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Home My WebLink About10777-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y. Certificate Of Occupancy No. Z1 00~2 Date ......... '~i~ .l-lt..1.4 ................ 19.. THIS CERTIFIES that the building ................................................ 44~ Wood Lane Peconic, N0~o Location of Property ............................................................... House No. Street Ham/et County Tax Map No. 1000 Section 8 6 . .Block 6 ~Lot · .~. Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated July l 1 1980 pursuant to which Building Permit No. 10777Z dated ...... .~l~.y..~.4 .............. 19 .~.0. ,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 ......... Annette Knoblock The certificate is issued to ..................... [o~n'e'r,'/~gt ..................... of the aforesaid building. Suffolk County Department of Health Approval .......................................... UNDERWRITERS CERTIFICATE NO. N 11.70696 Building Inspector Rev 4/79 ;FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 10777 Z -'~ Ju,-'/ / 1 pursuont to opplication doted ........................................................ , 19 ........ , ond opproved by the Building Inspector. Fee $ ....... Building Inspector 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 typewriter OR ink, and submitted 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 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. B. For existing buildings (prior to April 1957), Nomconforming 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 buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dweUing or land use $5.00 3. Copy of certificate of occupancy $1.00 Date..~./.l.¢/. ¢~. ~2. ...... New Building .... .~..~.../~.,. Old or Pre-existing Building ............Vacant Land ............. Location of Property....~..~. ~,~. · .............. · .~. ,~ ~.~ ..... .~.~~ Owner or Owners of Property ......................... County Tax Map No. 1000 Section .. ~..(~ ....... Block ..... ~. ........ Lot.. ~ .......... Subdivision . .~.~ .~ ~ ........ ~,),~./,_.~ ~_~,~iled Map No ........... Lot No~~ .............. Permit No. ¢~.~.~.~,te of Permit ~////~Applicant..~~...~~. Health Dept. Approva~ ........................ Labor Dept. Approval ........................ Unde~riters Approval ~. ~.~ ~. ........ Planning Board Approval ...................... Request for Temporary Certificate...~ .................. Final Certificate . .~ ................ Fee Submitted $.. ~ ~.~..~.'.~ ~ ...... Construction on above described building ~:~l~~ions. Applicant ~~~¢.~: .... : ............. THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 ..,~ ~a=cu 10, ~.¢~0 ,~..,ic.,io.~o.o.zi,. 05742s N 47069'S THIS CERTIFIES THAT Annette Knobloc~, n/end Wood La. (PvC. Rd.), 400' i~./o Zndian Neck La., Pecon£c,~. Y. in the follmving location; ~ Basement ~ 1st FI. [] 2nd FI. Section Block Lot wasexamlnedon ~rc~ ~ 1~0 a.dfoundtobelncompliance~viththerequirementsofthlsBoard. FIXTURE OUTLETS 6 DRYERS RXTURES RANGES COOKING DECKS OVENS FLUORESCENT MULTI-OUTLET SYSTEMS NO. OF FEET OTHER APPARATUS: 1 - GFCi ~lec. Room ~ea~e~/s:/~2.5, E R V I C NO. OF CC. COND. A,W,G, NOOF HI-LEG A.W.G, NO. OF NEUTRALS A.W,G. PER ,ff OF CC. COND OF HI-LEG OF NEUTRAL 1 3/0 1 1/o 1-2.0, 1-.5, 2-.7~kw Ruland glectric Matticuck, N.Y. ilg~Z Lie. 242E This certificate must not be altered in any manner; return to the office of the Board Jf incorrect. Inspectors may gDPY F~JR P-U-ILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. - FORM NO. I '"'--'-'~_ __ _. _ ~=~'~ TOWN OF SOUTHOLD BUILDING DEPARTMEN1 ~'"'~"d'~ ,~/' TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ...... Disapproved a/c .................................. APPLICATION FOR BUILDING PERMIT Application No.../.0 '7'7 7 .... Date - 19 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 necessa~ ~spections. (Signa~ame, if a co~oration) .... ............ State whether ap, l~icant is owner, lessee, agent, architect, engtneer, general contractor, electrician, plumber or builder. Name of owner of premises .~.....~... ,~'~...~~-~. ............................ (as on the tax roll or latest deed) 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 License No ....................... Other Trade s License No ...................... Location of land on which proposed work will be done .................................................. .... ............... .......... .... ..................... House Number .~..tr. eet Hamlet County Tax Map No. 1000 Section ................ Block ...... ~. ......... Lot ~ Subdivision ..................................... Fried Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and 9ccupancy . .~ ................................................... b. Intended use and occupancy .......................................... 3. Nature of work (check which applicable): New Building .......... Addition d~ ........ Alteration ....... ~... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimated Cost.. f..~'. ?. .'Y ?. . .~. ........................ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units.. ~../V.. ~. ...... Number of dwelling units on each floor ................ If garage, number of cars ........................................................................ 6. If business, commercial or mixed 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 .................. Depth ...................... Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height ............... Number of Stories ........................................................ 9. Size of lot: Front . .a-.'~.../.~. ............... Rear . .9.--'..~. ............... Depth . .~...~?. ............... 10. Date of Purchase ............................. Naroe of Former Owner ............................. 1 1. Zone or use district in which premises are situated .... ~.'~J..* ............................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be regraded . j~. ;~2'~, ~ ~'L~ 2~,~;~'.~ Will exc.~s fill bo removed from premises: Yes No 14. Name of Owner of premisesc~c. .,:..~.~.q~~f.~KddreSS r. 7~r~v~.~L~, - ......... PhoneNo ................ Name of Architect--.,;~ ~ ' ',_2~:~~' ' ' Address ... Phonephone No~7~/,&~.. ~'.'~N° ................ ~ .~. · · · Name of Contractor/~2;~-F,~. ~.' ... Address 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 .n. umber or d~ according to deed, and show street names and indicate whether interior or coroer lot..~ _~ ~ · ~ ~ . _ .~ l -rZ-_ STATE OF NEW YO~, COUmV.-gF...-/. -----e. .... /~~~~ .................. berg duly sworn, deposes ~d says that he is ~e applic~t .... ~hme ot ifi~vidu~ si~g contract) above nmed. He~sthe..~~~ ' .................................................................. (Con,actor, agent, co,orate officer, etc.) of s~d owner or ownem, ~d is duly auto,ed to perfom or have peffomed ~e ~d work ~d to m~e ~d file ~s app~ca~on; ~M ~ s~tements contmed ~ ~is application ~ tree to the best of his ~owledge ~d be~ef; ~d that ~e work wffi be perfomed ~ ~e m~ner set fo~ ~ ~e app~cation filed ~erewith. Sworn to before me ......... t.~ ...... dayof...~ ....... 19 ............... _. ......................... r~ Ex~es ~rch ~,i~~ /