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Home My WebLink About13079-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13980 Date 0ctober~ 31 .,1985 THIS CERTIFIES that the building ...... .np.w...d.w.~.l..1 .i.n.~: .......................... ~.5. 4..0 Yenn~cott Dr. Southold Location of Property House No. Street Hamlet County Tax Map No. 1000 Section ..... .5.5. .... Block ........ 4. ...... Lot ....... 3.4. ........ Subdivision ..... .Y.e.qn. p .c.o.t.t.. ~.a.q k. ......... Fi]ed Map No... 5. .~ .8.7. .Lot No ..... 4. .0 ....... conforms substantially to the Application for Building Permit heretofore filed in tiffs office dated ·..A p.r.i..l. 5 ........... ,19 .8.4. pursuant to which Building Permit No ...... 1.3. 9.7.9.Z. ......... dated .......... M.a. 7..~ ............ 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 ......... ... ?.r. Sy~.t.e.. 9B.e.-: f. gIn.i. 1. y..d.w.e..~ .~.i.n.g, ........................................... The certificate is issued to TIMOTHY W. & LORI A. McKIERNAN (owner~Y~ of the aforesaid building. 14-S0-43 Suffolk County Department of Health Approval . .~ ........................................ UNDERWRITBRS CERTIFICATE NO, N691474 Rev. 1/81 Building Inspector 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) N? 13079 Z Permission is hereby granted to: ......... ~-~(..Y......z~..¢..~..~..~-- ~ ~ ~ "~.-~_~,,~ ...... ~o....,~'.~~ ....... o~,.....~.~...~&~ .............. 7 ....... ~,,~.~......~-~ -- ~ ........... ~z~./' ~ .................. .&z..~ ....... co~ ,~ ~ ~o. ~0oo s~,o~ ...0.~.~ ...... ~ ....~.~ ..... [o, uo..~ ...... Building Inspector. ~ $ ..... ~.. Bulldi~ I~tor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCy Instructions BLDG. DEPT. TOWN OF SOUTHOLD,,, This application must be filled in Wpewriter OR ink, and submitted ~t11~ 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, proper~y lines, streets, and unusual natural or topographic featu res. 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: I, Accurate survey of p~operty 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 $15.0 0 3. Copy of certificate of occupancy $1.00 Date ...... .) ............ New Bu[Id[ng .... ~ ........ Old or Pre-existing Building ............ Vacant Land ............. Location of Property ........ .................... . ............................... Hou~ No, Street Hamlet or O n r, o, ,ro,.rt . ..... .... ~ ........... ~lock ......................... ................................ ~,~ ~ ~o.~/. ~...~o~ ~o .......... ,~r~ .o ........... ~a~e o~"er~ ~ }~ ~ .~,,~a.~ I~o~ ......................................... Healm Dem. Approval ....................... Labor Dept. Approval ........................ Unde~riters Approval Planning Board Approval Request for Temporary Certificate ..................... Final Certificate .. ~ ..... Fee Submitted $ ......................... Construction on above described building and permit meets all applicable codes and regulations. ~-,G:-~' '~-~'] '~ [ Applicant ............. ' ........ ~:~:~ ............ Rev. 10-10-7~ TOWN OF SOUT~OLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 C E R T ~ F I~ C A~T I O N Building Permit No. \~C~ Owner ~f~lO~l~_Xl ~ ~-0{~ ~(} (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 ~ day his in Suflolk County (plumber's ~i~ure) :ounty ~t/ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~- O]. 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.te ~a~ i~, i~ ~,,~.,,~.~.~.~,,~ ~ii~s~ N 691474 THIS CERTIFIES THAT only the electrical equipment as described below and introduced by the applicant named on the able appJicatlon ~um~er ~ t~ premises of in thefollowing location; ~ Basement "~ 1st FI. ~ 2.d FI. Section Block Lot was examined on and found to be in compliance tvlth the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS DRYERS OTHER APPARATUS: E R V I C · NO, OF HI-LEG NO OF NEUTRALS A, WG OF NEUTRA[ 2/O This certificate must not be altered in any manner; return fo the office of the Board ;f incorrect. Inspectors may be identified by, ~he~v' c~edenti~ls'/' copy~Fo~ ~ ~ A~Y MAN~ER. COMMENTS ' I F~ELD~ ,T ON FOUNDATION (1st) FOUNDATION (2nd) 2. ROUGH FRAME & FLUMBING INSULATION PER N, STATE ENERGY qODE FINAL ADDITIONAL COMMENTS: DEPARTMENTOFHEALTHSERVICE5 COUNTY OF SUFFOLK PETER F. COHALAN SUFFOLK COUNTY EXECUTIVE FACT SHEET LEAD IN DRINKING WATER SUPPLIES Sources of Lead Concentrations in Drinking Water Systems Use of lead solder in new plumbing or in plumbing modifications to existing water suppty piping. Lead is not a naturally occurring element in Long Island groundwater. Occurrences Lead is present in drinking water as a product of corrosion. The natural corrosiveness of Long Island groundwaters contributes to this process. Most public water supplies in Suffolk provide chemical treatment to increase the water's natural pH, and minimize corrosion products, but no amount of treatment can produce a totally non-corrosive water. Studies indicate that after prolonged periods of water non-use, lead concentrations can be found in excess of Drinking Water Standards. This problem appears to be limited to newly installed internal water piping systems, or recently modified systems, in which lead-based solder is used. Lead is rarely detected in routine water supply surve',tlance. This fact is seen as indicating that, at a particular location plumbed with lead solder, this problem will diminish with time. The New York State Health Department concurs with this evaluation. Health Considerations Lead is a compound which is accumulated in the body. Human intake can be expected to occur through many environmental sources, including water. Recommended Action In order to minimize lead occurences, the following steps are recommended: Particularly in new or recently modified plumbing systems, users should be encouraged to flush the water line for a period of at least two minutes prior to consumptive water use. This is particularly necessary after prolonged water non-use, such as the overnight period. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL Date . ,7.. 7.~/.,/.< ........... ,19 ..... File No ................................ PLEA~TAKE NOTICE tlzat~ your application dated .... for pemit to construct... ~)~(~:~.. ??~r~?r~.. ~ff~.~); ...... ~} .......... at Location of Property .. d~ .~2 .... F. ~'~ :~? ~..~. ..... House No. Street ~ :,: ?7'/~" .~.Z~.. ~o~ ~o...<~ .......... Subdivision/C>:~ ~7,, cl/..' Filed Map No ..... is returned herewith and disapproved on the following grounds ..;~ / .... . ..................... Building Inspector RV 1/80 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Disapproved a/c (B~iilding Inspector) APPLICATION FOR BUILDING PERMIT IN STRUCTION S 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 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~r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, bui~gYg code, housing code~nd regulations, and to admit authorized inspectors on premises and in building for necessa~ infit~d[ions~---- /If~Il] -~ ....... /(Signature of applicant, or ~ame, if .a corporation) State whether applicant is owner, lessee, agent, architect, en~neer, general contractor, electrician, plumber or builder. Nameofownerofpremises ~T~.FO. tg.~..~ ~L). ~, ~9~1...~.... .............. [ (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 ....... .-~.~...~..~. ! E ........ Plumber's License No ..... 7.~....~.~. !..~. ..... Electrician's License No .............. Other ~rade's License No. Location of land on which proposed work will be done .................................................. ............... ~xJX.J.....O. ..................... o.. r~Q~,~...-- ..... House Number Street Hamlet County Tax Map No. I000 Section .... ~..~. ......... Block .../-~. ........... . Lot ..... ~.~. .......... Subdivisiou. ... }Q . C O rPt21r~ Filed Map No. .~. !.~7........ Lot ...5(.0 ......... -- (~a~) .............. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ... ~.~.~.t~/~[ ~-... ~-~ }'~ ............................................. b. Intendeduseandoccupancy ..5~F~)!q~. ~.]1~[ [~.~.~. ..~2~. 3. Nature of work (check which applicable): New Building ....... Addition .......... Alteration .......... Repair. ............. Rem{vel .............. Demolition .............. Other Work ............... '~.~.~,[.~...! ~../.~Z'. c~ (Description) 4. Estimated Cost ............................. Fee .Z-- .......................... ' '~' (to be paid on filingI this application) 5. If dwelling, number of dwelling ~nits .... ./ .......... Number of dwelling units on each floor ................ If garage, number of cars ......c,~.............. ......................................... . .. . . .. 6. lf business, commercial or mixed occupancy, speeify nature and extent of each type of use ..................... 7. Dimensions of existing structure~, if any: Front ............... Rear .............. Depth ............... Height . .............. NuN!her of Stories ........................................................ Dimensions of same structure w{th alterations or additions: Front ................. Rear .................. Depth .................... J,. Height ...... ...... ............ Number 9f Stories ....................... 8. Dimensions of entire new constrUction: Front ...~...' ........ Rear .. ~..~-~. a... 9. Sizeoflot Front ~.~.~. i Rear 11. Zone or use district in which pr{miNes are situated ..................................................... 12. Does proposed construc¥on violkte any zoning law ordinance or regulation: . .' ....... : ....... 13. Will lot be regraded . .~>. ,~ ..... :.,. t, :;...,... Will e&cess fill be remove4 from premises: ~ No 14. Name of Owner of premises//~PAV...~f. Y: 6(~ Addres~ Phone No. aqv. N~e of Architect .......... ~ ................. Address ................... Phone No ................ Nme of Contractor ......... , ................. Address ................... Phone No ................ P~T DIAG~ Locate Clearly ~d distinctly ~1] buddings, whether existing or proposed, and. indicate ~1 set-back d~ensions from prope~y imes. Give street ~d block ~umber or description aceord~g to deed, ~d show street n~es and indicate whether interior or corner lot. STATE OF ,NEW YORK, COUNTY OF ........ , ',/Name of individual sign'ing contract) above.named, i ...... being duly sworn, deposes and says that he is the applicant He is the (Contractor , agent , corporate officer, ere . ) of said owner or owners, and is duly authorized to perform or have performed the said ,work and to make and file this pphcatlon that all statements contmned 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 Notary Public f~ ~- ~ ~ n~y~ NOIARY PDBt.~C, State of New '~'efk .. . "A SINGLE FAMILY' DWELLING ONLY