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Home My WebLink About11103-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..g; 0g.B!i ; · - · Date .......... Ldag..12, ..'. ............. 19 ~. THIS CERTIFIES that the building ................................................ Location of Property . ;~.59.~ ............. .~.e¢ou.Lc. ~1~ .............. ~.~... H~ ~o. ~1~ ~ty T~ Map No. I000 ~ction . ~ 2.6 ....... Block .. 0Z .......... ~t. pa~.~. ~..Q 1 ~... Minor Subdi~on... 14a~t ~.y.n · ~,..Hick~ ...... F~ed Map No. 2g~ .... ~t No .... J ......... confo~s substanti~ly to ~e AppOrtion for B~d~gPe~it heretofore fd~ · .ARrt.L .2 ........... ,19~.1. p~s~nt to w~ch B~ld~g Pe~it No...1. l ] ~..~ ........... dated ...Apv&.L. ~ 0 ................ 19.8.1, was i~u~, and c~fo~s to ~ ot~e r~ments of the app~cable provisions of thc law. ~e occup~cy for w~ch t~s ~ifi~te ~ ~u~ ~ ......... ........ a. pr. iva~ .one.~tamt~g. d~.el li~ ..................................... ~e cc~cate is i~ucd to ....... ~ i 1 ~. C ,..H i c k~.g ................. [o~er, ~ ~ .............. of the afores~d b~lding. Suffolk County Dep~ment of He~th Appro~ . .1.1.~ ~0~. i.O,. 3Z ~ ~/BZ,. R~.b.~ ,. ~ERWR~ERS CERTIFICA~ NO ....... N. 5.~14 ~g .................................. · Planning Board approval of Minor Subdivision, 3/8/82 Building Inspector Rw. 1/81 FORM NO. 2 TOWN OF SOUTHOI~D ~ BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDIHG FER~IT (THIS PERMIT MUST BE KEPT ON THE PREMIS COMPLETION OF THE WORK AUTHORIZED) ES UNTIL FULL N°. 11103 Z Date "i' Permission is hereby granted to: ,~' C ' ..... .............. ..... ~.~.~.~.~.....~.~.~...~ .......... ................................. '~"~::'z'"'_'"'Z"'"~ ........ ~ ............... ?'"""~;~'"':'"'"'-:~:7 ............................. County Tax Mop No. 1000 Section ..~...~.....~.. .......... Block "~-~"'7" ............ . Lot No. ~.../..C/..._.q.~....~... pursuant to opplication dated ..~:?,.C'~.~..(,, ....... .~,....: ....... ~ ...... , Building Inspector. 19~..:/.., and approved by the Building Inspector 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 subr~itted 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 alt 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. 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 unusua~ 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 .... .~- .~- .~.~..). ~)¢_ ~ ¢- 14 ,¢- ,~..¢'¢10,~,... , .~. ~.'.... .......... House No, Street Ham/et Owner or Owners of Property .. ~..~i~..~.-IL ~/./~..-.~.~. ?/1~ cou,ty Tax 000 Section ...... B ook. ......... .... ,.r~. ,~¢,, .--,', /~(c(~ ,~ 0/_5- Sub~-. . l .(.ql.'.l j ~.~. x. ~. . ~... . ~. l.,,x. ,./?.:: .... · ....Fffed-Map'"N'o;. ,,-, ,,-,. ¢),,.'-,t .0. . L-~'t-~;,l.8.-'* ...t .......... " ¢( ~' , ,,., , Permit No. '~/'//"~'~"r ,<;-...Datel¢' of Permit .~,/~, .~d...Applican~~ .' ~.~,?~//~.' / . __ Health Dept. App ova ........................ Labor Dept. Approval .............. ; ....... ,,. Underwriters Approval .~,..,~..~ .~./..~.? .~. ........ Planning Board Approval ~.¢. ,~..~./~,~.~.? ....... ~,.~ Request for Temporary Certificate ..................... Final Certificate................. Fee Submitted $ ....... ; ..................... Construction on above described building and p~er.~nif meets all appl~cable~codes and regulations. Rev. IO.10.7e '. THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000771 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 aplollcar~t rm~ed on the above application number in the premises of ~o~l~,~ I[i6m~y, N/S Pec~aic Bay Blvd., 70~" W/O S~gsbee ~A., Matti~ae~% ~oY~ ,n theJollow~,~g location; [~ Basement ~ ls~ Ft. ~ 2nd FI. Section Block Lot was exam,ned on Of~.~Jbe~2 30 ~ 1~$1 and found to be itt compliance w, th the requ,rements of this Board. 44 ~ECEPTACLES SWITCHES ~4 34 44 FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS HEATERS MULTI-OUTLET SYSTEMS NO OF FEET DIMMERS SERVICE DISCONNECT S E R V I C OTHER APPARATUS Detectors Lit~ i z/o 1 F~31ar~/ Elec. Co., Lic t 242E This certificate must not be altered in any manner, return to the office of the Board if mncorrect. Inspectors may be COPY FOR BUILDING DEPART/'4ENT. THIS COPY OF CERTIFICAT~ MUST NOT BE ALTERED IN ANY MANNER. FIELD FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE Ye FINAL ADDITIONAL COMMENTS: Memorandum from.... BUILDING INSPECTORS OFFICE TOWN OF SOUTHOLD TOWN H,~L~-, SOUT~IO~,D, N. Y. 11971 765-1802 LCf,a 2r YON SEC ._ DrJS:J~ DPTA. DEGREE DAYS: 6000 DESIGN TEMP: Heating: BLK. L0% ......... Outside: 0°~ Inside :--~VF Base~ent Heated lrot Heated CODE DESIGN/ Part ~ Part ~ ~ Part 5. SLrB-SYSTEI,[ A.) Walls, overall assembly 1. Opaque wall(framing & cavity) 2. Glazing 3. Windm,~ o/o of overall wall area h. Doors 5. Basement walls, above grade* 6. Basement walls, below grade(To 24") B.) Roof/ceiling, overall assembly 1. Opaque roof,(framing & cavity) 2. Glazing, (skylights, if any) C.) Floor, overall assembly 1. Fl~ors ovem ~nheated spaces ~. Floors exposed to ambient conditions 3. Unheated slab edge (to 24" below xrade or 24" under slab) 4. ~eated slab edge (to 24" below grade or 24" u~der slab) R value U Code Area insolation Value Reo~ Aw ' Aw _ A~ Aw__ Ag A= Af A~ A~ A~ Af_~- A~_~ RL Ri Ri Ri Winter Design Heat Loss (Includes Infiltration) ~_~ BTU/br. Thermostats: Provide thermostat for each zone Heatin~ Zones: Provide minimum of one zone per floor Insulation: Fiberglass batt w/foil faced vapor barrier(6"th~-R-t9,3½thk-R-11 Windows: Wood frame windows to be either insulating glass wm{h U-.69 or single glazed with storm windows. Doors: All doors to exterior or unheated areas to be insulated type (U less than .~) Doors to be weatherstripped four sides. Caulkin_~=: Applicant agrees to fully comply with section E-402.2 of the code in order to prevent air leakage through other building parts, lc:Doors, windows~ service entrances, ect. Weatherstrippin_~g_~: All operable new doors and new windows to'be W.S. Heating~_~s_tem: All piping in unheated basement and crawlspaces to have a minimu~ one inch pipe insulation. Service Water Heater: Maximum temperature setting to be 140 degrees TO ARCHITECTS OR PROFESSIONAL ENGINEERS SIGNATURE AND SEAL that these plans and specifications ~licable sections of the New York State Energy FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined~-~ ../..~..,19.~, Approved .~2/~.~..~. ./..C).., 1~5~[. Permit No. ~[[.~ ~ ~. ~ ~ Disapproved a/c ........ ~. ~ .............. .~ ....... f (Building Inspector) APPkI~ATIO~ FO~ B~IEDI~G PE~MIT Application No.././. (.?..~. ........ 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, relatmnship to adjoining premises or public streets or areas, and g~ving 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 promises available for inspection tltroughout 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 Ordmance 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. · .................. (Signature of applicant, or~ame, if a corporation) Y (Mailing address of pp ' ) .... ~" ' 'x '/~?'~' ......... 'a' hcant State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .' .~.~.~../.~/.q ,~.....~.?' ~../)..J5'.//.c?:~. ..... ('a} 'o'n~th'e' ;ax' ;o'1{ ;; i~t;~t' ......................... If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ............... ~ ....... Plumber's License No .... ./(/. &..~/~ Electrician's L~cense No. ~} .~../.t ........ /.~ ...... Other Trade's License No.. 1. Location of land on which proposed work will be done. /.~"e. ............................................ ?.::?: , .......................... ~ House Number ' Street ............. I~&~nlet County Tax Map No. 1000 Section .[.Z..~......~-.~.~../q.~>.. Block...~. 7 ............ L°t"..~..~..~'~ .O...~..~. ..... Subdivision ..................................... 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 . b. Intended use and occupancy ./.. 3. Nature of work (check which applicable): New Building t// Addition Alteration Repair .............. Removal .............. Demolition .............. Other Work ............... ~ (Description) 4. Estimated Cost.. ~.~..~?..~eff.-Y./?..~f..~ .................. Fee .~.~. ~... ~:.~,.. ........................ (to be paid on filing this application) 5. If dwelling, number of dwelling,umts ..../. .......... Number of dwelling units on each floor ................ ~fgarage number of cars .~ J 6. If business, commercial or mixe~d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stones ........................................................ Dimefisions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... '... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ Size of lot: Front ....... . ...... . ............. Rear ...................... Dopth ....................... Date of Purchase . .~..~ ( ................. N~n~0~o4~f Forrrj~r Owner . .M-f.~(eT./.¥.~...../(y?../.~'.~. ......... Zone or use district ir0which p[emises are situated ...... ~ ..... /'.(~... 4~.~_/~.~..~-~'~. ·. ........ ./. ......... Does proposed construction violate any zoning law, ordinance or regulation: .~~.~'q~.~.. .......... Will 10t be regraded ........ i .................... Will excess fill be removed froh~ premises: --Yes No Name of Owner of premises .................... Address ................... Phone No ................ Name of Architect ........................... Address ................... Phone No ................ Name of Contractor .......................... Address ................... Phone No ................ 10. 11. 12. 13. 14. PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and, indicate all set-back dimensions from proper~y hnes. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STA'rE OF NEWeYORI(,~ a ~ ~ COUNT~ .................... being duly sworn, deposes and says that he is the applicant (N~idual signing cofi~ract) above named. He is the ............. ~/(Contrac ~' ' '~-4q~'~ i ' ~ ..................................... r agent, co,orate officer, etc.) of s~d owner or owners, ~d is d¢ly authorized to perform or have perfomed the said work and to m~e and ~e this application; that all statements coatained ~ this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~aer set forth in the application filed therewith. ....... , NO~.~.PuBlic, ....... ~ .....~. ~.. County 1~ /'~. .................. , , ~o ' ' ' / (Signat~e of app~c~t) oou ~ ~o. SUFFOLK CO. HEALTH DEPT. APPROVAL /~ to STATEMENT OF INTENT THE WATER SUF~LY AND SEWAGE DISI~3SAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE ~ SUFFOLK CO. DEPT. OF HEALTH SERVICES. (si ~ A~LICANT l0 SUFF~K COUNTY DEPT. OF HEALTH 0 ~ SERVICES -- FOR APPROVAL OF ~ (~ CONSTRUCTION ONLY DATE: v ~ H. S, REF. NO.. / [- SO- lO A~ROVED: ' - % ~FFOLK CO. TAX MAP ~S~NATION: 0 DI~. ~CT. BL~K ~L. TE~ HOLE ~A~ RODERIC~ vAN LAND 5UEV[YO~5 GREEN~RT NEW YO~K .F ,? lAP?ROVED AS NO]~) ~OTI~ BUILDING DEPAETME~ AT 765-1802 9 AM TO 4 PM ~R ~E FOLLOWING INSPE~IONS: ' ~. FOUNDATION - ~O REQUIRED I FOR POURED CONCR~ 1. ROUGH - F~MING a PLUMBING ~. INSULATION ~. FINAL - CONSTRUCTION ~U~ BE COMPL~E FOR C.O. ~LL CONSTRUCTION SHALL THE REQUIREMENTS OF THE $TATE CONSTRUCT[ON & EN~ CODES. NOT RE$PONSIS~ DESIGN OR CONSTRU~ION ER~ t .7 0 ~0o LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT APPROVAL H,S NO STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO DEPT OF HEALTH SERVICES ($) APPLICANT SUFFOLK COUNTY DEPT. OF FIEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ON~LY DATE ~'-~ ~/ H. s. REP. NO. ,,//~.~/~ SUFFOLK CO TAX MAP DESIGNATION DIST. SECT bLOCK PCL OWNERS ADDRESS: Rmu m SEAL