The URL can be used to link to this page

Home My WebLink About11391-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ... ~ ....... Location of Property . ~ .1.8.5. .............. .Leew.a.rd Delve ' . .S. 9.u.t.h. 9.1.d' .. .ou= No. ' ......'~t~i ........... County Tax Map No. I000 Section ...0.7.9. ...... Block . .0.7 ........... Lot . :..0.2.2. .......... Subdivision .l~.~.a.v.d.. ~.c.v.e. ~..a.~...B.a~.v.i. 9F..Filed Map No..~,5:9.9...Lot No...3.5. ......... conforms substantially to the Application for Building permit heretofore fried in this office dated · · ~ ~ I~ ~ e;a b e r.. 1.8 .... ,19//1. pursuant to which Building Permit No...~ .1.3. ~ .~..Z. ........... dated .... ~ e p ~a b e r..2 5 .......... 19 .~ J, 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 ......... .... ~. p.v.~.v..a ke..o..n.e.-.t.a. ~.~A~.y., .d.w.~.% %.t.n.~: ........................................ Th rtifi dt .~p.t. qn..ips' ~.ap.s.i..s .& h..i.s w.i..f.e Fotini e ce cate is issue o .......... ~ ......................... of the aforesaid building. Suffolk County Department of Health Approval .1.1-~0-9y UNDERWRITERS CERTIFICATE NO ...... ~I..$(~J.0.~ ............................... Building Inspector Rev. 1/81 FO]E3{ NO, ~ TOWN'O! BUILDiN~ TOwN HALL' : $OUTH'OLD, N~. Y,, :: BUILDING (THIS PERMIT MUST BE KEPT ON TH:E PP'E~IS~S UNTIL ~ULL COMPLETION OF THE WORK AUTHOR ZED)· Permission is hereby granted to: et premises Iocoted ot ...... ~ ...;; ' ..~ .... 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 Wpewriter OF[ ink, and submitted in duplicate to the Building Inspec- tor with the following; for new bu[ldings 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-iS-9 form or equal). 3. Approval of electr{cal 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 s[te 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 bu_ildings. 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 3. Copy of certificate of occupancy $1.00 $5.00 Date~.~ /~/~ - New Building .......... Old or Pm-existing Building(X) ........ ~ ~Vacant Land ............ ocat,on of Property... .... ............... .... Hou~ No. St~t Hamlet Owner orOwnersofProper~ ~Q~(O~ ~(~ + ~f~/~ co.~,~x ~,~,o. ~000 s~,~o, .~ ........ ,,o~ ...~ .......... ~o:..~.~ ........ Subd~vi,~o..~~ .~.~..~ 6~ed ~.. No. E~f....~ot No..~ ........ Permit No ............................................... Health Dept. Approval ........................ Labor Dept. Approval ...................... ,.. Underwriters Approval ..................... Planning Board Approval .................. Request for Temporary Certificate ..................... Final Certificate . .~/..... Fee Submitted $. FIELD~ INS~.ECTION COMMENTS FOUNDATION (1st) FOUNDATION (~nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C~DE FINAL --------- ADDITIONAL COMMENTS: ioooizi THE NEW 'YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~-~ 85 JOHN STREET, NEW YORK, NEW YORK 100381 .ate ~ i2, 'i982 ,,,,,,~,o.~o.o.~u~ 13686~-82 N 561030 THIS CERTIFIES THAT only the electrical equipment ~ described below and introduced by the appllcat~t ~med on the able application ~umber it~ the premlses of in the following location; ~ Basement ~ 1st Fl. ~ 2nd Fl. Section Block Lot was exa,nined on ~y ~ , i 9~ and found to be in compllat~ce ~vith the require~nents of tkis Board. FIXTURES RANGES OVENS EXHAUST FANS FIXTURE SWIT~ES OUTLETS FLUORESCENT 57 DRYERS 37 MULTI-OUTLET SYSTEMS NO. OF FEET Fbtors ~ I-1HP 1-GFCI 1-4, ~[<[4 3-~FI 2-~ Detectors 2-1. 5I~ P~at NO, OF CC. COND. PER ,~ OF CC. COND. NO, OF HI-LEG OF HI-LEG OF NEUTRAL Paul R, Bur[~ Town Harbor Lane Southotd, N.Y. 11971 Lic,28~ 11 This certificate must not be altered in any manner; return to the office of the Board if !nco~rect. Inspecto~ may be their credentials. COPY FOR BUILpING DEPARTMENT. THIS COPY OF CERTI~ICA?E~ ~ J~ ~'~ -~MUS~NOT BE ~TER~D IN'ANY~ MANNER. FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, I~,I.Y, 11971 TEL.: 765-180~ Approved. . ~.~c~...., 1 . Permit No./477.4 .... Disapproved a/c ....... ; ......................... '. · .. (Building Inspector) ~ APPLICATION FOR BUILDING PERMIT Application No,/"/,ff.~../. ....... 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. Plot plan showing Iocation of lot and of buildings on premises, relationship to adjoining premises or public stre~ or areas, and giving a detailed description of layout of property must be drawn ou the diagram which is part of this apt: cation. c. The work covered by this application may not be commenced before issuance of Buil~ling Permit. d. Upon apprcval of this application, the Building Inspector will issue a Building Permit to the applicant. Such pern 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 Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance ora Building Permit 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 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 inspections. (Signature of applicant, or name, if a corporation) '(Mailing address of applicant) '~/'¢'7~(' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ ....... A'~..~-.~. (4.~.~. /~ ?. . %. '. .......................................... ' .......................... Name of owner of premises .. ,/~ ~.'~-.~..N4. ! .~..-,-.~.'.../~'.....~./~.Y. .... ~---., .z~..'~'. ~?. I.~ ................... (as on ttie tax roll or latest deed) If applicant is a corporation, signature of duly aothorized officer. (Name and title of corporate officer) Builder's License No...N.~.T...~.~.c.,¢.~?.~4 .~. ....... Plumber's License No.. ~ ~..'C.. ~.c!& .c.~../~.~ ..... Electrician's License No..[.,,/.~..w.. ~ c. ~<~'F:.~.~... Other Trade's License No.. ~. ,~,~. Location of land on whic~proposed work will be done... ~. e .~. ~.~... ~ ~ ~.5~ ~. ~.9{q~...~.~... .~.~.y.t~ >y .......... ¢.~ ~.~:... ~q~!..~ ........ ~e.q r~ ...... ~.~ ?'t .~:~ .... House Nmnber Street Hamlet County Tax Map No. 1000 Section ..... ~..7...t~. ..... Block ....... .~. ........ Lot ..... '.a..~... ....... Subdivision..L..~?.?~..~.~...~.~. ,~. ??..~..~...,~..,y?. ~((~.,.v'... Filed Map No. ~.~..'~ .V.q ...... Lot ....~.~..-'~. ...... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: .i.e.-r: a. Existing use and occupancy ......... .1('..~..~.-~...'?..'~-. ........................................... b Intended use and occupancy 1. Nature of work (check which applicable): New Building .... Addition .......... Alteration .......... · Repair Removal Demolition Other Work ' Estimated Cost Fee (to be paid on filing this application) ;. If dwelling, number of dwelling units ....... ! ....... Number of dwelling units on each floor .... ~. If garage, number of cars ............... -~. ....................................................... ; If busin iai d occupa specify ~stu d e f h typ of ·ess, commerc ormixe ncy, re an xtento eac e use ........ ........ .. .. . I. Dimensions of existing structures, if any: Front .. . .. ~.. .. . . Rear .. ...~ ..... . . Depth. .. .~-..... .... . Height .- Num her of Stories .. Dimensions of same structure with alterations or additions: Front...... .--.... .. ... . Rear .... . ..- .......... . Depth Height '-. Number of Stories L Dimensions of entire new construction: Front . 7~ *- to" Rear . ~.~ % I0.. Depth . · ~,4 .-.~ .... Height .... ~. ~. ....... Nu,mber of Stones ...... ,~'~.,-...a ......................... · .......... }. Size of lot: Front ... [..Z.~T ............... Rear ..... ,/.~'.!~. ..... Date o'fPurch e .... of Former Owner ....... .................. uated I. Zone or use district in c remis t . . ~.~.~...~.~..~.~. ?..c..... ~,. .L Does proposed construction vil~late any zoning law, ordinance or regulation: .... fl~.~.: ................. ~. W~U lot be regraded ..... ~.41~. ........... ...... Will excess fill be removed from premises: Yes L Name of Owner of premises . .-..q .~f... ~/,~'.~.~,. .... Address ~.zT~ .~.~.~;..Ld.~t ~V./~Phone No. ~/.z.: .~ ~?.: .~.t.~.y Name of Architect .. ~..~.~r~./..~,~e~. ~/..'~'~,.~rAddress ~/l~: .~..~.. ( ~-. ( F~.~t~Phone No. ?(4: .~'.~..~.- ~"..~..'~.e~' Name of Contractor . .,~.~..r'..~-~:~C~.,~...~ .... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from coperty lines. Give street and block number or description according to deed, and show street names and indicate whether ~terior or comer lot. rATE OF NEW,YORK, S S OUNTY OF..~..,~'.~. ~'~. ~... ' ...... .~...~,t~ ~.~.'.'.'.'.'.'.'.'.~..'.. ~. :.. ~. 7~..,,~..~.4/.~;. .......... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) ~ove named. c is the ....... (Contractor. agent, c;;I~;~a't; ~'fh~;;,'it;:~ ............................ f said owner or owners, and is duly authorized to pefl'om~ or have performed the said work and to make and file this )plication; that all statements contained in this application are true to the best of his knowledge and belief; and that the 'ork will be performed in the manner set forth in the application filed therewith. ~vorn to before me this' ....... · '~:~ ~. ....... day o f (,~~1~,~....., 19 ~:~. ota/y Public, ...... .,~ ..... County The sewage disposal and wa%er suppl~ facilities for t~is location have been i~spected b~ this depa~men~ ~d found ~ef of ~ene~al ~l~eri~ RODE, ICK VAN TUYL. P C LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. ~|-*.5,~.c~'~, , STATEMENT Of INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILl. CONFORM TO THE STANDARDS OF THI: SUFFOLK CO. DEPT. OF HEALTH SERVICES APPLICANT SUFFOLK COUNTY DEPT, OF HEALTH SERVICES -- FOR APPROVAL Of CONSTRUCTION ONLY DATE' H. S. REF NO APPROVED SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL OWNERS ADDRESS: DEED: L. N/'~ TEST HOLE sTAMP SEAL ' · · ' ', / ' , '\'\~. ' ' ' .... SUFFOLK CO. HEALTH DEPT. APPROVAL k ' ~ ~ a ....... ,~ ~ .... ' ..... ,-*~ ~ ~ ', ........ SUFFOLK C~. OF H~LTH SERVICES. ~ ~ J , ' ~ ' ~ SUFFOLK COU~Y DEPT- ~ HEALTH ~ / [ , ' ~Z~,~ z'' - , SERVICES -- FOR APPROVAL OF "It shou~ ~~t' si ce this pro~rty is i0mted in an ~ culturaJ' /~ ~ ';. ~ ' ' ' ~O~ ~[ '~ ~ '~T;" ' ' ' DATE: ...... : ....... Y~ { ~ , J area, the possibility exis*~ at the , water supply' may co.t~ .trace ~,~ ' ~ ~ ' . , A~OVED amounts of pest c des and/or~ 'ares ~[ ' ~ --~-~ ' ,~ ' J ' ~ ~ ' Y ~ ~, ~O~AVAL~rlU~CO~. , -- - , ~ I I I 4, F~NAL - CON.RUCTION MUST I I ~ ~ , ,, :, , ~,-- Architect and Engineer's Seal an "Alteration f this ~ume~ ~ce : ?I Signature o,ly good for ~itial use of by an Arch nsed profes* ', ~ , visions to or re-asa of drawings wtt~ S~tion 72C l, Subdivision 2. ' iI L out ~dhitect or Engin~r's ~proval N.Y. St~e'~ [ducation ~, 54655 Main Road Box 1412 So~ hots New Architect and Engineer's Se~l and only good for initial use of nA?~r~tiqn of this Document except Changes ater~ton~ 'or m-" ' ~ byron Ai-chite~t qr Li~ce.n.~ed Profes- X, ~ Ons to 6~"rn-use of draw n~ w th- .. sionai Engineer, is illegal .; ~. . ' ' ' , ' Sec{'on 7209 Subdivision 2,~ ~.~chitect or Engineer s.&oRr.oval :' ~ . . ~ N State Educat on caw. '",';~Oids ~,al ahdLSignatur~'on Saliie. : i i 'Y' , i¸4 SACCO, AHLERS & ASSOCIATE Architects & Ep~ineers ,516-765.5455 H ~.'~ U \V'A L. L iI · DDAT H //~-fG- STY L--E ~OLO~ O H!1Z~U L'K___ kt: O~ T H", C. LC. VA, T' i ,..9 (*9 (-~) A d Eng' ' rcMtect, an ideas Seal and Signature enly good ~or i, itial use of drswin~i Chsn~, ~lterstions or re- :uisions toot, ~e-use of drawings with. out ,,~chitqct .or, Engifleer's APproval voi~ls SeaFantt Signature on'same, Section' N.Y. State SACI~O; AHLERS & ASSOCIATE Architects & Engineers Road, Box 1412 South&Id, New York 11971 N" -, ~ I ' " - '~ ' ~,~.--""11 '"'111 ~ , _ _~_. , ,, ~ ~ __ ~ ___ : , - ~, ~. Si[natur~ nnly ~ for initial use of "Alterati )n of this Document exce~ visions to or re-use of drawings with- sional E gineer, is illegal". Architect* & Engineers k~k ~ ~ ~/r out Architect or Enpn~r's ~proval Section ~209, Su~ivision 2, s~6ss M.in Ro.d. Box 141~ So.~hold, ~ew -....~~~~*°' eg~' voids Seal and Signature on same. N.Y. St,te Education ~w, - ~,, ~~" B~_~ ~ -- - ~~~~~ ~ ¢~,w~ '- ~' ~v~ I ,Ill l, I ~" ........... ~ ' ~...,~ .: ,:....? ~ ~' ~,,, ~,~.. ~, , /A~IA~ , ~ ' ,' · ~; ' ~" ~ ~o" ~,~, ~ ~'~,?" ~,u, ~ ~"~/~ ' '~ ~ ~' , . , i ' L :': ~ ' ~. ~L¢ .... ~chitect and Engineer's Seal and,I SACCO, AHLERS & ASSOCIATE Signature only Eood br ~nitial use of "Alteration o~ this Document ~cel Architects · Engineers visions to or re-use 0f drawin~ with- s~nalEngineer, is illegal,,, s46ss Main Reid. Box 1412 Southold, New York 11971 ~ids ~al and Signature on same. N.y. State Eduction ~w,