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Home My WebLink About11039-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z10757 November 2 81 Date ................................. 19... THIS CERTIFIES that the ~lld~ng¢.~ lq i,.' ...... 250 y 'l;i~" 'h' ............................. Location of Property .... 67.5. ~l.t~y.. 1/19.~.r.y' .L.a.n.e. ~ .... Southold, New York House No, 0 5 2 03 Street 031 Hamlet County Tax Map No. lO00 Section ............ Block ............... Lot ................. 3horecreat 5584 19 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated February 7 19 81 11039 Z ..................... , ... pursuant to which Building Permit No ...................... dated.........February ..... 27......... .... . l~!..,wasissued, 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 Family Dwelling The certificate is issued to Yetvart K. 0hriker ..................... ...................... of the aforesaid building. 10/19/81, Robert A.Villa P.E.11-SO-09 Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. N532254 Rev. 1/81 TOWt~ OF BUILDING D£PART,~E~T /OWN HALL BUILDING ~,ERM~T {THIS PERMIT MUST BE KEPT ON THE PREM SE5 UNTIE FULL COMPLETION OF THE WORK AUTHOR ZED) N°. 11039 Z Permission is hereby granted to: to ....~.~.~.~ZL....~ ...... .~Z...~t~.~.t....~ .................... · ~ '7-- _ ~.<~c/c~ ~ ,~.: ~Z~.~Z:%....~. ........ ...~..~..~. ......... pu:rsuant to application d~ted' .~.~..:~ ' " ~~ .... ..~.,, ........ , 19~.Z,[ an~ approv~ by the B~ild~ng: Inspector. ~,b *... ........... ~ ~Bui~i~g :~n~ector Rey. 6/30/80 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 fillad in typewriter OR ink, and suSmitted 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 features. 2. Final appreval 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing ali 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. 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(X) .......... =/Vacant Land ............. Location of Property ,~. :2,~'~25'O /,~..A,~z~',~/~-y ~ ,-'¢/t,'~-~' Hour, No, ~/' 'Street ' ' ' ~ .... Ham/et Owner o~ Owners o~ P~opetty ............ .~.~_ T(X,~ ~ .,-~.//q..X.2<.~.ZL ........................ . County Tax Map No. 1000 Section ... ~, · ... ,....'-3'-'~2' Block "~ Lot Subdivision '..-~'~. p,,~'~.C./~.~.~.. 7- ........... Filed Map No. ,~ ~..Lot No.. ,/~ ........ Permit No. /~ .. Date of Permit ~.~-~/.Applicant ~'~/-~ Health Dept. Approva~ ..//?.~/T. ~.~. ....... Labor Dept. Approval ................ Unde~rit~rs Approval ........................ Plannin9 Board Approval ............. ~.'~ . . ,,. Request for Temporary~ertificate ..................... FinalCertfcat~.. ~ , · .~ ......... ~.~: '.~,~ Fee Subm tted $ ~ . ................. . .......... Construction on above described building and permit mee~ll app~cabl~codes and regulations. '. .................. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTR)CITY 8S JOHN STREET, NEW YORK, NEW YORK 10038 THI~ CERTIFIES THAT only the ~[ectrical equip,nent ~ described below and introduced by the applicant nanted on the able application nu tuber in the premises of in the following location; ~ Basement ~ 1st FI. ~ 2,td FL Sect/o,, Block Lot 19 ..~ o~.,.i,,~a on ~me 17, 1981 and fourtd to be in co.~pliance with the requirements q this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE 23 17 DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: 1-15.0~ Elco. 1-3~Ibn AG 1 ~ Detec~ C No OF CC COND, NO. OF HbLEG A, W, G NO OF NEUTRALS A W, G OF HI.lEG OF NEUTRAL 354 ~len Dr. $Tl.i.~ley, lg~ Yo 11967 7,,lc, ~2555 GENERAL MANAGER' ~J~ Th;s cerhflcate must not be altered in any manner;, return to the office of the Board ~f ,ncorrect Inspectors may be denhfed by their credontlals COPY:FOR I~UILDING Di~PA.?MENTo THIS COPY OF CE~!FIC,~T~ ,A~T ~97 ~E:AL~ERSD IN ANY MANNER. FIELD ~NS~CT!0N COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ,, ROUGH FRAME & PLUMBING INSULATION PER N.Y. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DFpARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined . .~.,:~.~..2.7 .... , 19.~./. ^pproved .: .... .7. ..... z // Disapproved a/c ........ ~~ ................ APPLICATION FOR BUILDING PERMIT 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 Permit. 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 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 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 herein 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. ..d'.c,.,,?. 7.,~./.~,,.,.,&..rd ~,,,'v$.~.././4 .~., ............... (Signature of applicant, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . ./~.' .~.~.~.-~.....~.....fi). d?~./~S~ .................................... (as on the tax roll or latest deed) If applicant is a corporat~~f duly authorized officer. ......... :-, ......... (Na~ and title of corporate officer) Builder's License No .......................... Plumber's License No../¢... ~..~~ Electrician's License NO. Z~.. ~. ~ Other Trade's License No ...................... 1. Location of land on which proposed work will be done. .~/~. .... . . :/ .......... . :,a. . ./...,, , ...................................................... : ....... House Nu,,b~,'~'~-' '~ Street Hamlet County Tax Map No. 1000 Section ...~ '~ ......... Block .... ~ ............ Lot.. ~.~' ............. Subdivision ..... ~o.~4~l~ ~.~ ~.t. ............... Filed Map No. ~ ...... Lot . .~ .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .. ~.~,~.,.....~ .-.~r-, .................................... b. Intended use and occupancy ........ ~ ff~Z& ..... ~,D ) ~ ....................... 3. Nature of work (check which applicable): New Building .......... Addition ......... Alteration .......... Repair .............. RemovAl .............. Demolition ............. Other Work ............... (Description) 4. Estimated Cost ...................................... Fee ..................................... i (to be paid on filing this application) 5. If dwellihg, number of dwelling units ............... Number of dwelling units on each floor ................ 6. If business, commercial or mixed Occupancy, specify nature and extent of each type of use ..................... 7 Dimension of e isting struct if any Front R Depth s x ufos,., ear ................... Height ............... Number of Stones ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ..................... .. Height ...................... Number of Stories ...................... ~.~ Dimensions of entire new construction Front .... .~..o. ...... Rear .... ~.O ........ Depth . o~o~. ......... Height .. c~l. .~..~ ....... mumbler of Stories ....... ]..}z,~. ........................................... 9. Size of lot: Front ............1 .......... Rear ...................... Depth ...................... 10. Date of Purchase ............ i ................. Name of Former Owner ............................. 11..Zone oruse dmnct in which premises are situated ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ....... .~./~'~5 ............... Will excess fill be removed from premises: Yes ~ 14. Name of Owner of premises . .r~ .~r.o/d~/~4~t~ .... Address d,4~4,q~....,~'..~/ .... Phone No. ~Z6 ~. ~.7.... pLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block r umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~RI~v ,d 'SS COUNTY OF~'~ ~,~-~/~,)'/' ~. , ',/[.~ ~me of individual sigging contract) above nmed. ~e is the ................................................................ . ~ ~ ~Contractor~gent, corporate officer, etc.) of s~ owner or owners, ~d is d~'ly fiu~~orm or have perfomed the s~d work ~d to m~e ~d file this application.; ~at ~I statements contained ~ t~pplication are true to the best of his knowledge and belief; and that the work will be perfo~ed in the m~n~r set forth in the application filed therewith. Sworn to before me this ........ No~I~ )~; .~.. ~~... County . ~ .... ......... ' i ~o, 5~-~115~5o, Sul~o~t Co~ (Signature of applicant) faeilities f~r ~ ~ ........ have ~ ~ .............. bee~ ~o be satisfactoPv.~---~ z · un,et o~ g~neral Engin~erln~ RODE~'ICK VAN '~¥k, P.C. LICENSED LAND $UEVE?OES GREEN~RT NEW YORK sTATEMENT .OF tNTENY THE WATER sUpPLY AND ~WAGE,DIs~sAL SY~EMS' FOR THIS RESIDENCE WILL ~FORM, TO THE STANDARDS OF SUFFOLK ~0. D[PT. OF HEALTH SUFFOLK COUNTY DEPT. dF HEALTH sERvICES -- FOR ~APPROVAL. , OF CONSTRUCT ION ONLY DATE: m APPROVEQ: SUFFOLK ~. TAX MA~ O~EES DEED ' ' 'P ' /"4 SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. ,syS~'EMS.FOe r~s, R~S~OEa~ :~[l'kL . C~NF~M ~ ST'AI~IIDj~RDS, DEPT. S~E R V ICES' - FoR OF -H~ALT~I A laeR o~t AL