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Home My WebLink About13348-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy ......... Date Juz THIS CERTIFIES that the building .... Qn. ?..f.a.m..~.y.. d. ~p.l.~. ~..ng ...................... Location of P err 1600 CAMP MINEOLA RD. MATTITUCK rop Y h~s~ h/d ....................... ~r'eSt' ....................... County Tax Map No. 1000 Section . . ~. 2. .2 ....... Block .... 5. .......... Lot .... .p ./.o..3. ....... Subdivision ,JOHN SIMt¢ICB Filed Map No9784-6 .Lot No. 4 conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... A~g....9. ......... ,19 ~.6. pursuant to which Building Permit No. 13348 Z dated ....... ~. ,u g,,. ! 3, ............. 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 ......... ..... qr,.~. ,f.~w~ )-y..c~.e.%%i. vg ...................................................... The certificate is issued to ....... ~.Q ~ F ?.~..~ Iq P., C. ~..~ 9.h..~ F.%~.~. S. ......................... (owner,/~e~ of the aforesaid building. Suffolk County Department of Health Approval .., 14 - S O- 158 UNDERWRITERS CERTIFICATE NO. N 68852 ? PLUMBERS CERTIFICATION APRIL 5, 1985 Rev. 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING FE~,MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 133~8 Z Permission is hereby gronted t9: ~, (-"-) .....k~.~....~.4.......u.~..~..,~. ........ to ,. , ....... ~ ...... ~ ........... / otp~e~,ses located ot l&.O.~......~.~...~.~.....~. ..... ~.~.~ County Tax Map No. 1000 Sect,on.~..~...-- .......... Block ...................... Lot N ........ pursuant to application dated ..... .~r~..?~..'~......~ .................. , 19..~..7., and approved by the / Building Inspector, Building Inspector (~,0 ? Rev. 6/30/80 FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. 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, §. Submit Planning Board approval of completed site plan requirements where applicable. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1, Accurate survey of pZToperty showing all property lines, streets, buildings and unusual natural or topographic featu res, 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, Fees: 1, 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 $15.00 .............. New Building . ....~.., ..... Old or Pre-existing Building ............ Vacant Land ............. Location of Property ,/~.~;~)... House No. Street 4/ Ham/et Owner or Owners of Property, .~....~., ~ .... E~----~/~. ....... .x ......... County Tax Map No. 1000, Sectlon, . . . / .~, ¢~ ..... Block ..... ~.. ........ Lot . . .~.//~..~, ..... SubdivisionJ¢~. ~,(/~ ¢.l ¢~"f ...Filed MapNo~ ~t'~,'~Lot No .... ~. ...... Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $, ''~ ' Construction on above described building and permit meet,s-~ll.applicable codes and regulations. Applicant ~~//~.~'~ ................................ TO~/N OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 ~- RLDG. DEp? CERTIFICATION Building Permit No. 13 ~q Owner %10 ~k ~~ (pleaSe ~Srint) Plumber F~///~//~ ~--/~Y~/~J (please print)' I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plum~'s Sign~ure) Sworn to before me this /~ ~ day of ~ , 19 Y~. Notar~ Pubiic~ ~L County Notary Public I~A~,OLD l. [~o. 52.657J',:5- S~%h~ 6our~ty FIELD INSPECTION FOUNDATION FOUNDATION 2. ROUGH FRAME & PLUMBING (2nd) COMMENTS INSULATION PER N. Yo STATE ENERGY ~.ODE ADDITIONAL COMMENTS: 76S-1802, BUILDING DEPT. INSPECTION ['~, FOUNDATION IST [] R°UGH' PLBG.~ [ ] FOUNDATION 2ND [ ~. INsu~TIoN ~: [~ ],FRAMING [ ] FINAL ~ REMARKS: , ' , , ' i loor~6~ THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY ~ was examined on April l~k 198~ and found to be i~t compliance with the r&quirements of this Board. FIXTURE SWITCHES OUTLETS 49 46 38 FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS INCANDESCENT FLUORESCENT VAPOR 49 DRYERS MOTORS APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I ': C OTHER APPARATUS: ~otOrs; 1-F 1-G.F.I. 2-Gmoke Detectors I HowLed ~lll ln~c~Lm Box 574 ~A~LiD ~oad Laurel, N.Y. 11948 Lie. 75~ GENERALll Per_ This certificate must not be ohered in any manner; return to the office of the Board if incorrect. Inspectors may be identified by COPY, FOR BUiLI ANY MANNER. 'FORM NO. 1 ToWN OF sOUTHOLD BUILDING DEPARTMENT TOWN HALL sOUTHOLD, N.Y. 11971 TEL.: 765-1803 )isapproved a/c .......................... (Building Inspector) APPLICATION FOR BUILDING pERMIT Received ........... ,19... Date .A.U~-8 · · · '~, ..... 19.Z4 ~ 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. ,." J ~ *~s a--lication may not be commenced before issuance of Building Permit· Such permit c. The work coverea u¥ u~ of this application, the Building Inspector will issued a Building permit to the applicant. d. Upon approval . -:,~ ~or insnection throughout the work. shall be kept on the premises avaaam~ ~ r part for any purpose whatever until a Certificate of Occupancy e. No building shall be occupied or used in whole or in 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 regulations, and to admit authorized inspectors on premises and in building f°r necessary ins~ec~t'm~ ~ (Si a~'~tuf~ [¢plicant, or name, ifa corporation) -' --a . .L,'~; t~ ~.. I~. I t~ u. · . · ....... (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. ............................ :"' Name of owner of premises...d .O ~ C. ~. h...(:~.m~'' 0./'.~ ~0 1 .... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. ' (Name and t~tle of corporate office ) Plumber's License No... .%~%/1%~.V. 9 [ [ 0 ~'' Other Trade's License No .................... ' Location of land on which proposed w°rk wiil be a°ne ........ - ............ ~ ~' ~Li ~. k Hamlet .~/~ .~' House Number Street ....... ........ ' '" ~'~ Lot ..... '-' ' :p'No lO0Osection ....... lock .... .... , ......... % County Tax . ' ' ' Subdivision · · .'~ .... ~ .........(Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... L/..C~C~C~ ~4~.'~.... t ~..~. ..... ............. ~ ................ & '¢3 .......... b. Intended use and occupancy · · .~ .Yl.~.'x. ~..~r... I~ ~...t ................. ! .8. 3. Nature of work (check which a phcable): New Building .......... Addition .......... Alteration .......... ' Rem6val Demolition Other Work Repair ......................................................... . .~..201 /.) ~ .~ (Description) 4. Estimated Cost ............................. Fee ................................. i 4. (to be paid on filing this application) 5. If dwelling, number ofdwellinglunits .............. Number of dwelling units on each floor.....~wr .......... If garage, number of cars .... ! ....c~ ............................................ ~ ................. 6.7. If business, commercial or mixe~ occupancy, specifyl//lnature and extent of each type of use .. ~ ............ Dimen:sions of existing structures, if any: Front . . . m, ~ .~ i. ...... Rear .............. Depth ............... Height ............... Number of Stories .......................................................lv/--~ Dimensions of same structure w3th alterations or additions: Front ................. Rear .................. Depth ................... i ' ' .Height ...................... Numbex,qf ~5$qries .......... .~.^. · r~. ,. · Dimensions oi entir~ rlew construction: Front .... ~'.~.. ~r. br .... Rear .... ~'.~'/. 'k.-J'.... Depth . .,2J.O..-17-.~... · Height ... t~../~.~..-~7~.: ..... Number of Stories .... ~ ............................................... 9. size or lot: ?. . . . . , .0............ Depth . ./.'~.~.,.O.~ .......... 10. Date of Purchase .. ~ ~.q .~...~;. ]. ~'.~./~6.... Sa_,m,e of Former Owner ~ ~.~. ~,~.l:~a.'t ~ .i .c, b4 ..... 11. Zone or use district in whic~ pr~mises are situated .... /~.~.~ .~. .... lqvm o ...... ~.~ ......................... 12. Does proposed construction violate any zoning law, ordinance or regulation: . ./g.O ........ ' 13. Will et be regraded ..... .~D ................... Will excess fil! be removed from premises: ~_ Y.es (No 14. Name of Owner of premises~.O.'q~,o}l .q~e~[..~e~5. Addres~-.~ ~,~ ~ole, 1~( ..... Phone No...e~.~ ~....~..O0.,,~' Name of Architect ' .~-.-~..r.~.~.. ~'J~. ~.~. ~ ......... Address .~ m.~..4 .~.r,:~.~ ~... Phone No./'~. 9.9. .-..O.~..O. 9~. Name of Contractor ~'.R t0.~$.'m..QO$O.~.~. ....... Address[~/*,a ./~d.. I .qa:h.3., P~d~hone No. g.?.ff. ?.S~. ~.."~.. PLOT DIAGRAM Locate 'clearly and distinctly al! buildings, whether existing or proposed, and, indicate all set-back dimensions from property lines. Give street and blockinumber or description according to deed, and show street names and indicate whether interior or corner lot.~.~ ,~&~....l~i~O .'~ 3c I "'~l(fi ~q ff ;~ ' COUNTY OF ...... ·.. S.S ......... ......... . ......... .' ' .'; .... : ' t.' ................... being duly sworn, deposes and says that he is the applicant (Name of lndlv~dual sigmng contract) above named, i He is'~he : ,1 (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this .application; that all statements cont.amed m th~s apphcanon 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 b~fore me this ......... · · · f.'-~. · ] .[~. · .... da; ~i ~.'..~ ..... ,19~.V Notary Public, . . . : . . ~""""' ' HELEN K, DE VOE I"' NOTARY PUBLIC, State of Ne~ York · (Signature of applicant) No, 4707878, Suffolk Oou,nW ~-- :""" ' 0 "r Z U ._1 0 h o~ oO ~ i-4,735 Ia E. ('YACk?