The URL can be used to link to this page

Home My WebLink About11254-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z.I.!§~¢ ........... Date January 28 1985 THIS CERTIFIES that the building .a...(.2) ......................................... Location of Property ...45.5. 5. ............... O.E .e g.o.n...~ 9.a.d. .............. .N.a. t: .t .i.g.u.q .15... House No. Street Hamlet County Tax Map No. 1000 Section ....0.9.6. ..... Block ....0.3 .......... Lot ..... 0.0.~ ......... Subdivision....X ............ ~ .............. Filed Map No...X ...... Lot No...X. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·. ,J.u. r)..e..1. ! ........... 19.8..1 pursuant to which Building Permit No .... 1. ~..2 .5.4., Z. .......... dated .... J..u. ~ y..7. ................. 19.8. 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 . .a. ...... 9B.e.-: .f .a.m.J~ ~. y..d.w. 9 ~ .1.i.n.g,..~.5= ~..13..s.u.m..m.e.p...o .c.c.u.p..a.np.y...o.n.l.y. ,...a.n.d...a.c?.q s..s.o.P.y. ..... building The certificate is issued to PIERRE WAGNER (owner, of the aforesaid building. Suffolk County Department of Health Approval .1. 1. 2./3q/s2 . UNDERWRITERS CERTIFICATE NO.. N 590321 *HIGH NITRATES: Water not formula or consumption by to be used for preparation of baby infants u~er 6 month, s of age. Building Inspector Rev. 1/81 Per~nission is hereby (THIS PERMIT :,MUST BE KEPT OH 3' cOMPLETION OF THE WORK ^UTHORIZE~) 11254Z Dote UHTIL FULL C~)ur~ty Ta~(, Map NO..]~100 Section ...... l BIock~ pu~s ant to application dated ...../.. Buih ling Ir~spector. Fee ;....,,?. .............. ,..., ,19 and approved by the !nspecto~ 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 Wpewriter 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 unusua~ 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 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 al~ property ~ines, 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 New Building ..... ~ ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...~.~. ~. ,,~'-. ........ ~.~'.~.~¢-~..~... ,¢~.~ ,,~.~. ............ .--/~,~..'~../.'~.~..~. House No, Street Hamlet Owner or Owners of Property .... ~./. ~/~-.~ .... ~t,/~,~, ............................... County Tax Map No. 1000 Section .... .~. ~. ¢ ..... Block ....~. .......... Lot ..... d ......... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /./.~, ~.~... Date of Permit . 7/7/~../.Applicant . ~'~./~.. Health Dept. Approval ./..~/~,/¢,~,..././.-.~.~.~,.~.~.. Labor Dept. Approval . Underwriters Approval .¢/)'/~. .... .-~.Y~.,~./...Planning Board Approval Request for Temporary Certificate ..................... Final Certificate . Fee Submitted $ .... ~ .~....d .............. Rev, 10-10-78 Construction on above described bu ilding and p~er.mit meets all applicable codes and regulations. Applicant ,~-.-....~,..~ ......................... THE NEW YORK BOARD OF FII~E UNDERWRITERS ..,~EAU o~ 8S ,JOHI~'i STREET, N~W YOR~, J~ 19, 1983 ~p.u~.ao.~o THIS CERT{FIES THAT ir~ tfle following locatio~; ~ Basement ~ 1st Ft. ~ 2nd Fl. ' Section Block Lot ~as ¢~ami.ed o. 5~ 13, 1983 and found to be in co~Pli~nce with the requirements 4 this Board, FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE SWITCHES OUTLETS 8 i1 DRYERS DIMMERS OTHER APPARATUS: Psnelhoa~ds; 1-6cir. lO0~s. 1-G.F.I. t-S~Dke De~ector 6. & $. Electric ~ouc~ld, N.Y., 11971 E R ~ V C E A, WG OF HI-LEG OF NEUTRAL ~¢.;578 om,RA~ ,~9.^OE. / This certificate must not be altered in any manner~ return to the office of t~e Board if inc~rect. Inspecto/s may be ,dentifled by their credentials. coPY ~o. mu,..,.o FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & FLUMBING INSULATION PER N. STATE ENERGY E. ODE FINAL (1st) (2nd DATE COMMENTS ~ ADDITIONAL COMMENTS: ,, , ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD. N.Y. 11971 TEL.: 765-1803 Examined ~ .7. ...... , 1977. Approv ....... Permit No. Application No. ~./.~.~.~..~. ....... Disapprove a/c ...-...7....~ ......................... /~ /7/ APPLICATION FOR BUILDING PERMIT Date~..ff.[ ....... 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 pl0t 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 pemfit 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, o~ 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. (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 .... . '/~./X-~... ~. ~.x~. ~ ............................................ ~ (as on the tax r6il or latest deed) If ~ppl.~nt is a corporation, signature o f duly authorized officer. Builder's License No ...... ,/~. [ ................ Plumber s License No../5~.~/..../~..~ Electrician's License No. ~. ~~. Other Trade's License No.../0'./A ............... Location of land on which proposed work will be done..~.. ~gt'~,~ ~. '~.~4...~. ~.. ........................ House Number Street Hamlet County Tax Map No. I000 Section ..... .O. ~'7~. ....... Block....~. ............ Lot .... ~.i ............ Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~..~.~. e~4..~.. .................................................... occupancy ... ~/O~..-,~....c. :~......L~Lo..~ ....... . ........................... b. Intended and 3. Nature of work (check which applicable): New Building ....... Addition .......... Alteration .......... Removal Demolition Other Work Repair ......................................................... ' ~ ~ ~.~ (Description) (to be paid on filing this application) 5. If dwelling, number of dwelling Units .......... ~ .... .Number of dwelling units on each floor ................ If garage, number of cars . .~.~'~....'~....t'~,~ .~.~..~ ............................................... 6. If business, commercial or mixedI occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of ~same structure with alterations or additions: Front ................. Rear .................. Denth i ' Heieht Number of Stories ........ .. ........ 8. Dimensinns of entire new construction: Front .... .~ ~-7 ~.. · · Rear .. ~.~...6(. ...... Depth .. ~ ~. ......... Height .... ,~O. ....... Nun~ber of Stones ..... / ~.~. ................................ ~ ......... 10. Date of Purchase ........... ; .................. Name of Former Ownerg.~'.s:. ~.9.~4~.~.t ............... ...... situated 11. Zone or use district ~n winch prermses are ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Willlotberegraded ..... /~i .............. , ..... Will excess ~ill ~be removed from premises: Yes 2~No Name of Architect .......... ; ................. Address Z.,~. :~..~.,,~. Phone No. PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEWj~ORJ~ ~ COUNTY OF.. ~,~ i,/e{~-e).~[,~ .... S.S ........ . ~ ~.. ~..~. ]~r~' ~Ya-~'t ............... being duly sworn, deposes and says that he is the applicant (Name of individuai signing contract) above named, i He is the .' ....~ .O.,~;]~. ~i · · · .t~a~1~.~-~'{2' .................................................... ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is drily authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... ......... NOTARY PUItI. IO, State of ~uw York No, $2-81;25850, Suffolk Coun~ (Signature of applicant) "It s~uld be nete~ tl~at since this'~ ~ ~ le~d re,an agricultural a~, ~ ~siMt~ exists that the w~ s~ly ~y ~contaih amounts of pesticides a~lor nitrates. Special analysis~Nl~ ~, .. ,/ SUFFOLK CO. HEALTH DEI~T. Af~ROVAL H.S. NO. t~O~A~Dff~ITIONAI, iNsriTUTIO~ Oe ~[AL C~'T'C F'-/O~L/~' ROE~RICK VAN TUYL, P.C. LICENSED LAN ~L~'NI~T ~WY~K THE WATER ~Y AND ~WA~ DI~AL SY~ FOR THIS RE$1DE~[ WILL CONFORM TO THE STANDAR~ ~ T~ ~FF~K COUNTY D['T. ~ ~ALTH SERVICES-FOR A~ROVAL CON'RUCTION ~_~ ~ i H, S. REF. ~.;~ ~VED: ~ ~. ~CT. ~K ~L. 11~ ~ SUFFOLK CO. HEALTH DEPT. ~VAL [ - STATEMENT ~ INTENT ' / ~ THE WATER ~Y AND SEWA~ DIS~~ ~ SYSTE~ FOR THIS REaD'CE ~ / ~ CONFORM TO THE STANDARDS OF THE ' SUFFOLK CO. DEPT. OF HEALTH SERVICe. ~ ' ~FFOLK COUNTY D~T, ~ HEALTH /' ~ : SERVICES -- FOR APPROVAL / I' CONSTRUCTION ONLY ~ ~ SUFFOLK CO. TAX MAP '~SIGNATION: OWNERS ADDRE~: High Nitrates - Wate~ n~ to be used for . preparation of baby formula o~ cons~ption b~ ~nfants under 6 months of age. T~ST HOL~ ~ ~A ra°ilitios for thls location have boom ,~.~~,~ lnspecte~ b7 this ~e~tme~t ~d found ~YORS LICE~D LAND GREE~RT ~W YORK