The URL can be used to link to this page

Home My WebLink About13186-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy THIS CERTIFIES that the building ...... ~..e.w..D.w.e..1.1j:.n. cj ............................ Location of Property . .4.4. 5. .0 .......... M..a.i.~...B.az.v.~.e..w..R.o..a.d .............. S.c..u~.h.o. 1..d .... House No, Street Hamlet County Tax Map No. 1000 Section .... 0.7.8 .....Block . . ,0.4. .......... Lot .... 0.0..4 .......... Subdivision ........... X. ................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... .M.a.y....3.0. ....... , 19.8.4. pursuant to which Building Permit No. 13186g dated ....... .G..u..n.c..4. ............. 198..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 ......... ....- New Private One Family D.w.e. lling ........ The certificate is issued to KEHL, ROBERT & SHELLEY ..................... ?o;¢,.'0;, ...................... of the aforesaid building. Suffolk County Department of Health Approval ........... ..................... UNDERWRITERS CERTIFICATE NO .................. 1,1701742 * Plumber Certificate Building Inspector Rev. 1/81 l~O~'~v NO. ~ TOWN OF $ou'rHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: _ n , .... ~~...~.. ....... /~i~ ................ .~..~......?......~.~....~u..~.......~ .. <z3.~.~..... .~.,.~.,....!.L.~.~.j. ........ , .......... at premises located at ......~.....~....~.~ ........ ~J.~ .... .~ ........ ~.~ ..... County Tax Map No. 1000 Section ..... ...C~....--J......~. ..... 8lock ........ ..L~. .......... Lot No ......,-~, ............... Building Inspector. Re~ 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765 - 1.802 APPLICATION FOR CERTI FI'CATE OF OCCUPANCY TOWN OF SOUTHOLD Instructions A. This application must be filled in typewriter OR ink, and submitted ~m Immmmmmm to the Building Inspec- tor with the following; for new buildi,gs or new use: ¢1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic feature~ v 2. Final approval of Health Dept. of water supply and sewerage disposal-(S~9 form or equal), 43. Approval of electrical i~staltation from Board of Fire Underwriters. 4. Commercial buildings, Ind~stria! 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 buildings {prior to April 1957), Non-conforming uses, or buildings and "pre-existing" ~and uses: 1. Accurate survey of p~operty 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. C./Fees: ~ 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling $ I5.0 0 ~ 3. Copy of certificate of occupancy $1.00 4.Vacant Land C.O. $5.00 t ~ c~) - (~)(-6~ Date .......................... New Building ~ ......... Old or Prg~existing Building ............ Vacant Land ............. Location of Property ............................. House No. Ham/et Owner or Owners of Property . .~..h~. [ ! ¢-~t..~.~. ~:;~..~'-'-~'~...~.~.1~h. P~. ...................... County Tax Map No. 1000 Section '-/~;) Block ~ Lot, .~. Subdivision....~. ~,¢fgj~j~q .............. ~ .... Filed Map No ........... Lot No .............. Permit No...'~.). ~.(o.-&-Date of Permit. 'l '~' )' "~j .Applicant .~ .~.~\~,~~ ............... Health Dept, Approval. i.d. ...... Labor Dept. Approval ........................ Underwriters Approval~%~ qO~q~ ~ Planning Board Approval ..... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $....~..~- ...................... Construction on above described building and permit meets all applicable codes and regulations. 0.~__ ~q[q"~ Applicant . ..~ .................... Rev, I0-10-78 ~ THE NEW YORK BOARD OF FIRE UNDERWRITERS 17{~r}378 BUREAU OF ELECTRICITY = 8S~JOHN STREET, NEW YORK, NEW YORK 1OO3~ Appllcatior~ No. or, file 'r.,s CERT,AL ]YT t ZgS N 701742-. only tke electrical equipment as described belotv and introduced by tke applicant named on the above application number i,~ the pren~ises of Robert Kehl, MAin B~y View, ~o~thold~ N Y (smith Dr. S.) iu the following location; ~ Basement k~ Ist FI. ~ 2nd Fl. Section Block Lot was examined on July 18 ~ 19~ and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS OUTLETS SWITCHES , FLUORESCENT VAPOR DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIME CLOCKS UNIT HEATER MULTI-OUTLET SYSTEMS NO. OF FEET DIMMERS SERVICE DISCONNECT OTHER APPARATUS: ~etors 1-1HP 2-GFCI, 2-~oko Detector Track Lighting 1~'-o" - l0 lites S E R V I NO OFpERCC.,e, COND / OF AccW'coNoG' NO OF HI LEG 1] 4/0 C E AWG, AW.G OF HI-LEG OF NEUTRAL I 2/O Charles ~ Hall Electric P O Box 1268 ~outhold, N ¥ 11971 Lic 657 E This certificate must not be altered in any manner; return to the office of the Board if ipcorrect. [nspecto[~ ma), be identified by ~'~mh-~r ~redenfials., COPY fOR BglLDiNG DEPARTMENT. THIS COPYOF CE.~{iFICATE ~U~TNOT S~ '~LTERED I~ ANY MANNE~. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL $OUTHOLD, N,Y. 11971 CERTIFICATION Date / - ,a b - 8F Building Permit No. [~1%~ ~ owneri~Shct\e~l_E.~!~...~ (please~rin~) P lumber_ <F~O_~. ~_~ (pleaDe print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber' s si~ature) Sworn to before me this ~2~_day of _ J~j~_~ 19~. Notary Public, MARK T. GAOEN NOTARY PUBLIC, State of New York No. 4695650 Qualified in Suffolk Counfy ,,.~,.._, CommissJof] £xpl,es M:,rch 30, County FIEL~ ~N~ECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING COMMENTS INSULATION FERN. Y. STATE~oDEENERGY II" FINAL ADDITIONAL COMMENTS: 7~54802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [/.,']/FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL REMARKS: ~/~ DATE INSPECTOR INSPECTION [/j/~FOUNDATION XST ~ '1 ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING REMARKs: [ ] FINAL DATE, INSPECTOR.,, ~_,/ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 Approved , 19~ q Permit No I ~ 5}(0'%--- Disapproved a/c ..................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT ,; Received .......... ,19... 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 codee and regu!ation~, and to necessary inspectiw~g. , , ,//// admit authorized inspectors on premises and in building for A .~t~...~~''~v"ff' (Signfiture of applicant, or name, if a corporation) ,tT. .)...-D. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................ Name of owner of pre,nises ..... .~..~..~..,~..~,w. .... ~.v..~.~.,~..77-..' .~.,..~.~..~'..6 .... ............................. (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 L~cense No ...................... 1. Location of land on which proposed work will be done .................................................. ................. . . .. ............ ..................... House Nu~nber Street Hamlet County Tax Map No. 1000 Section .. (7..7..~. .......... Block .... O...~/ ........... Lot...O..O..~.. .......... Subdivision...~?.~..~'£~....C.~.~..~....~..,5.7-.~. (7'.~'?. ...... Filed Map No..C/.?..~?. ...... Lot . ~ ............ (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /V0'b/'¢' /.,,r/~ ~,qtt/7~ b. Intended use and occupancy .... .~./~../(f.C./..~.~ ..................................................... 3. N,~ture of work (check which applicable): New Building .......... Addition .......... Alteration ......... Repair .............. Rembval .............. Demolition .............. Other Work ............... · I (Description) 4. Estimated Cost o Fee (to be paid on filing this application) 5. If dwelling, number of dwellingI units ..... ~..~..~. ..... Number of dwelling units on each floor ................ If garage, hum bar. of cars .... ; ................................................................... 6. If business, commercial or mix{d occupancy, specify nature and extent of each type of use ..................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............... Height ............... Nurnber of Stories ........................................................ Dimensions of same structure ~yith alterations or additions: Front ................. Rear .................. Dcpt ................... ~... Height ......... ~ ............ Number of Stones ...................... 8. D~mensmns ...... ofent~re~new construction Front ...~'.[. Rear .. ~.g Depth .~.K..' r ..... Height . 15 ............ Number of Stories .... /: g ................................................. · /~o' ! 1~'::, ~- ~1 7,~/~ 17¢,~' 9. Size of lot: Front .................... Rear ........... Depth [ ........... ~.... 10. ]}ate of Purchase .~,.7./0..M.Y.../.?..3. ............. Name of Former Owner~.~.~.a~,t'.,~ .~...E.~..~.~(.~. .......... 11. Zone or use district in which premises are situated ..................................................... 12. Does proposed construction vzolate any zoning law, ordinance or regulation: .... ~9 .......................... K'~' . 13. Will lot be regraded .... ~ ..... , ................ Will excess fill be removed from premises: Yes ~4. Name of Owner of premises . ~¢~.~../J,/,~'~.6'.~ ..... Address .. ~,~'~'¢~.. Phone No... N~e of Architect ......... ~ ................. Address ................... Phone No ................ N~e of Contractor .......................... Address ................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly al! buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street, cki number or description according to deed, and interior or corner lot. STATE OF NEW YORK, C ,SS OUNTY~21~ ................. ...... t~..~ ...... 1 .................. being duly sworn, deposes and says that he is the applicant (Name of individual sign'ing contract) above named. He is the ..... ~ ................................................................. (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 conthined 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 ............ ....... day .......... IdOTARY pUBLIC, Bta~e of New Yodl No, 1472SI~3 ............................. Qualified i[~ Suffolk County (Signature of applicant) C.,ornmi~lon Ex~ite* March 30.. $9~'~' q j /