HomeMy WebLinkAbout12926-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
Certificate Of Occupancy
No- Z12261 Date March 6 1985
THIS CERTIFIES that the building .... 0. n..% .f.a.m..~.3_2.. cl..w.e.~.~. $ .rig ......................
Location of Property ..l~5..49.c.k.e.y..C?.eek Drive ~{ Southold-
House No. ' .......... 'S't[e ............. Ham/et
County Tax Map No. ] 000 Section .0.7. 0. ........ Block 2 .Lot P / o ~ 9 · 1 3
Subdivision Minor Susan Terry .Filed Map No ....... Lo/No.
conforms substantially to the Application for Building Permit heretofore fried in this office dated
F e b. 14 19 $ 4 pursuant to which Building Permit No. ~. 2. ~.2.6.Z. ..............
dated ... ~la.r.G h..1 ~, ............... 19 ;3.4., 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 .........
..... Qram. £.o.n~y. 4~.t3, J~¢g .................................................
The certificate is issued to ...T..hp.m.a.s...&..~ 9.s.e.m.a. ~ y..K. J:..os .
[owner, 'l '~[' it,~k~ ~ ~( ...................
of the aforesaid building.
Suffolk County Department of Health Approval ..... .1.4.S. 0. :.2,5 .............................
UNDERWRITERS CERTIFICATE NO .......... ~) N 651232
Rev. 1/81
uuilding lnspecto~r~''~'
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
$outhold, N.Y.
Certificate Of Occupancy
No. Z13242
Date March 4 1985
THIS CERTIFIES that the building ...~.W $~.%r~g. ?.o.q ~_ ........ ; .....................
Location of Property .723,5 Jockey Creek D~,ive . . Southold ~
House IVo. Street ......... Hamlet
County Tax Map No. 1000 Section .... .0.7.0. .... Block . .2. ............ Lot..P./. 9..7.9.; .1.3 .....
· .. Minor Susan Terry .
Subdivision ............................... Filed Map No ......... Lot No ..............
conforms substantially to the Application for Building Permit heretofore fried in this office dated
.... F. eb...7.4 ........ ,1~.4.. pursuant to which Building Permit No.. 12S.2.fi Z .............
dated March 12
............................ 19.8.~., 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 .........
............. inground swimmin~ pool AccesDory ................................................................
Th¢ ¢ertificate is issued to Thomas & Rosemary Klos
(owner, IK~e~ ~lXt~ty~{~ X X X
of the aforesaid building.
Suffolk County Department of Health Approval .... .~ .4.~. 0 ~ ~ ~.
UNDERWRITERS CERTIFICATE NO ............. i~I.~ 5 0 9.3.3 ...........................
Building Inspector
Rev. 1/81
FOR~ NO, ~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 12926 Z
Permission is hereby grant~:
...~.~ ............................ ~.=.~ ....... 15.~ ........
..~.~...~,.,~ , ........ ~, ......... ~,., ......................... ,~.~~~
,o .......
~c ~ ~ ~. ........
~..~ ........... ~...~..~,~...~. ................ 4.~.~ ~..~. ~ ............
o, prem,se, ,~oted o, ....:.~...~.~....U~ .........
Cou.~ To× Mop No. 1000 Section ....... ~.-I..~ ...... BIo~ ...... ~. ........... Lot No......~...l.~.:.[.~
Building Inspector.
Building Inspector
Rev. 6/30/80
FORM NO. 6
TOWN OF SOUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 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:
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:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.00
3. Copy of certificate of occupancy $1.00
4.Vacant Land C.O. $5.00
New Building ............. Old or Pre-existing Building ............ Vacant Land .............
House No, Street Ham/et
County Tax Map No, 1000 Section ¢~. ?, ......... Block . .~ ........... Lot .~¢/..~.. ,~.~. ;~-.. ,
Subdivision.. ,~-?--~ .~--.~.~ '.~ .................. Filed Map No ........... Lot No ..............
Underwriters Approval . . (~ ~ .~.?~. ~,~ ....... Planning Board Approval . ....~.~... ..........
Request for Temporary Certificate...v~../'.c~.. ........... Final Certificate .... ~ ..............
Fee Submitted $ .............................
Construction on above described building and permit mee,ts all applicable codes and regulations.
Applicant , ~~, .~. - ..,- ...................
1000771 THE NEW YORK BOARD OF FIRE UNDERWRITERS
t~ BUREAU OF ELECTRICITy
Jt, .7 ' Jo.. ST.ET, .EW OR § Jg30_ 4,OO3
THIS CERTIFIES THAT
only the e~c trical equipment as ~scrlbed be~w attd introduced by t~ applicant named on the able application number in the premises of
~omas I~lo~, N/~4 Jockey Creek Dr.~ Y~outhol~
in ~h,lotlowln~ Ioc,~on; ~ Bose,nent ~ 1st FL ~ 2nd FL Section Block Lot
was exa,tined on ~"1~ ~y 2 ~ ] 9~4 and found to be in cornpliaace with the requirements of this Board.
FIXTURE
OUTLETS
~2
FURNACE MOTORS
OTHER APPARATUS:
FUTURE APPLIANCE FEEDERS
FIXTURES RANGES
FLUORESCENT MERCURY ~T, K, W
~PEClAL REC'PT
S
COOKING DECKS OVENS DISH WASHER~
1 4.6 !. 1.2
TIME CLOCKS EELL ·~UNIT HEATERS MU/TI-OUTLE1sYSTEMS
A~T A~PS T~ANS NO OF FEET
OF CC. COND
4/0
V I C E
A W'G NO. OF~EUTRAL$
OF HI-LEG
DIMMERS
OF NEUTRAL
4/o
Motors: ] -v
]-GoF.C.I., 1-5~moke Detector
l~hls cerhflcate must n°t be altered in any manner; return to the office of tho Board if incorrect. ,ns-ect~,---~~~7:ll ,I
COPY FOR B~ILDING DEPARTMENT. THIS COPY, OF.CERTIF CATE MUST NOT BE ~" T=U=n i~1 * ...... ...-- · ; ~
THE NEW YORK BOARD OF FIRE UNDERWRITERS
109'~)0~4~ BUREAU OF ELECTRICITY
~ 85 JOHN STREET, NEW YORK, NEW YORK 1003~
THiS CERTIFIES THAT
only ghe electrlcal equipment as described below and introduced by the applicant named on tke above application number in the pre.tises of
in the fotlowlng Iocatiotl; ~ Basement ~ 1st FI. ~ 2nd Fl. O~a~ Section Block Lot
was examined on and found to be in compliance with the r~quirements of this Board.
FIXTURE
of ~u~ envJx~nts
Per~
0PYFOR BUILDING DEPARTMFNT THIR
%NNER.
FIELD INSPECTION
FOUNDATION
(1st)
COMMENTS
FOUNDATION (2nd)
ROUGH FRAME &
PLUMBING
INSULATION PER N.
STATE ENERGY
qODE
FINAL
ADDIT] NTS:
FORM NO. 6
TOWN OF $OUTHOLD
Building Department
Town Hall
Southold, N.Y. 11971
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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.
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:
1. Certificate of occupancy $5.00
2. Certificate of occupancy on pre-existing dwelling $15.0 0
3. Copy of certificate of occupancy $I.00
4.Vacant Land C.O. $5.00
Date ~,...~..~,. ,~zr,c-.'~'~,,...k.~.~..~.~.. ·
New Building .... ~ ..... Old or Pre-existing Building ............ Vacant Land .............
Location of Property . .~.."+-. ~ >.~ .......... .~.o..c...~C~>~..C_.~f~.~.\~L..'~.~.\,~..f~ ......... ~<=.?..~..-~..~..~..u..~
House No. Street Hamlet
Owner or Owners of Property . ~ .~-~.o..,y% .~...-.~...C'~C~..t~d, .~.~..'-~ .... ~.~.~...~. ..............
County Tax Map No. 1000 Section ~.p.o.O..~..~.~ .o. B~ock . ..~ ........... Lot .~/O...X.~ ,.~...
\
Subd~ws~on..\ .~.~L.,C¢~ .I .~ .................... Filed Map No ........... Lot No ..............
Permit No,\.'~...~,~. ~.. Date of Permit k.'~,.~A..~.~:~,.~Applicant ....'~-.~,~,~k~-'.'~; .'~.~$,~q-~..".(..~,~::~_.~
Health Dept. Approval .... .~//~r .............. Labor Dept. Approval ..
Underwriters Approval . .~.g.. ~..~'~..~--.~..~:::~ ..... Planning Board Approval
Request for Temporary Certificate .... l~J./.O~ .......... Final Certificate
Fee Submitted $ .............................
Construction on above described building and permit meets all applicable codes and regulations.
Applicant . ~-~-~..'-.~%.~...¢~. ..........................
Examined..~e~ .]..~- .... f98.~..
Approved ...~...~¢&. f~.
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
$OUTHOLD, N.Y. 11971
TEL.: 765-1803
., 19~.~.. Permit No. ! .&.~?'..~..~..
Application No ..................
Disapproved a/c, .....................................
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date .~:9 9?.u.a. ~. Y.
INSTRUCTIONS
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 promises 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 ~tlJtting code housing code, and_r,,egulations, and to
admit authorized inspectors on premises m~d in building for necessary..~ ~~,~a'ti~)_~'~~ ' -
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Owner
Name of owner of premises T~O~g~..g~.d, .l~9B.e.r~a. Icy..~1.9.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. .d.~.:~:,~] . Li:P.J!' .~..
Plumber's License No. G:,.~.P4C. OL[ .............
/
Other Trade's License No ......................
1. Location of land on which proposed work will be done...J.°.c. ~.eF..C..r.e.e.k...D?.i.v..e...S..o.u.t.f.zo..1.d.t .N..Y .........
Jockey Creek Drive Southold
House Number Street Hamlet I ~
County Tax Map No. 1000 Section 070 Block 2 L '. .'
Subdivision...iT0!.~. .o../~. ....~.o. 5.~.~. .............. 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 vacant log
b. Intended use and occupancy one family 12esidence~ ~,,(7'¢'~:~:~10:~ .'~, '~ '
3. Nature of work (check which aplplicable): New Building ....X.X.X.... Addition .......... Alteration ..........
Repair .............. Removal .............. Demolition .............. Other Work ...............
~ (Description)
4 Estimated Cost ~?~ ~ODO. OO
(to be paid on filing this application)
5. If dwelling, number of dwelling ~nits J- Number of dwelling units on each floor. 1
If garage, number of cars ..... i ...................................................................
6. If business, commercJai or mixed occupancy, specify, nature and extent of each type of use . .1~..,{.a ................
7. Dimensions of existing structures, if any Front. p./.a. .......... Rear .............. Depth ...............
Height ............... Nun)ber of Stories ........................................................
Dimensions of same structure with alterations or additions: Front ................. Rear ..................
Depth .................... !.. Height ........ ; ............. Number of Stories ....................
8. Dimensions of entire new construction' Front.. 68. Rear ....6.8.' ......... Depth iz.~.O~i'.
Height ... [.O~. ..... .~... Number of Stories ~ .......................................................
9. Sizeoflot: Front ...].].0. ! Rear..1~1.. 3.~.'. . Depth ~09o9~'
10. Date o Purch ~-2 -80, '
f ase 5 Nam Fo E x~h I~, Terr
............ eof rmerOwner .~ ...... Z ....
11. Zone or use district in which premises are situated Residential
12. Does proposed construction violate any zoning law, ordinance or regulation: ...N. 9 ...........................
13. Will lot be regraded ...~..~9. , ................... Will excess fill be removed from premises: Yes XXNo X
t4. Name of Owner o f prem~se~l'xomas./.Ro ~.~rlla ~y..K~lressPO.. ~00.J,. ~ ~.t.Q hOgl,l~hone No.7.Sq. rT.q:.l,~r ......
Name of Architect .......... I .... Address Phone No
Name of Contractor ' Address Phone No
PLOT DIAGRAM
Locate clearly and distinctly alli buildings, whether existing or proposed, and, indicale all set-back dimensions from
property lines. Give street and block :number or description according to deed, and show sireet names and indicate whether
interior or corner lot.
OF 'S S
~' ~,~~'. · '. '~..'ff..~ .V..--'.: · · .~.'..~) .~.'. ,/~..~./~f~/eing d'~uly"/w~or!,/~d~eposes and says that~ e is the applie~t
(Name of individual sign'ing contract)
above named.
e the ...... . .
is
of said owner or owners, ~d is du~y authored to perform or have perfomed the said work and to m~e ~d file ~is
application; that all statements contained ~ this application are true to the best of his knowledge and belief; and that the
work will be perfomed in the m~ner set for~ ~ the application filed therewith.
Swam to before me this
........ /.~. dayo~ ~~
Not~ Public, . ..... ~ .... ~..~. County
~ "g~l~.~ ~ ~ ..... ~(S~tur~of ~plic~t)
S~ ~ ~ ~P~ SURVEY FOR
FEB. 21 ~1985
AT~OUTHOLD D~T[: ~UNE 18, 1980
EaCl[~ ~or ~h~a loea~o~ ha~e ~been ~N OF SOUTHOLD SCALE= 1"=40'
tn~pectec~ by th13 deper~en~ and found SUFFOLK COUNTY~ NEW YORK NO. 80-556
~ ~ --'' ~" ' ~ I* ~ SURVE~NEW YORK ~ STATEA VI~ATIONEoUCATiON~ S[CTIONLAW 720g OF THE USLIFE TITLE IN~F NEW YORK
Oh~ef of ~ene~al Engineering .comEs ~ THIS $URVEY~NOT ~AR~G THE LAND THO~S A.K~~KLOS
HEALTH DEPARTMENT-DATA FOR APPROVAL TO C~STRUC T AND ~ HIS 'BEHALF ~ T~E TITLE C~P~Y,
"' iI YOUNG a YOUNG AV .U
, RIVER~AD, NEW YORK
I=MQNUMENT ~
ACDEH W. YOUNG, PROFESSIONAL ENGINEER
AND ~AND SUEVEYOR N,Y.S, UCENSE NO,
~ ~ ~WA~D W, YOUNG~ LAND SURVEYOR
~ ~ L~T~ ~ W~L(W), SEPTIC TANK(SWa CES~OLS(~) SH~N NEeE~ ' N,Y. S. LICENSE N~.45893
TDY POST E0494 .