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Home My WebLink About13515-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certi[icafe O[ Occupancy No. Z16361 Date October 30, 1987 THIS CERTIFIES that the building One family dwell ing. Locaq of~ ~ 1300 BROADWATERS ROAD CUTCHOGUE ~ on rroper/y ............................................................... House No. Street Hamlet County Tax Map No. 1000 Section 104 .Block 9 .Lot 4. 1 Subdivision XX .Filed Map No. XX .Lot No. X× conforms substantially to the Application for Building Permit heretofore filed in this office dated Oct. 9, 1984 gp I3515Z ..... pursuant to which Buildin ermit No. dated . .~ .o .v.... !:..1.9.8. 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 ......... .O.n..e..~.a..m.i.]_.y., .d??.]_.]. ~.n.g.. ........................................................ The certificate is issued to .. THOMAS KELLgR ................... ~d~n'o;,'~gs&¥~r~.ig,,~ .................... of the aforesaid building. Suffolk County Department of Health Approval .... [ 3. 7.8.0.~ 9. .5..0. c. t. ;..2.8. :..1.9.8..7 ............ UNDERWRITERS CERTIFICATE NO. . N. 8. 9.5.7.6. .2 A p r i 1 27, 1987 .......... PLUMBERS CERTIFICATION DATED: Perfection Plumbing 7/6/87 · ' ~uilding Inspector Rev. 1/81 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 13515 Z Permission Is hereby granted to: .../..g~....~..~.:......~ ........... ...~....~....4.~..,.:~..~..~..:.~....z./~ ,o....~42~..~,~¢.~.~.....~r.~....~.. ...... ~~.~......~ ......... ~ ............. .......................... ] ................ .~: ................... -;~.. .................... ~ ........... :;~ ............. --;. ............... at premises located at ..../..~....~...(~).. ............. ~.~..,~C~.~-~..~"~..~...~.......~....':~. ~. ........................ .................................. ~,......._... ................................................. .~'.~./¢~..~:~..:~..~ ...... ..~x.~.;.~.....~.~ ................ ~ ..................... ~.~.. .................... .~ ............................... County Tax Map No. 1000 Section .J.~.,..~.. ......... Block .....~....~.. ......... Lot No.(~....~...'../..... pursuant to application doted ...~'~....;/.. ............... , 19.~., and approved by the Building Inspector. Rev. 6130/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted m~ 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. 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 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. C. Fees: Additions $25.00 1. Certificate of occupancy New Dwelling $25.0.0, Accessory ~$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certiflcate of occupancy $ 5.00, over 5 years $10.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Data .......................... NewCons tz~uction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ../. ~i~ .~, ~ .,~, ~,~) ,~, ,~..~.~..~--~. ~ 4¢~ ,4~... ,~.~ ,~,~,'./~,,~,4~'.N .(~,~.~ .~/4/~ House No. Street Ham/et Owner or Owners of Property .., .~,~, ,O, ~f/'~..~.,, [~,~c;"~./_.. ~'.~., .............. ................ County Tax Map No. 1000Section /.~..,~..~.~. .... Block ,.(~.~)~O Lot.0. G. ~..~..(~.] Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. ~. ,~/~,~, Date of Permit Applicant T'h~..~'..~ .. , Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building an~eets all applic~..~ an.~d regulations, Apphcant .. ,~.~", .~. ;~, .V. ........................................ Rev, 10-10-78 THE NEW YORK BOARD OF FIRE 'UNDERWRITERS BUREAU OF ELECTRICITY ~]~cil 27, .'Lg~TBS JOHN STREET. NEW 'YORK, THIS CERTIFIES THAT only the electrical equipment ~ ~scrlbed be~ and intmdaced by ~he applicant ~med on ~he a~ve application nu tuber in the prem~es of FIXTURE OUTLETS SWITCHES 48 3 42 33 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI*OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C Panelkoardsl-34cir., 200ar~ 1-4~on AC [~%it MobO:~ 5-Fhp, 1-3/~hp jacuzzi 3 G.F.CoI~, 3 ~cke Detectors 2/0 OF NEUTRAL Th(~uas Keller 168 Concord St. E. williston, N,Y 11596 This certificate must not be altered in any manner; return to the office of the Board ~ANAGER their credentials. COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERT FICATE M~ST ERED INiANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. /~J~' Owns r~ (pl e~s/e~ .~p_r iht) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. --~(plu/m~ignature) Sworn to before me 'this ~ day of '~ , ~c~,2~ ~~_ 19 ~ ~ ~ N~tarv Public Notary Public, County No. ~2~463~665, Suffolk Counfy FIEL.D INSFECT, ION ~ DATE COMMENTS FOUNDATION ( 1st ) FOUNDATION (2nd) 2. ,- · ' STATE ENERGY ~ QODE ~. ~lql .~ ..... .,. ADDITIONAL COMMENTS: BUILDING DEPT INSPECTION [/~UNDATION '"ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS: ~)~/ [ ] FINAL DATE ~//,/:~'F~'-~ INSPECTOR ~ ~_/ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [] FOUNDATION 2ND [] INSULATION [ ]FRAMING [ ]~FINAL REMARKS: ~~ ~ ~, BUILDING D£PT. INSPECTION [ ] FRAMING ' REMARKS: FOUNDATION XST []ROUGH PLBG. FOUNDATION 2ND []INSULATION []FINAL 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST ~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR ILO. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL, 765-1802 permit no.. 13515Z issued to Thomas 1 on __~_/1/84 for New Dwe---IIing is completed and ~ finel inspection hat; ( --') has not ( x ) been done. Art'-Underwriters Certificate is needed In order to complete this file, it is necessary that z~ Certificate of Occupancy be issued. Please fill out the cnc!osed forth, return Same to the above office with a check for $25.00 payable to the Town of Southoldo Please indicate to Whom the Certificate of Occupancy is to be mailed, and arrange with this office for an inspection date Occupancy or ttse in unlawft, 1 without a Occupancy. I'[oa~e help us to clear up this legal action doe~ not have to be taken. Certificate of matter so that Thank you for yo,r prompt attention. VL:gar oriel. Very truly you~, Victor Lessard Executive Administrator YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION 10-83-0692 PERI, IT ARTICLE 15,(ProteclionofWaler) ~ ARTICLE2S,(TidaJWetlands) 86-07 Jamaica[.A~v_e Woo_dhav~eens N ~roadwat~r~ .~ove on ~e north si~..of.Broad_~ water~ R~a~ Setm~ 3ESCRIPTIO~ OF PROJECT ~~~n on~ fhm~y d~ell~n_g__w%~h~10 _i~de d~4_7 flo~ock and associated sanita~ system a minimum of iL00 feet from tidal wetlands in accor- at Nassau Point" prepared by Roderlck Van Tuyl, P.C. dated Hay 31,1983. Southold _~as sa~] Po]lit ~OUNTY IFIA COMMUNITY NO. [ DAM NO. 1. The permittee shall file in the office of the appropriate Regional )urs m advance of ttle time of commencement and shall also r~)hfy him omptly in writing of the compiehon of the work. 2. The permitted work shall be sub)ecl to inspec{ion by an authorized der the work suspended if Ihe public interest s. requires. 3. As a condition of the issuance of this permit, lite applicant has ~pted expressly, by the execution of the applicaHon, the full legal ~espon- bdl[y for all damages, direct o~ indirecl, of whatever nature, a~ by who~ ecember31,1984 GENERAL CONDITIONS 8. That lhe State of New York shall in no case be liable for any damage or inJUry to the structure or work herein aufhor~zed which may be caused by or result from future operations undertaken by the State for the conservation or irnproven~nl of navigation, or for oiher purposes, and no claim or ri§hr to compensation shall accrue ~rom any such damage. 9. That if the display of l}ghts and signaJs on any work hereby authorized .~o-4 (9/75) ' FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Examined .d'd~..( .......... , 1~. Approved /.(.~/. / ........... I~.. Permit No...//.-~.~.~.../.¢7.~/~ D~sapproved a/ ............................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewritermr 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 s~'~eets 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 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 authotized inspectors on premises and in building for n~ecessary ins.,l~' ~.~.~.i°~l~s- ~ -J/2 ,~ (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 .... ~.~.4 7...~. ~.~ ~.~ ~ ~ ................... ' .......................... (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..../.o'...~_~.. Electrician's License No ....................... Other Trade's License No ....................... 1. Location of land on which proposed work will be done .................................................. .. .................. .,r.,s..... .......... ?.?. ........ House Number Street County Tax Map No. I000 Section .... /..O.,.~. ......... Block .... Subdivision ..................................... Filed Map No. (Name) Hamlet ,/ / ............ Lot. ~- ~ .../.~ ..~ ...... Lot... ~.~'..O~.. ..... State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... .~.~..C.../fJiQ~..~ ...~....Jf~.....~ ........................................ b. Intended use and occupancy ,/ '~ ~ ! ~' ,~. He3/-J g ........... 3. Nature of work (check which apphcable), New Building ...... Addition .......... Alteration .......... Repair .............. Removal ............ Demolition .............. Other Work ............... : ~ (Description) 4. Estimated Cost ..... ~. o-O Fee ~ '" (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 ... N.C...~.~ ............................................................... 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 ...'~. :.~C. ....... Depth . ,~.~. ......... Height ............. ,. Nu.mber of Stories ............... ~.~.~ ~. ................................... 11. Zone or use district in which premises are situated ..................................................... 12. r~oes proposed construction vio!ate any zoning law, ordinance or regulation: ....~/.~. .......................... 13. Will lot be regraded ......... : ................... Will excess fill be removed from premises: Yes 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 dec, d, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, !S.S COUNTY OF ................. : ............................. , .................. being duly sworn, deposes and says that he is the applicant (Name of individual signling contract) above named. He is the ...................... ............ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du~y 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 ........... ¢ ....... dayof .... ....... Notary Public, . ....... ~.. .. County "" ' HELEN I~,, DE NQTARY ]:[IBLJC, State oJ Flew York . . . ~ .*% . No, 470'1878, SufIolI~ Cotlnty (Signature of applicant) Tem~ [.x0~es~vl~ c 30, 19~