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Home My WebLink About13040-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall $outhold, N,Y, Certificate Of Occupancy No. Z12775 Date Sep. t. -. 3-3 198.4. THIS CERTIFIES that the building .... P.o. 9.1' .a..n.d..D.e..c.k..A.d..d.i.t.i.o..n .................. Location of Property ~$ds$ ~'oi .................. A..lp.i.n.e...Ay.e.: ................. F.: .I.. .... Street Hamlet County Tax Map No. 1000 Section .Q ], Q ........ Block ..... .0.8 ........Lot ... 0..1.3 ........... × Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .... .A.p .r.i.1. .... .1.0. .... 19.8.4. pursuant to which Building Permit No....1.3.0.4.0..z ............ dated .... .Ap.r..i.3- ...... .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 ......... .Pool And Deck Addition The certificate is issued to .... ~A~I~ ~..R.O.I~ .R~..&...E.I.L.E.E..N. ' ............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... I~[~k .................................. UNDERWRITERS CERTIFICATE NO ............ N..6.5.1.6..7.1 .............................. Rev. 1/81 Building Inspector FO~ NO. ~ TOWH OP $OUT~OLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o~, z ~o,. ...... ~ ........ ,~. ..................... ,,~.~' County Tox Map No. 1000 Sectio~ .................... Block ...................... Lot No ........ L.,,~ .......... pumuont to *ppli¢otion dr,t~:l ......... ~...~.. ................... , 19.....~.., ond oppro¥~l by th~ Building Inspector. Fee $..~. :.....: ............. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Ili(I Building Department I1 11 Town Hall t/till ,]outhold, N.Y. 11971 APPLICATION FOR CEhTIFICATE OF OCCUPANC~ Instructions 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 where applicable. B. 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.~leeS; 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling j' land use --?re-Existing C.O. $15.00 3. Copy of certificate of occupancy $1.00 / Vacant .lan~] C.O. $ 5.00 ........... ~ Bui~din§ .......... Old or Pre-existing Building ............ Vacant Land ............. Location of Property.~ f~r-d~ '..~.~ ,~.~.~0.~_ House No. Street Hamlet Owner or Owners of Property . .~-~,x County Tax Map No, 1000 Section ,. C~t .~, ........ Block .., ,0,~ ........ Lot ............... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No.l~.q~/.°. .~.. Date of Permit .~l.(.~. l ~..Applicant...~..~..~...'~......~..-...~..~ ..... Health Dept. Approval ........................ Labor Dept. Approval ........................ Unde~riters Approval. ~..~.~ ~. ~ ......... Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Ce~ificate .. ~.[~ ............ Foe Subm~tt,d $.... ..........................~ Construction on above demribed building and per, it meets all applicable codes and regulations. C~ Applicant ...~~~. ..................... %2, ~ ~ ,~ ooo9 3 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ 85[ JOHN STREET, NEW YORK, NEW YORK 10038 THiS CERTIFIES THAT Robert. 1-:. Wall, Private Rd., Pishers Island~ N.Y. was era,rtl.ed on July 3 ~ ~. 9~:J4 and found to be in commli.nce with the requirements of this Board, FIXTURE OUTLETS tECEPTACLES SWITCHES 1 1 DRYERS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS SYSTEMS NO. OF FEET E R V I C NO OF CC. COHO A W. G, HO OF HI-LEG A W.G. NO. OF NEUTRALS A, W G, P~R .~' OF CC CONO OF HI-LEG OF N~UTRAL (~wimming ]~ol) ~hi~ cert~£ica~e covers compliance atthe date of inspection onlyo Because of unusual environments ~t is advisable ~o have frequent test and/er repairs made by a ~ualified person. Robert ED ~..f~ll~ Alpine Ave., Fishers Island, N.Y. 06390 This certificate must not be altered in any manner; return to the office of the Board i( iocorrect. COPY FOR BglLDING DEPARTMENT, THIS COPY OF. CERTIFICATE I GENERAL may be identified 'edentiaJs. "D IN ANY MANNER. FI~LD'~INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y, 11971 TEL.: 765-1802 J. ¢.., i9 . Examined . . ~.. Approved ..... J..~.., 19 .~!1. Permit No.}.~.~. .1~..~..-~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS .~.~.../',0 Date .................. , a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 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 street or areas, and giving a detailed description of layout of properW must be drawn on the diagram which is part of this appli cation. c. The work covered by t!fis 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 permi 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 Occupanc,. 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 th{ Building Zone Ordinance of the Town of Southold, Suffolk Connty, New York, and other applicable Laws, Ordinances o 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 t¢ admit authorized inspectors on premises and in building for necessary inspec~Ljons ..... ..... /'~,/~(S~~pplicant, or)na~ne, if a corporaJ;ion) /' ~ ~. --J~'~~/': '~~~ address o f appli~;) State whether applicant is~wneL), lessee, agent, architect, e~riee~~m~e.~or builder. ........... .... ..... .... .*. ................ Name of owner of premises . ./.~. Z~. ~ .... ~ .... ~'.~.~...~'./~.'~....~.~.....~.. ~..~..~. ................ (as on the tax roll or ta~t,~st-d, eed). .. ~ .... '", If applicant is a corporation, signature of duly authorized officer. DATE: ~_]1_~1~. BP. ~ .............................................. FEE: J~'" -- BY: (Name and title of corporate officer) NOTi~Zv ru ~!1. ~I¢.IG DEPARTMENT AT 765_18r'9 9 P,M TO 4 PM FOR THE Builder's License No .......................... FOLLC".wlN'G IhjEp['CTIONS: Plumber's License No.. .~..~.'.~7..'7 .~.. ......... 1. FOUhm'A'rlONFOR p"~URFD CONCRETE" TWO REQUIRED Electrician's License No. ~. t.~..~. - ~ 2. ROUG*-! ~ ~RAMING & PLUMBING ................... 3. IlXlcU1 4. FIN/~l - c"h~'"'q'll*U~';lON MUST BE c"~nl '-r-F FOR C.O. Other Trade's License No ...................... ~,/L CchNc'rm IC'I-IoN-/C~AI-L MEL~ 1. Locationoflandonwhichproposedworkwillbedone....~?..~'~.././~.i~4.E.~...F~..~..r:.~'.~:~.2fi.~...,:r.~F~'~.~ ...... , ~/~/~ STATF~ONq/TRUe. I-i£)~L,~ ~c:~/~, ............................... House Number Street DESIGN ~i[2¥'4STRU¢/ County Tax Map No. 1000 Section .../.~. .......... Block ..... ~ ......... Lot .... /..'~. ........... Subdivision ..................................... Filed Map No ............... Lot ............... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy....~..~.."~..~.~.. ~ ............................ ' .................... 10. 11. 12. 14. Nature of work (check which applicable): New Building .......... Addition .. Alteration .......... Repair .............. Removal ............. Demolition ........... ... Other Work -'~""--~1~ ~_.~- ~' (--" (Description) Estimated Cost../.~ ................... Fee~ :'~ .~'. · · .~. .............. (to be paid on filing this application) If dwelling, number of dwelling units ............. Number of dwelling units on each floor ................ If garage, number of cars .... ~. ~..~ ......................... , ............................ If business,commercial or mixed occupancy, specify.n.~,t.ure and extent of eac~h.tyPe of use ..................... Dimensions of existing structures, if any: Front...~. ........ Rear .~..,~., ....... Depth...~.~.. Height /.~ Number of Stories'. ~. t~4.~ Din ith It ti dditi F R lensions of same structure w a era ons or a ons: rent ...77'. ...... , ..... ear .................. Depth '~ Height .... '.--: ........ Number of Stories...-7. .................. pth Dimensions of entire new construction: Front ............... Rear ............... De ............... Height ............... Number of Stories ........................................................ Size of lot: Front . ..~/. ~'~' ............... Rear.. f,.~.~.-'. ............. Depth, . ~,.~-'-_. ~:~,..,.,/......, .,...__, Date of Purchase .,;.,gg?. ~/.~.~..2 ............... Name ofFormer Owner .~'/'r,~'.,,(.,q,q~'...~..,'t../'A~'.'.(~..J~.'~../~/~..~f Zone or use distric't in which premises are situated .... ~--~d'. ,~.~'~eq..&< .... , ............................ Does proposed construction violate any zoning law, ordinance or regulation: . .,~'..'~. ........................... Will lot be regraded .......... i .... - ............. Will excess fill be removed from premises: Yes Name of Owner of premises .~. ~.,...Z~.~ ./_,.~.. Address ,,. d~?J~. ,~...~,-~.... Phone NoO'".</.~.-,J'~. ~..~-'q'~P~'~'~,~ Name of Architect ........................... Address .............. i ....Phone No ................ Name of Contractor ... ~ ........... Address ........... i ....Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and, iridicate 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_-7~ -~NE'//YORK, - - couvr,¥-OF ..... ,.. ~, .~.7., ~ ........................ being duly sworn, depbses and says that he is the applicant (Name of individual signing contract) 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 fiaid 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 .............. ' .d Notary. Public, '.~~o'u~ ........ County o, . ... .................... · ~,mml.lea I~p.., ~,,,, ao, ,,aO~ ; (Signature of applicant)