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Home My WebLink About13567-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No....Z,l.5. q ? J ........ Date ........ ~a.y..2.3., ................. 19.8.5. THIS CERTIFIES that the building .~ ~_.t.e.v.~ ¢~_.qq. ~..a.d. qt $.t.t. qn. ...................... Location of Property . .1.~ .................. ?.i.n. 9' .N.e.q .k..R.qa.d.. , . Southold House No. Street Ham/et County Tax Map No. 1000 Section . .0.7. Q ....... Block ...0.5. .......... Lot 042 Subdivision.. g ............................ Filed Map No .... X. ....Lot No. X conforms substantially to the Application for Building Permit heretofore filed in this office dated ...~gy.~.rclpfi,r,.,~] ..... ,19.8.4. pursuant to which Building Permit No. 13567 Z dated .... ~ py.e. r0 .b .e?..2. .~ ........... 19.8.~., 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 ......... ...~.t.~.t.i.q~.~..~¢.it.i..on to existin~ one-family d.w, elling. The certificate is issued to ....... ~.O.H. ~..&..~. 9.~p.~.~. ¥. p.~.E..T.Z.E.L. ......................... (owner. J~s*ee.o~ t~Ra~O of the aforesaid building, Suffolk County Department of Health Approval ...n.q ~...vp.q u..~.v.e.d. ......................... UNDERWRITERS CERTIFICATE NO .......... .hi.. 6. 9.2.1.6. 9 .............................. Building Inspector Rev. 1/81 ]p~u'M NO. f~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 13567 Dote ............................................. ...... . . ..., 19. Permission is hereby granted to: ..... ................. .~~...~...~.,....~./..~...~./. ............... at premises located at ....L~...'~J...~........~,.~t~.....~.,.~.....,.~....:......~..~ ............. County Tax Mop No. 1000 Section ........ .~..?....0..... Block ........ ..~.. ........ Lot No......~.~ ........ purslJont to application doted .... ~.~,..~..~ ............... , 19.~..~...., and approved by the Building Inspector. Fee $...w~..%..~ .......... 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 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 whereapplicable. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 or land use $5.00 3. Copy of cbrtificate of occupancy $1.00 Date ..~....J. ...... New Building ............ Old or Pre-existing Building ........ Vacant Land ............. Location of Property .~. ~. 7.~. ........... .~.j.'r].~,. J~,,~]~.~. ~ ............ .~.~.~.~..oJl~ .... House No, Street Ham/et Owner or Owners of Property . .~.~..~.r~, .~ .~[~9.r..~.~..~.~..~.i ?ffZ~{l ......................... County Tax Map No. 1000 Section . .~). ,~..O. ....... Block ... ~. ......... Lot..~..,---~ .......... Subdivision .......................... ....... Filed Map No...~. ....... Lot No .............. Permit NoZ'3~', ,~,,7,~-,. Date of Permit II.-.~(. ? ~. ~.Appiicant ,. ~.' ~-~C..~ ~..~.~ .~.~. y .......... Health Dept. Approval ........................ Labor Dept. Approval ........................ i -- Underwriters Approval ........................ Planning Board Approve ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ........................... Construction on above described building and/i~mit meets all~!;Iplicable codes and regulations. Ap, plicant .~..h.~~'. ........................ I'& / THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy 003"~ 85 JOHN STREET, NEW YORK, NEW YORK' 10038 Date ~a~ ~, '~es5 ~,~,,l,cat,onNo. onZ,e ~3~??~/s5 N 692169 only tbe electrical equipment as described below and introduced by the applicant named on the able application number in the premises of Mr Jo~ Dtet~l, 1675 P~e Neck ~., Sout~d, in tbe following locatlon; ~ Basement ~ 1st Fl. ~ 2ad FL Section Block Lot was exa~nined on ~ ~3~ 1~5 and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS DISH WASHERS EXHAUST FANS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT S E R V I C OTHER APPARATUS: NO, OP CC, COND NO OF HI-LEG~ OF HI-LEG NO, OFNEUTRAL! A, WG OF NEUTRAL Detector tiall Electric Inc. P 0 Box 1268 Southold, N Y 11971 Lic ~57 E Per_ 11 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. , THI OF CI TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. ;2~6 (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber s signature) Sworn to before me this ~ ) day of ~Y%~ , Notary Public, ~e~/~/~ County N~tary Public UNDA d. COOPER I~rARY PUBLIC, State of New York No. 4822563, Suffolk Cour~y/~, Term Expires March 30, 1'~/~; if; FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION ~ER N. Y. STATE ENERGY C,ODE FINAL COMMENTS ADDITIONAL COMMENTS: 76S-1802 BUILDING ,DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. 'FOUNDATION 2ND [ ] INSULATION' FRAMING [~INAL REMARKS: DATE. F/~/g~'~'"' INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUI LDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-t802 ]xamined..~.~..~. t., 19 tpproved . t~..~..~. ~., 19~.q. Permit No./..~.~.~.~.~..'~;k Received ........... ,19... )isapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .../ .......... INSTRUCTIONS a. This application must be completely filled in by Wpewriter or in ink and submitted to the Building Inspector, with 3 ,~ts of plans, accurate plot plan to scale~ Fee according to scl~edule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets r areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli- ation. 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 hall 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 aall have been granted~.~y the Building Inspector. . APPLICATION IS{HEREBY~'n MADE to the Building Department for the issuance of a Building Permit pursuant to the milding Zone Ordinafice of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~egulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. 'he applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to dmit authorized inspectors on premises and in building for'necessary,, ,,i~pecti°ns' ~ ·....~....~:..~.~ (Signature of applicant, or name, if a corporation) (Mailing address of applicant) ¢tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. %"~, 1 g ~ e-,. ~ · .......................................... Name of owner of premises .~9.~.,. ~D. ~ (1~0~.0'~. ~.~..~.~,-..--'~...L~..~.~..~.I ........................... ......... (as o[ 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. ~. 0.~1 D...L.O..~ 1 ~.Y.,,~ ..... , ~'t-~ ,~,~ Electricit n s License No?~ .3 II..~. !~..~'~..t-.'. S-.~.. J~ Ibfe ,~[ '~o~ ~ Other Trad e's License No.Cm.~. Y.'~... [5 .~?-.r..~.'~ ?.!~..S 0 ri 1. Location of land on which proposed work wffl be done ...................... ? ............................ . ................... ...... ................... Itouse Number Street Hamlet County Tax Map No. 1000 Section .............. Block .................. Lot ................... Subdivision ..................................... Filed Map No ............... Lot ............... (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 ..... ~/~-..~ ~.~.~7' . ............... b. Intended use and occupallcy ~. -& vFi '~ .. ~. '. 3 Nature of work (check which applicable): New Building Addition / Alteration ..~.. Repair .............. Removal .............. Demolition .......... : ....Other Work ............... ~.. (Description) 4. Estimated Co . . .~..(~ ................... Fee ............................ '" (to b~ paid on filing this application) 5. If dwe rig, number of dwelling units .............. Number of dwelling un s on each floor ............... If garage, number of cars ........................................... ! .................... ......... 6. If business, commercial or mixed occupancy, specify nature and extent of each ~_.e of use .... ~ .zte~/ ........ 7. Dimensions of existing structures, if any: Front-~.~.'.~. .... Rear "~.].~f.~--~ .... Depth .o~2~ ......... Height ../~, ~ .......... Number of Stories .... ( ................... ,~ .[ ................... Dimensions of same structure with alterations or additions: Front -~ ~...~/. Roo~ z,/~?_. ........ Depth ... ~ ................. Height . ./.~, .................. Number o.f Stories .......... ! ........ 8. Dim0nsions of entire new construction: Front .. ~.,,~ .~ .... Rear ~/.~-. ....... Depth . .Z/~ ......... Height ff[,, ./ .......... Number of Stories ....... Z ..... i ..... i ...... i, i, i,, i ......... 9. Size of lot: Front . ./..O.(>. ............... Rear../.O.Q:~./ ............ i Depth .~.~.7.t . ' ......... 10. Date of Purchase ............................. Name of F~ormer Owner .... g~,p~O,t:x.l~'./h .... 11. Zone or use district in which premises are situated. ,/~ ~l'c[~.~/~/~../ ......... i ............................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ... i ............................. 13. Will lot be regraded /V'O ............................ Will excess fill be,r2am~v~l~.r, om premises: ,_Yes Name of Architect ......... '7. ................. Address .., ..-T, . .~ ~.t 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 ~h0w street names and indicate whether interior or corner lot. ¢ q$,-L o ~TATE OF NEW YORK, ! o ~ / :OUNT¥~F,x~r ~ ~__--.S'S ~ . . ~,)~L (Name o~ maiviaum signi~ontract) ' ~bove named; ~ ~ , {e is the , (Contractor, agent, corporate offker~ ~f said owner or owne~, ~d is duly authorized to perform or have performed the said work and to m~a and fil~ t~s pplication; that all statements contused ~ this application are tru~ to th~ best of h~s ~owledge and belief; and that tork will b~ performed in th~ m~ner set forth ~ the application fil~d therewith. ;worn to be, -~ me this ............ ...... .......... 19 .f lota~ Public, ................ County '~ NOTARyNO PUBLIC, SuffolkState of New York ' '~. ~ature of applicat) .... 4/~'/878, CouHt~ ~ - F / ':5' JOl-I N · h4OT ~.. ii ih! ¸%, L Ij 1' FbUNDATON C~: ' ' REQUIRED '-z. ROUGH.. FRAM STATE CON~TRUCTIO, ~IGN OR COk STRUCTioN E~ROR~ SUPply SYSTEM o~ ~ co~ ~'CC ~ I[ copper lubing is used [or water d~stnbut g System;'pJping shaJJ be of types K or -- F~ i'j¢ ~~ . OCCUPANCY OR i~lT ':: ' ':',' 0F: 0CCUPA~Y': , ;j