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Home My WebLink About15464-zFORM NO 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No Z15968 Date.J.u.l,y 21, ]987 THIS CERTIFIES that the building On.e.f..a.m.i.1 y...dw.e. 1..1 i.n.g. ................ Location of Property .,. 76,5. .Maple Lane Greenport County Tax Map No 1000 Sectmn . .0.3.5. ... Block .. 08. ..... Lot I .04 Subdivision ....................... F~led Map No ......... Lot No ............. conforms substantially to the Application for Budding Pernut heretofore filed tn this office dated 0 c t. 3 !, 1986 pursuant to wtuch Braiding Permit No. 15464 Z dated .N.qv. :..7.,. ! .98.6. .......... was issued, and conforms to all of the reqmrements of the apphcable provimons of the law. The occupancy for which thru certificate ~s issued is ........ One family dwelling, 2 car garage and deck. Thecert~ficate~smsuedto KEVIN & ANNE MC ELROY (owner, of the aforesaid budding Suffolk County Department of Health. Approval .... 8.6. 7 .S.O.-. [ 6. 9...l.u. 1..y..l.:..I .9.8. 7. .......... UNDERWRITERS CERTIFICATE NO ..... PLUMBERS CERTIFICATION DATED: May 20, 1987 Bmldmg Inspector Rev 1/81 FO~M' NO. · TOV/N OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERi, IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 15464 Z Permtss~on ~s hereby granted to' ...)..~ .a,.~. ..~..A.e~,......ff,4. ...................... ~ ,'~,, Iici ........... ~..~ ......... ¥ .......... .~.l. ......... -, .................................... q'","T.""f£;; _""Y~_" ~ ........... ~Z'"~i'L'";"F';'~'"")/A_ .~, et premises located at .....L.~..~......r-r.-~,.~dL...(,~.~ ....-':~...~h~'.~..L.:, ......... I.~....,ff~..~ County Tax Mop No I000 Section ~:)'i~,~ . Block .... .~..~. ...... Lot No .... l.:..O...~. ..... pursuant to opphcot,on doted ~.~c~.d.~, ~1 ....... , 19 ~.~., and approved by the Budding Inspector Fee $. ?~c4...b. '.... Building Inspector FOR .0. 6 TOWN OF SOUTHOLO Build,n, Department Southold, N.Y, 11971 ~PLICATION FOR CERTIFICATE OF Instructions A. Th~s apphcat~on must be fdled in typewriter OR ink, and submitted m ~ to the Building Inspec- tor with the following; for new buildings or new use. 1. F~nal survey of property with accurate location of aH buildings, 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 mstallatmn from Board of Fire Underwriters. 4 Commercial buildings, Industrial buddings, Multiple Resdences and s~milar buildings and installa~ tions, a cert[hcate of Code compliance from the Architect or Engineer responsible for the building. 5.Submit Planmng Board approval of completed s~te plan requirements where apphcable. B. For existing buddings (prior to April 1957}, Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property hnes, streets, buddings and unusual natural or topograph ~c features. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buddings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent mforma- t~on required to prepare a certlhcate. C. Fees' Additions $25.00 1. Cert~hcate of occupancy New Dwe].lin~ $25.00, Accessory,SI0.00 Business 850 O0 2 Cert~fmate of occupancy on pre-exist~ng dwelling $ .50.00 3 Copy of certlficate of occupancy $ 5.00, over 5 years $]0.00 4.Vacant Land C.O. $ 20.00 5.Updated C.O. $ 50 00 Date ...................... ."//~./. NewConstruction ..... Old or Pre-existing Bu.ldJ, ng ........... Vacant Land ............. Location of PropertYHou~e ..... No.2~''~'''''~'''~' /~'''''~''' .......... Street ~'~~'- Owner or Owners of Property .... .~. ........................... .. ... County Tax Map No. 1000 Section ............... I~IOCK .............. Lot..~/5~ ...... Subdlws~on .......................... Filed Map No ....... .Lot No ........... ~.. Permit No ...... ~.~. Date of Permit .. Apphcant ...... Health Dept Approval ..................... Labor Dept Approval ....................... Underwriters Approval ........................ Planmn§ Board Approval ..................... Request for Temporary Certificate ............... F~nal Certificate ...................... Fee Submitted $ ...................... App Ican)~. ..... .~...- ... -~..~'..¥~. .............. THE [~00077J. THiS CERTIFIES THAT NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF ELECTRICITY 85 JOHN STREET. NEW YORK. NEW YORK 10038 ordy the e~ect r~ca/equ%ornent as d~cr~b~d bo~ a~ :~t~uc~ by t~ ~want ~ on t~ ~ apphcat~ number tn the prem~s of ~ev~, ~c~lroy, e/s Maple Lane, ~765, ~s exam~n~ on J~l%~ ~ t ~ 9~ 7 and found to ~e m comphance ~ ith the requ~remen~ of tb~s B~rd RXTUI~E FIXTURES RANGES OVENS DISH WASHERS EXHAUST FANS 27 43 DRYER~ FURNACE ~RRVt~ ~CONNECT S E R V I C OTD~R APPARATUS 1 1 Smoke Detector E 2/0 Ruland ~lect. Co. P. O. t~iOX 143 Mattltuck, N.Y. 1195~ Lic~242E TH~s ce~lficate m~t not be altered m ~ny ~nner; ~turn to the office of the Board if Incorr~t inspectors may be ~n~le~ by their credentma~s COPY FOR BUILDING DEPARTMENT THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. TOWN OF SOUTHOLD OFFICE OF BUILDING INSPECTOR P O. BOX 728 TOWN HALL SOUTHOLD, N.Y. 11971 TEL. 765-1802 CERTIFICATION Date &~/~ ) owner (please prifit) I Plumber 0 I~o q~d ~ (please print) ~ 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 th~s ~ 3 day of 6~u~z , Notary Public,~ County Notary Public NI~ 4 HELEN & DE ¥OE fUSLIC, State of New Yeek ..v.~%4707878, Suffolk County..O~. ~m r. xpees Ml~rch 30,19 765-],802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION FRAMING REMARKS: DATE 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [~FINAL REMARKS: ~ _~-.~.c,~ . ~/~*~r/ 765-1802 BUILDING DEPT. INSPECTION FOUNDATION 15T [ ] ROUGH PLBG. FOUNDATION 2ND £ ] INSULATION DATE 7G~-1~2 BUILDING DEPT. INSPECTION []FOUNDATION 1ST [ ] ROUGH PL.BG. []FOUNDATION 2ND [~NSULATION []FRAMING [ ] FINAL , / REMARKS: ~ DATE . INSPECTO 7GS-180~ BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FINAL ..... [ ] FRAMING REMARKS-' 765-'"802 BUILDING DEPT. INSPECTION [ ] FRAMING REMARKS: FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FINAL DATE 7GS-~,802 BUILDING DEl:ri.. INSPECTION [ '1 FOUNDATION '(ST [ ] ROUGH PLBG. [~"~OUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL DATE ? INSPECTO~ OUNDATION ~{{lst) OUNDATION (2nd) OUGH FRAME & PLUMBING iNSULATION PER N. STATE ENERGY CODE ADDITIONAL COMMENTS: FORM NO 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N.Y. 11971 TEL.. 765-1802 INSTRUCTIONS a. Tins apphcahon must be completely filled m by typewriter or in mk and submitted to the Bmldmg Inspector, w~th 3 sets of plans, accurate plot plan to scale Fee according to schedule b Plot plan showing location of lot and of braidings on premises, relationship to adjoining premises or public streets or areas, and giving a detmled description of layout of property must be drawn on the diagram wincla is part of this apph- catmn c. The work covered by th~s application may not be commenced before ~ssuance of Bm/drag Permit d. Upon approval of this apphcatlon, the Bmldmg Inspector wall issued a Bmldmg Permit to the apphcant. Such permit shall be kept on the preimses avmlable for mspectton throughout the work e. No burial,ny shall be occupied or used m whole or m part for any purpose whatever tmtd a Certificate of Occupancy shall have been granted by the Bmldmg Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Braiding Permit pursuant to the Bmldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances or Regulahons, for the construchon of bmldmgs, add,bond or alterahons, or for removal or demolition, as herem described The apphcant agrees to comply with all apphcable laws, ordinances, buddl/egIode, housm~tcode, and regulations, and to admxt authorized inspectors on premises and in budding for necessary rust'turns. . · . (S~gnature of appian]t, or nam~lj~a corporation) ........ ;.. . [rna~..i±ng address or app.~zcanC)brade--'l-'r Sta*e whether apphcant ts ~vner, lessee, agent, arcintect, engineer, general contractor, electrlcmn, plumber or /, '..' ......... Name ofownerofprem,ses ~ ~4,/,~./~' ~ .. (as on the tax roll or'latest deed) If applicant is a~d~f"~t!~jlb s]gnaj~are of_.~duly~'~lorized officer .~ (Name and htle of corporate officer) Builder's License No elumber'sLmenseNo t~~ {.~.' ~, %' Other Trade's License No ................ Location of land on which proposed work will be done House Number County Tax Map No 1000 Section Subdivision (Name) Street Block . g. F/led Map No Hamlet ..... Lot. Lot State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction a Exmlnguseanaoccupancy '~f~.~4,.l/~~ .~,~ ~f~,~f~ ~1/~ .... b Intended use and occupancy ~ .............. / (Descnpnon) ..... .... ........................ · .. ~'~ Number of dwelIl~t~ub2itPsa~dn :~c~l~ogotrh:s. ~,:~at,.~).... If garage, number of cars ..... ,~ ................................ 6. If business, commercial or mixed occupancy, specify nacre and extent of each type of use ............. _ . 7. Danensmns of existing structures, if any. Front ..... ~. ..... Rear ............ 'Depth ' ............. Height ...... Number of Stones ................................. D~mens~ons of same structure w,th alterations or addmons Front ............. Rear ............ Depth ............. Height ... 8. Dunens, ons ofentlre new construct,on Front.. .~..~.' i i. i. i 'Rei?umber of Stones .......... ! ...... . . .,~'.~, ...... Depth . ~ ......... He,ght .~1~* .... Number of Stones . . 9 Size oflot Front ........ ~' '~*i.-- .... Rear i 'i~$.~,'~' ............ Depth .1 ~.~-,¢ %¥ ! .... 10. Date of Purchase ..... '~'{~ . Name of Former Owner 1 1. Zone or use d~stnct m which premmes are s,tuated .......................................... 12 Does proposed construction violate any zomng law, ordinance or re~ulatmn ~ O 13. Will lot be regraded ...~ ~.$ ............ Will exc,ess fill be removed from premises: Yes 14. Name of Owner of prem,ses ~&0l~,~.S'~ ~&~4t~"~Address~.~. '~ ~.t~l~ll~..1~, ~ . Phone No...~.¥~}." .1~.~.~ Name of Archttect ................. Address . ...~.~. ~ .~.~a Phone No. Name of Contractor ~. ~..~ ~.'$.~ ~"~0 . Address]~$'9. ttt.~, t.~..~... Phone No. I5, Is this property located withxnl00 feet of a tidal wetland? * Yes ..... No .~"... · If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and dmtmctly all bufldmgs, whether exmtmg or proposed, and red,cate all set-back dnnens, ons from property hnes. Give street and block number or descnptmn according to deed, and show street names and ,ndmate whether interior or comer lot. STATE OF NEW YORK, S S cou Y OF. ' .....t.,~-.~-~~e~d~wd']al s]J~i~g.co~t~,~. ·,~,- - -~, .~..~ . being duly sworn, deposes ~d says that he ~s the apphcant He m the ....... (Contractor, agent, co.orate ofhcer, etc.) of smd owner or ownem, apphcanon, ~at all statements contained m th~s apphcat,on are true to the best of hs ~owledge and behef, and that the work wall be perfomed m the m~ner set form m the apphcat~on filed therewith. Sworn to before me this ........... ~./ .day of .... NotawPubhc, ~ ~.~.~ .... Count. Y~... ~ ~ ~ ~ ~ ~ (Si~ature of apphc~t) SUFFOLK CO HEALTH DEPT APPROVAL ~ H $ NO STATEMENT OF INTENT SYSTEMS FOR THIS RESIDENCE WILL N.~. CONFORM TO THE STANDARDS Of THE ~ SUFFOLK CO DEPT OF HEALTH SERVICES SUFFOLK COUNTY DEPT OF HEALTH ~/~ . SERVICES ~ FOR APPROVAL OF {/:~ _~:+~ ~.. CONSTRUCTION ONLY ~ DATE..... H S REF. NO .... APPROVEDiLi m ~' gIST SECT BL~K LL RODERICK VAN TUYL, P C 002 GREEN~RT NEW YORK SUFFOLK CO. HEALTH DEPT. APPROVAL ,~ ,. ....... STATEMENT OF INTENT CONFO.. PLEASENOTE k:~_~..~ ' , SERVICES - FOR AP~V~L OF '. , % CONSTRUCTIONO"CY ~/~/~ seniia~ distance 5. ~4 .,~ ~o ~ '- ~ g~ all w~ter supPlY and sewe~ - r '' ' ................................. APPROVED SUFFO[~''c'o '~AX MAP DESIGNATION ~ , :[ DIST. SECT. BL~K PCL ~ ;' ~ ~ I OWNERS ADDRE~ _ J ~ RODERICK VAN TUYL, P C ~/~ /000, 5e¢~ ~=-, ~I~ ~, P-[ i O0 GREEN~RT NEW YORK SUFFOLK CO. HEALTH, DEPT. APPROVAL ~%...., , ,, ..--,, , i %-~. ' SUFFOLK COUNTY HEALTH DEPARTMENT ....... '~'~ '~ LY ! 6, ~I~GLE FAMILY DWELLING ON '?::" ~ ~ ~E S~A~ ~S~SAL ~ATER SU~Y FACILITIES FOR THE SYSTEMS FO~ THIS/ RESIDENCE WILL ~~~ ~ L~ATION HAVE BEEN IN~ BY THIS DEPARTMENT AN~ CONFORM ~, f~EZ~AN~R~ O~_TME ~OWN Off ~H~¢, ~.~ :: I ' . . . . '~ Chl~ of Wastewater Ma~e~ent ~tion A~LIC~T ,.. . SUFFOLK COUNTY DEPT. ~ OF HEALTH ' i &~-.-~ SERVICES -- FOR APPROVAL OFf ('. ~;:v ¢' CONSTRUCTION ONLY ~ ~. ~*~ ~O"~. .- ~.~ ~, %% DATE: ~ H.S. ~EF. NO. C A~ROVED: ., -} ~FFOLK CO. TAX MAP ~51GNATIJ: .' ~ , ~ DIST. ~CT. BL~K ~L. x I' t I ~ OWNERS ADDRE~: - ~ Cz' -~~ I . :* , TEST HOLE ~A~ ' ~'/ ' I ' / < ~. ~ : ~ ~.~ [ .... ~ ~ SEAL e = /'~*1 pi~ ,' ~ ,' RODERICK VAN TUYL. P.C. : '~': " ' , J LICENSED LAND SURVEY~S / : i ..... if ca~ar tubing ~ used fo; water distributing systam; piping 'shaR be of ~pes K or L only, SUPPLY S~STE~ cANNOT EXCEED 2/10 o~ I~ ~AD. PLUMBER CERTIFICATION , ON LEAD CONTENT BEFORE CERTIFICATE OF OCCUPANCY OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE '-, '~ OF OCCUPANCY ~[ CO~"l ETE FOR C.O. AI,~ ~:ONSTRUC.TION SHALL MEET THE REQUIREMENTS Of- ~'HE CODES NOT~NSIaLE FOR OR CC,~TRUCTION ERRORS, GR£ENPORT~ NY 11944