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Home My WebLink About13448-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z14991 Date October 15, 86 THIS CERTIFIES that the building ... Inground swimming pool & fence L ..... 4710 Old North Roa,d Southold, N.Y. . ocauon o[ rroper[y ~S&~ k/o[ ....................... ~}r'e~t' ....................... County Tax Map No. 1000 Section . .q 5. .5 ....... Block 2 .Lot 8.4 Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated s. e. p.t.... ] 9., ........... ,19 8 6 pursuant to which Building Permit No. 1 3 44 8. Z dated ....S.e.p.t. :..1.9.: .............. 19...,86 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 ......... Inground Swimming pool & fence The certificate is issued to Gary A. & Nancy B. Lillis of the aforesaid building. Suffolk County Department of Health Approval .... N / A UNDERWRITERS CERTIFICATE NO ....................... N66.5708 .......................... Rev. 1/81 ~O~W 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) 13448 Z Permission is hereby granted to:~.~ __ ..... ................... ~.....~.~.~.~,~1, ........... ~ ....... 1.~.~..~...~ ........... ~ ,.,._/).' i~,,.' ~ ....(;?,.,.,.,.,.,.~........~...~ ................ ~...~ ........... ~.....~:~ .......... :/ .................................................... at premises located at ......~...'?./...~.. .......... ~(~.~.. ......~..~..~ .................................................... County Tax Map No. 1000 Section .... .1~..~...~.. ...... Block ....... ~ ......... Lot No ...... .~..:.,~... ....... to application dated ..~~.~.....l..~..~'~ ........ , 19.~.,-- and appmv~ by the pu~uant 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 This application must be filled in WpewHter 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 where applicable, For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existingt!_ 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling / 3. Copy of certificate of occupancy $1.00 landuse--Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date .., .'~', .X~, ?,/~,'~-'. ........ New Building ............. Old or Pre-existing Building ............ Vacant Land............. Location of Property House No. Street Ham/et Owner or Owners of Property ............................... County Tax Map No. 1000 Section ...~?.' .~..~. ...... Block . ..~.. .......... Lot.. ~.-. ~.~. ........ Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. /..??.z/~.~.p.~ Date of Permit ...... Applicant. . ., ............... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ...................... Request for Temporary Certifica~ ............. Fee Submitted $. ~.'.?~.~. ........ .Planning Board Approval ...................... ...... Final Certificate ....................... Construction on above described building and permit meets all applicable codes and regulations. Applicant ............................................... Rev. 10~10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 8~ JOHN STREET, NEW YORK, NEW ~ORK 10038 ~y A~ ~11i~4 ~],0 Old ~r~ ~4 ~u~ld~ N.Y~ in the /ollowirtg location; [] Base,nent [] 1st FI. [] 2nd Fl. (,A~L~(~ Section Block and Jound to be in compliance with the requiretnents of this Board. FIXTURE OUTLETS DRYERS RECEPTACLES 1 SW[TCHES 1 FIXTURES RANGES rOOKING DECKS OVENS DISH WASHERS EXHAUST FANS FLUORESCENT SYSTEMS NO. OF FEET S E R I C E NO OF CC, COND. A W G, NO. OF HI-LEG A, W. G, NO OF NEUTRALST A, W G L OTH R PP US: ~i~mir~_.Poo~.~ This certificate cover~ com~liemce at the c~te of iz~pectio~ only o B~use of u~usu~l enviroZm~nts it is adviS~JJle to have frequent test amd/or repairs made by a qualific~l ~ody Pe~illo Pat La~e., ~'ttituck, ~.Y, 11552 ]'his certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors ~U~T NOT SE COPY ~FOR BUILDING DEPARTMENT TH S COPYOF CERTIFICATE = ANY MANNER. F 1 EOLD I~SPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) 2. ROUdH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY G,ODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: FINAL DATE,,, 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1802 Iq Permit No./%qq Approved ' ' ' 'k~ ......... ........... *Disapproved a/c ..................................... ....... (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... 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 l~remises 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 BuildLng 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 in 'o . ~ · "' iSign94:tffe of applicant, or name, if a corporat'on) (Mailing address of applicant) [ [~Of State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ..G. 7 . c7:.or ................................................... o f premises .~/~/C .~. ~?..~...~d9.~.~"¢..~.:...~.[..~['~ .............................. Name of owner ' (aslon the tax roil.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..~... ~ ................................... House ............. Number ' ' Street ......... Hamlet ( ........ County Tax Map No. 1000 Section ...-..~..~.~. ...... Block .... C>~ ........... Lot... Y:..~. ......... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of pc~ses and intended use and occupancy of proposed construction: a. Existing use and occupancy ....~./~.(~. J~(~'f.~. ! · .~- ............................................ b. Intended use and occupancy id~'~{~.~.[.~..C..~?. .... .~.f..~..~.....~..Cd~../..QqtkIj.-M..~..~...C).~ .... 3. Nature of work (check which applicable): New Building ..... ' ..... Addition .......... AlteraJ[ion .......... Repair .............. Rem?al .............. Demolition .............. Other Wor~! ~5[B I.~6. '~C~t~ 4. Estimated Cost... :...~--' ................. Fee . . '...~.. ............................ (to be paid on filing this application) 5.If dwelling, number of dwelling! units .............. Number of dwelling units on 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, if any: Front ............... Rear .............. Depth ............... Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth ................... i · · Height ...................... Number of Stories ...................... 8. Dimensions of entire new construction: Front ............... Rear ............... Depth ............... Height .............. ,~_,Nu,m.,b~r of Stories ......... ' .............................................. 9. Sizeoflot: Front .. ~:~{~./.,L)(~ ......... Rear... ~.:~_~/~9 ....... Depth .~..~.,,?t.~..[ ............ 10. ,D. ate of Purchase .......................... c~',. N~-m~ of Former Owner ............................. 11. Zone or use district in which pr~mises are situated .'~<~.~g ~D.~.J~2.~. I A/.~ ............................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ................................ 13. Will lot be ~egraded ........ L ..................... Will excess fill be removed frompremises: _Ye~ ~I~o 14. Name of Owner of premise~/~.J~, ~/g.L~. ¢~,[ .C~ddress ~)/.~). ~t{_.[.~_~Vhone No. ¢7./. Name of Architect . · · ~. Address .-~h' :-;2-'. ............. --' ....... ~ ...... Phone No ................ Name of Contractor .,5.¢,..I.ib,c.~f2,OY~tF-~Y.T~... Address ~J .(~O .~.o~'~/~l)~-.... Phone No. ~.Z..?.~.~.... PLOT DIAGRAM Locate clearly and distinctly al1 buildings, whether existing or proposed, an& indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot. H[t.}:N K. D~ VOE No 4707878, Suf[olk CBunfy Term Exp~es ~h.. ,?; l~ (Signature of applicant) STATE OF NEW YORK, COUNTY OF .......... ....... (Name of individual signing contract) above named. He is the..: .................... ! ................................................................... , (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dui authorized-to 'perform or have performed the said work and to make and file this application;~ that all statements co~.t~ned/n 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. worn to before me this being duly sworn, deposes and says that he is the applicant