The URL can be used to link to this page

Home My WebLink About13547-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13541 Date June 19, 8.5. THIS CERTIFIES that the building .... N..~..w.p.w.e..1.1.i.n.g .............................. Location of Property .. 3. .0..8.0. ............... .H.o.n.r.y.~..L.a..n.o ..............P.e.g.o.n.5:c. ...... House rye. Street Hamlet County Tax Map No. 1000 Section . ,q 7..4 ....... Block .... 0..2 ......... Lot ..... .0.4,4,., 8. ...... Subdivision. ,P.e.~ .o~.~q..Kp.o.~.~..s ............. Filed Map No..6.6.0.7...Lot No.., .7 .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .O.q¢: ...... .2.4. ....19 .8.4. pursuant to which Building Permit No.....1.3.5.4.7.? ........... dated .... .N.qv... ..... 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 ......... ..... -.-..-:-N.e.w. Pr~iv.~l~..O~..F.a..mi.13..l~.w.e.l. 1. '%.n~.~-77:-.- ............................ The certificate is issued to ............... qO..H.N.S,E.I~. !..R.O.B..E.R.T. .......................... (owner, I~.~ae.or-tertmlO of the aforesaid building. Suffolk County Department of Health Approval ........... .3..47.8.0.7.3_.8.7. .................... UNDERWRITERS CERTIFICATE NO ................... .N.6.7.9.7. .8.2 ....................... Building Inspector F~B.M NO. ft TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, No Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO Permission is hereby gronted to: /~ ,~- .....~.~.~.a...~.o~.~.~.....~ ........... ,o ..~~~...~.~......z~~.~.....~~ ................... ~ ...................... .~ ............................................................................... ~~.~x..~.~ Coun~ T~x M~p No. ,000 ~ctio~ O.Z~. ...... BIlK ......... Lot No. purs,ont '0 appllcot,o, dat~ ~<Z~....,~........,~-' 1~, and approv~ by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 JUN ( 0 APPLICATION FOR CERTIFICATE OF OCCUPANCY ~_J~ Z~ i ~o{~D-~Oj. 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: 1. Finat 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), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~3perty 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 dwelling $15,0 0 3, Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 Date..~..--.../..~..."..~.~. ........ New Building ............. Old or Pre-existing Building'. ........... Vacant Land ............. Location of Property .... B..o..8..o. .... .... i.<- ............ House No. Street Ham/et Owner or Owners of Property ,, RP, ,~,~,/~. ,~.. , ,~. ,~,~,~,~, F/ ............................... CountyTax Map No. 1000 Section ...~..?~'. ....... Block . ..~..! .......... Lot...z~.4.,...~. ..... Subdivision ..... ~.~, .~?.~.~ 9,. ~.~.~./-.~ ......... Filed Map No ........... Lot No .... ~.. ........ ~;3ate ///~ ~. ~.~.~..-~. Permit No..-~ .-.,. of. Permit., ,.-.,.,.%~,pplicant .............. Health Dept. Approval UnderwritersApprov/~al ~-/Z~. ~..~..~. ........ Plannin card reval '-'- .... ....... g B App .................. Request for Temporary Certificate ..................... Final Certificate ..................... Fee Submitted $ ....... -,~..~. ............. .,,/~ / / Construction on above described building and per, flit [:~r~ets all applic~le codes and regulations. ~.~t~ L4qI Applicant ..... ~/.g¢~'. ~- · .~A~"~ .................. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS [001071 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW'YORK i00~'8, ~ehg Feb=uary 22, 1985 30360'7/84 ..re ~,,.ll,'.tio. No. on~l'e N 679782 THIS CERTIFIES THAT only the ~lectrical equipment as described below and introduced by t~ appl~a~t ~med on t~ ob~e appilcatlon nunzber in t~ premises of R~ert Johnsen, 3080 Hand's ~ne, Lot~7, Peconic, ~ inthefollowinglocation; ~ B~eme,,t ~ lstFI. ~2nd FL Section Block Lot was examined on ~nd found to be in compliance ~ith the requ~rer~ents of th~s Board. ........ F~rU~y 14, 1985 : FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE SWI'/CHES 31 44 40 31 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 OTHER APPARATUS: Motors t 1-F 1-3}ton A/C Unit with air handler 1-GoF.C,I. 1-Smoke detector 1 2/0 A. WG OF HI-LEG NO OF NEUTRALS AW.G OF NEUTRAL 2/0 G & S Elaotric Box 215 Southold, NY 11971 Li¢~578 This certificate must not be altered in any manner; return to the office of the Board if incoi~tect. may be :identified ANY MANNER. ~ . COMMENT'S ~ ~ FIELD INSPECTION FOUNDATION (l~t__) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL · .~.~. r .~.~,.~...-...~..~. ~ ......... PLEASE TAKE NOTICE that your application dated .(~.C..7~.~--.~........~.' .~ ..... , 19 ~. for pemit to ~0~~.. ~ .~.~.. ~~ ........... at ~us~ ~o~ .......... ~}reet ...... Hamlet County Tax Map No. 1000 Section ...~Z~. .... Block ...~. ....... ~t ~.~.~.~ ..... s~vi~o~c ~.~/s ~ ~a~ ~o ................. Lo~ ~o...~ ............. ~~. . ~ .... 7~c~c. . . /~. . .~~. . .~.~. . . ~.~ .......... . ~.~.~..~~...~..~C~.o..../~.~/~../.~ ..... . ~~.~.. ~.~ ......................................... Building Inspect~ RV 1/80 TOWN OF $OUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. Owner Plumber (please print) (please prxnt) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. M (plu~" s signature) Sworn to before me this /~ day of Notary Public, Not~y Public WZ~'TH~NNmLLE 76S.~.80Z BUILDING DEPT, INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [~/FOUNDATION 2ND [ ]INSULATION [ ] FRAMING [ ] FINAL REMARKS, ,,, DATE INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 Examined//k//o'7~.... ~/.~. .... 19 '~.~.c/~ Approved ~. ~"~.... ~?. .... , 19~. Permit No. APPLICATION FOR BUILDING PERMIT 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 Buildin~ 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 fo~ rer~oval or diemolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build~.g cjCde, housinfl code, and regulations, and to admit authorized inspectors on premises and in building for necessary insp~~~_ ~ ~ (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 .... .~..~..[9..~.~..~-....'~'..~. h .~.*.~ .% .......................................... (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 ...................... I. Location of land on which proposed work will be done .................................................. '-- t o .,.c.. .................. House Number Street Hamlet County Tax Map No. 100121Sectio, n .~,..~..~..~ ....... Block ...... .O..~ ......... Lot... / ........ Subdivision ..... ~..~..o.B. i .~... ~.~..O..~, .~. ~ ....... Filed Map No .... { .~-~ ....... Lot... 7 .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . ~ ..... k~.~.....~-~f~/~. .................................... b. Intended use and occupancy ........... 3. Nature of work (check which applicable): New Building ....... 'Addition . q ........ Alteration . ......... Repair Removal Demolition ~ Other Work 4. Estimated Cost ......... t.<~..°..O. ................... Fe~ [ iP' ' g ' appli~ati~) 5. If dwelling, number of dwelling units .............. Number of dwelling units on each floor ..... ' ........... If garage, number of cars ................................................ 6. I,Lhusiness, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. 4¢ia~nsions of existing structures, if any: Front ............... Rear ...... ; ....... Depth ............... l~ht Number of Stories . Dimensions of same structure with alterations or additions: Front ........... i ..... Rear .................. 12te4ath Height Number of Stories ' 8. Dimensions of entire new construction: Front ..... ~.o. ....... Rear .. 2.°. ., ....... Depth . .~...zx. ......... Height ./6. Number of Stories ..... /. ......... , . Date of Purchase ~- ~ ~' .N m ofF ~ nwn~r i ,,¢~:~ 11. Zone or use dlstr, ct ~n winch premises are situated ..... .~.....Y. ......................................... 12. D.o. es proposed coi~'gtruetion vi~olate ~]~y zoning law, ordinance or regulation: ./LG~.~ ........................... 13. Will lot be regraded ...... ~.~. ~_..~.$&.; ......... Will exces~s fill be rem. eyed frpm premises: Yes Name of Architect .............. ': ............ Address ................. Phm~ ~u .... t ~ Name of Contractor " Address ' ' ~ 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 s oW street names and ~ndmate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY O~ ...... aa; ........ ......... ~ .o.~.~..~..I .... ~r'~a ./~ ~ .S..~. ~ ............. being duly sworn, depgses and says that he is the applicant (Name of individual signing contract) above named. He is the {~ cO vt (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 · NOTARY PUBLIC, State 0[ Nev~ York : / (Signature of apphcant) No, 4707878, Suifolk Term Expires March 30, 19tllCS ~ !: '., f {~INGLE FAMILY DWELLING ONLY SUFFOLK COUNTY DEPART,V~ENT OF HEALTH SERVICES FOR APPROVAL OF CONSTRUCTION ONLY HEALTH DEPAR1'MENT-DATA FOR APPROVAL TO CO~STRUC ~ NEA~ESTW~ aAIN MI ~ ~SOURCE ~W~TE~: ~ ~F CO. TAX MAP ~ SECTION OT~, ~GK ~ LOT ~EE A~ ~ ~[~LI~I WITHIN I00 FEET OF T~ PROPERTY NOTE, ~KE · = MONUMENT SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON 8E~ 29~1977 AS FILE N0.6607 gRANDIS & ~ONS iN~. 1046 sum/Ey FOe ROBERT W. JOH~JSEN LOTiNQ; 7, "PECONIC KNOLLS" AT ~E~ONIC TOWN OF' SOUTHOLD SUFFOEK COUNT~, NEW YORK N~dTH~IEEO Al. rEliCTION OR ADDITION TO EURVE~f I~[A VIOLATION ~ SECTION 7209 O~ THE NEW Y~RK'~$TATE EDUCAI~ION LAW DATE' AUGUST 25,1984 SCALE= I" = 50' NO. 84-706 ALDEN W. YOUNG, PROFESSIONAL ENGINEER AND LAND suRvEYOR N Y.S UCENSE, HOWARD W. YOUNG, LAND SURVEYOR N.Y.~. LICENSE N0.45893 . FEB. Z), 1985 ~he sewa~ 4is~os8l a~6 wate~ sqppIy LOT ~. 7, "PECONIC KNOLLS" OCT. 30, 1984 taeiltttea tot this [oo~t~o~ have bees AT PECONIC : DATE: AUeUST 2~,1984 tnspected by this de~rtment ~d ~6und ~N ~ SOUTHOLD SCALE~ I" = 50' ~ ~UtM~lZ[O ALTERATION OR AODIYION ~ Chief O~ ORdeal ~ngineerinB suavE~ m:A VI~ATION ~ S~CT~ON 7ZO~ ~ NEW YORK STATE E~CATION LAW Se~oea ~ GUARANTEE~: INOI~TEO HEREON ~ALL RUN ~LY ~ HEAL~ DEPARTMENT-D~T& F~ APPRO~ TO C~S~RUCT ~ ~ ms sz~[F ~ T~ T~[~ c~v, sov~- . . , ~ , YOUNG YOUNG .,v~.~AO, NOT~ ALDEN W. YOUNG, PROFESSIONAL EN61NEER SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ~UFFOLK COUNTY ON ~E~. ~i~TT A8 FILE NO.~ AND LA~D SURVEYOR N.Y.S. UCENSE NO. 12845 HOWARD W. YOUNG, LAND SURVEYOR / 0 OCCU?AHCV OR ~ ·,~ USE IS ~UHLAVffIIL 'ff Copper fuBing is used r For Wqter distributing, '. SyStem; piping shall be ii6_F,~_ t~^~.~.p. NOTIFY BUILDING DEFAFT~NT 765-1802 9 FOLLOWING INSPECTIONS: ~, FOUNDATION - ~ REQUI~ED. ' FOR POURED CONCRETE 3. INSULATION 4, FINAL BE COMPLETE FOR AIL CONSTRUCTION SHALL THE RE~U[REME~S ~ATE CONSTRU~ON ~ODES, NOT RES~NSlBLE DESIGN OR CON~TRucTroN ERRORS.