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HomeMy WebLinkAbout11457-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi{icate O{ Occupancy No. ,Z] D.982 ...... Date ...... ~l. qy...1.2 ....., .............. 19 82. THIS CERTIFIES that the building ................................................ Location of Property , ,4.7,5 ................... AiL(liS. J~aBO ............... I$.a..t.t.i.~x!..c.k.. House No. Street Ham/et County Tax Map No. 1000 Section . .12.3 ....... Block . 015 ............ Lot . .09.4. ...0.09 ........ Subdivision... X .......................... Filed Map No...X ...... Lot No..X. ........... conforms substantially to the Application for Building Permit heretofore filed' in this office dated .November'..9 ......... , 19 8.1. pursuant to which Building Permit No..1.1.6.57..Z. ............ dated ...N o~r.o, m b e r..17 ............ 19..8.1, 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..priva.te, o~e-. fantily..d.we ll~.Bg, ......................................... The certificate is issued to ...Harry..M ,. ~,..grl.e.rl~. 1~....4~.q.u.l. 1..1.a?.d. ................... (owner. I~.e~. re,awe) of the aforesaid building. Suffolk County Department of Health Approval . .t.1.-.$0.-.1. l 5 ,. 5./.4/{3.~ ~ . .B p.b.g.,..A.... ~. ~3.1.a. ~ UNDERWRITERS CERTIFICATE NO ....... .~. 5.5.8. ~. ~.0 .................................. Rev. 1/81 ~uilding Inspector BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISI COMPLETION OF THE WORK AUTHORIZED) ]~0, ~57 Z Date '.~i' S UNTIL EULL Permission is hereby granted to: .~.../.~7... ........... J...J..: ....... ,.... ................ ....~..,...~z,.~,....~<~..z:.-~...~.,..~.~- .:....i ......... ~ ...... ~ ........ ~'~'"~'~"'~'~'~z~'~]~'"~""~""x~~ ~//~ .... Couhty TaXx Map No. 1000 Section .~..~..~... ........ Block ~ .......... iLot No.: ...~..;~.~. pu?siant ;o application dated ...~..~.;~..~r~.~.~.~....].t...., 19~/.., and iapproved by the Buddi g 16spector. F~e ~$..,~.~.~......,.~.~ · ......... ~i" ' ';": ...... ? ....................... 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 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. 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 whece 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 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 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-existing Building ............ Vacant Land ............. Location of Property . .A.~.o,~, ,s. ,L?.~..e. ,~..C, .~.m~, .H, .~?,e.o.~, .~..R,o?, .d.,..N.~, ,t,t.~,t,?,c,~.,..,N... ?, .. ........ House No. Street Ham/et Harry M, & Arlene E, Jaquillard Owner or Owners of Property ............................................................ County Tax Map No. 1000 Section 123 Block 0 Lot P/O 4 Subdivision .... ~ ........................... Filed Map No. 2.0.9.9...P.o.2.~Lot No .............. Permit No .......... Date of Permitl.~/..~.7./.8.~.Applicant . INLAND HOMES, THC, 1 ,].457Z ................................. Health Dept. Approval ...5/.4./~B.2} .............. Labor Dept. Approval ........................ N558250 Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ...... y.e,s ............. Fee Submitted $..5. ,..07 ....................... Construction on above described building and p~etsfill,.a.pp~regulations.~,~._.~. ~ ~' Applicant ........ ~ ............................. ..v. ,o-,o.7a C, O .[0 COMMENTS FIEI~ ~,~$PECTION 1. FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: 1000744 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~[I[[~ 85 JOHN STREET, NEW YORK, NEW YORK 1OO$1~ ..,e April 27. 1982 ~..,,~.~io.~o.o.f,~ 15~685/82 N 558250 THIS CERTIFIES THAT onJy the eJectrJca~ equ~po~ent ~s described belo~ and i~troduced by t~ appl~cartt ~med on the able application number in the premises of Harry Jackalard, Alois Lane, Ma~tituck, N.Y. ~.~.~.,i.~do. April 19, 1982 and found to be in compl~ance with the rdquirements of this Hoard. 25 34 DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: Motors: 1-F 1-G.F .C. I 2-Smoke Detector E R C NO. OE NEUTRALS A, WG OF NEUTRAL Younga Pt. Mat~ituck P. O. Box 372 OENERAI-~4~N~GER ~ Laurel, N.Y. 11948 lic.2148 l! ~ /) ~lhis must not m any manner; return to office the Board if incorrect. Inspectors may be ~identified by~Jhei~ credentials. be altered the COPY FOR BUI[91NG D[P~RTMENT. 1~1S COFY OF ~ER~I~ICATE ~ NOT BE ~ER~O I~ ANY MANNER. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined/~.~.../..~. ..... , 19 .~../ Approved .~..~..~.. '/'7 ...... , I~./.. Permit No. Application No ............ APPLICATION FOR BUILDING PERMIT Date .N.o.y.e.m.b.e.r...9 ...... , 198. i" INSTRUCTIONS a. This application must be completely filled in by typewriter or fn 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 adjoining premises or public stre* or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this apl: cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon apprcval of this application, the Building Inspector wilt issue a Building Permit to the applicant. Such pern shall be kept on tim premises available for inspection throughout the work. e. No buildiug shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan shall have been~ranted by the Building Inspector. APPLICAT)ONI" IS HEREBY MADE to the Buildiug Department for the issuance cfa Building~Permit pursuant to t Building Zone~©rdinance of the Town of Southold, Suffolk County, New York, and other applical~le Laws Ordinances Regulations, fol~the construction of buildings, additions or alterations or for removal or demolition, as herein describe The app icant aorees to comply with all applicable laws, ordinances, building code, housing code, ~nd regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. INLAND HOMES~ INC. (Signature of applicant, or name, if a corporation) . kT.,. 2. ...... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, General Contractor Nmncofowncrofprcmiscs Harry H. & Arlene E. Jaquillard (as on the tax roll or latest deed) If applicant is a corporation, signature of duly anthorized officer. Robert E. Hiltz, Pres. (N{ne and title of corporate officer) Builder's ~-,icense No .......................... Plumber's License No. 517-P Electrician's License No. 2148-E ther Trade s License No ...................... Location of land on which proposed work will be done. Alois Lane & Camp lVlineola Read .... 'tuck~ N. Y. House Number Street Hamlet County Tax Map No. 1000 Section . .123 ............. Block . 6 Lot..P../.O .4 Subdivision ..................................... Filed Map No ............... Lot .............. (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: E ' ting d Vaca t a. xls use an occupancy n b. Intended use and occupancy 1-Family Dwelling XX t. Nature of work (check which ap'plicable): New Building .......... Addition .......... Alteration .......... Repair .............. Removal ............. Demolition .............. Other Work ............... Estimated Cost ............... Fe .............. . .......... (to be paid on filing this application) ;. Ifdwefling, number of dwelling kin/ts .... .1 .......... Number ofdweiling units on each floor ................ If garage number of cars ;. If busihess, commercial or mixed occupancy, specify nsture and extent of each type of use .................... ~. Dimensions of existing if any: Front.. !L' · ' ' "~ Rear Depth tleigbt Nuniber of Stories Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth .................... .. Itmght ...................... Nu~'~ber of Stories ......... i,' ......... ~ 80 R' ~'- .D. epth.J( ..~.: ~. Dimensions of entire new construction: Front ............... ear .... ~r.~o .............. lteight; . . ~ ~ ......... Nmfiber of Stories . , ] ..................................... i .... ). Size of lot: Front .... /.e:).l~...,'' .......... Rear , J.~,;~. ............... Depth .~ .[ ~..~. .............. ) Date o'fPurchase ........... ' ................. Name of Former Owner 1. Zone Or use district in which premises are situated .................................. ". ................ ..~Does proposed construct/on violate any zoning law, ordinance or regulation: ............ i. Wil.~ lot be regraded ......... ................... Will excess fill be removed from premises: Yes No 1. Name or Owner of premises .H.a. ~.zT..B.:..~.a.9 .u~..1.1.~C~ress ................... Phone No ................ Name of Architect .......... ................. Address ................ .... Phone No. . Nam' ~" 'r ' Robert 1~, Hxitz ........................ · e 01 cont actor 'IlX!L~'ND 'BOIvlF,~;' TN¢; .... Address Bpx liT, at. xtu i .ll$o PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from roperty lines. Give street and block munber or description according to deed, and show street names and indicate whether tcrior or corner lot. TATE OF NE's,"i ~Kr-,. curry OF....S?.F. 9.I'.K ...... !S.S Robert E. Hiitz .... .... . ................... ~ .................... being duly sworn, deposes and say~ that he is tire applicant (Name of indMdual sig~ling contract) ~ove named. : ContraCtor PiS the ..................... i,' ' ':" '. ............................................................ (Contractor, agent, corporate officer, etc.) £ said owner or owners, mid is duly authorized to perform or have pm~formed the said work and to mak~ and file this >plicationI that all statements contained in this application are true to ~he best of his knowledge and belief; and that the 'ork will be performed in the manner set forth ht the applicatLon filed therewith. wont to before me this .......... ....... ..o4,gXy, Public, . .,....,-, ...... ~ ~ / IIOTARY PUBLIO, State of INew .Yolk. · · .~_-.q.'~..: · :..."¢..&:..... ,.../."' '~N' ~ ......... , t Iio.~ 1.S~0, s~01~u/~.9' Rooert E. Hiltz ~ (SigXtta4m~'~l~pplicant) : Term F. xplre~ March 30, 19.0~ % f "it should be note4 tlmt since propeH..y is located ia an a~icultuml area, the poss[biJity ~ists .t~t the ' ~ter supply ~Y co~tE~n tr~ce amounts of S~aJ anaJysis ~ t~C[ ,r~ui~- Contmd this De~dment ~' sampling". SUFFOLK CO. HE,ALTH DEPT. APPRiOVAL H.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL. SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK C(~n~' 7~ ~ ~ox H/ -~ , , 'SUFFOL~/ ~OUNTY DEPT~ OF HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY /~/~ DATE: // / H. S. REF. NO.: ,APPRO~, SUFFOLK CO. HEALTH DEPT. APPROVAL /~/AC~,NT ) H.S NO. ~ ~L ~.: STATEMENT OF INTENT ~_ THE WATER SU~LY AND SEWAGE DI~SAL ~ ~ SYS~[~$ FOE f~IS E[SlB[~6[ WILL CONFORM TO THE STANDARDS OF THE [ ~, ~FOLK CO. DE~. OF HEALTH SERVICES. ::, z ~ ~' ~ SUFFOLK COUNTY ~PT. OF HEALTH ~ _ ~-~' - poe~l SUFFOLK CO, TAX MAP ~SIGNATIOfl: ~ DIST. ~CT. BL~K ~L ~: L. 2o~ P. 2~ (~e~.) factlitteS for this location he,-,e bee~ , inspected by this department and found u,,o~: a ,:~4.~ - ~'~,, ~ 6e~ioee SEAL SUE,/g%'~f;~ERiCK VAN TUYL. OREEN~RT NEW YORK dlflb3~ 3H~ ~3W llYHS ISN03 / ~ ¢ , .~ ~' ~SRW NOI~DR~SNOD ' ]VNM ' ~P~I~U~ T~ 2~lO~'..¢&' ~/~ ~O. U~LAYN~T P~' ~ ~. ~' ~- ~A~ ,' ' . ' ~HESE, DRAWINGS AND SPECIFICATIONS ARE INSTRUMENTS ~, ~1~, ,~ ~ ~ ~NT ~H~ ~ ~0 , , , - , , ; THE P~OPERTY OF THE ARCHITECT WHETHER THE PROJECT ' . '~ - ' A~k HOT TO BE USED N ANY O?FIER PROJECT ~CEP fl WRI~EN AUTHORI~TION OF THE ARCHITECT~ ' ~c:,.:u,.~ / ¢ I-- -..1 .,L _ __l t I _ II I I 12.-