The URL can be used to link to this page

Home My WebLink About16665-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No Z-17363 Date OCTOBER 4~ 1988 THIS CERTIFIES that the buildin~ NEW DWELLING Location of Property 772 ROW OFF INDIAN NECK LANE House No, Street County Tax Map No. 1000 Section 086 Block 04 Subdivision Filed Map No. PECONIC~N.Y. Hamlet Lot 1.11 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 3~ 1987 pursuant to which Building Permit No. 16665-Z dated DECEMBER 4~ 1987 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 WITH GARAGE & DECK AS APPLIED FOR The certificate is issued to JAMES & MURIELANDREWS (owner, ~) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 87-SO-221 N029780-AUGUST 25, 1988 UNDERWRITERS CERTIFICATE NO. PLUMBERS CERTIFICATION DATED SEPT. 24, 1988 B~ld~ng Inspector Rev. 1/81 ~ NO. B TOV/N 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) NO- 'i6665 z Permission is hereby granted to: ~., , !./.~ l . · ~.-.-.~~~ ~,,~,~ ......... :.....~..~....~.......=:.~ ...... ~.....~ ...... ~~ .... at premises located at 2K,....~...~.. ....... )...'j~...._~...~m......~....~....O)..~., ................................. CountyJ'Tax Map No. 1000 Section .... ..q..~....~. .......... Block ....... .~....~ ......... Lot No..'./.~....!..:..~... pursuant to application dated ...... ~ ................. , 19..~..~.., and approved [ay the Building Inspector. Fee $.,7,,-~.'~,1~/, ..~. Building Inspector Rev. 6/30/80 BLDG, DEPT, TgWN' OF S0UTHOL?___' FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hall Southotd, N.Y. 11971 765 - 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted -, ~ 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. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land 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: Additions $25.00 1. Certificate of occupancy New Dwelling, $25.00, Accessory ISt0-00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 5 0.0 0 3. Copy of certificate of occupancy $ 5.00, over 5 years $I0.00 5.Updated C.O. $ 50.00 Date ....................... NewConstruction ...... Old or Pre-existing Building ,. ........... Vacant~and ............. House No. f ~/ Street Hamlet County Tax Map No. 1000 Section 0 ~ Block Subdivision ................................. Filed Map No.. ,/, ....... Lot No .............. Permit No ........... Date of Permit .../..z. .... Applicant ..... :~;:-~ , . Health Dept. Approval ........................ Labor Dept, Approval ........................ Underwriters Approval ........................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ ............................. Construction on above described building and P~~~d regulations. ....... TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date '/ Buildin~Permit No. Owner (please print) Plumber --~3 ~ ~ (pl%ase print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumber's signature) Sworn to before me this / day of ~ Not r Publio Notary Public NOTARY Pd(~LIC, State of ~v York TOWN OF SOUTIIOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 72g TOWN HALL SOUTtlOLD, N.Y. 11971 TEL. 765-1802 To Whom This May Concern, We are unable to complete your Certificate of Occupancy because .of the following reasons. /~/An_ application for Certificate of Occupancy //s not on file. /~/No Underwriters Certificat~ file. /~/The check is(outdated/~' on file~.b /~// No llealth Dept. Approval on file. /5/ No final ins.pection has been made. Please contact our office on this matter. Thank you for your cooperation. Building Permit t~ A ~-~.¢ ~ Z Building Dept. ***/--~No_ Plumber Solder Certificate on file. ( all permits involving plumbing beinq issued after April 1,1984 ) FQUNDATION { 1st) FOUNDATION (2nd) ROUGH FRAME & .PLUMBING IHSULATION PER N. Y. STATE ENERGY CODE FI~AL ADDITIONAL COMMENTS. o ~ 76~-1802 BUILDING DEPT, INSPECTION F~~OUNDATION 1ST ~ FOUNDATION :;'ND FRAMING ROUGH PLBG. INSULATION FINAL REMARKS: 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 1ST []ROUGH PLBG. []FOUNDATION 2ND []INSULATION []FRAMING []FINAL ...,,,.,,s; DATE INSPECT~ 765-1802 BUILDING DEPT. INSPECTION / FOUNDATION 1ST [ ]R~GH PLBG. FOUNDATION 2ND [,~ INSULATION [ ] FRAMING ~r ]FINAL DATE INSPECTOR 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST []ROUGH PLBG. FOUNDATION 2ND []INSULATION FRAMING []FINAL 76S-~.802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING FINAL DATE ._,/~///,,'~/~ ? INSPECTOR// THE NEW YORK BOARD OF FIRE UNDERWRITERS 10001~,~ BUREAU OF ELECTRICITY r--- 85 JOHN STREET. NEW YORK, NEW YORK 100'48 /)att, At~G~ ST ~5, ]988 ~pplication No. on file THIS CE~IFIES THAT ~y t~ e~t~ ~uipme~t ~ ~ ~ a~ int~ by t~ ~i~nt ~ on t~ a~ ~t~ numar in t~ p~mM of in the~ollowing ~utlon; ~ ~nt ~ I,t FI. ~ 2~ ~. .~tion Bilk W exami~ on AUGUST 0A., 'l 988 and found to be in ~nlpllan~ with the ~qulrements of th~ ~. Lot .XTUel RXTUII~S RANGES OVENS ~ WASNEI$ EXHAUST FANS 3'7 44 DRYERS RJRNACE ~TORS Kite AFfLIANCl ~ TIME CLOCKS EXMMERS SIRVICE DISCONNECT S E AIR 4 TON A/C UNITS-2 ROTORS: 1-1 H.P. S~()Kg DBTgCTOR :-1 TRACK I,TGHT~NG: Il V I C E ~>, / 0 PAUL R. BURNS 276 TO~N SOUTHOLD, NY.. / -~ ') ~i$ cedifico~ m~t ~t h ,hr~ in any ~n~r; ~urn to the office of t~ ~rd if incurS. {nsp~ors ~y ~ }de~ by hit c~}$. THIS INAHY/I BLDG. DEPT. TOWNI OF sO u~OLq iI BOARD OF HEALTH .."-,,,.-.. 3 SETS OF PLANS ....... suRvEY TOWN OF SOUTHOLD CHECK --~'.~JP- ~( gUILDINGDEPARTMENT §EP?IC FORM ............. ., TOWN HALL NOTIFY $OUTHOLD. N.Y. 11971 .°~..~..{~5.-~ 1,~3.'--~." TEL.: 765-1802 CALL - - MAIL TO: Examined ./~.....~L'%~...'~°'~'~-...~..., 19 ~.? Approve..~rtM~....LJ.., 19~.?. Permit No. J. ~.~ ~ Disapproved a/c ..................................... ,,,, (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............ 19 INSTRUCTIONS a. Tkis 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 permiI 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 uhtil a Certificate of Occupanc3 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 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 tc admit authorized inspectors on premises and in building for necessary inspec}ioI~s,e -- ,o . /'2 ..... · · ' (Si,,natnre of applicant, or name, if a corporatmn) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ~ ............... ~.'. ~ ~. ~ ................................. (as on the tax roll or latest deed) If applicant ~~~uly author~d~ficer. .... ........ (Name and title of co,orate officer) . ALL CONTRACTOR*S ~ST Bg SUFFOLK COUNTY LICENSED Builder's License No .......................... e m er's i nse,o. ~le~trician's ~icense No...~..~.~ .... ' Other Trade's License No ...................... 1. Location of land on which proposed work will be done}.. ........................................ . House Number Street Hamlet County Tax Map No. 1000 Section ......... ?.(.~ .... Block ..... ~ .......... Lot...e.~q...(< ..15' ...... ' Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises aud intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy Nature of work (check which applicable): New Building .....~'. .... Addition ·. Repair .............. Removal i .............. Demolition ........... Estimated Cost ........ /. ~..~ .O...q~,~-'.. ................. ~ Fee .......... i " (to be I L If dwelling, number of dwelling uuit~ ~/d~d-'~ Number of dwelling units ~n ea~h~,floOr ...,?~_~. ,~.~-, ..... If garage number of cars .2.1 -- If business, commercial or mixed occupancy, specify nature and extent of each type of use ..................... Dimensions of existing structures, iflany: Front ............... Rear .............. Depth ............... Height ............... Number ~f Stories ........................................................ Dhnensions'of same structure with alterations or additions: Front ................. Rear ............. Depth ...................... .I~eight ......... h. ~.., ....... Number of Stories .. D~menmons of entire new construct,gu Front ..... 0.¢ ....... Rear .... .~. }r..8.. .... ' 'lJe'p'ti/i' Height ...... .~..o..~ ...... k~a,Nmnber 9f2,,,Stories ~ ~ .'w. .... ,;, .... .. . ............................ ........ '. Size of lot. Front .... } ......~ ......... 'I~ i. i i~.~.~..~.~.., i. i"ii. Depth . .~/.%47. q.~. L Date of Purchase ..... ~34,,....°.~.') .............. Name of Former Owner ............................ 1. Zone or use d~stmct m which preml es are situated ......................................... !. Does proposed construction violate,any zoning law ordinance or reoulation' ~..~ .... rill lot be regraded .....~,]'..oj,~....(~pl~7. ).... ~ ..... Will excess fill be rer~ved from premises: Yes k Name of Owner of premiX'es ~;t~.~l, 't'~t,t~.#,.t~/./.:/'.{~.~'d~esf,'f: .~...?,?.~..[.~. Phone No..~..~.-.6. ? .07. .... NameofArchitect .,,.,,,...,.,I,,,., ....,,,Address ......... -- ..... Phone No ................ Name of Contractor . ~]. ~'~...~.'~.' ' ~..tqm. ~ .....Addre~ .~. ~-./(t-.~.~.. 'd~. ~/~. m .... N~ 5. Is this property located within 300 feet of a tidal wetland? *Yes ..... No ..... *If yes, Southoid Town Trustegs Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buiI,'dings, whether existing or proposed, and. indicate ail set-back dimensions from operty lines. Give street and block number or description according to deed, and show street names and indicate whether terior or corner lot. 'ATE OF NEW~Y,O,~K~, S S ' OUNT¥ OF..x/.g../j.~ ...... ............. 7~. · .~.'. · '~" '~..'q/.~. · .~.~--~-- ......... being duly sworn, depose~ and says that he is the applicant (Name of individual signing c~ntract) ove named. ~ is the ~ (Contractor agent corporate officer etc) said owner or owne~, ~d is duly authorized to perform or have performed the said work and to m~e and file this plication; that ail statements cont~ned ~ this application are true to the best of his knowledge and belief; and that the ~rk w~l be perfo~ed in the m~ne~ setlforth in the application filed therewith.' ~om to before me this ..... 4A~ ........... day of.. ../ .... .......................... ~~y,~ ~ (Signature of applicant) SUFFOLK CO. HEALTH DEPT. APPROVAL H.S. NO, ~ STATEMENT OF INTENT .... ~ THE WATER SUPPLY AND SEWAGE DIS~AL [ SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE ~ ~_ SUFFOLK C EP SERVICES. ~ ? SUFFOLK COUNTY DEPT. OF HEALTH '- SUFFOLK CO. TAX MAP DES~ATION: LAND SURVEYORS GREEN~RT NEW YORK f l ' su?o~K '" ':: :~:~,,.'""' ~ sewage d~s~g~ ~nd w:' :~ ,u~y ~itRi~ for ~ / / VAN T U.,~.~, LICENSEO LAND SURVEYORS GREENPORT NEW YORK SUFFOLK CO. HEALTH DEPT H.S. NO,~ r ~ THE WATER SUPPLY AND SEt~,~i SYsTEMs FOR THIS REd, U?5 '.. ~. YV~LL COUNTY '" :,::'~ OF SERVICES ~'~ (~- ~ ;~ ~: ~;'. 0 V A LOF CONSTR UCT~ON ~. ' DATE: ...... A~OVED PCL, DEED: L.'~ TEST