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Home My WebLink About12890-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No...gJ 3.5.0..0 ......... Date .............. ~...~..e. THIS CERTIFIES that the buildingZ~.e,w. .d.¥.e.]-.~.Jr..~. ............................... Location of Property . .z4-../4:Q .................... ......... House IVo. Street Hamlet County Tax Map No. 1000 Section ....0.5..6 ..... Block .. 9.7. .......... Lot . ...0.0.9 .......... Subdivision.. ~.o.~]59~.c~. ~.o.~?~ ........... Filed Map No.. 5.8~..5..Lot No...'] 7 ......... conforms substantially to the Application for Building Permit heretofore fried in this office dated · ?.o..b?.u.8.~.~r..6. ........19 ~.~. pursuant to which Building Permit No...q.~3~.O..Z. ........... dated ..... ]~.~.~.:t?~. ~X .~7 .......... 19~../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 ......... .................. a..p~i.v.~e..o~o .-L~:i~Z .~o~3&n. ~.. .......................... The certificate is issued to ...... JOKbT E. F,_~SSE~L (owner, ,=~= of the aforesaid building. , Suffolk County Department of Health Approval .J ./t'V.S.0.7.'1.2.,..~../.9./.~..~..S.~.o.p.h..e.n...3.....~..o.s.~.a., ~P.E. UNDERWRITERS CERTIFICATE NO ......... .1J..~.9.Q72¢. ............................... Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 12S90 Z Permission is hereby granted to: ......... ~..~:.~.~.~ ............. ..... ~_.7........~.~:~.~.~..~ ....... ~ ................... ro ....... .~;~z~.~..,~.~..cZ......~.~,~Z~.~_~.....,~¢~.~..~../..¢~..~-- .................... ( at premises located at ....~.....~....~....../~p.~.//.:~......-.~..~-~(.J~.~*~ ............... ~ ............... ~.. ~ .~..~.~..~......::~.<~/~. ........ ~~.. ...................... ~z:~..:.....Z. ............. County Tax Map No. 1000 Section ..J~......~..~.. ..... Block ....~...~... ........ Lot No...(~..~....~.. ....... pursuant to application dated ....~-~~..~.........~... ...... , 19 .~.~..~., and approved by the Building Inspector. Fee $..~..~.. ..... Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD ~)outhold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions in duplicate A. This application must be filled in typewriter OR ink, and submitted, ,,V,,, ?o'~he 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 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: I. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 New Building . ./~.~. ...... Old or Pre-existing Building $15.00 Date ~'/ ~ ............ Vacant Land ............. Location of Property .~..~.'~. · .~-~-4..~-~-/./. ·~. .............. ~u~ No. ' .... Street Ham/et Owner or Owners of Proper~ ....... - ............................ County Tax MaE No. 1000 Sect~.. 0.~ ...... Block ... ,~: Z ....... Lot..~0.~ ....... Subdivision .~ ~(~e .J~ ......... Filed Map' No.~T~...Lot No../'7' ........ Permit No./~. Da: of ~ormit~.AP~licant · · ~.~.~ ............ Bequest for Temporarg Certificate ....... Final Certificate Constructiononabovedescribedbuildingan~p:ritm~:l,~cod'sandregulation" .l:~u~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~- BUREAU OF ELECTRICITY i ~ 85 JOHN STREET, NEW YORK, NEW YORK 1OO3E Oate ~ ~, ~ ~W~.,,~.~.o.~'~ ~'~/~ N690724 THIS CERTIFIES THAT only the e~ctrical equipment as described below and introduced by tt~ applicant named on the above application number in the premises of in the/allowing location; ~ Basement ~ 1st FI. ~ 2nd Fl. Section Block was exarnined on i~,y ~ ~ .k~ and found to be in comt~liance with the rbquirement$ of this Board. Lot FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES FLUORE$CEN~ DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: S E R A. WG OF CC, COND 2/O C OF HI-LEG /.AC 7~ E This certificate must not be aJtered in any manner; return to the office of the Board if inco[rect. Inspectors may be ii / FIEL~ INSPECTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY GODE FINAL ADDITIONAL COMMENTS: 765-1802 BUILDING DEPT. INSPECTIO~N' ~,~FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZND [ ], INSULATION [ ] FRAMING REMARKS: [ ] FINAL DATE iNSPECTOR 765-1802 BUILDING DEPT. INSPECTION* [ ] FOuNDATioN 1ST [ ] ROUGH [ ] FOUNDATION ZND [ ] INSULATION [~FRAMING [ ] FINAL Mr. Edward F. Hi~derman Town of Southold Office of Building Inspector To~n Southold~ 11971 Mr John Hassell 37 Huron Rd. Bellerose Village .N.Y. 11001 Building Permit # 12890Z Dear Mr. Hinderman, The construction of my house in Southold Shores is complete and I ~euld like to obtain a" Creti~icate o'f Occupancy" To the best of my knowledge~ a final inspection by your department is all that remains. I have listed belo~ the status of the various inspections as I kno~ them: (1) Health Depar ment-copies of the approval are enclosed. (2) Electrical Inspec~ipn- the inspection has been completed and the "Underwri~er Oerti~icate" has been applied for. (5) Town of Southold-requzred~ Enclosed are prints, sho~ing the building with modifications made during conmtruction. FORM NO. 3 TOWN OF SOUTHOLD BIJILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL File No.... ............................. To ......... ... ~p2~... ~.c.~Ocv'. ~r.~<e~~. ......... PLEASE TAKE NOTICE that your application dated ...... ~" ..... ~ ........ 19 . for permit to construct. ~ ~.~. ~X'.<~. · ,~= Z< ........ ~ ........... .~.. at Location of Property :.. 6~/,< .... ~2ff-~4/~ ~. . C]~:Oppo~?'~- W. ~, Co,~ty T~x mp So. ~000 S~tion .. C~ :~; ...... moo~ .. C~.~ ....... Lot .CZO. ~ ....... S,bdivi~ion~7~X'. ~X'~il~a mp ~o... ,~.P. ..... Lot ~o .... ~'. ~ .......... is returned herewith and disapproved on the following grounds . ~--~.. ~fi~.c.-~e~-~C;r~ ......... Building Inspector RV 1/80 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 .~ .~...., 19~6:~/ TEL.: 765-1803 Examined '. · · · Approved'~.~..~., .dZ ..... , 1 .9~.. Permit No. ,/.~ .O~t"~: 7'~ ,* "~o cJ~/~E ~ (Building Inspector) APPLICATION FOR BUILDING PER~IT INSTRUCTIONS Rece3. ved / /r~' · Date .... .A/.~. ........ ,19 ~./ a. Tins application must be completely filled in by Wpewriter 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 m. ust 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 regulation_s, and to admit authorized inspectors on premises and in building for neces.sar~ inspeqtions. ~ ~ (M ailing address of applicant) /I O e / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · U a}0T. 1 ....'2 ............................................................... Name of owner of premises... 10~. -U:'. · - .~* .................................................... (J (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 .... ~ .................... x: Plumber's License No. ~7(~_...~/.~.-~fd_z~/ .~.7..'T'- ~ Electrician's License No. ~..~.~.2...~..~.o..4~.~/ 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 ,...0..~. 6....0 .~. ...... Block . .0..-~. ~. 0.0. ......... Lot..01).~.*.0 ~ ~. ...... Subdivision . .~... ~L[~ ........... 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 ............................................................... b. Intended use and occupancy ...~ .................................................. 3. Nature of work (check which applicable): New Building .. Addition .......... Alteration Repair .............. RemOval ............ Demolition .............. Other Work ............... (to be paid on :ing is applica ion) 5. If dwelling, number of dweliingiunits. .~ ........... 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. Dimensions of existing structur{s, if any: Front ............... Rear .............. Depth ............... lteight ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front ................. Rear .................. Depth : Height Number of Stories 8. Dimensions of entire new construction: Front ......... , ..... Rear ............... Depth ............... ~?ight ............... Number of Stories ..................................... ,. .................. 10.9' DateSiZe of lot: FrontofPurchase '*' ~.~,,.0., .......... ear .. Name of Former Owner 11. Zone 9r use district in which pr~mises are situated ..................................................... ' 12. Does proposed construction violate agy zoning law, ordiltance or regulation: ............................ 13. Will lot be regraded ..... j~[-!~,./:~.. ............... K,Will excess fill~,, ,.-~ ,-.-]~-~'em°v-~t from premises: Yes Name of Owner of premises ..i .................. Address ...... ~..../--~'='.... Phone No~¢..edo~'~. c~,~.~. 14. Name of Architect ......... : .................. Address ................... Phone No. ~. Name of Contractor ........ .................. Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and~ indicate 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 NEW,YORK, , ~ ,, ,, COUNT~Y OF..~ ¢~ .~z'PT~).Z:. ].~. .....i a'o ..... ',L .off. ¢... ~...J~..~..3'..3~.././i ............ being duly sworn, deposes and says that he is the applicant , (Name of individual sigfiing contract) above named. He is the ..................... i .................................................................... i (Contractor, agegt, corporate officer, etc.) of said owner or o~ners, 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 ...... ~., ,c/. ....~ ........ day of...~~ ...... 19 .o¥^.¥ us..o, .0w ¥or No. 52-4524771 i · ~mrnJssioll Expires Uerc~ ~0, 198k ~2~, O~ 90.0 ~" ~ --'~ 0 Z