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Home My WebLink About13538-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..Z. 1.3..6~.8. ......... Date ........ .&u. gu..s.t..2. ............... 19.8.~ THIS CERTIFIES that the building . .O.n. ?..f.a.~. ~..1L .d.w. ?.~.Z.~.n. ~ ........................ Location of Property .. .... ..6.6.5. 3.H.$ ?.&~.~...D.~.~.~. $ ............... ~.0.~ ?.H.qL. ~ ............. County Tax Map No. 1000 Section .. 0..7.8 ....... Block ... 0. ! .......... Lot ..... .0.2.0. ........ Subdivision WEST CREEK ESTATES Filed Map No.3 8.6.8. LotNo. 39 conforms substantially to the Application for Building Permit heretofore filed in this office dated .... O.c..t ....2.~. ..........19.8.3. pursuant to which Building Permit No....~ .3.5.3. 8..Z ............ dated .... .iq.o.v. :..1.5. ............... 19.8.6., 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 ......... .... qN~.. ??.~. ~..~Y..~.~..~b.~.~.~. 9 ...................................................... The certificate is issued to .......... .~.0.~.E..~ .T. A. 9.~AC.~...cp.h~..~.~.~ ....................... of the aforesaid building. Suffolk County Department of Health Approval 14 - S O- 16 4 N701663 UNDERWRITERS CERTIFICATE NO ................................................ PLUMBERS CERTIFICATE 7/31/85 Rev. 1/81 Building Inspector I~OB~ NO. Ii TOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fl"HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No 13538 Z Permission is hereby granted to: .. _ ...... ~ .~ ...... Z?.~,.,~.....,C~ .... ~. ./.~.....~..~,,,~..~.~.~.......~/..~.: ...... ' . .~ ~~ . ~ //w~ ~ .... ~.. .~ ...... ,....~ ,~ ..... ~~~.~~.....~~ ..................................... ........................... ~~~.~~......~.~ ............................... ~, ,,,~,,, ,~,,, ~, ..~....~z~e~......~:..~ ............................... ~ ........ .................................. ~ :~ -- ~ ~ __ .~ .......... ~ ................... ~ ~..~ ....................... .... .~~ ~ ........... Z ............................. ~...~.~ ..... co~,~ ~ ~,~ ~o. ~ooo s,~,,~....~.~ ....... ~,~ ~Z ........... = ~o, ~o..~ .......... Building Inspector. Fee :il;j,/ .................. Rev. 6/30/80 I~LDG. DEPT. TOWN OF SOUTHOLD APPLICATION FOR CERTIFICATE OF OCCUPANCY FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 Instructions 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. 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 pa~operty showing all property lines, streets, buildings and unusual natural or topographic featu res. 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 $15.00 Date ........... / ....~ .......... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property .................... , ............................ House No. Street Ham/et Owner or wners of Proper ............................................................ County Tax Map No, 1000 Section . D~ Block ~ / Lot... D. ~ ~ Subdivision ................................. Filed MaP~7~ ;-? / ,,~ ') r--N° ........... Lot No..../ ....... Permit No../.3.~. ~.~..Z;., Date of Permit../'~J~'L..Appiicant~G~ .~'~.~/.',~.C/.~.'~ Health Dept. Approval . ./.~...~. ,,~3~. (~ ..... .~ ........... ){O c-~ Labor Dept. Approval~ / ........................ Underwriters Approval ....................... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $..'~...~--~ .................... Construction on above described building and permit meets all~icab~s and regulations. Rev, lo-10-7e TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner (please print) Plumber GREG M~LLER P.O. BOX LINDENHUiiSL N,Y~ 11.7.5Z I certify that the solder used contains less than 2/10 of 1% lead. Sworn to before me this ,L~'O dayOf J-/~ '_ . ~ Notary Public, ~ u/~c~-~.//C County in the water supply system ~' (plu~' ;l~nature) Plumbing & Heating Contractor P.O. f~OX 744 LIND£NHUh:~;f, N,'f, ~17~7 lOOO968 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ' 85 JOHN STREET, NEW YORK, NEON Y~ORK 1OO35 ..re J.~y ~.4.~8S ~.piie~tlo. No.o,,Sile ~3~/8~ N 701663 THIS CERTIFIES THAT P~135382 only the electrical equipment as described belo~ and introduced by t~ applicant ~,ned on the able application number in the preo~ises of Robert collins in tbe Sollowing Iocatlon~ [] Basemen~ ~as e~.,ni,,ed o. July 18 t 1985 FIXTURE OUTLETS 645 Shepard D~., Southold, N.Y. [] 1st FI. [] 2nd FI. Section Block and found to be in compliance with the requirements of this Board. Lot FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS 18 23 DRYERS FURNACE MOTORS TIME CLOCKS UNIT HEATERS MULTbOUTLET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: Motors~ 1-1 G.F.C.I.- l Smoke Detector- 1 NO OF CC COND A W G ~_NO OF HI-LEG PER ,~/ OF CC COND, * OF HI-LEG NO. OF NEUTRALS A. WG OF NEUTRAL 4 W. T. Stock Inc. 11 Behrendt Court Sayville, N.Y., 11782 GENERAL ,~ Per ~L ~L ,'~r This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. ~COPYFORBOILOINGOEPARTMENT. THI$COPYOFCER!IFICAT~UE~TNOTBEt IN ANY MANNER, FIELD INSPECTION'~ COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY FINAL ADDITIONAL COMMENTS: 785.'1802 BUILDING DEPT. INSPECTION~ [~/~OUNDATION 1ST [ ] ROUGH PLBG, [] FOUNDATION ZND [ ] INSULATION [ ] FRAMING FINAL REMARKS: BUILDING DEPT. INSPECTION []FOUNDATION xST [ ] ROUGH PLBG. []FOUNDATION 2ND [~] INSULATION []FRAMING [ ] FINAL REMARKS: INSPECTOR 7GS-'~802 BUILDING DEPT. INSPECTION [ ]FOUNDATION '~ST [ ] ROUGH PLBG. ~/FOUNDATION ZND [ ]INSULATION [ ] FRAMING [ ] FINAL REMARKS: DATE INSPECTOR ~..~ 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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 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 building for necessary inspections. .~-. -- ,,3 A, ,-' J ~ (Signature (~f applicant, or name, if a corporation) (Mailing address of applicant) 7/TVtF State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Name of owner of premises ............................... (~[s on the tax roll or latest deed) If appJ4cant is a cornoration, signat~.~Le of duly authorized officer. (Name and title of corporate officer) Builder's License No ...................... i .... Plumber's LicenseNo ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Location of la~d on wliich proposed work will be done:..~. · . . ·.~. '.&.~.~.d, ...... I~;~se ~q~-l~er'J ................. Str;et Y' I)~n'l;; ......... County Tax Map No. 1000 Section ..... .7./~. ......... Block ..... .~ ............ Lot .... ~...)--..4~. .... Subdivision..~?...~..~.~'.. ..... i... 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 ............. .L?.~~ ................................. b. Intended use and occupancy ...... .~.. ~: ..~ .~...../~.. !..?./....~..~-~ 3. Nature of work (check which applicable): NeF, Building . ~... ',A~Oition ,~ ....~, :,,. ,Alteratio, p . ~ i, ',.., (to be]paid on filing this application) 5. If dwelling number of dwelling units ...... ~.~ ......... Number of dwelling ,units on each floor ..... · 6. If business, commercial or mixed occupancy3.specify nature and extent o~ each type of use ............... ; ..... 7 Dimensions of~existing structures, if any: Front Rear Depth Height Number of Stories Dh=hens!ohs of same structure' with alterations or additions: Front ~ ~. ' Depth ...................... Height .................. :... Number of Stories ..................... 8. Dimensions of entire new construction: Front $ ~" ' ' ' D~th .~.'.~ Height ... I,? t Number of Stories ~ ' . , 11. Zone or use district in which premises are situated ......................... 1 ............................ 12. Does proposed construction violate any zoning law_ ordinance or regulation: .... i ·/Y'.* ....................... 13. Will lot be regraded ........~f~... ........ .~ ...... ..... Will excess fill be removed from ~remises: Yes Name of Architect ........ ., ........ ~ ........ Address ............. ..,... rhone No..... ........ Name of Contractor ~ ~./.~.. ...... Address q{~ ~ ..... ~'. rhone No .... ~ &,E..L~'.~¥~.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. in,dicate 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. ~ATE OF NEW YORK, COUNTY OF .... ./,.&_...~.~:q~... S.S ........... ,z,/.4_/y ,~/~..T7' .,(ff~ .~4..7'..~... ............ being duly sworn, dep6ses and says that he is the applicant (Name of individual signing contract) above named. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly 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 hi~ 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 ............ ; ......... day of. (~.~...~.~...'~.~ ...... ,19 .~.. . · ,[qotary Public, //.v~:.4'/~2~.~/(~,~ ~:~. ).,1~.::..~.~) County ~ '. 25930E. ,.~ [XCAVATll)N IItSP ON SUFFOLK CO, HEALTH DEPT. APPROVAL H; S. NO. THE W~TER:~L~ CONFOR~ TO THE STANDAR:~ O~" THE SUFFOLK CO. DE~,~ OF ,,HEALTH SERVICES.' .~iNGLE ~A~E~WELLING SUFFOLK couNTY DEPT, OF HEALTH SE.RVICES -- FOR APPROVAL OF CONSTRUCTION ONLY ' "~"' ' ' H: $. REF. NO., APPROVED:.. ~w RODJERIC~K VAN TUYL, P.C. LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEI~:~'. APPROVAL H.S. NO ...... STATEMENT OF |NTENiT 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 HEALTH SERVICES -- FOR APPROVAL OF CONSTRUCTION ONLY ' ' DATE: , , H. S- REF. NO.. APPROVED: SUFFOLK CO. TAX MAP OESIGNATK~N: DIST. SECT. BLOCK PCL. OWNERS ADDREss: OEED:L. '" T'EST HoLE' SEAL ~ ' ' '*'~0 ~ THE WATE. ~Y AND ~*~ Dt~AL - - "' ' ' iOF7 " , ~ , - CONFORM TO THE STA~AR~ OF CONSTR~T ION ONLY ~ '~ L~ ~' ~ ~ a~ ~ ~t*~ ~T DIST. ~CT. ~K ~L. ' --'~~-"~-~_ ~.~. N-~Z~Sa"30"~" -'~: ~S0., ~ ~ ." ""' '"~~~_~"'"?-~, &, ~ ~[., ..... '~ ~~"~r~T~': ~T ~W Y~K A~?~O~V:D AS NO~E~D; 765-1802 9 AM TO 4 PM FOR FOLLOWrNG iNSpECTIONS: I.FOUN'DATrON - TWO REQUI FOR pOURm coNCR~E ~ R~ ~AMrNG & pLUME - ~~:&.,4~.~,~. ~LL ~N'~u~O~ sHALL THE ~E~U~E~E~S OF THE ~~T,~I ::, I OCCUPANCY OR WITHOUT PRIOR WRITTEN CON- J I 1-4 / I, DF_ _L?.VAT 0,,4 ~o2