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Home My WebLink About13565-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Zfl 566q- Date July 23 THIS CERTIFIES that the building ....o~.~ .-¢'B.m.~ .ly..d.w..e.ll±ng: .................... LocationofProperty ...2~.00 .......... ~5.~lge. r,ane .. Cutaho.~ue House No. Stroet ................ Ham/et County Tax Map No. 1000 Section ...... ~35 .... Block ......... .2. .... Lot .... .~. ........... Subdivision ........ ~ ...................... Filed Map No .... .~....Lot No .... .~ ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated October 29 84 f13565Z ...................... 19... pursuant to which Building Permit No ...................... dated .... .lXl.o.~.~.m?..e.~..2.? ...........198..z[. ,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 ......... New one-£amily dwelling. The certificate is issued to J0~IN & AMY BAG~IVI of the aforesaid building. Suffolk County Department of Health Approval I~4-S0-2flz[ UNDERWRITERS CERTIFICATE NO ............ N695850 Building Inspector Rev. 1/81 TO~N O~ $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N_o BUILDING PERMIT ~HIS PERMIT MUST BI: KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) 'J 35J~5 Z Date ....~., ~ .~.......'~,,./, ............. Permission is hereby granted to: ::::::::::::::::::::::: :::::::::::::::::::::: . ...~~v~....u.:5:.....!..~..~.~-..... . .~: ............................... ~...~;. ...... ~......:...; ............ ~p ............... ~.....~. ............................... ~t ~r m se ~ote~ ot .................... :~~ .......................... ~ ......... .~.~ .......... County Tox Map No. 1000 Section ..... ..C~..~.....~.. ..... Block ........ ..'~... ........ Lot No ......... ~ ............ Building Inspector. Pee $ t~'th 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 ia ~llll~l 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 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 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 ~ Date ........... New Building ............. Old or Pre-existing Building ...~ ......... Vacant Land ............. Locat on of Pro crt C~'7('O~) "'~(D(:~'~ "~'~ C~/'-~ if--//~::~/~'~ P Y .................................... / .............................. House No. Street Ham/et Owner or Owners of Property ~,~~)/'/'/~U/ /¢' ¢ Cou nty Tax Map No, 1000 Section ..... ¢,~' .~..... Block. c~ Lot .... .~. Subdivision..[.~.' .~..~...~....t~.~..~. ~'~. ........... Filed Map No ........... Lot No ....~. ........ Permit No. 1,~¢'~ .~. Date of Permit .......... Applicant .................................. .,~.~ ~.1¢ App Health Dept. Approval . ./(-/. ............. Labor Dept, royal ........................ Underwriters Approval..4 ~..~..~'.~ .~, ........... Planning Board Approval ...................... Request for Temporary Certificate ...... · ."~-~..~'i'-'~ i. ...... Final Certificate ...... ~ ............ Fee Submitted $ .... ~ ...... .~, .~-..(J..-7 ....... / Construction o n above described build lng and perm it nYeets a ll,~pplicable ~pdes a nj~regu la, ions. ./. ..... ................ 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 -'~/~(~d/ /~ /~ 3 '~(~[~ ~ (please print) Plumber~/CLT~- L. .~:'90,'-/.,"-~ ~7~ . (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Sworn to before me this 19 Notary Public,~/~_~ County State of New York Notary P uk~& c~ KAREN SCHUL~ i~c~sr~ } ub ~c~ Sta~e of ~OW YO~ N 4822,491 ~uzl]f~c.i ~; Suffolk ~t~ C~mn,ission Exp~es ~h ~,-~ NEW YORK BOARD OF FIRE UNDERWRITERS THE 100028'~ SUREAU OF ELECTRICITY · 1~ 85 JOHN STREET, NEW YORK, NEW YORK 1OO3~ Da,e June 12, 1985 ~pplic,~io, No.o, yile309601/85 , N 695850 THIS CERTIFIES THAT only the electrical equipment ~ described below and introduced by the applicant nameE on the above applieatlort number in ~he premls~s of ~k~, Jo~ ~gli~, 2700 Br~e L~9, ~t~o~e, N.Y. in the following lo,'ution; ~ Basement ~ 1st Fl. ~ 2nd FL , ' Section Bt~k Lot was examined on J~ ~ , ~8~ and /ound to be in compliance w tb the requirements of this Board. FIXTURE OUTLETS 31 DRYERS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: Motors; 1-1bp i~G.F.C.I, 2-Smoke Detectors. T~ack Lighting: 8'0" 4 lites. I C NO OF CC, CONQ NO OF HI-LE~ PER ~ CC. COND 1 i OF HI-LEG NO. OF NEUTRALS 1 Weber Walter Finger 405 Birch Lane CMtchogue, N.Y. 11935 Lie. 1845 This certificate must not be altered in any manner; return to the office of the Board if incm'rect. /nspecto~,s may be ridenfified COPY FOR B? LD NG DEP THIS COPY OF CERTIFICATE I Y ANY MANNER. FIELD I N.~2 ~ E ~-~ION COMMENTS FOUNDATION (1st) FOUNDATION 2. (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY G?DE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 7654803 Examined .A)...~J,~.....~...~. ~., 19 Approved . ./Q....t)?~....~...~.1., 19 ~.~.. Permit No. Disapproved a/c ..................................... BLDG. DEPT, TOWN OF SOUTHOLD Application No .................. (Building Inspector) 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 Building Department for the issuance ~' a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and/qther applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for remg~al or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cod, l~, housing code, and regulations, and to admit authorized inspectors on premises and in building for nece~~:;'~: ~(Signature/oLa~plica~tf, or name, ifa corporation) ~ '-"'.....";~....~. ~'../.,? ~-.o. ,,. ~,,..~,:.,¢,~ ,,~_,. ~,,<.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. d2...c?...,w. ~-5.&. .............................................. Name of owner of premises..d.°~.....~..../~....~t..~. .... . .~..~...~./.'.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 ...................... 1. Location of land on which proposed work will be done .................................................. .... .¢..7.o. O ............... g}. x:./. ~. x~7:.X. ~< ....... ~" ./~.. :..~-.x'..~: ~7 ................. House Number Street Hamle'[ County Tax Map No. 1000 Section ....0.)~.~.. ......... Block....~.~, .......... Lot....(~...~. ............ Subdivision..~.~...~./,,..../~.'.~.' ~'--~.'i .......... Filed Map No. '~?. ?.2 ...... Lot..~..~ .......... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ¢.~./~..~. i.. ~..~..~..~. l~ .................................. b. Intended use and occupancy ......... 1'"' "~' '/~ 1' '~' '? .... .J~..~'~/.~.~/I ..... './~.~ ' Nature of work (check which a~plicable): New Repair .............. Removal ..... If dwelling, number of dwelling ~mts .... Building ...~...... Addition .......... Alteration .......... .... Demolition ........... Other Work ............... (Description) (to be paid on filing this application) ........ Number o f dwelling units on each floor...~77'. ~-.-~.'~-. ...... If garage, number of cars .... .*~--::~x...'. ............................................... . .... . ........ If business, commercial or mixed occupancy, specify nature and extent of each type of use ....-'7-... 2 '. ? ........... ..... if any: Front ' ' - Rear ' Depth Dimensions of cresting structurqs ............................................. Height ............... Nun~ber 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 . .,~.~ .......... Depth . ~.i ~ ......... 10, Date of Purchase ........... ! .................. Name of Former Owner ./...~ '~,'~.~i.~'i~.~' i-i ............ --1 1. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vioJate any zoning law, ordinance or regulation: ...,~..t;?. ......................... 131 Will lot be regraded . y..~ :... .......... ,~ ........ Will exqess fill 1~ rl}moxed from premises: Yes 1 4. Name Of Owner of premises Jo.[} ~/.~. t0f~.~.t~/~g[t, glAddress ~.~c~fi. .i?. /.(.o, .(-.~.r(t~?l~one No ................ I ....... Address .............. , ..... Phone No ................ Name of Architect . i '~ .... PLOT DIAGRAM Locate clearly and distinctly alii buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and block inumber or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S S .... c:.-,., COU ~NTY~-20, _ F ' ' ": '?~' '~'?'~'~ .... i~ .'- .... .... ,....~-~4/.~.( ............... being duly sworn, ~leposes and says that he is the applicant (Name of individual sign'ing 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 m this application are true to the best of his knowledge and belief; and that the work will be performed in the mannqr set forth in the application filed therewith. Sworn to before me this ........ ........ ., ..... day . . . ?. . . . .C?E<. . . . . ., l .... _.J 'TIE. $55- 17.-. lO E IZO0 kJ Co"r el' ~76.00 N55- 18- flo ~j I'~ 3 60 [~RI D ('~ E. LAL~E " N/F DAvIDs ~ S55- 1'7-10 E 120.0 0 ~ 0 ~ ~ 0 0 0 ~7~.o0 ~ ~r~OLlq C~U~ D[PARTMENT OF H~LTH ~ERVICES ~ FOR APPROVAL OF CONSTRUCTION OF ~ Smile Family R~ide~ Only FILED MAP NO. ~ DATE FILED~.~ CERTIFIED ONLY TO:i ~ ~WqD~ ..... HAWKINS ~WEBB BY~~'~- ' ENGINEERS-~URVEYORS-DESIGNERS-PLANNERS 9 F DAVIDS ~ $55-1~-IOF_ 120.0 0 0 0 ' i o ~ ' ~-. ,~- ~ ~I~E LA~E ~OJECT 0 8CaP h'CY 8R OF OCCUN ,CY PLUMBER CERTIFICATION ON LEAD CON~'ENT BEFO.,2E CERTIFICATE OF OCCUPANCY , SOLDF~P~ US/aD iN WATER SUPPLY SYSTEM CANNOT EXCEED 2/10 Dj' 1% LEAD. If copper tubing is used for water distributing system; piping shall be of types K or L only AP~2GULD AS NOTED ~ENT AT 76B-]802 9 AM TO 4 PM FOR THE gOLLoW/N~ INSPECTIONS: I FOUNDATION _ TWO REQUIRED FO~ POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3 INSULATION 4. FINAL . gONSTRUC~[ON MUST CODES, NOT RESPONSIBLE FOR DESIGN O~ CONSTRUCT ON ERRORS Phone 477,0400 Main Road