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Home My WebLink About16367-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No.Z16102 Date August 27, 1987 THIS CERTIFIES that the building . .2.n.d.. f..19.o.r. .................................... Location of Property ...... 1.0.8.0.. ?.a.~. r..w.a.y..D..r j?.e. .......... C.u.t. ch.og .u?.,..~: .Y .. . House Ho· Street ..... 1213r~l'e~ County Tax Map No. 1000 Section 109 ·Block 05 .Lot 1/4.6 Subdivision FAIRWAY FARMS .Filed Map No. 6066 .Lot No. 14 conforms substantially to the Application for Building Permit heretofore filed in this office dated ·.. b.u.g:..1 .9 .... J .9.8.7.... pursuant to which Building Permit No.. 1. 6. .3 .6.7.Z. ............. dated ....~.ug.....2 .2 .... ! .9 .8.7 ........... 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 ......... ,...C.o.m. p .1 .e.t.e...2.n.d...~ .i p.o.r...i.n.t.e, r, .i p,r..a, ,s, .a,E p. ,i .5.e.d' . .f 9Y.' .......................... The certificate is issued to M. DOLLY DIEFFENBACH ..................... .................. of the aforesaid building. Suffolk County Department of Health Approval .......... ~ ./.A ............................. UNDERWRITERS CERTIFICATE NO .................. IXj. 8..I 0.8.7. 9..M.a.y., .2.0 .... ! .9.8.7. ........ PLUMBERS CERTIFICATION DATED: EDWARD SCHILLER 8/26/87 Building Inspector Rev. 1/81 l~OB~ NO. ~ TO~N OF $O~THOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .L~..:~..o....~~..~.....~.,~ ............. ....,.,,~,,,~...~,...w,,.....~...~.¥,..:..:..%.~.~ ........ . .......................... ........... County Tax Mop No. lO00 Section .... .I...O....c~ ......... Block ..... ..~...~. ......... Lot No....!,.~. ,'...~. .......... pursuant to application dated ..... ~~.~.~.. ....... ~..~. ........... , 19.~....'~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 t FORM NO. 6 TOWN OF $OUTHOLD Building Department Town Hal[ Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted I~ 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 prOperty 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. C. Fees: Additions $25.00 1. Certificete of occupancy New Dwelling. S25.00, Accessory iS10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50-. 00 3. Copy of cerdficate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 8/19/87 5.Updated C.O. $ 50.00 Date .......................... NewConstruction ...... Old or Pre-existing Building ............ Vacant Land ............. Location of Property 1080 Fairway 'Drive Cutchogue, New York House No. Street I-lam/et Owner or Owners of Property M. Dolly Dieffenbach }09 05 ~4.6 County Tax Map No. 1000 Section ............... Block ............... Lot ................ Subdivision M/o Fairway Far-,- Fil 6~66 ............. ed Map No. . Lot No. 8/22 Edwin & D. ollv Dieffenbach Permit No. ~6367Z Date of Permit .......... Applicant Health Dept. Approval ........................ Labor Dept. Approval ........................ 10870 Underwriters Approval ...N.8 .................... Planning Board. Approval ...................... Request for Temporary Certificate ..................... Final Certificate ....................... Fee Submitted $ 25.00 Construction on above d~scribed building and,c~e~' eels aH ,app~-gble codes and regulations. ^ .... Rev, 10-10-78 THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001381 BUREAU OF ELECTRICITY ~g 85 JOHN STREET, NEW YORK, NEW YORK 10038 ~.,~ ~ay 20, 1957 .~pp,,catio,,~'o.o.S,e 251283/SS N 81 0~7~" THIS CERTIFIES THAT o~iy the electrical equipment ~ ~scribed below and introduced by the applicant ~med on the above application number in the premises of P.E. Dieffenbach, 6 Fairwa~~tchogue, ~Y FIXTURE OUTLETS R~CEPTACLE!! SWITCHES INCANDESCENT 21 9 6 DRYERS [ FURNACE MOTORS FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS FtUORE$CENT SYSTEMS NO. OF FEET E OTHER APPARATUS: Electric room heaters:l-2.Skw.,1-.65kw.,1-.~kw., Motors:l-F 1-G.F.C.I. Track lighting: 4 feet 4 lites Jody Pumillo ~ Pat Lane ~, · Mat~ituck, NY 11952 Lic#2300E ~l MAN~fR . This certificate must not be aJtered in any manner; return fo the office of the Board if incorrect. Inspectors may be identif~d ~ their credentials. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P.O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 CERTIFICATION TEL. 765-1802 TOWN OF $O(JT~OLD ~ Date Owner /~- ~6~//~/ ~.~/~./~,.f.,2~/¢C_'/¢L (please print) Plumber ~6~/~ ~/~/d ~ ~-~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (plumb: s signature) Sworn to before me this ~ ~ day of % ,~ · ¢ Notary Public Notary Public, /~ County HELEN K DE VOE I~TARY PUS/lC, ~t~te of ~w go~k No. 4707878, Suffolk Count~ f~ Term Expires Merch 30,15 ~ / COMMENkS FIELD IN S~?EC~-iI ON 1. ~OUNDATION (1st FOUNDATION (2nd ROUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY %ODE FINAL ADDITIONAL COMMENTS: lh///'/ zoo ~v'.~' t ~oo ~ BOARD OF HEALTH ..~.~.. , TOWN OF $OUTHOLD CHECK ~ ~5~ ~. ~ ~ ~ . BUILDING DEPARTMENT SEPTIC FORM ............. : TOWN HALL NOTIFY $OUTHOLD, N.Y. 11971 TEL.: 765-1802 CALL ................ MAIL TO: Disapproved a/c ................................ .~. ............................... ...... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................. ,19... INSTRUCTIONS a. Tiffs 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 approvai of this application, the Building lnspector will issued a Building Permit to the applicant. Suchpermit shall be kept on the premises available for inspection throughout the work. e. No building shall lib 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 m 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 ir/~0ct~ions., ~ , · '- ~u~ '1.~:~~'~} ' (}~a't,o'r~, .... ~ 'g pp' , ,' . P ' p X. . /. . . .q,e o cz , .,K.;/. . /. 4 . . . (Mailing address of applicant) State whether applicant is owner, lessee a~h~ architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..../~...,...)~..o. g,,¢.)(... ~/5~..~-7:-. ~'.~..~../9. G/-/ .................................. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) ALL CONTRACTOR'S MUST BE SUFFOLK COUNTY LICENSED Builder's License No ....... .~.~q .~..~../~ ........... Plumber's License No .... 7.q, 7. Electrician's License No. ~..3..O.O..~. ..... Other Trade's License No ...................... 1. Location of land on which proposed work will be done .................................................. . ....... .... ....................................... House Number Street Hamlet County Tax Map No. i000 Section ../.O. ~.' ........... Block . .~..-. ............. Lot../.' .~..../o ............ Subdivision.../~-..'?..L(~t..Or/...'~. '2(....fl:.~..re..,"/..,5. ......... Filed Map No..~.O..6.~. ........ Lot . ./.'~. ......... (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .'~.".'~. ;~../'..27..--'~-/.':(..~'. 7~T .............................................. b. Intended use and occupancy ..... ,.[7. r?-.~?. (../. 3. Nature of work (check whlch apphcable): New Building Addition .......... Alteration .... Repair .............. Removal .. ............. Demoliti,on . ............. Other Work ............... 4. estlmareacost < i ... Fee ............................... ~ " (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... Number of dwelling units on each floor ................ If garage, number of cars .... i .................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each ~ype bf hse: . ................... 7. Dimensions of existing structures, if any: Front...~7.~. ...... '... Rear .............. D,epth . 7-.~.. i ........ · ' l Height Number of Stories . ' ' . ' · . . ' L . "".': .................... ~ ..... ,; ............... Dnmenmons of same structure with alterations or additions: Front ~..ff.~.~..,~'.q~--~ Rear Depth ~ Height" Number of Stories Dimensions of entire new constructi, on Front .... ·..' ..... Rear ............ Depth > j ~ ~. . Height ............... Number of Stones ....... ~ .......... : .............................. / ...... t ......... ....... ............. tP. lh. :15: ."! ...... r 1 I. Zone or use district in which prbmises are situated.. 12. Does proposed construction.violate any zoning law, ordinance or regulation: . ~O ....................... 13. Will lot be regraded .... ,~.~. · ! ................... Will excess fill be removed from premises: Yes ("~) 14. Name of Owner of premises t~..I ~9;/./¥..~.t~F?XbO. l,7OlAddres~/e 'f,,9./~lf~.tq....,..,27~....'~.. Phone No.7.~ .~.~,~.~'~.'~ Name of Architect ......... ~ ..../.~ ............ AddresS.. '.. 9??.¢??..~ ??.../.. Phone No ~..t ~ 4~./' 7~.. · ..... Nam of C r i e ont actor ........ i ................. Address ..:.: .... - .... Phone No .... 15. ~s this property located ]within 300 feet of a tidal wetland? *Yes ..... No .e~... · If yes, Southold Town Trqstees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block ~umber or description according to deed, and show street names and indicate whether : ~J ' '4) 9. 10. . interior or corner lot. / STATE OF NEW YORK, S.S COUNTY OF ................. ...... · ~.L '~Q:.~../'~. ].~. ·..'-.~. l~5" ..'~'. ~r~. ,&-,"~/. q~..'~-/~. · · being duly sworn, deposes and says that he is the applicant (Name of individual sign!rig contract) above named. lie is the ............. ./~. ~..~. ~ ............................................................. ! (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~ 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 his knowledge and belief; and that the work will be performed in the manne~ set forth in the application filed therewith. Sworn to before me this ............... /..?....,..day of! .... ............ Notary Public ....... ~...~...~...~...~..d'~-w'..... County , , I ] . NO. 4707~78, Suffolk Count~ lerm Expir~ March 30,1~"_~