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Home My WebLink About13617-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z15463 Date December 5 .................................................. 1986 THIS CERTIFIES that the building Addition Location of Property 275 Doqwoo,d. Lane East Marion House HO. Street Ham/et County Tax Map No. 1000 Section ... 9.2.7. ..... Block . 1 ,Lot 9 Subdivision .G..a.r.d.i.n..e'.r.s..B..ay..E.s..t:..S.e..c..2..Filed Map No. 275 .Lot No. 95 & 96 conforms substantially to the Application for Building Permit heretofore filed in this office dated ' Dec. 5 .8.4p gp 1361,7Z ...................... 1,9 . ursuant to which Buildin ermit No ..................... dated . . .D,e.c.:..1.1. ................. 19 . 8..4, 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 ......... ....... Ad.d..i.t.i. qn...~.q .e..x.i.s.t. ¢.n~..d..w.e.l.l.i..n~.. ..................................... The certificate is issued to THALIA G. SAMBAC,H, (owner, ~Y~]f~ ~e~FzzYJX of the aforesaid building. Suffolk County Department of Health Approval ....... .N/.A. ............................... N7.55343 UNDERWRITERS CERTIFICATE NO ................................................. PLUMBERS CERTIFICATE Rev. 1/81 12/2/86 ' ~ Building Inspect°r . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. No BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF: THE WORK AUTHORIZED) · II 13 6 ~ 7 z Da,e ...--b~.~....~... . ........................ , Permission is hereby granted to: ,o.~~.....~,~..~.... ' .... ~....~ .... at premises located at ....~,.~....~.~...,.~..~....~..~ ......... ..~.~..~.......~....~..~... .................... County Tax Map No. 1000 Section ......~.....~...~1.. ....... Block ......... .~ ........... Lot No ..... ..~. ................ pursuant to application dated .~..~.~......~.~. ............... , 19.~...~..., and approved by the BuJld~ng Inspector. Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Buildlng Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPAN( . . Instructions '~ , Iz: \~[ ~!., ~ ,- This application must be filled in typewriter OR ink, and submitted .., ~ 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 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. Commemial 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 property 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. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 5. Updated C.O. $15.00 $15.00 Date .................. NewCons truction Old or Pre-existing Building Vacant Land Location of Property .. ~.7.~.. ............................................. p.~.~.~?.O.)?. ~..,~-.)-~c~ .~../~..~../~..~..~/07... House IVo. , ~/~/~J ~ ~, ~. Street Hamlet Owner or Owners of P operty ............................ County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision Filed Map No Lot No Permit No ........... Date of Permit .......... Applicant .......................... . ...... . Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ................ Final Certificate THE NEW YORK BOARD OF FI-RE UNDERWRITERS 100137,~ BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038~ THIS CERTIFIES THAT Warren Sa,bach, 275 D~wood Lane, East ~arion~ ~.Y. ~nthefollowlngh,~t&qn;~ent ~ IstFI. ~ 2nd FL Section Bilk Lot FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FtUORESCENT 11 11 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R I NO.% C CONO jOF A.CC.W.CONg.O. NO, OF Hi. LEG OTHER APP TUE: , Pa~ards: 1-6cir., 100aal~)s selected load panel for generator 1-GFI 1-Smoke Detector 1-40amB Transger swtich OF HI,LEG NO, OF NEUTRALS OF NEUTRAL Dennis D. Claire, jr Po O. Box 284 .aurel, N.Y. 11948 L LtC~2342E This certificate must not be altered in any manner; return to the office of the Board if',incOrrect. GENERAL MANAGER may be identified by copy ~:OR BU THIS COPY OF CERTI rERED IN, ANY MANNER. TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 72// TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. /3~ /7 ~ Owner ~3 ~/~9 (please print) Plumber (p~lease pri'nt) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber ' s/ signature) Sworn to before me this '~ day of Dg-C~ , Public, ~d/ County Notary Notary Public 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ]FRAMING ~]FINAL REMARKS: DATE FIEL~ INSPECTION COMMENTS FOUNDATION ( 1 st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qgDE FINAL ADDITIONAL COMMENTS: 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 ApproX..o~...,.~.,%. !1 .... , 198. ~.l. Permit No. 1 .~../P.~.'~...~.. Disapproved a/c ..................................... ................................ ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... Date. . ................ , , 1 INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted 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 issued 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 Law% 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 building for necessary ~spections. ~ ~ r~ (Signature of applicant, or name, if a corporation) 7' 173 Hillside Ave. ·..Wil ti.st-on..[aa~k.,..NY. -1.1.596 ............... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· Consulting Engineer Name of owner of premises Thalia G. Sambach (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 .................................................. 275 Dogwood Lane Gardiners BAy Estates East Marion House Number Street Hamlet County Tax Map No. 1000 Section . . .Q.37 .......... Block ...... .1 ........... Lot ..... .9. ............ Subdivision Gardiners BAy Estates Sec. 2 Filed Map No. 275 Lot 95 g 96 (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: One family residence, attadhed one qa..r, gAr. a.g~ .............. a. Existing use and occupancy ............................................ Master bedroom & bath b. Intended use and occupancy .................................................................... 3. Nature ofwork(checkwhich applicable): New Building ..... ' ..... 'Addition . 'i' X ..... Alteration .. ........ Repair .............. Removal .............. Demolition ........... i... Other Work ....... ~ ....... ,! (Desciiption) 4 Estimated Cost $25. ,.090 Fee $25.. 09 (to be paid on filing this application) 5. If dwelling, number of dwelling units.., one Number of dwelling uni(s on each floor ..... If garage number of cars one 6. If business, commercial or mixed occupancy, specify nature and extent of each ty~e of use ..................... 7. Dimensions of existing structures, if any Front. 5 3.'.&': ........ Rear ...5.9 '. ~:' ...... Depth ~.fi '.. 5..~4 '. .... 1! Height ... ,1.4 ' ......... Number of Stories ..... z ....................... i ............................ Dimensions of same structure with alterations or additions: Front 59 ' 8" ' 59 ' 8" ............ ~ ..... Rear ................. Depth .... .4.4. '...1.0.". ......... Heigi~t 14' Number ofiStories..o, ne 8. Dimensions of entire new construction: Front ....2.8. [9 '.' ...... Rear . .2.8.'.6. '.'.i ....... Depth .2.4. '...~.0.". Hei 2 · one ght ............... Number of Stones .................................. , ....... ,... · 118.% 101 ' 160 9, Size of iot: Front .. ..................... Rear ....................... I)~th ................ I0. ate of Purchase ............................ Name of Former Owner ., .................. 11. Zone or use district in which premises are situated, mas id.mnqe ............. i ...................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... i ............................ 13. Will lot be regraded . .~9 ........................ Will excess fill be remove~l from premises: x Yes No 14. Name of O~ner.ofpremises .................... Address ............... i... Phone No. Name of ~ ..... Wg~.rer~ ~,. Sa~uba¢~. Address . 173. Hillside.gVe, Phone No.. 7477509~ ...... Name of Contractor .......................... Addres~i~%~¢9O. p~¥.k,..Ny... Phone No.. .............. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. " /->?'./ '"" r .l '-' -"'"'-.'-' ' / J' ~ / , ~ i LOT 94 . STATE O~ NE~ YORK,' COU~Y OF .... S.S ............ ~DR .g.. ~aeb~Gh ................. b~ing du[y gworu, d~po~g and ~y~ that ~: i~ th~ ~ppH:ant (Name of individual signing contract) i above namfld, , He is the G~l~Ang E~g$ne L (Contractor, agent, corporate officer, etc.) of said owner or owne~, ~d Js duly autho~zed to perfo~ or have peffo~cd the s~id work ~nd '~o m~e ~d' ~le this application; that all statements contained ~ this application are true to thc best of his ~owledge andbeliefl and thai: the work wUl bc perfo~ed in the m~ncr set forth ~ the application filed therewith. Swo~ to b~forc m~ this December ~o 84 - Nota~ Public ..... County - I . . ~ ~. ~ ........ . / l~otary Public, State of New YorR No. 30'6377700 ~ . Quallt~ed in .Nassau Countv ....................... ;~ ................ ~ ' . Commiss~on Expires March 30, ~9~ /{~zg~tum of'applic~t)