The URL can be used to link to this page

Home My WebLink About13107-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z.!.2.8.9.2. ..... Date October ~6 ...................................... 19 84 THIS CERTIFIES that the building ........ .0.n.e..f..a.m.i.l.y...d.w.q ]: .1.i.n.g. ................. 5.9.5 L.?.n.g.v.i.e..w L.a..n.e Southold Pwperty., .... . .......................................... Location of House ivo, Street Ham/et County Tax Map No. 1000 Section , 0.8.~. ....... Block .. 5 ............ Lot .... ~. ............ Subdivision.. ~.e.~.~.y. ~.~t~ ............... Filed Map No. ~9.0.~ .... Lot No...z~7 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~y..8. ....... 195.4. pursuant to wlfich Building Permit No. J.3. q..0?.Z .............. dated .... O.~Y..~. .................. 198.4.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which tiffs certificate is issued is ......... ...o..n.e..f.a..m.~.z.y., .d.w.e.~. ~..i.n.~ ...................................................... The certificate is issued to ....... .6.e.q r. g .e..C.a..v .a 6.n.a, .r .o ................................. (owner, ~( ~(e~)X X of the aforesaid building. Suffolk County Department of Health Approval ...... ~. 4. :-.S.q ~ ~ ~ ........................... UNDERWRITERS CERTIFICATE NO .............. P..e p.d.~ n. $ ............................ Building Inspector Rev. 1/81 TOWN OF SOUTHOLD ~UILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS pERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 13107 Z Date ..................... .~ ................................ , 19.~. Permission is hereby granted to: .~.~ ....... ~ ............. LI.:...I ......................... ~,~,,,,e,,~,ed~,..~::~ ......... ~..=....~..~, ............ ~=~.....~~ .......... ~.~ ........... County Tax Mop No. 1000 Section ...... .~.~..~...~.. ..... Block ........ ..~.~... ....... Lot No .......~.. ............... pursuant to application dated ......... ..'~.~..~..?...~..~.....~. ...................... ,19.~..~., and approved by the Building Inspector. Rev. 6/30/80 FORM NO. $ TOWN OF SOUTHOLD Building Department Town Hall ,~Jouthold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A, This application must be filled in typewriter OR ink, and submitted-~F~c;t;.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 instalJation 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 buiJdings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty 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 buiJdings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1, Certificate of occupancy $§,00 2. Certificate of occupancy on pre-existing dwelling 3. Copy of certif cate of occupancy $1.00 landuse--Fre-Existing C.O. $15.00 Vacant land C.~. $ 5.00 Date ........ .~..~./. ~' ¥ ........... New Building ....... Old or Pre-existing Building .... Vacant Land ............. Location of Property ............. ~, .~-,~;? ................... ~,. ,', ., Owner or Owners of ProperW ............ ~¢9 County Tax Map No. ,000Section ...~ .~. ....... Block ...... ~ ...... Lot ..... ~ ........ ..... ....... ,ermitNo. J~..~ Date of Permit ~l~/~..Applie,nt ..g.~...~...~..~.~ Health Dept. Approval ............... Labor Dept. Approval ........................ ............... ...................... Request for Tempora~ Certificate ..................... Final Certificate .... ~ ............. Fee Submitted $ ......................, . TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Building Permit No. ~% [~ Owner (pIease print) (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. 4~ f] ~plumber's signature) Sworn to before me this /~ day of Od~- , ~ ,2~. 19 ~ Notary Public Notary Public,~/~~ County HELEN K, DE NOTARY PUEJ[IC, State of New York N~ 4707878, Sullo~k lerm ~:.xlmes March 30, 19~~' THE NEW YORK BOARD OF FIRE UNDERWRITERS 1000771 I~UREAU OF ELECTRICITY ~'i, 85 JOHN STREET, NEW YORK, NEW YORK 10038 George Cav~gnaro, s/s Lomgview Ave.b00'w/BFyview Rd. Southold,N.Y, thefollowing locatlon; ~ Basement ~ 1st ~7. ~ 2nd Fl. Section Block Lot was examlned on Oc~. ).]-~ ~95~ ,,,d found to be in rompliance with the requlrements of tkis Board. FIXTURES RANGES OVENS OISH WASHERS FANS 27 43 22 27 DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATERS DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: 1 GFCI. 1 smoke detect:or S E R NO. OF CC COND ] A. W G, 1 1/o I C NO OF HI-LEG A, WG OF NEUTRAL i/o Ruland Elco.Co. P~O~Box 143 Mmtcituck,N,Y.11952 lic. 242 E This certificate must not be altered in any manner; return to the office of the Board if incorrect. Inspectors may be their credentials · COPY FOR BpILDING DEP~,RTMENT. THIS COPY. OF CERTIFICAT~ ~U~T NOT BE ~TERED IN ANY MANNER. ~'I ELD IilSP~CTION C OI-h,1L N T S ~ OU~I)ATIOII ( lst) FOUND~TIOU 2. ( 2nd ) ROUGH FRAME & PLUMBING 711SULATION PER N. Y. STATE ENERGY C,ODE 76S,1802 BUILDING DEPT; INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION ZNDi[ ]INSULATION [ ] FRAMING, [~/FINAL' 'REMARKS': DATE,, ,! , iNSPECTOR* ~-~* 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST ,~ ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [ ] FINAL .2 ~ ~?/.///v?/:/INSPECTOR~ DATE / BUILDINO DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] BOUGH PLBG. f ;1 FOUNDATION ZND [ ]INSULATION FRAMING [/,~FINAL REMARKS: DATE INSPECTOR TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~UTHOLD, N. Y. ...... ? .... .............. , .............................. ~proved ...... ~.~.~ .................... Permit No . Disapproved a/c ............................................................................................ Application No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ................................................ , 19 ............ INSTRUCTIONS o. This application must be completely filled in by typewriter o¢ in ink and submitted in triplicate 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 ofproperty must be drawn on the diagram which is part of this application. 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 issue 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 occupiedor 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 Deportment 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, os 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 buildings for necessary/inspections. ........ .......... (Signature of applicon, or name, if a corporation) .... ........ ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ /~..~:r.'/~ ....................... '~ .................................................................................................................. . Name of owner of premises ..,..~.......................~....~........~d.~..~../...~.... ............................................................................................... ' If applicanLis~a corporate, signature~of~uly author zed officer ...... ~.: ......................................... ~...T..~?~...~ .... / (Name and title of corporate officer) Builder's License No ..................................................... Plumber's,License No...~'/~..t.~..~...~/~,)/,/~'.'/~ Other Trade's License No ................................................ Location of Iond on which p~oposed wor~k will be done. Map No.: ...... .......~r/ ...~....4~..~.k.~..~.. ...... Lot No....~.~ ............... Numb~ Street and ~' ....... ~'"'"'V~ ........................................................... ~ ~ ~ ~ ~ ~ A ............................................. Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................................................................................................. b. Intended use and occupancy ........ ,~.....~.~/~....~.~...: ............................................................. 3. Nature of work (check which ]applicable): New Building.. ........ ~Addition .................. Alteration ................ Repair .................. Removal ' .................. Demolitior ..................... Other Work ................................................. .... · ' ~ ;~ D (Description) , ' ' (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ~ ........... Number of dwelling units on each floor ............................ If ga'rage, number of cars ........... ~ ............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent af each type of use ............................ 7. Dimensions of ex st ng structures, if any: Front ............................ Rear ................................Depth .................... Height ........................ Numbler of Stories ................................................................................................................. Dimqnsions of same structural with alterations or additions; Front .................................... Rear ............................ Depth ................................Height ............................ N~umbe~r~ of Stories ................. T'"?~r ..... j~..~...~; .............. 8. Dimensions of entire new construction: Front ...... .~_..Cj?...Z.~.. ............. Rear ...... .'~....~)....¥..~ ....... Depth Height ....... ../.~...'. ..... Number of Stories ........ ~......~ZJ ......................................................................................... 9. Size of lot: Front ......... L..~.~ ...................................... Rear ..............: ........................... Depth ................................ 10. Date of Purchase ..... ~.~ ........................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does: proposed construction violate any zoning [aw, ordinance or regulation: ...... ~ ......................................... W I at be rearaded . ......... ~./,~.~'. ........ Will excess fill be removed from premises: ( ) Yes ( Name of Architect '~'~--' ...................... ............... ~ .............................................. Address ................................Phone No; PLOT DIAGRAM. [ocat~ clear y and distinctly ali buildings, whether existing or proposed, and indicate oil set-back dimensions from property hnes. Gwe street and block number or description according to deed, and show street names and indicate whether inteFior or corner Iol. COUNTY ~,z~....~'i"~ , ~ I~-~/.~.~ ) ~ ' ' duly sworn, deposes and soys that he is the applicam ................. ~ ................. f ....................................... Demg (Name of individual sigping contract) above named. ~ ~ ~ He is the ................................................................................................................................................................................. j (Contractor,' agent, corporate officer, etc,) of said owner or owners, and is ddiy authorized to perform or have performed the said work and to make and file this applidation; that all statements contained in this application are true to the best of his knowledge and belief; and that the wgrk will be performed in t:he manner set fo~h in the applicati~ ~ therewith. ) ~ory Public, . ..... ~ ........... ~ ~[ Coun~ /~;;......~--~ ........................... r 0 6 ..... I~OD'E'RI¢'~ VAN T~,,L,YL, P.C. LICENSED LAND SURV~'YORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL h.S. NO. STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THiS RESIDENCE WILL CONFORM tO THE ST~ANDARDS~ OF ThE (si ~ ...... APPLICANT SUFFOLK COUNTY DEPT OF HEALTH SERVICES FOR APPROVAL OF CONStrUCTION ONLY DATE: 5~ APPROVED. ~ r · '~ .'%~C'-"~"' ~' SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PCL. I OWNERS ADDRESS: P' 2:~ ~' ' -~ TEST HOLE STAMP SEAL !75.0 LICENSED LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL H. S, NO, STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFOR.I~ TE) THE ST-~N~R~ OF THE APPA- tC~ NT ,/ / SUFFOLK coUNTY DE~T. O¢ HEALTH ~ SERVICES - FOR APPROVAL OF ~ CONSTRUCTION ONLY DATE: H. S. REF, NO., APPROVed: SUFFOLK CO. TAX MAP DESIGNATION: DIST. SECT. BLOCK PEk OWNERS ADDREss: _ .................... TEST HOLE STAMP [~ SEAL I L. ~ _ ~/ACA J 0 SUFFOLK CO. HEALTH DEPT. APPROVAL ~ '- H.S. NO. ~; ¢' :; ~ '~ STATEMENT Of INTENT r~ ~ o , ~ m THE WATER SUPPLY AND SEWAGE DISPOSAL ~_~-- ~ ~ ~& ~ .~ SYSTEMS FOR THIS RESIDENCE WILL ~' ~ ~ n CONFORM TO THE STANDARDS OF THE '- t ,,~ , a j SUFFOLK CO. DEPT. Of HEALTH SERVICES. ~,, ~ (S) ..... o APPLICANT ,~, ~ >, ~ ~ SUFFOLK COUNTY DEPT. OF HEALTH ~ SERVICES -- FOR APPROVAL OF .,, ¢ m CONSTRUCTION ONlY ,, m u ,-~ co ~ DATE: · ~ ~ ~ o H.S. REF. NO,, )'~- ~ APPROVED: ~ ,,, .,, SUFFOLK CO. TAX P DESIGNAT ON \ ~, DIST. SECT BLOCK PCL. -~ '\ . '~.. OWNERS; ADDRESS: .,,5~ALE - 40', ~ "~'~"~i.?,~.*.t:.:~'~. t TEST HOLE STAMP '" A,I~EA' ~7~'Or'~ ¢: ~''' ~,r~*o,~,~ ~,,~,,,,,~ ?.,. ~"~ I SEAL LICENSED LAND SURV~:YORS GREENPORT NEW YORk I DATE: .B.P. ~: _! ~.) 0 ::~ FEE~ I~ff~ .A,- ~ BY: _ ~, ~. L. NOTIFTM B' ~lf hlF]G DEPARTMFNT AT 765-180P 9 AhA TO 4 PM FOR THE If copper tubing Is used for water distributing sysiem~ piping shall be ot: types K or L only SUPPLy SY$~TEM EXCEED CANNOT 2/lo of l% LEAD. / ,?' \ I' T m-j-T V 0 U P L ? . ¢,', \