Name of Owner of premises ///t~j-d:,l~t. I Name of Architect ..... .:~ . ~... Ntnne of Contractor .~..'~..~.~Xe.g Locate clearly and distinctly MI buildinI roperty 1 nes. Give street and block number, terior or corner tot. ions or additions: Front ..... -~./.2 ........ Rear .... .~. o ........... /or N b of Stol /. font ............... Rear ............... Depth ............... .......... ,.~Name of Former Owner ~b~ d~:~,...'"1}':.. [~J.~./v..~."~.. situated...~..'~ 0' ................... ~.: .*. .... ~". ......... ' ........ ming law, ordinance or regulation: .... ~.O. ...................... Will excess fill beg;emoved from premises: Yes t./~..~..~{~. I I Address ~.~oq.~../~4b/~.~.... Phone No..5/~./;Z. '/g~/O · · .......... Address ................. Phone No .... : ...... ;.... ......... ^dd, s ..... Phone No. VJ . .7.. · PLOT DIAGRAM s, whether existing or proposed, and. indicate ,11 set-back dimensions from ~r description according to deed, and show street names and indicate whether OF NE V~~ ]~Y~RK -- S S ouxrY · · ..,.. ~,'//':~.m.. · ~ ..... ~ 5~e~... ~ein~ duly ~wo~n. d~o.~,,nd ~a~ t,,~,~ i~,~,~ ' (Name or lndix ~dual signing cont 'acO ~ove named. , is the .................. ;'dr(~ nt, corporate officer, etc.) "said owner or ownem, m~d is ~rm or have performed the said work and to m~ and file ~plication; that all statements coniained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the m~ner set fo] h ~ the application filed therewith. ~om to before me this .......... .......... .... ~ta,yeubl,c, ........... . ..... ..... ~~ou,t~., ///_ ~ ' ~ Term Expires ~arch ~0, 1 \\ \ ~-~ -- ~I~OI.,K CO. H~ALi'tl ~. JItIplq~<~VAL ~ · 1~ ~C¢'1~]9~1 ,. ~. ~. .,. ___ ~__ ~ ~ ~ ~ ~ / SEtVlC[~:~ F:=I "A~OVAL OF ~ : ~ ~e.~age ~osal and -~to~ su )~lv ~ ~ ~ ~4~:~.~~''°" ~,~;.~ ~ ,, ~ ~ ~ ~ ..,,~.-.:: ::. ...... ,,, Hig ' ares ' war& ~ to be Used for Preparation of bah- for~la- or consumptiom by infants under 6 mos. of a~e. SUFFOLK CO. HEALTH DEPT. APPROVAL STATEMENT OF ~NTENT mFFOLK CO DE~ OF HEALTH SEEV CES. SUFF~K COUNTY DEPT. OF HEALTH CONST"UCT IO" ONLY 61: AP~';£~ AS NOTED ~/ NOTiF¥~t~iCi'~iNG ~EPARTMFNT AT 76D-18O~ 9 AM 'FO 4 PM FOP. THE CODES. NOT RESPON~I[~LE FOR DESIGN OR CONSTRUCTION ERRORS, -I