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Home My WebLink About13342-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13218 Date February 15 19.85. THIS CERTIFIES that the building ...A..d .d3.~. 5:. 9P..~. o...e.x.~ s..~.5.n.g, .d.~.e. 1..1 .~.n.g .......... Location of Property 1180 l~ine N.e.c.k.?..d: ................ .Sg.u.t:.h. 9.1.d. .......... Street I~ ~o~ ............ Hamlet County Tax Map No. 1000 Section .0. 7. .0 ........ Block .... 9.8 ......... Lot .... .2.1 ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated A~g...5. .., 19 .~.6. pursuant to which Building Permit No... J.3.3.4. ¢.Z ............ dated ...... ~.u. g .u.s.~.. ~..3 ............ 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 ......... Add .a bedroom and bath to existing .d.w.e..1.1.i.~g... Richard M. & Doris M. Sher. man ......... of the aforesaid building. Suffolk County Department of Health Approval ...~/..A .................................... UNDERWRITERS CERTIFICATE NO ........... #.~ ~ 7.0.4. 55 .............................. Plumbers Certification 2/11/85 Mike dacobi Building Inspector Rev. 1/81 I~'OBliK NO* B TOWN OP $OUTFIOLD 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? 133{2 Z Permission is hereby granted to:. ..~~.~....~..:~:......f..I...~..~ ............ ~ , · ...~ ................... ..~.....~........~.~.._...~..... ............................................................ ~. ................ at premises located at ..... .~.J..~...~....~...~....)~.~.....~ ........... ~....~... · .~... ........... County Tax Map No. 1000 Section ..... ..~....~....0. ........ Block ...... ..~.~ ........ Lot No ......~..1 ........... pursuant to application dated ....... ~..~.....~.......~... ............. , 19.~..~..., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Delm~tment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in triplicate to the Building Inspector 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 dispcsal--(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 installations, 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), Nan-conforming uses, or buildings and "pre-existing" land uses: 1. ,Accurate survey of property 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 in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 ................ New Building .................... Old or Pre-existing Building ........ ~ ................ Vacant Land ............................ Location Of Property ..../../..~...~......./~./...~..~..../..//...~..~..~.....~..~...-~.~. ........ ...~..~...~...~...~.../.~..?.....~...'..~..,....~../...~...?./. ..... Owner Or Owners Of Property ./..~?.c~/..~..~.~.~.~....~..~.`..?..~../~.~.~./.~..~../..~`.~....~..~..~.~/~../..~.~.~. .......... Subdivision .................................................. ?, ........... Lot No ............. Block No ............. House No ............. Permit No. ~..%~....~..~/.~....~.~. Date Of Permit ..~../..?,~..~Applicant ~../...~.Z/.~...~....../../.~.../~..~..~..~..~.../.~....~..~...~..../~-~ Health Dept. Approval ............................................ Labor Dept. Approval ................................................ Underwriters Approval .......... ../~.. ................................ Planning Board Approval ........................................ Request For Temporary Certificate ........................................ Final Certificate ......Z~ ................................ Fee Submitted $ ...~..~..'.~ ...................... Construction on above described building and permit meets all applicable codes and regulations. Applicant .....~..-~.~,....~...~c~'7~ /~, ...~.~/~.~./..7-.'~../~ .................................... Sworn to before me this / ................ day of ............................................ Notary PubJic .................................... County (stamp or seal) TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date Building Permit No. (please print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plu~' s signature) Sworn to before me this /~ ~ay of ~/2~ , 19~f~-. Notary Public,~County Notary Publ/ic FIELD ~NS?E~TION COMMENTS FOUNDATION (1st) FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) INSULATION PER N. STATE ENERGY QODE FINAL ADDITIONAL COMMENTS THE NEW YORK BOARD OF FIRE UNDERWRITERS ~.O(JO[;~l BUREAU OF ELECTRICITY ~ 85 JOHN ,STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the electrical equipment as described bel~ and i~troduced by the applicant ~amed on tko able application number in the premises of ~ich~'d ~he~an, 1180 P~e ~eck ~ad, Sou~old, ~.Y. in tke yollowing Ioc, tion; ~ Basement ~ 1st Fl. ~ 2nd FI. S~tlon Block Lot was examined on and found to be in compliance with the requiretnents of ~h~s Board. ~ce~e~ 03, ~984 RXYUEES RANGE5 OVENS DISH WASHERS EXHAUST ~ANS FIXTURE DRYERS SYSTEMS NO. OF FEET OTHER APPARATUS: M~tors ~ 1~3/4h~. E R %E %Co oI OF CC CONO I C NO, OF HI-LEG OF HI-LEG NO, OF NEUTRALS A, WG OF NEUTRAL Paul ~urns southold, N.Y. 11971 This certificate must not be altered in any manner;, return to the office of the Board if !ncorrect. I~specto(s may be 'identified cre~{enfia(s. COPY,FOR B~ILDING DEP,~RTMENT. THIS COPY. OF CERTIFICATE MU I AN¥ MANNER. 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Examine ........... ~..~..., 19 ~ .t! Approved~~~X~. ),t.,., 19~..~. Permit No.I.i.&:.&-, .ti, .~:..':'~.. Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Received..t~/.~. .... ,19..~. a. This application must be completely filled in by typewriter orin 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 approvai 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 admit authorized inspectors on premises and in building for necessa~¢~ ..~..~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... A.~...o~...-....A.c.~, ~¢..~... Name of owner of premises .... i~t~e'. ¢ .c~..~..~. .~.~.:...~i....~...P. t'.~. ~/~, .... O.'~..O~.17. m .t:3~. · b~. ......... (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...~)..°.~(.' .... . .~. J.~..~..~.-.~.... Plumber's License No. ~' ~ Electrician's License No. " ~ Other Trade's License No. " a Location of land on which proposed work will be done .................................................. .... ............... :,w., ........... ................ House Number Street Hamlet County Tax Map No. 1000 Section ...... 7.~. ........ Block .... 1~. ~> ........ Lot ..... ~. J .......... Subdivision ..................................... 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 ....................... .~)~; .~! .[tI~ ............................. 3. Nature of work (check which applicable): New Building .......... Addition~. ......... Alteration .......... Repair . ............. RemOval .............. Demolition .............. Other Work ............... q~ ~ (Description) 4. Estimated Cost ........................... Fee ...................................... ,~ '~ (to be paid on filing this application) 5. If dwelling, number of dwelling Units · · · .~ ......... Number of dwelling units on each floor ............ '.' If garage, number of cars ..... i .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each typq of use ................... 7. D~menslons of existing structures, If any: Front .... ~;B ....... Rear ... ~ .~ ....... Depth .. ~ .~. ......... Height ... ](~. ........ Num~ber of Stories ..... ] ......................................... : ........ Dimensions of same structure w~th alterations or additions' Front ~ ~ ' Rear . Depth ..... ~ ............ Height ....... I.(~...~ .......... Number of Stopes ........ ( ...... ., ...... 8. Dimensions of entire new construction: Front.. ~'.~!5 Rear .~. Denth ."~.~ .'~.' i i i Height ...... ].~... :.. Number of Stories ...... / ....... , ............................... 9. Size of lot' Front IO.~. i ... Rear lO.~.. . De th 1.~O.' 10. Date of Purchase ........... i .................. Name of Eormejc,Owner .............................. l 1. Zone or use district in which pr~mises are situated .... ~ .... ]~.,~{.~..eF.h~.. (.o~. ........................ 12. Does proposed construction violate any zoning law, ordinance or regulation' . /~2o .... 13. Wall lot be regraded ........ ~.O. ................. Will excess fill be removed from premises: ~ No Name of Contractor ' Address Phone No PLOT DIAGRAM Locate clearly and distinctly ail!buildings, whether existing or proposed, and. indicate ail set-back dimensions from property lines. Give street and block aumber or description according to deed, and show street names and indicate whether interior or corner lot. STATI OF . ...... .4~/A.~. .... . . .~.1.~..~ .~. ~-~.C ........ being duly sworn, deposes and says that he is the applicant (Name of individual sign!ng contract) above named. He is the .................. . .................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 l