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Home My WebLink About15805-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N,Y. Certificate Of Occupancy N°.Z.l. 6' '6.7.8 ........... Date .. ?.e.b. :. .2.6. ,...1.9.8.8. .............. THIS CERTIFIES that the building .... .A.d.d.i.t..5_.o.n. .................................. Location 2265 MILL LANE PECONIC of Property ................................... House No. Street ............. County Tax Map No. I000 Section . . 9.6.7. ...... Block .... .0.7. ........Lot . . . .0.5 ............ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ·./l a r c h.. 20 ,.. 1.987.. pursuant to which Building Permit No...1.5.8. 0..5 .Z ............. dated March 28, 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 ......... Addition to a seasonal one family dwelling. JAMES J & KATHRYN NORMAN The certificate is issued to ..................... .................... of the aforesaid building. Suffolk County Department of Health Approval N835807 10/5/87 UNDERWRITERS CERTIFICATE NO ........... ' ....................................... PLUMBERS CERTIFICATION DATED: ./ Braiding Inspector Rev. 1/81 TOW~ 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~ 15805' Z Permission is hereby gronted to: ..... ..s...~....~..,..~...~...~.,.. - .................. :::::::::::::::::::::::::::::: ................. I'";7""Z'"'L' .................................................................................... County Tax Map No. 1'000 Section ...... ..~).....~...~.. ...... Block .... ..~....-~. .......... Lot No ..... .C~..~.. ........... pursuant to application dated ..... ......~~.......~....o.. ............ , 19~..~.., and approved by the Building Inspector. Building Inspector Rev. 6/30/80 FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N,Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter 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 natural or topographic featu res. 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 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 200LS $25.00ALTERAT[ON $25.00 I. Certificate of occupancy New Dwellin~ $25.00, Accessory ,$10.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certificate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.updated C.O. $ 50.00 Date .... .2./.2.6./.8.8. ............. NewCOnstruction xx OIdorPre-existingSuilding .... Vacant Land ...... Location of Property 2265 Mill Lane Pec. House No. Street Ham/et J. ~ KATHRYN NORMAN~ Owner or Owners of Property .......... J. AMES..-.;. County Tax Map No. 1000 Section ..... 067 Block 7 . Lot..5. ...... Subdivision ................................. Filed Map No ........... Lot No .............. PermitNo .. 15805z Date fP it Applicant ......... o 6rm ............................................ 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 per_gi:d~rpeets all applicable codes and regulations. Applicant...~..~.~./,~..~.~ ........................ ooo3 3 THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY r " BS JOHN STREET, NEW YORK, NEW YORK 10038 THIS CERTIFIES THAT o~y the electrical equipment ~ ~scrlbed be~w and intr~aced by the applicant ~med on the above application number in the premises of 6 5 3 6 FURNACE MOTORS FUTURE APPLIANCE FEEDERS TIMECLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS SYSTEMS NO. OF FEET SERVICE DISCONNECT OTHER APPARATUS: S E R V I C NO, OF CC, COND I A W, G. NO OF HI-LEG j A w O, NO OF NEUTRA[$ A, WG OF NEU'~AL 2 C~tale Electrical Cont. ~c. 73~5 ~la Rd. Mattituck, N .¥. 11952 This certificate must not be altered in any manner; return to the office of the Boqrd if incorrect. Inspectors may be credenfiaJs. COPY FOR BUILDING $ E ~LTERED IN ANY MANNER. OUNDATION (1st) OUNDAT!ON (2nd OUGH FRAME & PLUMBING ~NSULATION PER N. Y. STATE ENERGY CODE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ]~ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [~RAMING [ ]FINAL INSPECTOR~ 76S-1802 BUILDING DEPT. NSPECTION FOUNDATION ~IST [ ] ROUGH PLBG. FOUNDATION 2ND' [ ~J~SULATION [ ] FRAMING [ ] FINAL DATE ?F~/,~/,~ INSPECTOR~ ? / 765-1802 BUILDING DEPT. INSPECTION []FOUNDATION 15T [ ] ROUGH PLBG. []FOUNDATION 2ND [ ] INSULATION []FRAMING [~'~INAL REMARKS: ~ DATE L_ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ~°OUTHOLD, N.Y. 11971 .TEL.: 765-1803 Disapproved a/c ....................... i ........... ~ (Bui!ding Inspector) APPLICATION FOR BUiLDiNG PERMIT Date ................... 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 tiffs 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 {t 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 alterat~fi~or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordina;a~es,~b~tilding coct~ hous. i~tg~code, and regulations, and to admit authorized inspectors on premises and in building for nece~s.a~ix[spections[ ........ / /--~'fih-itFfre of,.~pplicant, br name, if 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 . .'-.'~ .ck~ O~ .~..'~'. :'.~..0 ~.~.~..A).. .... .Of..~.. ...... . '.[d:~..: ........................... (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. (Name and title of c. orporate officer) Builder's License No....~.. ~ ?.l ............... Plumber's License No ......................... Electrician's License No ....................... Other Trade's License No ...................... ,,~, [~ ~" ~ ~~. 1. Location of land on which proposed work will be done ...................................... ...................................... ........................... }louse Num bet Street Hamlet County Tax Map No. 1000 Section ...... ~.~ ......... Block .... ~. ............. Lot ..... ~. ............. Subdivision ..................................... Filed Map No ............... Lot ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... .~?..~. t.4.~..~.'~.}.,[ ....... % . .~..~0 .~..a-I ......................... b. Intended use and occupancy ........ 3. Nature of work (check which applicable): New Building .......... Addition ........ Alteration .......... Pal R m D oliti Othe W rk Re r .............. e oval..:.., ........ em on .............. r o ............. ~ g~ O (Z~ ~ ' (Description) 4. Estimated Cost ................................. Fee ........................ ~ ..... ~ (to be paid on filing this application) 5 If dwelling number of dwelling units Number o f dwelling units on each floor If garage, number of cars ..., .................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................... 7. Dimensions of existing structures, if any: Front ............... Rear .............. Depth ............. Height ............... NUmber of Stories ...................................................... Dimensions of same structure with alterations or additions: Front ................. Rear ................ Depth .................. i · · · Height .......... J ............ Number~of Stories ............. 8. Dnnenmons of entire new construction: Front .... .~. ........ Rear ...<~ .......... Depth ... ~ 2. ...... Height .l .Off .......... Number_ of Stories ..... 1.' .......................................... . . .... 9 Size of lot: Front ' ' Rear Depth 10. Date of Purchase ......... ; ................... Name of Former Owner ............................. 1~1.. Zon~ or use district in which premises are situated .......................................... : .......... 12. Does proposed construction vi¢late any zoning law, ordinance or regulation: ...... .~..Q ...................... 13. Will lot be regraded ....... ~).q~ .................. Will excess fill be remoyed from premises: (~ No 14. Name of Owner of premises . ,'~.°r.v'.ff'..~.. ~.o.~tg. Address .I.qed..~/~ .~.~ ~ $t9. Phone No ................ Name of Architect .......... ' ................. Address . . ~f.O.~a~ [...~30..~l~ .... Phone No .............. ~. Name of Contractor . ~..q; ~.*~.. ~ ~.~.. g) ~ P}~? .... Address .$.O .~.~.(~ t, lq]. ....... Phone No..~..(~. ~o~O..~.. 15. Is this property located withini;00 ~eet of a tidal wetland? * Yes ..... No~ .... " · If yes, Southold Town Tcustees Permit may be required. PLOT DIAGRAM 'i "/~? ,DMa Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YQI~K, COUNT" OF.. /'t'/"P'g'~<'/A--'q ~'~ ' · . r.j. .~'q~. · · .~.'.../.*.d/".(../~.: ./-7~..~'. ............... being duly sworn, depose~,~md says that he is the applicant (Name of individual signing 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 contained 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 ;2 ........... ~...~. day;f ~.~ .. ,19 :. . ...... i ~mm~ggl2~ir~[~r~t%~r~ ~ ~ (f ""[' (Signature ~ applic~t)