The URL can be used to link to this page

Home My WebLink About12836-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southoid, N.Y. Certificate Of Occupancy No. Z15012 Date October 20, ' 19.86. THIS CERTIFIES that the bullding One family dwelling with attached deck& .......................... a~'gac h~ · gar'pge .... ~10 Sleepy Hollow Lane & 50 Grissom Lane Southgld, N.Y. Location of Property ~s~ ~/'o ......................................................... · Street Ham/et County Tax Map No. 1000 Section 078 . .Block 01 .Lot 10.6 S ..... M/o Sleepy Hollow 6351 4 uoatwsmn ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore ffed in this office dated J.a. nua.ry 9. 19 86 pursuant to which Building Permit No. 12836Z dated January 9, 1986 ............................... , 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 ......... One family dwelling wit~ at,~ached deck & attached garage Robert & Carol Bohn The certificate is issued to ..................................... k ..................... (owner, ~6.~e~e~ of the aforesaid building. Suffolk County Department of Health Approval 1 3- 8 O- 2 2 5 UNDERWRITERS CERTIFICATE NO. N 7 2 5 9 5 0 & N 7 2 5 9 5 PLUMBERS CERTIFICATION Dated October ~4, 1986 Inspector Rev. 1/81 FOyer NO. 9 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) 12836 Z Permission is hereby granted to.~.~ ~-~ ..~ ...~.. .~.(r../oc~..~.~...:.~. ......... /...L.~?.. / ~~~.....~....~.....~Z~.....~~ ~ ' ~/~" ~o ...... ..................... .-T..~ et p~mises I~oted at ...~......~~...~/~ ................................... ~ ........ ,.~.~..~~ ......... ~..~.~z.~ ................................... ~.~.~.~ ................ co.~ ~ ~ ~. ~0oo s~.o....~.7~ ....... ~=~ .~Z ............. ~ ~. Q~.~...~.... ~u~u~t to ~li~tio~ d~t~d ........................................................ , 19 ........ , ~d ~p~ro~ by t~ Building Inspector. Fee $.../.~.....~... ......... Rev. 6/30/80 THE NEW YORK BOARD OF FIRE UNDERWRITERS ~-- 01~. BUREAU OF ELECTRICITY 85 JOHN STREET, NEW YORK, NEW 'YORK 10038 THIS CERTIFIES THAT in the following locatlon; ~ Basement ~ 1st Fl. ~ 2nd Fl. ' Section Block Lo~ 4 ~ b~ 1985 and found to be b~ co,nplia,ce with tke req,ire~e,ts of tAis Board. OUTLETSFIXTURE SWITCHES FIXTURES RANGES OVENS DISH WASHERS EXHAUST FLUORESCENT SYSTEMS OTHER APPARATUS: s~auket, N Y 11733 E · R NO, OF CC. COND A.W. O PER ~ OF CC. COND 1 4/0 2675 V C E O~ ~J- LE~ NO. OF NEUTRAI~.~, oFA NWE~IT~AL , / GENEI~AL MANAGER ~o~o~ THE NEW YORK BOARD OF FIRE UNDERWRITERS ~- 0]. BUREAU OF ELECTRICITy 85 JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT only the etectr~cul equipment as ~scribed below and introduced by the applicant ~amed on the able application number ~n the premises of ~.~s~ Way ~ Sl~py Holi~ ~, N Y in ~he follo~ng Iocat~on~ ~ Basement ~ l~t FI. ~ 2nd FI. S~ction Bloc~ Lot ~es examined on }~:~ ~ ¢ ~ ~ and found to be in complia~ce with the requirements of this Board. FIXTURE FIXTURES RANGES COOKING DECKS OVENS EXHAUST OUTLETS SWITCHES INCANDESCENT FLUORESCENT 27 43 53 OTHER APPARATUS: E R V I NO. O~'ERC~'CO N D'OF Acc.W.coNo.G. NO OF HI-LEO C AW.G, OF HI-LEG NO. OF NEUTRALS AW.G 121 Ekh~p Pasture [~ certificate must not be altered in any manner;, return to the office of the Board if incorrect. Inspectors may be identified b their . w ~ ul[m eDEPA T E T,T~mCOPYOF ~TJ ~S~ / LT~S I~A~yMA~ER. FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in Wpewriter OR ink, and submitted m~ 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 natura~ 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. Commereia[ 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 buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of p~operW 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 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 5. Updated C.O. $15.00 $15.00 Date .......................... NewCons truction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property . House No. Street ~rnlet Owner or Owners of Property ..~.,O, b./~,~t--'iL-- .~.,I?.,p~,.,J~-T.,...,.~.Q..~.,i~.' County Tax Map No. 1000 Section ... Subdivision....~. ,/~,~'~,'/.//~.4,i,-?,~-'. ......... Filed Map No. ~,, ,~.-~,~-,/,..Lot No... ~, ......... Permit No./,~, O~,-~.'~, '.~-Date of Permit .......... Applicant...'~ ,G. ~/~,~, .~. ,~,~?~, .~.~, .............. Health Dept. Approval ../.~, ,~.C?..-~ .~, .~..~. ..... Labor Dept. Approval ........................ Underwriters Approval., ./~/..2.~ .~-. ~-,~ .~./, ....... Planning Board Approval ................. ..... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ..... .-3',~.O. .................. Construction on above described building ~"--~'tme~t~lapplicable codes and regulations. Applicant../~..T.~: .~,: .(/. ?.T , :'~ ................................ ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. ]~ox 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's Office (agency Freedom of Information Officer). One copy will be returned to you in response to your request, or as an interim response. TO: (Department ~or Officer, iF'known, that has the information you are requesting.) RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply date, file title, tax map number, and any other pertinent information.) Printod ~ame: Address: Mailing Address (if different from above): Telephone Number: Date: [ ] APPROVED RECEIVED [ ] APPROVED WITH DELAY* I ] DENIED* FEB 1 9 I99~ Fr~o~ of Information Officer Date * If delayed or denied see reverse side for explanation. FIELD ~S?~CTION COMMENTS FOUNDATION (1st) FOUNDATION (2nd) ROUGH FRAME & PLUMBING INSULATION PER N. Y. STATE ENERGY qODE ADDITIONAL COMMENTS: SUFFOLK COUNtrY HEALTH SINGLE FAMILY DWELLING ,. REF. NO. z/,.~,.~ OCT 7- 1986 DISPOSAL AND WATER SUPPLY HAVE BEEN INSPECTED BY BE SATISFACTORY. hief of Wastewater Mana .Y 0 FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N,Y, 11971 TEL.: 765-1803 (Building Inspector) APPLICATION FOR BUILDING PERMIT Received..~.~./.i...,19~. Date../../7 ........... 19~' ~Z 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 regu~ation~S, and to admit authorized inspectors on premises and in building for necessary ins~t~.,,l~'-~_f_' (Signature of applicant, or name, if a corporation) .~?:..~o..~ .~.~.o.. ~.~.. ~.<¢. ?.~..o... ~7.. (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... .~..o.q.~...~.'..77.,, 6...~.'~...~?./< ..... /~..o'~., .X<'. .......................... (as on the tax roll or latest deed) If applicant is a corporation, signature of drily authorized officer. (Name and title of corporate officer) Builder's License No. 7~t~l Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ......................-*,-~[ 1. Location of land on which proposed work will be don~e...~..~..~.~..~.y .-- .~./Q..g~..o. qz/...~..~1 .... ~-. .............. ?. ............... '., i ........ .... ................. House Number Street Hamlet County Tax Map No. 1000 Section .. ~ ....... Block .................. Lot ................. . .~.~z~/~. '7,.~. ~t .///c.~:.L.~.c..c-'. .............. Filed Map No...~. ~..~/ .... Lot ............... Subdivision · ' ~// (Name) ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: .V'.;~ C,Y~,L .~C77.'.. ~ ~-~.~ ~ " ' '. ................. a. Existing use and occupancy ................. , t~.:. .... ,., ,,. · ....... b Intended use and occupancy ........ ' .................. '.".. ,~., .......................... 3. Nature of work (check whmh apphcable)~ New Building ......... Addition .......... Alteration ...... Repair .............. Rem?al .............. Demolition .............. Other Work ............... e~.//.6/..~.' ,uo (Description) 4. Estimated Cost ......................... e ................................... (to be paid on filing this application) 5. If dwelling, number of dwelling ~nits .. :.. g ........ Number of dwelling units on each floor... ~. ........... If garage number of cars 6. If business, commercial or mixed occupaficy, specify nature and extent of each type of use .... /M. O4v,C'-. ........... 7 Dimensions of existing structurds if any:' Front fc/P.~F.: Rear Depth Height ............... Number of Stories ........................................................ Dimensions of same structure with alterations or additions: Front A/o/v~- Rear Depth .................... '.. Height: ..................... Number of Stories ...................... 8. Dimensions of entire new construction: Front .... '~.~ ./, ..... Rear ..... 7.~-: ...... Depth ............. Height Number of Stories m_... . 9. Size of lot: Front .'~-.sC?.~ Rear ..... '.'2-.q. ~. / Depth . ./~.o. .... 10. Date of Purchase .......... i ...... ~ ........... Name of Former Owner ............................. I 1.Zone or use district in which pr~mises are situated ..................................................... 12. I)oes proposed construction violate any Zoning law, ordinance or regulation: ................................ 13. Will lot be regraded ..... J/..~ .... ~ ............ Will excess fill be remov, ed from premises: ~ No 14. Name of Owner of premise~ . ./~.c~. ;/~7.4~ .~. ~,.4 ~.~.. Address &c~.,'~.. ,~..~./-<~..v/.~.44... Phone No. 2~.~}J/~.... Name of Architect ~. V4..~..~./7~..rfq'. T?-. TT/.4.t.(-.¢Address ................... Phone No ................ Name of Contractor .... ','~.A~,/,~..,lc?.. (2~-..0..~... Address .~'.~./. e~ B.o.~.q,~ Ut ~.~.. Phone No. 2¢J7///~. ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and blockl number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, S.S COUNTY OF ................. · .'"'~.'. ~ .(~.' ....... ~ ..................... being duly sworn, deposes and says that he is the applicant (Name of individual sig¢ing con~ract) above named· He is the ............. /~. · ~ 7. ~q~t'~ · · .~. · · ................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authc~rized 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 his knowledge and belief; and that the work will be performed in the mann'er set forth in the application filed therewith. Sworn to before me this .............. day of ........ 19 ota ., Public, ......County ..X'O