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Home My WebLink About16012-zFORM NO 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Budding Inspector Town Hall Southold, N.Y. Certificate Ot: Occupancy No z16588 THIS CERTIFIES that the building . .On. ~. f a.m. zly..d.w.e 1.~..~.ng ............. IZio~seN1760o Sterling Road Cutchogue Location of Property ......... '~tre~t ............. Hamlet County Tax Map No 1000Secnon 10.4 .... Block 4 .... Lot ...!6 ....... Subdtvis~onM.a.p .o.f..N.a s..s a.u..F..a.rm.s ...... Filed Map No 1.1.7.9. .... Lot No 150 conforms substantially to the Apphcahon for Bmldmg Permit heretofore flied m this office dated May 4, 1987 pursuant to wtuch Bmldlng Permit No. 16012Z dated M.a.y 27, 1987 . ,.. .. was issued, and conforms to all of the requirements of the applicable provimons of the law. The occupancy for Much this cernflcate is issued is ...... ... O..ne .f.a.m..i.l.y...d.w.e.l.l..~.ng., .~ay.ta~ch.e~d g. ar.a. ge.. The certificate is issued to ...A.%FH.~P..W... a. MARC..~RKZ' ..~:. ?.~..~.S.~..a ................. (owner, of the aforesaid bmldmg. Suffolk County Department of Health Approval UNDERWRITERS CERTIFICATE NO., 877Sq-§9 .1.1!~/.88 ............ N845203 12/1/87 PLUMBERS CERTIFICATION DATED:T & G Plumbl_ng & Heating 12/11/? Rev 1/81 IrOW~ NO. ~B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N*. 16012 z County Tax Mop No. 10OO Section ...... ~/.O..~.. ..... Block .......... .~.. ........ Lot No .....L..~. ........... pursuont Building Inspector. Rev 6/30/80 FORM NO, 6 TOWN OF SOUTHOLD Bu ilding Department Town Hall Southold, N.Y. 11971 765- 1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. Th~s apphcation must be fdled in typewriter OR ink, and submitted m ~ to the Building inspec- tor w~th the following; for new buddings or new use: 1. Final survey of property w~th accurate location of a{[ buddings, property lines, streets, and unusual natural or topographic features, 2.Final approval of Health Dept of water supply and sewerage d[sposal-(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrml buildings, Multiple Remdences and similar buildings and installa- tions, a certificate of Code complmnce from the Architect or Engineer responsible for the building. 5.Submit Planmng Board approval of completed rote plan requirements where apphcable. B. For existing buildings (prior to Aprd 1957), Non-conforming uses, or buddings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topograph lc 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 tnspectton of buddings or premises, or other pertinent tnforma- tton required to prepare a certificate. C. Fees. Addztions $25.00 1. Certificate of occupancy New Dwellzng $25.00, Accessory ,$t0.00 Business $50.00 2. Certificate of occupancy on pre-existing dwelling $ 50.00 3. Copy of certlflcate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50.00 Date ....................... NewConstructzon ..... Old or Pre-e×~st mg Building ............ Vacant Land ............. Location of Property . I?&Q. $:bezcling .Roe4::[+. O~.t.e, hOi~p,~t ,. ~....%,..1.19~5 ................ House No. Street Narc/et Owner or Owners of Property . k~.t_recL ~,. &, ~ar~z:el;. ~..~;L.e.s.9 ,re.e? .................... County Tax Map No. 1000 Section .10./~ ........ Block .../~- .......... Lot .17~.,...1.6. ...... Subd,v,sron .".1~. 0.]~. ~.J~.~..A.U..F...A~...~ ....... Fded Map No...1.1.~...9 .... Lot No..1.~.0. Permit No.].60%¢~... Date ofPerm,t ~../.2.~/.~.~,, .Apphcant ~N!.gL~D HO.,~.,,o INC. ~1/.1 ~/88 App Health Dept Approval ................. Labor Dept. royal ....................... Underwriters Approval ~.~ .2,0~. ............ Planmng Board Approval ...................... Request for Temporary Certificate .................. Final Certificate ...................... Fee Submitted $ 25.0D ..................... Construction on above described budding aDcLpermtt meets all apphcajole codes and regulations A lc nC ~ r', ~~~.,~- ,.. pp,at ............... ~..~. ................... Robert E. Hiltz, INLA~r~HOMEB, THE NEW YORK BOARD OF FIRE UNDERWRITERS 1001460 BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK lO03S THIS CE~IFIES THAT m thefot~owlngl{~at~o~. ~B~e~nt Ist FI ~ ~nd ~t ~eet~on BI~k FIXTU!E! i FIXTURES RANGES OVENS ,D~SH WASHERS EXHAUST FANS SWITCHES OUTLETS 1.5 42 2.2 15 DRYERS FURNACE MOTORS FUTURE TIME CLOCKS UNIT HEATEIS MULTI-OUTLET DIMMERS SYSTEMS S~RVIC~ DISCONNECT $ E R OTHE~ APPARATUS ~-G. F.C.I. 1-Smoke Detector C NO OF NEUTRALS A W G O~ NEU~'RAL South Park Electrical 4 Park Place Patchogue, N.Y. 11772 Lic.$173E Per This certificate musf not be altered in any manner, return to the off~ce of the ~oard sf incorrect Inspectors may be ~ent~fle~J by their credenhals COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED iN ANY MANNER. TO~ OF SOUTI~OI,D OFF1CE OF BUILDING INSPECTOR P.O BOX 728 TOWN HALL SOUTHOLD, N Y. 11971 TEL. 765-1802 C E RTI F I ~T I ON Date December 11~ 1987 Buildzng Permit No.__~_Q~ Owner Alfrod ~ Margaret Miesemer (please ~rint) PlumberT & G Pl.um~ing & Heating (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. Gale Kaske/d/b/a T & G Plumbing & Heating Sworn to before me this 19~ · Notary Public, ,~/¢~/~ County Notary Public OU~]DATIOU 1 s t) OUNDATIO:~ (2nd) OUGH FRAME & PLUMBING ~,~SULATION FERN. STATE ENERGY CODE FI:.~AL ADDITIO}IAL COMMENTS: STE~L1N~ '~ 7 {I0.~0 PINE 'f f?&c, 12D. - IL 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION ZND [ ] INSULATION FRAMING [~L DATE ~Z/~/~~ NSPECTOR.~~/ 76S-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING [/~INAL INSPECTOR~~~ DATE ~d~~ 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ]FINAL REMARKS: ~ / DATE 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [/~ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [,~j~FRAMING FINAL 765-1802 BUILDING DEPT. INSPECTION ['~]'~NDATION 1ST [ ] FOUNDATION FRAMING ROUGH PLBG. 2ND [ ] INSULATION [ ] FINAL Disapproved a/c .. FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.: 765-1802 ,19 7 · 19F'/ Permit No.). (Building Inspector) APPLICATION FOR BUILDING PERMIT i TOWN OF SOUTHOLD I Received ........... ~19. Date I~.a,~r ....... .1., 19[ INSTRUCTIONS a Tins apphcatmn must be completely filled m by typewriter or in ink and submitted to the Buddmg Inspector, wil sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showmg locatmn of lot and of buildmgs on premises, relatmnshlp to adjommg premises or pubhc sty or areas, and gtving a detailed descnphon of layout of property must be drawn on the diagram which ~s part of this a~ catmn c The work covered by tins apphcatlon may not be commenced before issuance of Budding Permit. d Upon approval of this application, the Building Inspector will ~ssued a Building Permit to the applicant. Such shall be kept on the premises available for inspection throughout the work e. No building shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occup~ shall have been granted by the Budding Inspector APPLICATION IS HEREBY MAbE to the Bmldmg Department for the issuance of a Bmlding Permit pursuant to Bmldlng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinance Regulations, for the construction of bmldmgs, additions or alterations, or for removal or demohtton, as herein descril The apphcant agrees to comply .with all apphcable laws, ordmances, bufldmg code, housing code, and regulations, an, admit authorized inspectors on premlses and in budding for necessary inspections. ,. r o.. ..... (Signature of apphcant, qr name, if a corporation) .B..qx.. !.12,..I~,~ $ ~p,e)g ,. I~., .¥,. 1195~ ..... State whether apphcant is owner, lessee, agent, architect, en~neer, general contractor, electncmn, plumber or buil, ·. . General Contractor. .......... Name of owner of premises Alfred..W. & l~la.~g~t~.e$. Eo MieJtemer (as on the tax roll or latest deed) If apphcant is a corporation, s~gnature of duly authorized officer (Name and ntle of corporate officer) Budder's License No .......... Plumber's License No . ..517-R Electrician's L~cense No 28~..6.. Other Trade's L~cense No. 1760 Location of land on which proposed work will be done S~e~I-int~ Road, r Cll~hOgll,e ~ N. House Number Street Hamlet County Tax Map No 1000 Section 10~- .. Block 14: Lot. Pc%. 16 "MAP OF NASSAU FARMS" Subdivision .... Filed Map No 1179 Lot · 150 (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construchon a Existmg use and occupancy b Intended use and occupancy .1 Pamily c~welli-~g ..... · Nature of work (check winch applicable). New Building . x2r.. . .. Addition.. .... .... Alteration ... ... Repmr .. . Removal ........... Demolition ......... Other Work ........... ~ ,'1~ ,,'v~p_' (Description) 4 Estunated Cost ............................. Fee .................................... (to be prod on filing this application) 5. If dwelling, number of dwelling units 1 ........ Number of dwelling units on each floor ............... If garage, number of cars . 1 ................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each,,~type of us~ ~ ',~'/' '~'~L ....... 7. Dunenslonsofexistmgstructures, ifany' Front ......... Rear .. _~~..M~c~F .~7.~-~ . ...... Height .......... Number of Stones ................. ;;.~- ~..~ Dimensions of same structure with alterations or additions Front ... [~ ~ ...... Rear .............. Depth .................. Height ................. N,u'mber of Stones ..................... 8. Dunenslons of entire new construction' Front .. ~ ...... Reef' .. 6~ ......... Depth ... ~ ........ Height , I ~l'~&.~. .. Number of Stones ...... ~ ....... /(. ............................... ! ~ It) '* 9. Size oflot Front . [.0 ......... Rear .... I...y ........ Depth .... /?~. ....... 10. Date of Purchase ............. Name of Former Owner ................... I I. Zone or use district in winch premises are situated ......................................... 12 Does proposed construction violate any zomng law, ordinance or regulatmn' ... ~.~. 13 Will lot be regraded .................. Will excess fill be removed from premises. Yes 14 Name of Owner of premlsesFx~Alfred Mieaeme~ddres~ .~ba~go~P&-n-, Phone No. 661-~086. . Name of Architect ............... A~Gress~' · ......... Faone mo ............ Name of Contractor ]~T&ND. WOI~A~..INC. , , Address ~ox. 1~.7 ,Ea~i%l/(~hone No. 298~9696 · · · 15. Is this property located wlthtntO0 feet of a tidal wetland? * Yes ..... No ..~. · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and d~stmctly all bufldmgs, whether exlsbng or proposed, and. Indicate all set-back dn'nenslons fro~ property lmes Give street and block number or descnphon according to deed, and show street names and mdlcate wheth.: intenor or corner lot. STATE OF NEW YORK, S.S COUNTY OF ......... ...... Robert: .E.. lt&lt z · · (Name of individual Slglllng contract) above named bemg duly sworn, deposes and says that he is the apphca He is the ... Contractor (Contractor, agent, corporate officer, etc.) of smd owner or owners, and is duly authorized to perform or have performed the said work and to make and file tt apphcatmn, that all statements contained m this application are true to the best of his knowledge and belief, and that t work will be performed in the manner set forth in the application filed therewith Sworn to before me this .............. .t~...day of...1~. ~'., .............. 19.87. Notary Public, ~j~o~..~. ~"¢$rP'l'l[' ..... County LINDA J COOPER , ature of apphc Notary Pubhe, State of New York Robert E. No 4822563. Suffolk Court SUF~FOU< COUNTY DED~VMENT OCr HEJM. m ~ .. Ns!p~E FAMILY DWELUNG O~LY oA~~.S. REF. NO. ,,~-~,~-~,~ The sewage disposal and water suf~ply facifiti~ fro' ~ location have been inspected by this Oepartmeflt al/or SCALE TI'FL.,E I'~ Eq: ~f4 ~J t,4 E-~'F SUI~.K CO. HEALTH. 'DE~IGNAT ION: D~T. ~CT. BLOCK P~L. 6REENPORT NEW yQ~K SINGLE FA: EXPIRES TWO YEE~i (~OMI,I.QNW~EA,..TH LAJ'4D Il TLE !~ LICENSED LANO ~EVEYOES GREE~RT NEW YORK H S NO ,, FROM DAT~- O.;: APPROVAL STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO T~,~T,~,~R~ OF THE (DJ ..... - ' '- + ,M.~b~ ~k~ ;;.Y.;: 252 'SUFFOLK COUNTY BEPT OF HEALTH SERVICES -- ~.¢R APPROVAL OF CONSTRUCTION ONLY ~ ~ A~ROVED , .... ,, ', SUFFOLK CO TAX MAP DESIGNATION. DIST. SECT_ BL~K PCL ~ ~o4 4 0~s ADO~E~ ....... DEED. ..... TEST HOLE s£,~c J i Phone 477-0400 ~ Main Road GREENPORT, N,Y. 1 ! 944