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Home My WebLink About13562-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ...... re~av, ati.om .&, ~d~i~.qD ................. Location of Property ~55 & 260 MacDonald Grossing Laurel House No. Street Hamlet County Tax Map No. 1000 Section ..... .fl~.5 - · .Block ........... /+...Lot ...... J 7. ........ Subdivision ~.dgemsre ~Park .Filed Map No. 7/42 .Lot No. fl 0 conforms substantially to the Application for Building Permit heretofore filed in this office dated November fl fl 19 .~ pursuant to which Building Permit No. fl 3562Z dated ....ET.oy.e.m..~.e?..2.'1. ............ 19 .~?., 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 ......... ...... R..e.np.v.a.t..ip.n...a.n.d..a..d.d.i.t.i. 9.n' .~.o...e.x.i.s~ing one-£amily dwelling, The certificate is issued to ROBERT JESSBt~ of the aforesaid building. Suffolk County Department of Health Approval .... UNDERWRITERS CERTIFICATE NO .................. 79 ........................ Building Inspector Rev. 1/81 iro'~M NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 13562 Z Permission is hereby granted,,t,oj, .....~. ...... ;-;....~ ....... , ............................................... ~.~.~.~...~.:~.:..tL~.~ ~,~...~~.~.~.,....~....~~...~_ _ .......................... . .............. at premises located at ...... .~. ........ .~...~..~ ................................ ~ ~....~. County Tax Map No. 1000 Section, ....~...~..~.... ..... Block ........ .~.. .......... Lot No ......J..7 ............ pursuant to application dated ...~..~....~ ....... ~ ................ , 19.~..~.., and approved by the Building Inspector. Rev. 6/30/80 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 is ~ to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of properW 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~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 ............. House No. Street Ham/et Owner or Owners of Property o.~e~ ., , .5,~,, u,~, ? ................ County Tax Map No. 1000 Section ............... Block .............. Lot .............. No J3~,~2. ? D cfR rmit )°.J.~..~'],~, ,~.Applicant Permit .......... ate e ................................... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval .... .~.. 17.~. ~.-)..~.O...Planning Board Approval Request for Temporary Certificate ..................... Final Certificate ..... ~ ................. Construction on above described building and permit, meets all applicable codes and regulations. C',{~ ~r-~ I S--/q '-~ Appl,cant j~ ~ ~ ~ ~/~..' Rev. 10-10-78 THE NEW YORK BOARD OF FI'RE UNDERWRITERS 1000801 BUREAU OF ELECTRICITY ~-~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~..,,~..o.~o.o.~,,~ N 703790 THIS CERTIFIES THAT only the electrical equ~p.~ent ~ described be~ and introduced by the applicant ~med on t~ able application number in the premises of w~ exatnirled o~ A~8~ O~ ~ 1995 and found to be in co~npllance wlt[~ the requlre~nents of tbls Board, FIXTURE FIXTURES RANGES OVENS EXHAUST FANS OUTLETS SWITCHES NCANDESCE~T FLUORESCENTVAFOR 3~ 47 31 DRYERS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1-4ton A/C ~-Lites S E R V I C W' G. NO OF HI-LEG [ A W, G, NO- OFpE COND OF ~C. COND OF HI-LEG NO, OF TRAM OE NEUTRAL 3/0 ~h~s ~chun~ ~ox 30 11978 This certificate must not be artered in any manner; return to the office of the Board if incorrect. Inspector, s MANAGER INER. FIELD INSFECTION 1. FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & FLUMBING INSULATION ?ER N. Y. STATE ENERGY ~ODE COMMENTS FINAL ADDITIONAL COMMENTS: OFFICE OF BUILDING INSPECTOR P,O~ BOX 728 TOWN HALL SOUTHOLD, N.Y, 1 t97! TEL. 765-1802 C E R T I F I C A T I ,O ~~, Building Permit No. t ~i~,~'~ (please print) (please p~i .~) I certify that the solder used in ghe ~,ater supply systeia contains less than 2/10 of 1% lead. (plumber ' s signature)~'~"~"- - Sworn to before m,~tthis \ ,/ ~ . ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved ~. · .e~T2. · · .~. ·..~.o..., 19~.~. Permit No./.~..S.'7~..~..:~. Disapproved a/c ..................................... BLDG. DEPT. TOWN OF SOUTHOLp Received ........... ,19 } ,~. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date 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 publi~ 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 tmtil 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, ~ad other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for $~f)~oval or den)~lition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, build'.m.~'~I'de, hous~/g//o6de, and regulations, and to admit authorized inspectors on premises and in building for necessary inspectj~/J~. ~/~ /] ,, r-~ ...... .... (Signature of applicar~ft, or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. E ........................ ............................ Name of owner of premises..(. '.[~..' .~..~.;")..~..Q.~..g..o~.. ...... ~.~.t. ?..-~.~ ......................... (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 w~l be done ...................... ~ ..................... - ...... ....... ...... . ; ........ House Number Street County Tax Map No. 1000 Sectionc~ ~l q~' Block <5 t--I Lot (51 Q Subdivision ..... o~o__,oo, o~'~., ~CYr', Filed Map No. Lot \O (Name) 2. State existing use and ~ccupancy ~f premises and intended use and ~cc.u-pancy ~f pr~p~sed c~nstructi~n: a. Existing use and occupancy ............. .~ ' · ............. b. Intended use and occupancy., ~* ~.'..°~.~./-'.' .~.~.~f~..: ............................ 3. Nature of work (che, ok which applicable): New Building .......... Addition ...... Alteration, .~... ..... Repair ....... ~ ..... Removal .............. Demolition .............. Other Work~t,~k~k,Cg~ .... {i~ ' '..~...~.,..~. ,~.. '.t (Description) 4. Estimated Cost . . .(~..c~. .................... Fee ...................................... ' , · * · , (to be paid on filing this application) 5: -q~dw*lltltgTffLl~lS~t'~i~ftt~elling[ units..tZb~.¢~.. ....... Number of dwelling units on each floor. ~.. ~.......... If garage, number of cars .... .~/~..~9.°.... ~.~.~.~.~. ?..~ ................................................ 6. If business commercial or mix{d occupancy, specify nature and extent of each type of use . . , . 7. D,mans,ons of exist'~ng structures,,, if' any Front .....~..O~._. ............... Rear G-C) ....... Depth ~-7' ........ Height ...... ~ ...... Number of Stories .. ~>M..~. ................................................ Dimeqsions of same st~cture with alterations or additions: Front ................ Rear .. ~..~.. ......... Depth ......... ~- .c7... Height ..... ~(4 ............... Number of Stories..(:Y~J...~. .............. 8. Dimensions of entire new constructxon Front ............... Rear ............... Depth ............... Height ............... Number of Stories ............. t ............................................ 9. Size of lot: Front .... ~;~.o..., ............ Rear .. ~ ............... Depth ...[~...' ....... 10. Date of Purchase .......... ................... Name of Former Owner ............................. 1 1. Zone or use district in which pr'emises are situated ..................... 12. Does proposed constructlon vi01ate any zoning law, ordinance or regulation: ..kb.c? .......................... 13. Will lot be regraded ........ .tg. qD ................. Will excess fill be removed from premises: Yes No 14. Name of Owner of pren~ses"~¥~',U,. ~ ...... Address .... ~p~---'. 12t:r~o ·. · Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property li~es. Give street and block, number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OFiNEW YORK, i COUNTY OF ............ i S.S ................................................. being duly sworn, deposes and says that he is the applicant (Name of individual sigl 'ting 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 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 ........... ........ dayo .. ............. 19 .7 .iff Notary Public ...... .~.'.~.~..~.g..?..d-~-..... County /4~ ~~ ! :: .... .................. i~).TARY PLJ~,LtC, State of New ,', ol k - - / (Signature of applicant) ~}l 470t875, Suifol~; County_ ,~ . - [ , ~]~m~ ~,q}r,qs Ma~ch 30, 19~/~'-q r ~OTE: SUFFOLK COUNTY TAX MAP U ~ MONUMENT LOT NOS, REFER TO MAP OF '~OG~tlIERE PARK~'~ F ~O IN THE OFFIC[ OF THE CbERK OF ~UFFOLK COUNT~. for dESSUP Survey ROBERT R L_o u re I 'lbwn of Southold Suff. Co., N.Y. Sca le, i"=40' May 26,1958 June 19, 1984 PROFE~ LAND SURVEYOR, N.Y.$. 12845 [ I '% 'l ~ ~ ~-u~ cd. to 9 d -I ,] sOLDER USED IN WATER SUPPLY SYSTEM CANNOT EXCEED 2/lO of 1% LEAD. PLUMBER CERTiFICATION ON LEAD CONTENT BEFORE CERTZFIC~ TE OF OCCUPANCY A? ......3 AS NOTED ~AE~_~_E: li/a~]~q B.P. ~ /,.~-2~-*~ NOTIF~-~I~I'~G DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: ), FOUNnATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 2. INSUlaTION 4 FINAL - CONSTPUCTION MUST BE C~pi~TE FOR C O, ALL CONSTRUCTfON SHALL MEET THE REO]rm~cNTS OF THE STATE CONgTRUCTION & ENerGY CODES, NOT RESPONSIBL~ F~R ~ESIGN OR CONSTRUCTION ERRORS If copper tubing is used for water distributing sys.em~ piping shall be of types K or L only