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Home My WebLink About13566-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N.Y. Certificate Of Occupancy No...~?~,~.~.? ......... Date ......... ~.3~. .~Q ................. 19 .~.~. THIS CERTIFIES that the build[ng-~-.~¢~...d~¢~.].5.~ ................................. Location of Property .. fi.~6. ~ .................. .~.~.~y. ~,~,~t.e. ........... . ~.~.q~.. House No. Street Ham/et County Tax Map No. 1000 Section . .fl ~ ....... Block . . 0B. .......... Lot ... gD. QE .......... Subdivision ..... ~ ........................ Filed Map No... ~ .... Lot No .... X ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... Iqo.~.om~ e~..~ ..... 19~./Y. pursuant to which Building Permit No....'1 ~.6, .Z .......... dated ........ ~q¥.e.m.~.e?...2.fl. ...... 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 ......... ...... .~..p.~. ~.v?.~.e., .o.n.e.z-.&~. ~..a.w. ,e.:t~.~.~. ~: ...................................... The certificate is issued to ...... ~. ,O.~.~.X.A., .X4k...H~...A ..... (ow~er, ~c~'~r~) ...................... of the aforesaid building. Suffolk County Department of Health Approval .q.~:-.S.O.-:~.~.~./Tz/~.~. ~. ~.~.e.l;)~.~.n..~. ~..C.q~ ,~.~. ~. v,. UNDERWRITERS CERTIFICATE NO ......... ~..~.q.~.cj ./¢ ................................. Rev. 1/81 Building Inspector l~U~ NO. ~ 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) No 13566 Z Permission is hereby granted to: ........ ;';~""~"~i~-~ .................. ~ ................... ....'~.~.....~.:..%...../../...t~.~ .... ........ ........... "; ......... i ...... :"'"7~'"'~";~'~:"~;~£ 'i"'~ ~':;'"i'""~'~';":'"~ ................................ at premises iocorea ar ................. .~s~.~r::~...~,/~v ....... ~.....-n,~....~,~,~ .............................. County Tax Map No. 1000 Section ..... ~...~..~.. ...... B~ock ....... .~. ........... Lot No ..... ..~. ................. pursuant to application dated ..... ..~....~.....~......~.. ............... 19..~..~, and approved by the Building Inspector. 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 in duplicate 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 disposa[-(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 approvai~ of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-e_xist!ng" land uses: 1. Accurate survey of peoperty showing all property ~ines, 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. C. Fees: 1. Certificate of occupancy $5.00 / /s,/$5.00/ 2. Certificate of occupancy on pre-existing dwelling ~r land use $ 3. Copy of certificate of occupancy $1.00 Date ... j .. New Building ............. Old or Pre-existing Building(Z) ......... ~/Vacant Land 2 ...... Location of Property , ,,/,~,-,& ~ ............... ~...~,, .... t~,~)..~.'.Z?~.,/..~,(¢..~./~, House No, t .... Hamlet ow o ofP op ty S ner or wners r er - County Tax Map No. 1000 Section . ./,,,~ & ....... Block ..... ~ ....... Lot .... ,-~.. ........ Subdivision ................................. Filed Map No ........... Lot No .............. .-. Permit N o~..~....&~,. ~Z~ Date of Permit .Applicant ~.. ~,~, .~.-. Z.~T..~'.~..., .~'TJ. ~...,~,~.-J... Health Dept. Approval ...................... Labor Dept. Approval ...................... ,.. Underwriters Approval ........................ Planning Board Approval .................. Request for Temporary Certificate Final Certificat~ Fee Submitted $ .......... ~ .................. Construction on above described building and permit~mee~s all appl~cable~cgd~ and regulations. A' licant~.~,_,.,~. ~,~.~') ~,..~.-~. PP c/~" ...... ;' '" .... X, ' ......... ~7 ................. Co TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 1197t TEL. 765-1802 CERTIFICATION Building Permit No. Owner (please print) Plumber ~./~- ~ ~ ~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s signature) Swor~/~o before me this __/~ day of ,/'~,~ ' 19~. ~/ Notary Public, ~Mf~//<. County ~AN A. JACOBS NOTARY PUBLIC, State of New york No. 4702900 Quahfied in Suffolk County Commission Expires March 30, 19 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. /_¢ (please print) Plumber ~. (plea'se Print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. - . (piumber's signature) / Sworn to before me this , ~/~day of /~/¢ ;~ , Notary PublicA. 5~'/~Q County Notary Public FLEXI :Si,ECTION 1. FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY %ODE FINAL COMMENTo ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000771 BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW_YORK 10038 THIS CERTIFIES THAT ~examinedo. ~y 6~_ [~985 ~Y°u~tobe~"~m~ew~ththe~equ~em~n~fthisB°ard'. 18 cb i 1). O. Box 143 ' Mattituck~ N.Y 11952 Lic. 242 This certificate must not be altered in any mannerr return to the office of the Board if incorrect. Inspectors mc~y be identified by iNSPECTION [~//FOUNDATION 1ST [ ] ROUGH PLBG.' FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS DATE, INSPECTOR 78S.Z802 BUILDING DEPT. INSPECTION FOUNDATION XST [ ] ROUGH PLBG. ~']//FouNDATION ZND [ ] INSULATION FRAMING FINAL REMARKS: DATE INSPECTOR .... ~ ,"; ;~-~,~ FORMNO, 1 OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL ~°OUTHOLD, N.Y. 11971 TEL.: 7654802 Examined..k).~ .~...'.&J., 19 .~ Approved. ~ ~.~. ~.)., 19 ~ ~. Pe~it No./. Z,~.~.~ Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BLDG. DEPT. .... TOWN OF SOUTHOL._..,,,.......=,.~D Received ........... ,19... 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 Inspecto~ 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 insgections, f'/ ,~ .... /_/:..~..~../~ ..... . .~..J.o..~..-c.../.~...c. .... (Signature of applic~int, or name, if a corporation) .. ~ .~....~d/......~...~. ~.-:..4Yr... z c.~. ~.:...~ (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~.O. ~...~../'6 .... .~..~../~..~../'f...~ ............................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ..... (Name and title of corporate ~/fficer) Builder's License No. Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... 1. Locationoflandonwhichproposedworkwillbedone..,~5~.~/ff...../~...~..,~.y....~...~..~ .................... ......... !.q.4.57 .......... -- ............... House Num bet Street Hamlet County Tax Map No. 1000 Section .../~..~. ......... Block .................. Lot ................... Subdivision. ,' ................................... Filed Map No ..... ~. ........ Lot ..... ~ ........ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ' / '¢ --v /t C /~ /~ / - . ..... , ............................. a. Existing use and occupancy ................................ b. Intended use and occupancy .../....~'/'~..'~)../.¢....~,..~. · .~..~..~...~..~..~':~ ....................... 3. Nature of work (check which applicable): New Building .......... Addition . 'i ........ Alteration .......... Repair .............. Removal .............. Demolition ........... ~... Other Work ............... ~ (Description) 4. Estimated Cost ................ '. . ,x (to belpaid on filing this application) 5. If dwelling, number of dwelling units ............... Number of dwelling units ~an each floor ................ If garage, number of cars ........................................... i ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, lfany: Front ............... Rear ....... i ....... Depth ............... Height ............... Number Of Stories ........................... i ............................ Dimensions of same structure with alterations or additions: Front ........... i ..... Rear .................. Depth ...................... Height ...................... Number of Stories ............. ~ ........ 8. Dimensions of entire new construction: Front ............... Rear ....... i ....... Depth ............... Height ............... Number of Stories ........................ ' ......... .... , .........;>g% ..... 9. Size of lot: Front ..../O.O ............. Rear ........~.O..o. ........... Depth ...................... 10. DateofPurchase ............................. Name of Former Owner .i ............................ 1 1 Zone or use district in which premises are situated ~ 12 ;'~ ..... ordinance or regulation: · Does proposed construction wolate any zomng law ..... : ............................ 13. Will lot be regraded .... g~..~. · .. ................ Will excess fill be remove:d from premises: ...Yes_.. 14. Name of Owner of premises ,~..~x~./7[~,'~ A~./~.,.. Address ............ i . ..PhoneNo ....... .N.o. Name of Architect . Address ............... i ....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 show street names and indicate whether interior or corner lot. STATE OF NB~ORK,, g - S COUI~TY ~ ..... 8. ~/~ (Name of individual signing contractJ 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 shid work and to make and file this application; that all statements contained M this application are true to the best of his ~owledge and belief; and that the work will be perfomed in the m~ner set for~ in the application filed therewith. Sworn to before me this ....... ~'. ...... day of. ~~ ..... 19~ ....... k J_/z d ~o[~g~OllC, .......... ~..V.. ~<~... County ~ ~ - ~-~~... ~..~.~ ......... ,~.~.~:7..,r}b: .... SUF~ D ST DEED: ~:.:.D L.:'', P.'.~.. 'u' ...... ~EST HOLE' STAMP SEAL 'X: '/ '._ :'-' *'*[..--::; ...., RODERICK VAN TUYL, P.C. ~. V,~____'--~.w~, LICENSED LAND SURVEYORS GREENPORT NEW YORK i&O. CO The sewage di$~l ~ad water a~plT facilities for this iooatiol have Xnspected by %hi~ de~rt~n% ~ f~d Ohief of ~en~l ~neeri~ Se~ices SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO. 1/~-'~O-'?~ STATEMENT Of INTENT HE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. (s) APPLICANT SUFFOLK COUNTY DEPT OF HEALTH SERVICES -- FOr APPROVAL Of CONSTRUCTION ONLY DATE: APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK P~L. O~/NERSI ADDRESS: DEED: STAMP Sect,~n 720~ ~ the New York Education Law. SEAL NEW YORK If copper ~ubing is used for water distributing system; piping dnoil be of types K or L only OF OCCUPANCY ~z~ ~/zo o/.,oC, 4~voz, ~ ~,,o z~z. L4D. PLUMBER CERTIFICATION' ON L~AD CO~V2~NT P~FORE C£~T.U, ~, ,:.". ~ ~ ',C' PF ()C 'C',.r/~..L NC}" A=.- 3 AS NOTED FEE Jo,.da BY: V, NOTIFY BNILDING DEPARTMENT AT 765-1802 9 AM TO 4 PM FOR THE FOLLO\Aq NG IMSPECTIONS: 1. FOUNnATIOiN - TWO REQLIIRBD FOR P~iIRCD CONCRETE 2. ROUGEI - FRAMING & PLUMBING 3. IF.[SUI AT[ON I