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Home My WebLink About13119-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y, Certificate Of Occupancy No..~.]~ .272.4.' ...... Date ...... $.ep.t.., ...13.,..:. ............. 198..4. THIS CERTIFIES that the building .... 9~a.e..F~t.ra.J_.]~y. p.w.e.Z..~.5..n, cj ..................... Location of Property .. ~3.9.5 ............. Q.].d.. O~.c.h~O..~.n.e ..... ~a.s. ~. Mqrion House No. Street ...... l~/~l'e~ County Tax Map No. 1000 Section .. 03,1. ...... Block ..... .0.7. .......Lot , .(}~.3 ............ Subdivision, .Gor.d,5. i~e~c~q, .BAT..8~ ......... Filed Map No. 508~ .... Lot No, ~-.8.6 ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... g.p,r.5.1... 2.3 ..... 1 9.8 4 pursuant to which Building Permit No.. J- 3.21, ], 9 g ............. dated ......... .~.a. kg..1.1. ........... 1 9.8.4, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ....k...P.r.k. vAt .~.e..O.b.e. ?Am..5..3.y. ,D..w.e.3_.l. 5..rig .......................................... The certificate is issued to .... kl~g'vlt?l~5. ~. ~ryaI~$,a4'~I. ~ 2~ ~[ & .i~I.A.R.T.H.~. . . (owner, Jessee.~r. tenant, L .... of the aforesaid building. Suffolk County Department of Health Approval ..... J-A-~SO:-.6.7 ........................... UNDERWRITERS CERTIFICATE NO...P.e.n..d.J,.n. cj ....................................... Rev, 1/81 Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) N? 1311§ Z Date ........... Permission is hereby granted to: ....~..~.~....~ ........... ..~.~....~. .~..~.~.....~..:.~.....~.~.~..~.~ ....... ~o...~~.....~....~.~..~..~....~..~.~~.~. ....... ~ ........ .... r'~' ........ :, .......... ';"~;? ........ 'Y~";"~'~-"~'"'~177;'""~_"";"~'5~? at premises located at ...I....~....l .............. ./J~...~...~...L~.....'-~-,~.. ...... · .~..~:~.......:.'...I...~d.....~...~.~.... County Tax Map No. 1000 Section .... ..~......~....). ....... Block ........ ..~. .......... Lot No .......~..~...~.. ...... pursuant to application dated ......... ~...~ ........................ ,19..~...~., and approved by the Building Inspector. Fee $ ........................ Bullclifig Insfmctor Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall $outhold, 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 sin~ilar buildings and installa- tions, a certificate of Code comp{iance 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 peoperty showing ail 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. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling/ land 3. Copy of certificate of occupancy $1.00 use--Pre-Existing C.O. $15.00 Vacant'land C.O. $ 5.00 Date.. ?.(~.~ .~:../. :;. · .~.~..~. ~. · New Building ..... ~ ...... Old or Pre-existing Building ............ Vacant Land ............. Lo t on of Property.. .... Hou~ No. Street Ham/et Owner or Owners of Property .. County Tax Map No. 1000 Section ... ~J ......... Block .... ~ ......... Lot ..... /~ ........ .Filed Map No, ~.~ ~...Lot No .... ~ ....... Unde~riters Approval ........................ Planning Board' Approval ..... ~ ~ ~. ......... Reque~ for Temporary Certificate ..................... Final Certificate ..... -~ ............... Fee Submitted 8..~:.0~ ..................... Construction on above described building and per,nit meets all applicable codes and regulations. ::.. ............. Rev. 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~LO01071 BUREAU OF ELECTRICITY ~-J~ E6 JOHN STREET, NEW YORK, NEW YORK 100~38 THIS CERTIFIES THAT o~ly the electrical equlp~e~t ~ described belo~ and i~troduced by t~ applicant na~ned on t~ above appl~catlon number i~ t~ pre~s of ~'~ ~le, C/O Old ~'~d in the follo~ing Ioc~o,~; ~ B~e~e.t ~ 1~ FL ~ ~nd FL Section Block Lot was exa~nined on and found to be in compliance with ~he requlre~nents of this Board. FIXTURE SWITCHES OUTLETS DRYERS FURNACE MOTORS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS UNIT HEATERS MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT S E R V I NO OF CC, COND A W, G NO. OF HI-LEG PER ,~ OF CC COND ~/O OTHER APPARATUS: C TA-ax~ l~ght.[~. 1~ G ~ 8 ~lectric~l P.O. Box 215 ~outhold, N.Y. 1197t Lio#~?8 GENERAt This certificate must not be aJtered {n any manner; return to the office of the Board if inco(rect Inspector~ may be identified by their COPY yon B~ILDING DEPARTMENT. THIS COPY OF .CERIIFI( , , I ANY MANNER. HENRY J. SMITH & SON, Inc. MAIN ROAD SOUTHOLD, N.Y. 11971 (616) 765--3690 September 12, 1984 John Bertani Builder Inc. Colonial Road Southold, N.Y. Dear Sir: This is to certify that low lead solder - 95.5% - was used on the domestic water system at the home of Rev. William G Hempel, 3rd, Old Orchard Road, East Marion, N.Y. HPS:ag Yours tr u~v, ~ENRY J. SMITH & SON INC. FIE! INS?ECTION COM~4LNT., FOU~IDATION (1st) 2. (2nd) ROUGH FRAME & PLUMBING ~NSULATION FERN. STATE ENERGY C.ODE FIt!AL FORM NO. 2 TOWN OF SOUTI-IOLD BU1LDING DEPARTMENT TOWN CLERK'S OFFICE SOUTIIOLD, N.Y. NOTICE OF DISAPPROVAL Eile No ................................ for permit to construct .... ,~5:¢~.. .... (5::~'~(.s ,., ~e... ,~)~ .~(e (f.4~ q~' ................. -,vat ... ~o¢~ ..... / ....... ~o~ . .<.; ......... County Tax Map No. I000 Section~ .... ~2~. · Subfli~i~i .... ?~. Eiled Map No. is returned herewith and disapproved on the following grounds ~ :__., ~ __.., /.,-.. - ., :-, ......... :5~:~ ....... Building Inspector RV 1/80 "FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1803 · .......... ,19 . Examined , ~ I I 'x No.]. !.~. .~.. Disapproved a/c ..................................... Received.. (Building Inspector) APPLICATION FOB BUILDING PEBMIT 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 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 regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant, or name, if a corporation) ·..~. e/.-~,~ ~,~c .... /go. 'r .-~v'J~.../(¢:Z.(... (Mailing address-of applicant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builderi,, Name of owner of premises ....... /xJ./. d~-/~./~ .... ~.~-~./¢4. ~7..~L. · · · .~Z~../~. ............................. (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 ..... ].~./. ................. Plumber's License No..~., .~.' ..... ~..~../~. · Electrician's License No.. ~.~..-~....------------------~. · .~ .... Other Trade's License No. . .~/./. ............... 1. Location of land on which proposed work will be done .... ~.~t~.. t?z;L~. .... /fi6. .............. ·..~..~..~g./m~..~ ........................................ House Number Street Hamlet County Tax Map No. 1000 Section ..... ~ ./ ......... Block ... ~. ............. Lot.../~ .............. Subdivision .~./.,~(iq. am~./?~'-~' .~F"-~/~-)~..~... Filed Map No....3.'~.O. ~.,~ .... Lot.. ~.~3~ ....... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... b4//~C_.~g/.~. ..................................................... b. Intended use and occupancy ..... (0.x4.~.. ~'~Vx~'.t'.~... [~ .~q..~... f .~.~'. 3. Nature of work (check which applicable): New Building .......... 'Addition .......... Alteration .......... Repair .............. Rembval .............. Demolition .............. Other Work ............... ~/~ (Description) 4. Estimated Cost . 6:FO.! ~ Fee ' ~" (to be paid on filing this application) 5. If dwelling, number of dwelling!units ............... Number of dwelling units on each fioor ................ If garage number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... 7 Dim ns'onsof ' 'ngstru tur6 'fany: Fro t ' ' Rea Depth Height ............... Number of Stories.. ...................................................... Dimensions of same structure w~th alterations or additions: Front ................. Rear ................. Depth'. .................... Height ........... ,.t, .......... Number of Slories ..................... 8. Dimensions of entired~w const,ruction: Front ..... ~A/. ~...,... Rear ...... ~..~x~. .....Depth .:..Z~,. ........ Height .. .,%...r~..-rt. Number of Stories ......... .~.~... . 10. Date of Purchase ............................ Name of Former Owner ............................. 1 1. Zone or use district in which pr~mises, are situated .................................................... . 12. Does proposed construction rio'ate any zonine law. ordinance or regulation. 13. Will lot be regraded ...... ,44o,, .,..,...;/ .... , ........ Will excess ~11 b~ removed from premises: Yes ;~ No 14. Name of Owner of premises tdlU(~.~t..~, d~-f.~q~.. Address .~-~~ .~c~.. Phone No ................ Name of Architect ... 't ........................ Address ................ Phone No ..... ~,~ ..... ~... PLOT DIAGRAM Locate clearly and distinctly alll buildings, whether existing or proposed, and, indicate all set-back dimensions from property l~nes. 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, _ county OF ..... '. .... !S.S ...... . , . .,, , . . . . ., rv J nu. ~. being duly swom, deposes ~d says that he is the applicant (Name of individual signing contract) above named. He is the...~~. ~(~ ..................................................... ~ ~Contractor, agent, corporate officer, etc.) of saki owner or owners, ~d is dul~ authorized to perfom or have perfo~ed the said work and to m~e and file this 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~ne~ set forth in the application filed therewith. Sworn to before me this z/ OCCUPANCY OR USE IS [~HLA~'~FUL E flFiCATE ~F OCCU~,~,C¥ ,% DATE: ? ¢' .B P. 765-1802 9 AM TO Z PM FOR THE 2. ROUGH - FRAMING 3. INSULA H~H 4 :F~NAL - C~]STPU~qlON' MOSZ ALL coFrSTm FCTION SHALL MEET STAT~ CONSTRUCT ON CODES. NOT RESPONSIBLE DESIGN OR CONSTRUCTION ERRQRS ~ copper tubing is used [or water distributing ,' system; piping shall be o pesKorLonly - , .. PLUMBER CERTiFiC~TIO ON LEAD CO CERTIFICATE 'OF OCCUPANCy i, ¸;4 T r' J T , I