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Home My WebLink About13282-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...g13.0.37 ........ Date ............ pg. qe..m~..e.r....3 ........ 19 .8.4. THIS CERTIFIES that the building . .N. ~.w..D.w..e.l.i.~n. g ................................ Location of Property 4300 Soundview Ave. Southoid ' h~s'e ~o~ ........................................................ Street Ham/et County Tax Map No. 1000 Section . . .0.6.8. ...... Block ..... 0.4. ........ Lot ...0.2 ............. Subdivision ........ ~( ...................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .J.u.l.x ...... .1.1..., 19..8.4pursuant to which Building Permit No. 132827, dated ............. .J.u.i.y .......1.6.. 19.8..4, 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 Private One Family Dwelling The certificate is issued to JOHNSEN, ROBERT ..................... ?o¥,,'o;, :&;,d,;o ...................... of the aforesaid building. Suffolk County Department of Health Approval ...N/?. .................................... UNDERWRITERS CERTIFICATE NO. Iq668462 Building Inspector Rev. 1/81 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) Permission is hereby grante~ -- ,o.~ ....... ~....~.~.~.~.~~.....~....~..~. ~~~...~...~..~...~....~....~ .................................................... at premises I~ated at ............................................................................................................................ County Tox Mop No. 1000 Section ...... ..~..~....~.. ..... Block ......... ~ ......... Lot No ........ .~ .......... pursuent to opplication doted ....... .~,~f......).l ....................... , 19.~...~.., end approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall 5.~outhold, N,Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitte~Jp!!cc~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. Fina~ approva~ of Hea~th 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-existing" land uses: 1. Accurate survey of peoperty 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, C. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land use --?re-~;×±s f,±n~ C.O. $15 · 00 3. Copy of certificate of occupancy $1.00 Vacant. ia~d C.0, $ 5.00 Date./..~?.-.. ~...~..'...~..~. ...... New Building ............. Old or Pre-existing Building ............ Vacant Land ............. House No. Street Ham/et Owner or Owners of Property .. ~..O~'~.T' .~.~.~.,.~.~./~ .................... County Tax Map No. 1000 Section ~' 8 Block .~ Lot.., ,~.. · Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 13 ,~..~..~. ?J~ate of Permit ~.'?..~.'.~.?.Appiicant .... ~.o.~..~..~?-,,, .~.o.~..~.s,~. ?. ....... ,~'.~, !' ,~,T, ' ,t~, .~ pt App Health Dept, Approval ,. ; .......... Labor De , royal ........................ Underwriters Approval .~,. ¥,~.~ .~ ,~, ,~. ......... Planning Board' Approval ...................... Request for Temporary Certificate ..................... Final Certificate .................... Fee ub S mitted $ .;.,.~,~ ...................... / / //I Construction on above described building and permit~,et~xappli_cable q/~des.and regulations. c V-. ').._ Rev. 10-10-78 ~r FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & (1st) PLUMBING INSULATION PER N. STATE ENERGY CODE (2nd) FINAL COMMENTS ADDITIONAL COMMENTS: TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. Owner Plumber / g,, (please print) 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 Notary Public,~ ty ~¢¢~ t~tiBLI¢, Stotu of Mew York 765'~,802 BUILDING DEPT. INSPECTION' [ ] FOUNDATION IST [ ] ROUGH PLBG. ~ FOUNDATION 2ND J' ] INSULATION ]FRAMING,, [ ]FINAL 7GS-1802 BUILDING DEPT. INSPECTION FOUNDATION lST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKS: ~ FINAL DATE INSPECTOR THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITy 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the able application number in the premises of ~rt Jo~s~, 43~ ~mdview Av~o~ P~)utt~ld~ ~n thefollo~ia~loc~ion; ~ B~e~e~ ~ l~t FL ~ 2ad FL Section Block was exa,nlned on ~V~II~~ ~ ~ 1~ and found to be in compliance with the requirements of this Board. FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS FIXTURE OUTLETS SWITCHES FtUORESCENT 27 44 37 27 DRYERS FURNACR MOTORS TIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO, OF FEET SERVICE DISCONNECT S E R V I C l~STon A/C Unit A. WG OF HI-LEG OF NEUTRAL S Electric 216 L~c. 578 Per___ 11 This certificate must not be altered in ony manner; return to the office of the Board if incorrect. Inspectors may be identified by their credentials. COPY FOR B~ILDING DEPARTMENT. THI~ coPy,OF CERT?FICATI~ !~ T NOT BE .z IN ANY MANNER. Examined Approved 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-1803 .... 1 .~. .... 19)~ ~. Permit No. Disapproved a/c ..................................... ................................ , (Building Inspector) APPLICATION FOR BUILDING PERMIT Received ........... ,19... INSTRUCTIONS a. Tins 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 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 forjeXh~al or demo!i)ion, as herein described· The applicant agrees to comply with all applicable laws, ordinances, buildin)(, cod)~, housing co~e, and regulations, and to admit authorized inspectors on premises and in building for necessary inspe~s~ 5j~---,~/. ~~~" ( '~ (Signa~fure of applicant,~6r name, if a corporation) · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... t~. ~eg .... .e. ?..a.y ~ .a.c~.e .~ ........................................................ Name of owner of premises. ~O.[ ~'.~?..vi'-7... ~.~.]1.~..5 ~.rJ .............................................. : (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 ..... /~/~. 7..-~. .... Electrician's License No ...... Other Trade s License No .................... ./. 1. Location of land on which proposed work will be done .................................................. · ..43o.o. ..... ...... .... ................... House Number 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: a. Existing use and occupancy ~ .~,~. .~....o .t~./~' ~.. ~ ~... b. Intended use and occupancy ...... ~.///r5~ .... ~..~: ./.,.~.~.,.. g~..~... ~r~,. ........ 3. Nature of work (check which a~plicable): New Building .. ddition .......... Alteration .......... Repair .............. Rembval .............. Demolition ......... ,..,. Other Work..., ...... , . ... ' " (Description) 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 ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use . '; .~: ................. 7. ,,I~.en. sions of existing structures, if any: Front ............... Rear .............. Depth ............... HeNt ............... Number of Stories ..................................................... Din~e~ons of same structure With alterations or additions Front ................. Rear .............. D.epth .~% ; 'ght ' "" ~ ................... He~ ...................... Number of Stones.......h ............... 8. Dimensions of entire new construction: Front ... ~.~. ........ l~ear .... 7.~. ........ Depth .3~.~. . P./. ...... Height ... j~ ......... Number of Stories ... ~. ................................................... 9. Sizeoflot: Front ~ ~,~ Rear · .~-./g ............ Depth .~..~.°..~. .............. 10. !)ate of Purchase ...... ,~.~! .................. N, ame of Fo, truer Owner ./,,:~8~,~..~ ................... 11. Zone or use district in which premises are situated ,j~ ~ ~. ~ .~,..q .. 12. Does proposed construction vioiate any zoning law, ordinan" ce or regulatio'n':' . . ~.::::::::::::: ::::::::::: 13. Will lot be regraded ..... /~ · . · :.~....~ .......... Will excess fill be remoged from,l~relnises: Yes (~ 14. Name of Owner of premises ff~,be,P/.. ~.,~.t'~oa~'.rj.. Address ~q.~..~.~.q .n~..~.t,o. l~gn~e No..~.~',~"7//~.~.... Name of Architect = t a Address Phone No Name of Contractor . .'.'. Address ' ' Phone No interior or corner lot. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and b ock,number or description according to deed, and show street names and indicate whether STATE OF NEW YORK, COUNT¥ F ................. is S ....... ~.~..~.e.~.~.... ~.~. ~.~r.~.~. i,~ ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the . ~ ~ w-et~ i (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 ......... : ............... day of ................... ,19... ~ Notary Public, . ............................... :o:nty