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Home My WebLink About12987-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy Z12706 Date ........ August 16~ 1984 THIS CERTIFIES that the building ... 0;q.~ ~ f ~rti. 1 y..c[N e ] .] .i.q g: ..................... 940 Tuckers Lane Southold Location of Property ............................................................... House No. 59 Str~t 5.6 Hamlet County Tax Map No. 1000 Section ............ Block ............... Lot ................. S ..... .... 6313Lot Green fields 6 BDQ1VISlOn ............................... l~lleo Map No ......... No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated March 30 12987Z ...................... 1984. pursuant to which Btdlding Permit No ...................... dated.....,.,..,..,.,......April 9 ..... ,19,84, wasissued, 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-family dwelling. The certificate is issued to LORETTA V0M LEHM (owner, of the aforesaid building. Suffolk County Department of Health Approval 14 - S 0- 5 6 UNDERWRITERS CERTIFICATE NO.. N 6 5 2 5 7 6 Building Inspector Rev, 1/81 FO~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING I'ERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NV 1298 Z Date ...................................... , 19 County Tax Map No. 1000 Section ..... ..~.....~.,.~[., ....... Block ........ ~. .......... Lot No .....,,~..:.,',~. ......... pursuant to applicotion dated ...... ....~CL~...c~......~.....c[ .................... , 19..~...~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall ,~outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitte~'Jcctc 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-existing" land uses: 1, Accurate survev of peopertv 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. Fees: 1. Certificate of occupancy $5.00 / Certificate of occupancy on pre-existing dwelling / land 2. 3. Copy of certificate of occupancy $1.00 ~ use --Pre-Existing C.O. $15.00 Vacant land C.O. $ 5.00 Date /~'~ ~; /~/~ New Building ............. Old or Pre-existing Building ............ Vacant Land ............. Location of Property ...~..~../~. .... "~ ~ .;- ............ House No. Street Hamlet Owner or Owners of Property . .L ~.~-~./.~..~.. ,~.. ~../~1... ~..~.~'~ ....................... County Tax Map No. 1000 Section .. ~:~.'~ ...... Block ............. Lot. ~,~#.~ .......... Subdivision...G ~.~.'.~'..~..~.[.~.'./77..~. ........... Filed Map No..~..~.~/.~...Lot No. ~. .......... - Permit No.//~.' .~..~.'4~ Date of Permit . .Applicant. ~../..~.~....~._.~.~..57.,. .............. ,~.~..~.,.~+ /.~.~,~'~z.~. Labor gept Approval -~ Health Dept. Approval ................................... JuL.~'~/. '~, {~'~¢'/'~' Planning Board' Approval Underwriters Approval '~ Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $,. , ~.-,~ .................... Construction on above described building a. nd per~:~it meets all applicable c~des anl:l regulations. (~L.~ "'~-- \ ~-q~)~ Applicant .~7,~ ,~ ~.."~ .~'~. -.~ ~ ............ ..... Rev, 10-10-78 FIELD I~SFECTION 1. FOUNDATION ( ls t ) COMMENTS FOUNDATION (2nd) 2. ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY C,ODE FINAL ADDITIONAL COMMENTS: THE NEW YORK BOARD OF FIRE UNDERWRITERS ~i].~1 BUREAU OF ELECTRICITY ~ 86 JOHN STREET, NEW YORK, NEW YORK 10038 .ate ~Ly ~, ~4 Ap.~ic~t~o,,No. on~iI~ ~?O353/~N 652576 THIS CERTIFIES THAT only the electrical equipment as described belo~v and i~¢rodueed by tl~e in the ~ollowing location; was examined on July 16~ 1984 FIXTURE OUTLETS SWITCHES DRYERS FIXTURES ~CANDE$CENT FLUORESCENT ~ 2nd Fl. Section Block Lot and found to be in compliar~ce with the requirements of this Board. RANGES OVENS DISH WASHERS EXHAUST FANS SYSTEMS NO. OF FEET OTHER APPARATUS: E R V I C '~hree '~" Elect. Inc. RT. Box 4~, ~o%~d Avenu~ GEN~RAt MANA~e . /~ ~1 Riverh~, N.Y. 11~1 L~332~ 11 ,~-~' ~ This certificate must not be offered in any manner; return ,o t,e office o~ the Board ,{ incorrect, inspectors mo;'~:P"' {den, iJJed by their c~ COPY FOR BU LD NG DEPARTMENT. THIS COPY. OF CERTIFICATE ~U~T NoT BE ~LTERED I~ ANY MANNER. - .,~ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ~.~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION ~/~FRAMING [ ] FINAL REMARKS: FORM NO. I ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 19~. Permit No.. ! '.~. ~.'.~.~..~. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Tkis 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 for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regu,lations, and to admit authorized inspectors on premises and in building for necessary (Signature of applicant, or name, if a corporation) · (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .. ~ P..~'...~..~.'¥?..'?-....~.< .~.o....dr.S.: .......................................... (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.?.O'-..-. .?. ............ Electrician's License No.. ~..~..~.?.< .~. ........... Other Trade's License No ...................... 1. Location of land on which proposed work will be done..~.,/..$. . './~..&..~-.~'..t~..~...~...~.~..~?.~...~..7'...~/.~../{...)7~. p.~.~:... .............................. ....... .h-/. .......... ttouse Number Street Hamlet County Tax Map No. 1000 Section ....~..~. .......... Block ....~..r..~.~,~.',d~,~, Lot, ,t~. ............... Subdivision .... .~..~..z~.~-.~'..~f?.zr~. ~..< ............. 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 ..................................................................... · ~4~ ~'~,~/~ ~,,~z.z~2'g, .................... b. Intended use and occupancy .(2 ............................................. 3. Nature of work (check which applicable): New Building . ~ .... Addition ' Alteration Repair .............. Removal .............. Demolition .............. Other Work .... ................. Fee .-?..O. (Description) 4. Estimated Cost ......... ~.~..~ . .~:~. ~..~ (to be paid on filing this application) 5. If dwelling, number of dwelling units... ~ ....... Number of dwelling units on each floor .~..P.~.C ~..o'..P:.. If garage, number of cars . .~i ................................................................. ial or mixed occ specify at re and exte t fea h type of use ' ' 6. If business, commerc upancy, n u n o c .................... 7. Dimensions ofex~st~ng structures, ~fany: Front ............... Rear .............. Depth ............... Height ............... Nulnber of Stories ........................................................ Dimensions of same structure With alterations or additions: Front ............. ' ....Rear .................. Depth ................... ... Height ...................... Number, of Stories ............ ,, ......... 8. Dimensions of en,~ire new consiruction Front ~..~. ~. .... Rear . Height . .~-~ll~ ......... Number of Stories .,5.~. ' ' .......... . . ' ............ ~,t, ' ........ ,~ ...................... I ............... 9. Sizeoflot Front ...~..o~.~ Rear /,~..~ De,,th ~..~,~'"~ 10. Date of Purchase /~...~.~,..':-./.q.~.~. .... Name of Former Owner ~.o..t,,.z.~.../-(.a..~.a..,q= ............ 1 1. Zone or use district in which p/cruises are situated ..................................................... 12. D6es proposed construction violate any zoning law, ordinance or regulation: . ~.14 ....................... 13. Will lot be regraded .... '/~' '~i ..........· .......... Will ex~cess fill be removed from premises: Yes No 14. :Name of Owner of premises &~..~'.~,,:'..~..Z.~'.a.,./~t,. AddressP.,¢ Name of Architect . ~tl/~.o ~ ~ .~t-/6(.~r~.: . . Address. ?.." ..... Nmne of Contractor . .~ ~..t:'~..c,. ~,./~. $~.. ........ Address .x. ~. ..... 5..~ ........ Phone No..'.'... 2.~. ....... PLOT DIAGRAM Locate clearly and distinctly al!, buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and bloc~ number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ........ , S.S ..... ~-, ~v~.. 0¢r,-~q...c--.~...~,. 3.q .oi .',,~..g-: ............... being duly sworn, deposes and says that he is the applicant (Name of individual sig~ing contract) above named. Heisthe ~o~-,~t ~,~o~.~ O..~. ~.mS./~, .~ ......................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du!y authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....................... day ......... , Nora Pubhc ...~ ,~.'..~.~.~//P~-~ ry , · ................ Count ,, ,,~ HEt;EN N0r,~RY PtJb*.tC, ?re o! ito. w Y0r/~ . ($~gnature of apphcant) Nt~. 4707878 ,~uffo~k Ootmty ,? n 0 -r i~1 --I 7 "r 017 CO'<T / "q Z m m / "0 ¢3 ;~ ~,1 g = C~l~/ ' T Z .- m -,,r r-~, J ~ mr r- L T T m