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Home My WebLink About13218-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z13122 Date Jan. 10 198..5 THIS CERTIFIES that the building ...... .N?.w., .D .w.e.l. ]: .i.n.q, ........................... Location of Property 9 4 5 Jockey Creek Dr. Sou%hold House No. Street Hamlet County Tax Map No. 1000 Section ...0..7.0 ...... Block ...0..2 .......... Lot .. ?../.O..0.1..9...5.... Subdivision .. ?.d...~.h..~ .e.~FX ............... Filed Map No ......... Lot No...1 ........... conforms substantially to the Application for Building Permit heretofore f'ded in this office dated .... .~.u.n.o. ..... .1.2 ......19 .8.4. pursuant to which Building Permit No ..... .1.3.2. .1.8.g. ......... dated ...... ~u..n.c...1..2 ............ 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 ......... ............. ~..~.w..o.n..~. ?.a.m..~.~×. s..~?.~). ~: .~.~ .................... . .................... & KATHLEEN WHITNEY The certificate is issued to ..... .RICHARD. ............................. (owner, of the aforesaid building. Suffolk County Department of Health Approval ......... 214-80-1 N662698 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev. 1/81 lrOB~ NO. ~ TOWN OF $OUTHOLD 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? 13218 Z Permission is hereby granted to~, ,~. ~.~...~......~..: .................... .~.~~ ....... ~..t..~.~..~ ................... . ,o ....... ............. ,,--.~~....~.,......: ......... ~.. ...... , ............ ~. ...... ~......~.... .......... ..:~. ............ .~. ............................. o, p,e,~,ses logo,ed at ...~..'Z..~..~.~.h.....~ ....... -~., ............. ~ ~ ............... County Tax Mop No. 1000 Section ....... ..0....~..0. ...... Block ........ ..~r... ......... Lot No ..... !~q../..~..& pursuant to application dated ..,,,,,_~...Z...',2w, ....................... , 19..~.,,~., end approved by the Building Inspector. Rev. 6/30/80 FORM NO. E 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 submitte~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. 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: I. 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 anv housing code or safety inspect[on of buildings or premises, or other pertinent informa- tion required to prepare a certificete. Fees: 1. Certificate of occupancy $5.00 / 2. Certificate of occupancy on pre-existing dwelling land use --?re-Ex is ting C $15 · O0 3. Copy of certificate of occupancy $1.00 ~ Vacant land C.~5-~ $ 5.00 Date .-~, .~,, ................. New Building .... z~. ........ Old or Pre-existing Building ............ Vacant Land ............. LocationofProperty ~ ~/J~ ~//~/~- y .~. ./~. .~. .~.~. . ~2,RIV'~ .~UT~t~. ... Hou~ No, Stoat Hamlet Owner or Owners of Property CounW Tax Map No. 1000 Section ......... ~ ..................... Block .~ ....... Lot ~, ~q'~ ' ' Filed Map No ~ Lot No Subdivision ....................................................... Permit No. ~.~ D~te of Permit .... ~ .~/.Applicen~ .. ~ ...... T ............... Health Dept. Approval . l~ A~7. 1~ ......... Labor Dept. Approval ........................ Unde~ritera Approval. ~ ~ ~ ~q~ ......... Planning Board Approwl ...................... ~eque~ for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ .......................... Construction on above described building and I~ermit meets all applicable~c~des and regulations. ^pp,,cant ........................ Rev. 10-10-78 ~' FIELD INSPECTION FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING 3. INSULATION FERN. STATE ENERGY COMMENTS QODE FINAL ADDITIONAL COMMENTS: % ! 7 THE NEW YORK BOARD OF FIRE UNDERWRITERS 100107] BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~ Date ¢~ Application No. on file T.,S CERT,F~%t~[T''' ~.9~ ~S?27~/~ N 6 6 2 $ 9 8 only tlw electrical equipment as described below and introduced by the applicant named on the able application number in the premises of Rlc~x~t ~tnoy, Jo~ey Cr~k L~'ive, N/S ~ M~n ~ ~a~, ~out~ld~ in the followlng location; ~ Base.tent ~ 1st FI. ~ 2nd FI. Section Block rot was examined on ~0~ 1 s ~ and found to be in compliance with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS OUTLETS SWtTCHES FLUORESCENT 19 28 DRYERS SYSTEMS OTHER APPARATUS: PER ~¢ A W G, NO OF HI-LEG OF CC. COND AW.G OF HI-LEG A, WG OF NEUTRAL S Electric 215 ~uthold, N,Y. 11971 Lic. 578 NT. THIS 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 '~' ~ ~c_ It, ~ ~' ,~ (please p~int) ' (please print) I certify that the solder used in the water supply system. contains less than 2/10 of 1% lead. (p~u~be~' s signature) Sworn to befor~ me this 19 ~'~. Notary Public Notary Public, ~'o.~t'-~oL--/~ County LIN~^ ~- 0AWSON Notary Public, 5~8~e of NeW York No. 46946B~ Oualif!e .... ",19 ~'~ d ir~ suffolk County 765-1802 BUILDING DEPT. INSPECTION!: [ ] FOUNDATION XST [ ] ROUGH PWG. I'~ FOUNDATION ZND [ ] INSULATION [ ] FRAMING REMARKS :'"'~, ~ [ ] FINAL DATE INSPECTOR J 76S.t802 BUILDING DEPT. INSPECTION FOUNDATION ZST [ ] ROUGH PLBG. FOUNDATION ZND [~INSULATIoN [ ] FRAMING RKMARKS: [ ] FINAL DATE INSPECTOR 'FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~OUTHOLD, N.Y. 11971 TEL.: 765-180:3 Examined . .~ J..ar'..., 19~ Approved ...~¢x~.. ! .~'..., 19~.{. Permit No../.~..>--./. ?. ~ v Disapproved a/c ..................................... Received ........... ,19.. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .............. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with: sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on promises, relationship to adjoining premises or public street 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 permi 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 Occupanc: 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 th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o 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 t~ :admit authorized inspectors on premises and in building for necessary ip, spections. __ ,~ ).~{,/ , _- (Signature of applicant, or naif a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .,?./.C./.-/~ .R,D..O.:..~./.~..~./.t'?..b..-.&'?/'...~.~.-..~.&/..~-'..t~..~'..P'. ...................... (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 .................................................. Ct 4 .y. .C. ..................................... House Number Street Hamlet County Tax Map No. 1000 Section . . .4?. .~.. ~. ......... Block .... ~ ........... Lot .................. Subdivision ~'DJ~-J'/ 7~?'~.~.P-'. ·~. ..Y' ...... Filed Map No..~.o. 7/. e.7..-.~.. Lot ..... /. ......... (Name) 2. State existlng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....................................................... - .............. b. Intended use and occupancy . .~.~.~.Z~/. ¢../~. . ~..~..~'..~.~../.~/. ~. ......................................... ( ' ppi' ' ' ' ' 3. Nature of work check which a icable): New uilding ...... Addition ........ Alteration ......... Repair Removal Demolition ' Other Work ~ (Description) 4 Estimated Cost ~.o, ~oo Fee '~" '(to b~ paid on filing this application) 5 If dwelling number of dwelling units ~..~..~ Number of dwelling un!ts on each floor If garage, number of cars ........... g-r .............................. i ................. . ........... 6. If business, commercial or mixed occupancy, specify nature and extent of each t~pe of use ... ZS),,~'~d~...' ......... 7 Dimensions of existing structures if any: Front 2)7//o49r. Rear ' Depth Height Number of Stories . Dimensions of same structure with alterations or additions: Front i Rear pth .Hight ' ' De ...................... e ...................... Number of Stones ..................... 8. Dimensions of entire new constrnchon: Front ... ~.gg..~ ....... Rear .... 7..~.If. ...... Depth .. ~-.~'f. ...... ight ./.~. f / /~,~ : He ........... Number of Stories ....................... ~ ........................... 9. Sizeoflot: Front · ./.~.( ...... Rear ..... /..~." i Depth ~..~..~ / 10 Date of Purchase Name of Former Owner ~ &~D~.~./.~' ./.~..~'.~..~..~. 1 1 Zone district in which p cruises are situated 1 2' or use r ........................ i ............................. . Does proposed construction violate any zoning law, ordinance or regulation: ... i.x"Lf~ ...................... 13. Will lot be regraded ...,.. Z2/'~F.., ................ Will excess~ fill be removed from premises. Yes Nc 14. Name of Owner of premises . .Av.~..~,./.~,~../~,H,t..F~./.~..~' Address .Y.~.S'. (.~-~..e~.~..~.p. !p./~,, Phone No.. Name of Architect Address I Phone No Name of Contractor ~/~, lq ~.. ~. ~.~. ~'~qW. ! ....... Address .~,g; 0~g//~-...~./?i ..... Phone No.. 7.F,,57.~./.fi'~..~.. ,. PLOT DIAGRAM Locate clearly and distinctly all buildings, Whether. existing or proposed, and. ifidicate all set-back dimensions from property lines. Give street and block number or doscriptmn according to deed, and sh6w street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF .......... S,S (Name of individual signing contracl above named. ......... being duly sworn, deposes and says that he is the applicant He is the ............................................................ ! .................... ......... (Contractor, agent, cor.pomte officer, etci) 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 contained in this application are true to the best of h s 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 of., .~ ........... , 19~ NOTARY PUBDC, Sidle of New York ~, No 4]07818. SuHolk CotmI~ ~ (Signatffr~ of CREEK 4 LOCATION MAP SCALE: I" =600' (O0 ~ NOTE=I. DIST. top?. SECT. o?o CONTOUR LINES SHOWN THUS: ..... 20 ..... ARE FR~ M,U.S.~G.S. CHARTs 'SOUTHOLD~ N.Y." SUFFOLK COUNTY TAX MAP BLOCK ~.~ LOT P/O 19.§ THE WATER SUPPLY AND SEWAGE DISPOSAL FACILITIES FOR MINOR SUBDIVISION PLAN FOR EDITH M, TERRY AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK APR. I, 1980 DATE : FEB. 25, 1980 SCALE: I" =100' NO. ~ 80-107-A ALL LOTS IN THIS OEVELOPMENT SHALL COMPLY WITH THE STANDARDS AND REQUIREMENTS OFTHE SUFFOLK COUNTY DEPARTMENT OF HEALTH, YOUNG YOUNG Il /~ · [ ALDEN W, YOUNG,PROFESSIONAL ENGINEER II I AND A,DSURVEYO"'~.¥.S.L,CE,SENO., S4S II & -l I HOWASD W. YOUNG, LAND SURVEYOR [{.,,.--.-.L~ N*YS' LICENSENO:45895 400 OSTRANDER AVENUE RIVERHEAD , NEW YORK